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Drabkin M, Fairbrother N, Crighton B, Miller E, Brant R, Riar S, Albert A, Barr RG. Prepartum and postpartum mothers' and fathers' feelings of frustration in response to infant crying. Infant Ment Health J 2024; 45:276-285. [PMID: 38343150 DOI: 10.1002/imhj.22107] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 04/29/2024]
Abstract
In this cross-sectional study performed in Canada, we evaluated the frustration levels of prepartum and postpartum mother and father couple-pairs. Our goal was to determine if there were differences in frustration levels between mothers and fathers while listening to prolonged infant crying, and further, how frustration levels might differ between prepartum and postpartum samples. Using two discrete groups, prepartum (Sample 1; N = 48) and postpartum (Sample 2; N = 44) mother and father couple-pairs completed 600 s of listening to audio-recorded infant cry sounds. Participants continuously reported their subjective frustration using a computerized Continuous Visual Analog Scale (CVAS). There was no significant difference in frustration responses between mothers and fathers across both prepartum and postpartum samples. Postpartum mothers and fathers experienced greater frustration than their prepartum counterparts, and frustration increased faster in postpartum couples compared to prepartum couples. Informing first-time parents of the universal experiences of frustration to prolonged crying bouts that are characteristic of their infant's early weeks of life may lead to greater understanding towards their infant, and perhaps decreased instances of harmful responses.
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Affiliation(s)
- Meriah Drabkin
- Faculty of Medicine, Queen's University, Kingston, Canada
| | - Nichole Fairbrother
- Department of Psychiatry, Queen Alexandra Centre for Children's Health, University of British Columbia, Victoria, British Columbia, Canada
| | - Brianna Crighton
- Faculty of Medicine, Medical Science Building, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica Miller
- Faculty of Medicine, BC Women's Hospital & Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shivraj Riar
- Surrey Memorial Hospital Endocrinology Group, Surrey, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Ronald G Barr
- Evidence to Innovation, BC Children's Hospital, Vancouver, British Columbia, Canada
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Skakoon-Sparling S, Fairbrother N, Socha P, Faaborg-Andersen M, Noor SW, Hart TA. Multidimensional Measurement of Attitudes Toward Consensual Non-Monogamy. J Sex Res 2024:1-12. [PMID: 38437686 DOI: 10.1080/00224499.2024.2320454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Despite increased interest in consensual non-monogamy (CNM), significant stigma remains against CNM. Consequently, there is a need for scales to assess attitudes toward CNM. In response to this need we developed the Multidimensional Attitudes toward CNM Scale (MACS). Items were developed in consultation with content experts and data were collected from two samples at two different Canadian Universities. Fit indices of exploratory (Sample A) and confirmatory (Sample B) factor analysis suggested a 16-item scale with three underlying factors: CNM is Dysfunctional, CNM is Immoral, and CNM is Healthy and Satisfying. Validity analyses, conducted using the combined sample (n = 806; 79% women; 67% heterosexual), demonstrated that participants with higher MACS total scores (i.e. more negative attitudes) were less likely to have ever been involved in a CNM relationship and were more likely to report monogamy as their ideal relationship style. Higher MACS scores were also associated with more negative attitudes toward bisexuality and toward women, and higher scores on measures of homophobia and jealousy. In contrast, individuals with higher scores on the CNM is Healthy subscale tended to score higher on measures of empathy. The MACS demonstrates strong psychometric properties and can assist in better understanding attitudes toward CNM relationships in research and clinical settings.
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Affiliation(s)
- S Skakoon-Sparling
- Psychology, Toronto Metropolitan University
- Psychology, University of Guelph
| | | | - P Socha
- Psychiatry, University of British Columbia
- Epidemiology, Biostatistics and Occupational Health, McGill University
| | | | - S W Noor
- Psychology, Toronto Metropolitan University
- Kinesiology & Health Science, Louisiana State University Shreveport
| | - T A Hart
- Psychology, Toronto Metropolitan University
- Dalla Lana School of Public Health, University of Toronto
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3
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Fairbrother N, Stagg B, Scoten O, Keeney C, Cargnelli C. Perinatal anxiety disorders screening study: a study protocol. BMC Psychiatry 2024; 24:162. [PMID: 38395837 PMCID: PMC10893673 DOI: 10.1186/s12888-024-05575-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. METHODS A large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks' gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. DISCUSSION This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Bryn Stagg
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Olivia Scoten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Claudia Cargnelli
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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Johnston C, Fairbrother N, Butska L, Stoll K. Systematic Screening for Perinatal Anxiety and why it Matters. J Obstet Gynaecol Can 2024; 46:102240. [PMID: 37827330 DOI: 10.1016/j.jogc.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Carly Johnston
- Faculty of Medicine, Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC
| | | | - Luba Butska
- Midwifery Program, Department of Family Practice, University of British Columbia, BC
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, BC.
