1
|
Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
Collapse
Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| |
Collapse
|
2
|
Rohr JC, Bourassa KA, Thompson DS, Fowler JC, Frueh BC, Weinstein BL, Petrosino J, Madan A. History of childhood physical abuse is associated with gut microbiota diversity among adult psychiatric inpatients. J Affect Disord 2023; 331:50-56. [PMID: 36933668 DOI: 10.1016/j.jad.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Traumatic life events are associated with the development of psychiatric and chronic medical illnesses. This exploratory study examined the relationship between traumatic life events and the gut microbiota among adult psychiatric inpatients. METHODS 105 adult psychiatric inpatients provided clinical data and a single fecal sample shortly after admission. A modified version of the Stressful Life Events Screening Questionnaire was used to quantify history of traumatic life events. 16S rRNA gene sequencing was used to analyze the gut microbial community. RESULTS Gut microbiota diversity was not associated with overall trauma score or any of the three trauma factor scores. Upon item-level analysis, history of childhood physical abuse was uniquely associated with beta diversity. Linear Discriminant Analysis Effect Size (LefSe) analyses revealed that childhood physical abuse was associated with abundance of distinct bacterial taxa associated with inflammation. LIMITATIONS This study did not account for dietary differences, though diet was highly restricted as all participants were psychiatric inpatients. Absolute variance accounted for by the taxa was small though practically meaningful. The study was not powered for full subgroup analysis based on race and ethnicity. CONCLUSIONS This study is among the first to demonstrate a relationship between childhood physical abuse and gut microbiota composition among adult psychiatric patients. These findings suggest that early childhood adverse events may have long-conferred systemic consequences. Future efforts may target the gut microbiota for the prevention and/or treatment of psychiatric and medical risk associated with traumatic life events.
Collapse
Affiliation(s)
- Jessica C Rohr
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA.
| | - Katelynn A Bourassa
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA
| | - Dominique S Thompson
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Department of Molecular Virology & Microbiology, Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - J Christopher Fowler
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Houston Methodist Academic Institute, Houston, TX, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Benjamin L Weinstein
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA
| | - Joseph Petrosino
- Department of Molecular Virology & Microbiology, Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Houston Methodist Academic Institute, Houston, TX, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
3
|
Bourassa KA, Postolache TT, Dagdag A, Fuchs D, Okusaga OO. Plasma soluble P-selectin correlates with triglycerides and nitrite in overweight/obese patients with schizophrenia. Pteridines 2020; 31:61-67. [PMID: 32982068 PMCID: PMC7518413 DOI: 10.1515/pteridines-2020-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Soluble P-selectin (sP-selectin) is associated with risk factors for cardiovascular disease (CVD) but this association has not been evaluated in patients with schizophrenia. This study primarily evaluated the association of sP-selectin with plasma lipids and nitrite (NO2−) respectively in overweight/obese adults with schizophrenia. Methods: One-hundred and six patients with schizophrenia (mean age 32.9 years; 71.60% male) were recruited from a psychiatric hospital. Participants completed a structured interview and provided a fasting blood sample. Body mass index (BMI) was used to divide the sample into normal weight and overweight/obese groups. Pearson’s and partial correlation coefficients (controlling for age, sex, race, education, and inflammation) were calculated to examine the association of sP-selectin with plasma lipids, and NO2− in the overweight/obese patients (primary analysis), as well as in the normal weight patients and the total sample (exploratory analyses). Results: After controlling for potential confounders, sP-selectin positively correlated with triglycerides (r = 0.38, p = 0.01) and NO2− (r = 0.40, p < 0.01) in the overweight/obese group only. Conclusions: Future longitudinal studies should evaluate the utility of sP-selectin as a biomarker of CVD in overweight/obese adults with schizophrenia (for example, by relating sP-selectin to incidence of cardiovascular events).