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Fairbrother N, Keeney CL, Albert AK. Interest in prenatal stress management training: association with medical risk and mental health. J Reprod Infant Psychol 2023:1-15. [PMID: 37675936 DOI: 10.1080/02646838.2023.2254800] [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] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/24/2022] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The objective of this study was to document levels of interest in stress management training (SMT) during pregnancy, including differences in interest in SMT across levels of medical risk in pregnancy. We also sought to assess differences in pregnancy-specific stress, prenatal worry and depressed mood across levels of medical risk in pregnancy and investigate predictors of interest in SMT. METHODS We surveyed 379 English-speaking, pregnant people living in Vancouver, Canada, between November 2007 and November 2010. Questionnaires were administered during the third trimester and assessed interest and preferred format of SMT, pregnancy-specific stress, prenatal worry, depressed mood and medical risk in pregnancy. RESULTS Interest in stress management training programmes during pregnancy was common, with 32% of participants being quite-to-very interested. Preference was split between self-guided study (41%), group counselling (38%) and one-on-one counselling (34%). Higher pregnancy-specific stress and depressed mood, but not medical risk in pregnancy, were associated with higher interest in SMT. Participants experiencing higher stress levels or lower medical risk were more interested in one-on-one counselling. CONCLUSION Findings indicate that subjective distress rather than objective circumstances is a better predictor of interest in SMT. Care providers should inquire early-on about interest in SMT during pregnancy and ensure awareness of SMT options.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Cora L Keeney
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Arianne K Albert
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
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Bayrampour H, Hohn RE, Tamana SK, Sawatzky R, Janssen PA, Bone JN, Fairbrother N, Joseph KS. Pregnancy-Specific Anxiety Tool (PSAT): Instrument Development and Psychometric Evaluation. J Clin Psychiatry 2023; 84. [PMID: 37074299 DOI: 10.4088/jcp.22m14696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Objective: Pregnancy-specific anxiety (PSA) is a distinct construct from general anxiety and depression. The purpose of this study was to develop, evaluate, and validate the Pregnancy-Specific Anxiety Tool (PSAT), to measure PSA and its severity. Methods: The study was carried out in 2 stages. Stage 1 involved item development and content and face validation. Stage 2 included psychometric evaluation to examine item distributions and correlational structure, dimensionality, internal consistency reliability, stability, and construct, convergent, and criterion validity, using 2 independent samples (initial sample N = 494, May-October 2018; validation sample N = 325, July 2019-May 2020). Results: Eighty-two items were evaluated for face validity and 41 items were considered in stage 2 based on feedback from participants and experts. Model fit from exploratory factor analysis and patterns of item-factor loadings suggested a 6-factor model with 33 items. The 6 factors included items pertaining to health and well-being of the baby, labor and the pregnant person's well-being, postpartum, support, career and finance, and indicators of severity. Confirmatory factor analysis carried out using the initial sample showed good fit with the validation sample. The area under the curve (AUC) for the diagnosis of adjustment disorders (AD) was 0.73 (95% CI, 0.67-0.79), and for AD/any anxiety disorders, the AUC was 0.80 (95% CI, 0.75-0.85). Conclusions: The PSAT can be useful for screening and monitoring of PSA, and pregnant people with scores higher than 10 should be considered for further assessment.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Family Practice, University of British Columbia (UBC), Vancouver, Canada
- Corresponding author: Hamideh Bayrampour, MSc, PhD, Department of Family Practice, 320 - 5950 University Blvd, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Richard E Hohn
- Department of Psychology, Simon Fraser University, Vancouver, Canada
| | - Sukhpreet K Tamana
- Department of Pediatrics, University of British Columbia (UBC), Vancouver, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, Canada
- Centre for Health Evaluation and Outcome Science, Providence Health Care, Vancouver, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia (UBC), Vancouver, Canada
| | - Nichole Fairbrother
- Department of Family Practice, University of British Columbia (UBC), Vancouver, Canada
| | - K S Joseph
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
- Department of Obstetrics and Gynecology, University of British Columbia (UBC), Vancouver, Canada
- Children's and Women's Hospital of British Columbia, Vancouver, Canada
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7
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Fairbrother N, Albert A, Collardeau F, Keeney C. The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth. Int J Environ Res Public Health 2022; 19:ijerph19084647. [PMID: 35457513 PMCID: PMC9028446 DOI: 10.3390/ijerph19084647] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022]
Abstract
Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence: ; Tel.: +1-250-0519-5390 (ext. 36439)
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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8
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Fairbrother N, Collardeau F, Woody SR, Wolfe DA, Fawcett JM. Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder: Relation to Maternal Physical Aggression Toward the Infant. J Clin Psychiatry 2022; 83. [PMID: 35235718 DOI: 10.4088/jcp.21m14006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers' UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant. Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017. Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively. Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%-9%). Findings provide critical and reassuring information regarding the relation between new mothers' UITs of intentional harm and risk of physical violence toward the infant.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,*Corresponding author: Nichole Fairbrother, PhD, Room 002, Pearkes Bldg, Queen Alexandra Centre for Children's Health, 3970 Haro Rd, Victoria, BC V8N 4A9
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Sheila R Woody
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wolfe
- Faculty of Education, Western University, London, Ontario, Canada
| | - Jonathan M Fawcett
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
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9
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Fairbrother N, Collardeau F, Albert A, Stoll K. Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth. Int J Environ Res Public Health 2022; 19:ijerph19042223. [PMID: 35206412 PMCID: PMC8872365 DOI: 10.3390/ijerph19042223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/27/2022]
Abstract
Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence:
| | - Fanie Collardeau
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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10
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Hicks LM, Ou C, Charlebois J, Tarasoff L, Pawluski J, Roos LE, Hooykaas A, Fairbrother N, Carter M, Tomfohr-Madsen L. Assessment of Canadian perinatal mental health services from the provider perspective: Where can we improve? Front Psychiatry 2022; 13:929496. [PMID: 36213903 PMCID: PMC9537741 DOI: 10.3389/fpsyt.2022.929496] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Perinatal mental health disorders are common, and rates have increased during the COVID-19 pandemic. It is unclear where providers may improve perinatal mental health care, particularly in countries lacking national guidelines, such as Canada. METHODS A cross-sectional survey of perinatal health providers was conducted to describe the landscape of perinatal mental health knowledge, screening, and treatment practices across Canada. Providers were recruited through listservs, social media, and snowball sampling. Participants completed an online survey that assessed their perinatal mental health training, service provision types, their patient wait times, and treatment barriers, and COVID-19 pandemic-related impacts. RESULTS A total of 435 providers completed the survey, including physicians, midwives, psychologists, social workers, nurses, and allied non-mental health professionals. Most (87.0%) did not have workplace mandated screening for perinatal mental illness but a third (66%) use a validated screening tool. Many (42%) providers stated their patients needed to wait more than 2 months for services. More than half (57.3%) reported they did not receive or were unsure if they received specialized training in perinatal mental health. Most (87.0%) indicated there were cultural, linguistic, and financial barriers to accessing services. Over two-thirds (69.0%) reported the COVID-19 pandemic reduced access to services. CONCLUSION Survey findings reveal significant gaps in training, screening tool use, and timely and culturally safe treatment of perinatal mental health concerns. There is critical need for coordinated and nationally mandated perinatal mental health services in Canada to improve care for pregnant and postpartum people.
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Affiliation(s)
- Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, United States
| | - Christine Ou
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Lesley Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Jodi Pawluski
- IRSET - Institut de Recherche en Santé, Environnement et Travail, University of Rennes 1, Rennes, France
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Hooykaas
- College of Social and Applied Social Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Abstract
Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ (N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).
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Affiliation(s)
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Cora Keeney
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Devan Tchir
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose B Cameron
- The University of British Columbia, Vancouver, British Columbia, Canada
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12
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Fairbrother N, Collardeau F. High Prevalence of Perinatal-Occurring Obsessive-Compulsive Disorder: Reply to Di Giacomo et al. J Clin Psychiatry 2021; 82. [PMID: 34670027 DOI: 10.4088/jcp.21lr14069a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Victoria, Canada.,Corresponding author: Nichole Fairbrother, PhD, Room 002, Pearkes Bldg, Queen Alexandra Centre for Children's Health, 2400 Arbutus Rd, Victoria, BC V8N 1V7, Canada
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, Canada
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13
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Fairbrother N, Collardeau F, Albert AYK, Challacombe FL, Thordarson DS, Woody SR, Janssen PA. High Prevalence and Incidence of Obsessive-Compulsive Disorder Among Women Across Pregnancy and the Postpartum. J Clin Psychiatry 2021; 82. [PMID: 34033273 DOI: 10.4088/jcp.20m13398] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: During the perinatal period, women are at an increased risk for the onset/exacerbation of obsessive-compulsive disorder (OCD) and may experience perinatal-specific obsessions and/or compulsions. Past research has provided preliminary findings regarding the prevalence of OCD in the perinatal period but has often reported limited metrics and ignored perinatal specific symptoms. This research aimed to assess the prevalence and incidence of maternal OCD between the third trimester in pregnancy and 6 months postpartum. Methods: An unselected sample of 763 English-speaking pregnant women and new mothers participated in a