Collapse
Affiliation(s)
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA, Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center (VAMC), Aurora, CO, USA, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA, VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University, Innsbruck, Austria
| | - Olaoluwa O Okusaga
- Michael E. DeBakey VA Medical Center, Houston, TX, USA, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
4
|
Wykes TL, Bourassa KA, Slosser AE, McKibbin CL. Community Mental Health Providers' Beliefs About Addressing Weight Loss Among Youth Clients with Serious Emotional Disturbance and Overweight/Obesity: An Elicitation Study. Community Ment Health J 2018; 54:1136-1145. [PMID: 29427055 PMCID: PMC9911299 DOI: 10.1007/s10597-018-0242-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/27/2018] [Indexed: 01/24/2023]
Abstract
Youth with Serious Emotional Disturbance (SED) have high rates of overweight/obesity. Factors influencing mental health provider intentions to deliver weight-related advice are unclear. This study used qualitative methodology and Theory of Planned Behavior (TPB) constructs to examine these factors. Community mental health providers serving youth with SED were recruited via convenience sampling and an online provider list. Participants completed an open-ended TPB-based questionnaire online. Content analysis identified thematic beliefs. Twenty-one providers completed the questionnaire. Providers identified behavioral beliefs (e.g., client defensiveness), normative beliefs (e.g., medical professionals), and control beliefs (e.g., limited resources) that impact decisions to provide weight-related advice. Knowledge of factors that may influence providers' delivery of weight-related advice may lead to more effective healthy lifestyle programming for youth with SED.
Collapse
Affiliation(s)
- Thomas L Wykes
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Katelynn A Bourassa
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Andrea E Slosser
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Christine L McKibbin
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA.
| |
Collapse
|
5
|
Bourassa KA, McKibbin CL, Hartung CM, Bartholomew KL, Lee AA, Stevens AE, Buxton Y, Slosser AE, Andren KAK. Barriers and facilitators of obesity management in families of youth with emotional and behavioral disorders. J Health Psychol 2016; 22:1469-1479. [PMID: 26929167 DOI: 10.1177/1359105316630136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While youth with emotional and behavioral disorders experience increased rates of obesity, few obesity interventions exist that are tailored to their needs. Qualitative methods were employed to elucidate obesity management practices in this population. In all, 56 participants (i.e. 21 youths with emotional and behavioral disorders, 20 caregivers of youth with emotional and behavioral disorders, and 15 mental health providers) were recruited from community mental health centers. Participants completed a demographic form and semi-structured interview regarding obesity-related behaviors. Barriers (e.g. psychiatric symptoms) and facilitators (e.g. social support) to obesity management were identified. These results highlight preferred intervention components for this unique population.
Collapse
|
6
|
Lee AA, McKibbin CL, Bourassa KA, Wykes TL, Kitchen Andren KA. Depression, diabetic complications and disability among persons with comorbid schizophrenia and type 2 diabetes. Psychosomatics 2014; 55:343-351. [PMID: 24751112 PMCID: PMC10066802 DOI: 10.1016/j.psym.2013.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/24/2013] [Accepted: 12/27/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND People with schizophrenia are at increased risk for type 2 diabetes, its complications, depression, and disability. However, little is known about the interrelationships of these 3 factors in adults with schizophrenia and type 2 diabetes. OBJECTIVE We sought to assess the number of diabetic complications and depressive symptom severity as predictors of disability and evaluate depressive symptom severity as a mediator of the relationship between diabetic complications and disability in a sample of 62 adults with schizophrenia and type 2 diabetes. METHODS Two- and 3-step sequential regression models were used to evaluate the relationship of depression and number of diabetic complications with disability. Path analysis with bootstrapping was used to evaluate depressive symptom severity as a mediator of the relationship between complications and disability. RESULTS Diabetic complications significantly predicted disability scores when controlling for age, gender, socioeconomic status, hemoglobin A1C, positive symptom severity, and negative symptom severity. The addition of depression severity scores resulted in a significant increase in explained variance in disability scores. In the final model, only depression severity scores were significantly associated with disability scores. The full model accounted for 56.2% of the variance in disability scores. Path analysis revealed a significant indirect association of diabetic complications to disability through depression severity scores while controlling for all covariates. The association between complications and disability was nonsignificant when depressive symptom severity was included in the model. CONCLUSIONS Depressive symptoms may present an important and tractable target for interventions aimed at reducing disability in people with schizophrenia and type 2 diabetes.
Collapse
Affiliation(s)
- Aaron A Lee
- Department of Psychology, University of Wyoming, Laramie, WY
| | | | | | - Thomas L Wykes
- Department of Psychology, University of Wyoming, Laramie, WY
| | | |
Collapse
|