longitudinal, province-wide study between their third trimester in pregnancy and 9 months postpartum. They completed 3 online questionnaires and interviews (data collected between February 9, 2014, and February 14, 2017) and were administered a diagnostic interview to determine OCD status based on DSM-5 diagnostic criteria. Results: A weighted prenatal period prevalence of 7.8% and a postpartum period prevalence of 16.9% were found. The average, prenatal, point prevalence estimate was 2.9%, and the average, postpartum, point prevalence estimate was 7.0%. Point prevalence gradually increased over the course of pregnancy and the early postpartum, attaining a peak of close to 9% at approximately 8 weeks postpartum, with a gradual decline thereafter. The cumulative incidence of new OCD diagnoses was estimated at 9% by 6 months postpartum. Conclusions: Our study suggests that when women are encouraged to report their perinatal-specific symptoms, and current diagnostic criteria are applied, estimates for perinatal OCD may be higher than previously believed.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Victoria, Canada.,Corresponding author: Nichole Fairbrother, PhD, Room 002, Pearkes Bldg, Queen Alexandra Centre for Children's Health, 2400 Arbutus Rd, Victoria, BC V8N 1V7, Canada
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, Canada
| | - Arianne Y K Albert
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, Canada
| | - Fiona L Challacombe
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Dana S Thordarson
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Sheila R Woody
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Abrar A, Fairbrother N, Smith AP, Skoll A, Albert AYK. Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta-analysis. Birth 2020; 47:13-20. [PMID: 31222840 DOI: 10.1111/birt.12443] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/17/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Symptoms of anxiety are common among pregnant and postpartum women, and 15%-20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta-analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy. METHODS This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle-Ottawa Quality Assessment Scale for case-control studies was used to perform a quality assessment review. A random-effects meta-analysis was used to calculate the estimated average standardized mean differences. RESULTS Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high-risk groups. CONCLUSIONS Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy.
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Affiliation(s)
- Ambar Abrar
- Social Dimensions of Health Program, The University of Victoria, Victoria, British Columbia, Canada
| | - Nichole Fairbrother
- Department of Psychiatry and Island Medical Program, The University of British Columbia, Vancouver, British Columbia, Canada
| | - André P Smith
- Department of Sociology, The University of Victoria, Victoria, British Columbia, Canada
| | - Amanda Skoll
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y K Albert
- Women's Health Research Institute, British Columbia's Women's Hospital and Health Centre and Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
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Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. J Clin Psychiatry 2019; 80:18r12527. [PMID: 31347796 PMCID: PMC6839961 DOI: 10.4088/jcp.18r12527] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates. DATA SOURCES An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders. STUDY SELECTION Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included. DATA EXTRACTION Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder. RESULTS Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that "true" prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women. CONCLUSIONS Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.
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Affiliation(s)
- Emily J. Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Nichole Fairbrother
- Department of Psychiatry / Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Megan L. Cox
- Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Ian R. White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Jonathan M. Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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16
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Fairbrother N, Hart TA, Fairbrother M. Open Relationship Prevalence, Characteristics, and Correlates in a Nationally Representative Sample of Canadian Adults. J Sex Res 2019; 56:695-704. [PMID: 30932711 DOI: 10.1080/00224499.2019.1580667] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Open relationships are those in which individuals agree to participate in sexual and/or emotional and romantic interactions with more than one partner. Accurate estimates of the prevalence of open relationships, based on representative, unbiased samples, are few, and there are none from outside of the United States. We present findings from a nationally representative sample of 2,003 Canadian adults, administered in 2017 via an online questionnaire. Overall, 2.4% of all participants, and 4.0% of those currently in a relationship, reported currently being in an open relationship. One-fifth of participants reported prior engagement in an open relationship, and 12% reported open as their ideal relationship type. Men, compared with women, were more likely to report prior open relationship engagement and to identify open as their ideal relationship type. Younger participants were more likely both to engage in and to prefer open relationships. Relationship satisfaction did not differ significantly between monogamous and open relationships. Having a match between one's actual relationship type and one's preferred relationship type was associated with greater relationship satisfaction. Findings suggest that, while currently only a small proportion of the population is in an open relationship, interest in open relationships is higher, particularly among younger adults, and open appears to be a viable and important relationship type.
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Affiliation(s)
| | - Trevor A Hart
- b Department of Psychology, Ryerson University; and Department of Psychology, University of Toronto
- c Dalla Lana School of Public Health , University of Toronto
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Fairbrother N, Corbyn B, Thordarson DS, Ma A, Surm D. Screening for perinatal anxiety disorders: Room to grow. J Affect Disord 2019; 250:363-370. [PMID: 30877859 DOI: 10.1016/j.jad.2019.03.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/14/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most prevalent of all mental health conditions, disproportionately affecting women. The value of perinatal AD screening is well established but there is very limited evidence to support the applicability of existing anxiety screening instruments. To our knowledge, no previous studies have evaluated an AD screening instrument in a perinatal population using full gold standard methodology. OBJECTIVE To assess the accuracy of the most commonly used and/or recommended screening tools for perinatal AD (i.e., the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), and the Generalized Anxiety Disorder 7 and 2-item Scales (GAD-7 and GAD-2) alongside a clinically derived alternative; the Anxiety Disorder - 13 (AD-13). METHODS 310 Canadian women completed mood and anxiety questionnaires at approximately 3-months postpartum. Those scoring at/above cut-off on one or more questionnaire completed a diagnostic interview for depression and all AD (n = 115). The accuracy of each scale was assessed via ROC analyses. RESULTS Only the AD-13 met the standard of a clinically useful screening measure, with an area under the curve (AUC) above 0.8. This was achieved with and without the inclusion of the related disorders. No other measure demonstrated an AUC above 0.8, either including or excluding the related disorders. CONCLUSIONS Neither the EPDS/EPDS 3-A, nor the GAD-7/GAD-2 can be recommended for widespread use as a perinatal AD screening tool. The high performance of the AD-13 is a good indication that an effective alternative is well within reach.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry, Queen Alexandra Centre for Children's Health, University of British Columbia, Room 002, Pearkes Building, 2400 Arbutus Road, Victoria, British Columbia, V8N 1V7, Canada.
| | - Bryony Corbyn
- Department of Psychiatry, Queen Alexandra Centre for Children's Health, University of British Columbia, Room 002, Pearkes Building, 2400 Arbutus Road, Victoria, British Columbia, V8N 1V7, Canada
| | - Dana S Thordarson
- Department of Family Practice, University of British Columbia, British Columbia, Canada
| | - Annie Ma
- Department of Psychiatry, Queen Alexandra Centre for Children's Health, University of British Columbia, Room 002, Pearkes Building, 2400 Arbutus Road, Victoria, British Columbia, V8N 1V7, Canada
| | - Danika Surm
- Department of Family Practice, University of British Columbia, British Columbia, Canada
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18
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Fawcett JM, Fairbrother N, Fawcett EJ, White IR. A Bayesian multivariate approach to estimating the prevalence of a superordinate category of disorders. Int J Methods Psychiatr Res 2018; 27:e1742. [PMID: 30216590 PMCID: PMC6383646 DOI: 10.1002/mpr.1742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/17/2018] [Accepted: 07/03/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Epidemiological research plays an important role in public health, facilitated by the meta-analytic aggregation of epidemiological trials into a single, more powerful estimate. This form of aggregation is complicated when estimating the prevalence of a superordinate category of disorders (e.g., "any anxiety disorder," "any cardiac disorder") because epidemiological studies rarely include all of the disorders selected to define the superordinate category. In this paper, we suggest that estimating the prevalence of a superordinate category based on studies with differing operationalization of that category (in the form of different disorders measured) is both common and ill-advised. Our objective is to provide a better approach. METHODS We propose a multivariate method using individual disorder prevalences to produce a fully Bayesian estimate of the probability of having one or more of those disorders. We validate this approach using a recent case study and parameter recovery simulations. RESULTS Our approach produced less biased and more reliable estimates than other common approaches, which were at times highly biased. CONCLUSION Although our approach entails additional effort (e.g., contacting authors for individual participant data), the improved accuracy of the prevalence estimates obtained is significant and therefore recommended.
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Affiliation(s)
- Jonathan M Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nichole Fairbrother
- Department of Psychiatry and the Island Medical Program, University of British Columbia, Vancouver, BC, Canada
| | - Emily J Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ian R White
- MRC Clinical Trials Unit, University College London, London, UK
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Ovanessian MM, Fairbrother N, Vorstenbosch V, McCabe RE, Rowa K, Antony MM. Psychometric Properties and Clinical Utility of the Specific Phobia Questionnaire in an Anxiety Disorders Sample. J Psychopathol Behav Assess 2018. [DOI: 10.1007/s10862-018-9687-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Prior JC, Konishi C, Hitchcock CL, Kingwell E, Janssen P, Cheung AP, Fairbrother N, Goshtasebi A. Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women. Int J Environ Res Public Health 2018; 15:ijerph15051016. [PMID: 29783630 PMCID: PMC5982055 DOI: 10.3390/ijerph15051016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 11/16/2022]
Abstract
Approximately 33% of normal-length (21⁻35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (-0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): "Can you tell by the way you feel that your period is coming?" and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- School of Population and Public Health, University of British Columbia; Vancouver, BC V6T 1Z3, Canada.
- BC Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Chiaki Konishi
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 0G4, Canada.
| | | | - Elaine Kingwell
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | - Patti Janssen
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- School of Population and Public Health, University of British Columbia; Vancouver, BC V6T 1Z3, Canada.
- BC Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Anthony P Cheung
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC V6T 2A1, Canada.
- Grace Fertility Centre, Vancouver, BC V5Z 1G1, Canada.
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada.
| | - Azita Goshtasebi
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
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21
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Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth 2018; 45:7-18. [PMID: 29057487 DOI: 10.1111/birt.12316] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 06/26/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB. METHODS Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies. RESULTS Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours). CONCLUSIONS Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Department of Nursing, University of Iceland, Reykjavík, Iceland
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Island Medical Program, Victoria, Canada
| | - Elizabeth Nethery
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Stoll K, Fairbrother N, Thordarson DS. Childbirth Fear: Relation to Birth and Care Provider Preferences. J Midwifery Womens Health 2018; 63:58-67. [PMID: 29364575 DOI: 10.1111/jmwh.12675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received. METHODS A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40-item scale that measures 9 dimensions of childbirth fear. RESULTS Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients. DISCUSSION At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth.
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Fairbrother N, Thordarson DS, Stoll K. Fine tuning fear of childbirth: the relationship between Childbirth Fear Questionnaire subscales and demographic and reproductive variables. J Reprod Infant Psychol 2017. [DOI: 10.1080/02646838.2017.1396300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Victoria, B.C., Canada
| | - Dana S. Thordarson
- Department of Family Practice, University of British Columbia, Vancouver, B.C., Canada
| | - Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, B.C., Canada
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Goshtasebi A, Kalyan S, Konishi C, Hitchcock C, Cheung A, Janssen P, Fairbrother N, Prior J. Does Molimina Indicate Ovulation? Can J Diabetes 2017. [DOI: 10.1016/j.jcjd.2017.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fairbrother N, Young AH, Zhang A, Janssen P, Antony MM. The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy. Arch Womens Ment Health 2017; 20:311-319. [PMID: 28032213 DOI: 10.1007/s00737-016-0704-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 09/07/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
Abstract
Over 20% of pregnancies involve medical difficulties that pose some threat to the health and well-being of the mother, her developing infant, or both. We report on the first comparison of the prevalence and incidence of maternal anxiety disorders (AD) in pregnancy and the postpartum, across levels of medical risk in pregnancy. Pregnant women (N = 310) completed postnatal screening measures for anxiety. Women who scored at or above cutoff on one or more of the screening measures were administered a diagnostic interview (n = 115) for AD. Pregnancies were classified into low, moderate, or high risk based on self-report and contact with high-risk maternity clinics. The incidence of AD in pregnancy was higher among women classified as experiencing a medically moderate or high-risk pregnancy, compared with women classified as experiencing a medically low-risk pregnancy. Across risk groups, there were no differences in AD prevalence or in the incidence of AD in the postpartum. Demographic characteristics and parity did not contribute meaningfully to outcomes. Pregnancies characterized by medical risks are associated with an increased likelihood of new onset AD. Women experiencing medically complex pregnancies should be screened for anxiety and offered appropriate treatment.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry, Island Medical Program, University of British Columbia, Queen Alexandra Centre for Children's Health, 2400 Arbutus Road, Victoria, BC, V8N 1V7, Canada.
| | - Allan H Young
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, Strand, London, England, WC2R 2LS, UK
| | - Areiyu Zhang
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa Fertility Centre, 955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada
| | - Patricia Janssen
- UBC School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
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Affiliation(s)
- Danielle Duplassie
- Department of Counseling Psychology, Adler University, Vancouver, BC, Canada
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia Island Medical Program, Victoria, BC, Canada
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Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord 2016; 200:148-55. [PMID: 27131505 DOI: 10.1016/j.jad.2015.12.082] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [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: 10/21/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anxiety and related disorders (AD) disproportionately affect women, and are the most prevalent of all mental health conditions. The current research represents the first study of maternal postpartum AD prevalence in which all of the AD are assessed, and one of few studies of this type in which maternal prenatal AD incidence is assessed. METHODS A Canadian sample of pregnant women (N=310) was recruited from a defined geographical area between November 2007 and November 2010. Participants were first administered postnatal mood and anxiety screening measures. Those who scored at or above cutoff on one or more of these measures were administered a diagnostic interview for depression and anxiety at approximately three months postpartum (n=115). Findings from the diagnostic interview were used to estimate the prevalence and incidence of mood and AD in pregnancy, as well as at and during the first three months postpartum. Period prevalence and incidence estimates were obtained retrospectively from interview data collected postnatally. RESULTS The prevalence of AD during pregnancy and the early postpartum period (15.8% and 17.1% respectively) exceeded that of depression (3.9% and 4.8% respectively). The prevalence of OCD in our sample exceeded that of OCD among adults aged 18-64. Parity was unrelated to AD prevalence. Slightly less than 5% of participants were comorbid for both AD, and depression. LIMITATIONS This study is limited by a relatively small sample size for a prevalence study, and non-random sample selection. As only women who scored above cutoff on one or more screening measures were interviewed, prevalence estimates are conservative. Finally, prenatal prevalence estimates are based on retrospective report provided postpartum. CONCLUSIONS This study provides evidence that, as a group, anxiety and related conditions affect a significant proportion of postpartum women, and are more prevalent than is postpartum depression.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry, Island Medical Program, University of British Columbia, Canada.
| | | | | | - Emma Tucker
- Faculty of Medicine, Island Medical Program, University of British Columbia, Canada
| | - Allan H Young
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
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Abstract
Most North American universities offer sexual assault prevention programs focusing on attitude change. However, the few program outcome evaluations suggest that these programs may not be effective. This review summarizes the research on sexual assault program evaluation. It is apparent that the most promising avenue for sexual assault prevention may be self-defense training, which is presently not an integral component of typical prevention programs. The substantial body of research on risk factors for sexual assault is also reviewed, and it is concluded that existing rape prevention programs could be improved by focusing on these factors.
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Abstract
BACKGROUND Mood and anxiety and related disorders (AD) account for a significant proportion of mental health conditions, with close to 30 % of the population (28.8 %) suffering from an AD at some time in their life, and over fifteen percent (16.2 %) suffering from a mood disorder. The existing empirical literature leaves a number of important gaps with respect to our understanding of mood, anxiety and stress related difficulties among pregnant and postpartum women. The objective of this research is to address these. METHODS Participants were 660 English-speaking pregnant women. Participants for the portion of the research estimating the prevalence/incidence of perinatal mood disorders and AD (N = 347) were recruited proportionally from a geographically defined area. All participants were recruited via prenatal clinic visits at hospitals, physician offices and midwifery clinics, and via community outreach at events and through word of mouth. Recruitment took place between November 9, 2007 and November 12, 2010. Participants were administered questionnaires prenatally at two time points (approximately 24 and 33 weeks gestation) and again at 4-6 weeks' postpartum and 6-months postpartum. Prevalence/incidence study participants who screened above cut-off on one or more of the 4-6 week mood and anxiety questionnaires were also administered a diagnostic interview for mood disorders and AD at approximately 8-12 weeks postpartum. DISCUSSION This research addresses a number of gaps in our understanding of mood, anxiety and stress among pregnant and postpartum women. Specifically, gaps in our knowledge regarding the prevalence and incidence of (a) AD and mood disorders, and (b) anxiety and stress among women experiencing a medically high-risk pregnancy, interest in stress management training in pregnancy, mental health treatment barriers and access and screening for anxiety among pregnant and postpartum women are addressed. The findings from this series of studies have the potential to improve screening, assessment and treatment of mood and anxiety problems suffered by pregnant and postpartum women.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Room 141, Eric Martin Pavilion, Royal Jubilee Hospital, 2328 Trent Street, Victoria, BC, V8R 4Z3, Canada.
| | - Allan H. Young
- Centre for Affective Disorders, BRC Cluster Lead, Experimental Medicine & Clinical Trials Cluster, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King’s College London, PO72, De Crespigny Park, Denmark Hill, London, SE5 8AF Canada
| | - Patricia Janssen
- Maternal Child Health, UBC School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T-1Z3, Canada.
| | - Martin M. Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Emma Tucker
- Faculty of Medicine, Island Medical Program, University of British Columbia, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada. .,Medical Sciences Building, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
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Fairbrother N, Barr RG, Pauwels J, Brant R, Green J. Maternal thoughts of harm in response to infant crying: an experimental analysis. Arch Womens Ment Health 2015; 18:447-55. [PMID: 25377762 DOI: 10.1007/s00737-014-0471-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/18/2014] [Indexed: 11/29/2022]
Abstract
Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, Faculty of Medicine, University of British Columbia, Room 141 Eric Martin Pavilion, Royal Jubilee Hospital, 2328 Trent Street, Victoria, BC, V8R 4Z3, Canada,
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Vedam S, Stoll K, Schummers L, Fairbrother N, Klein MC, Thordarson D, Kornelsen J, Dharamsi S, Rogers J, Liston R, Kaczorowski J. The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth. BMC Pregnancy Childbirth 2014; 14:353. [PMID: 25352366 PMCID: PMC4287472 DOI: 10.1186/1471-2393-14-353] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. METHODS In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. RESULTS Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. CONCLUSIONS Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.
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Affiliation(s)
- Saraswathi Vedam
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Kathrin Stoll
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Laura Schummers
- />Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Nichole Fairbrother
- />Island Medical Program, University of British Columbia, Royal Jubilee Hospital, Room 141 Eric Martin Pavilion, 2328 Trent Street, Victoria, BC V8R 4Z3 Canada
| | - Michael C Klein
- />Child and Family Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4 Canada
| | - Dana Thordarson
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Jude Kornelsen
- />Centre for Rural Health Research, University of British Columbia, Suite 300 David Strangway Bldg, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Shafik Dharamsi
- />Department of Family Practice, University of British Columbia, Suite 300 David Strangway Bldg, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Judy Rogers
- />Midwifery Education Program, Ryerson University, 99 Gerrard Street East Room SHE-582, Toronto, ON M5B 2L4 Canada
| | - Robert Liston
- />Faculty of Medicine, University of British Columbia, C420 - 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Janusz Kaczorowski
- />Department of Family and Emergency Medicine, University of Montreal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, Office: S03.416, 850 rue St-Denis, Montreal, QC H2X 0A9 Canada
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Vedam S, Schummers L, Stoll K, Rogers J, Klein MC, Fairbrother N, Dharamsi S, Liston R, Chong GK, Kaczorowski J. The Canadian Birth Place Study: Describing maternity practice and providers' exposure to home birth. Midwifery 2012; 28:600-8. [DOI: 10.1016/j.midw.2012.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 06/08/2012] [Accepted: 06/10/2012] [Indexed: 10/28/2022]
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Abstract
Using an experimental design, this study assessed knowledge, attitudes, and intentions regarding infant feeding practices among Canadian female university undergraduates (N = 285). Participants completed a survey of knowledge, attitudes, and intentions with respect to infant-feeding practices. Two versions of the survey were randomly distributed to participants: one containing a photograph of a woman breastfeeding her infant (n = 131) and the other containing a photograph of the same women bottle-feeding her infant (n = 154). Findings indicated that the majority of the sample had been breastfed (84%) and intend to breastfeed their own offspring (97%). The intention to breastfeed future offspring was predicted by knowledge, attitudes, and perceptions of social norms. Participants reported more positive attitudes toward visual depictions of breastfeeding compared with bottle-feeding but less positive views of breastfeeding in public compared with bottle-feeding in public. Participants also significantly underestimated the health benefits and optimal duration of breastfeeding. The findings highlight gaps in knowledge that may contribute to premature cessation of breastfeeding among Canadian women and suggest the need for breastfeeding education.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Victoria, BC, Canada
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Stoll K, Fairbrother N, Carty E, Jordan N, Miceli C, Vostrcil Y, Willihnganz L. "It's all the rage these days": University students' attitudes toward vaginal and cesarean birth. Birth 2009; 36:133-40. [PMID: 19489807 DOI: 10.1111/j.1523-536x.2009.00310.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND At 30 percent, British Columbia has the highest cesarean section rate in Canada. Little is known about the childbirth views and birthing preferences of college-aged women and men. The objectives of this study were to document (a) the prevalence of cesarean versus vaginal delivery as the preferred mode of delivery among nonpregnant university students without a history of childbirth, (b) the reasons for reported childbirth preferences, and (c) confidence in vaginal birth as a predictor of childbirth preference. METHODS A cohort of 3,680 male and female university students without a history of childbirth participated in an online survey of childbirth preferences. The study used a mixed methods approach (quantitative thematic analysis and logistic regression modeling). Prevalence of, and reasons for, preferred mode of delivery were analyzed separately for male and female respondents. RESULTS Most men and women responded that they preferred vaginal delivery, with 9 percent stating a preference for cesarean delivery. Reasons for preferred mode of delivery were similar for men and women. For women, confidence in vaginal birth emerged as a significant predictor of childbirth preference. CONCLUSIONS Results indicate that a preference for cesarean section is linked to fear of childbirth and driven by low confidence in vaginal birth. Educational strategies targeting university-aged men and women may be helpful in alleviating fears of vaginal birth and providing evidence-based information about different birth options.
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Affiliation(s)
- Kathrin Stoll
- Division of Midwifery, Department of Family Practice, University of British Columbia, B54-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
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Bretherick KL, Fairbrother N, Avila L, Harbord SHA, Robinson WP. Fertility and aging: do reproductive-aged Canadian women know what they need to know? Fertil Steril 2009; 93:2162-8. [PMID: 19296943 DOI: 10.1016/j.fertnstert.2009.01.064] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/19/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Female fertility declines with age; however, women are increasingly delaying childbearing until later in their reproductive years. One of the factors that may contribute to this trend is a general lack of knowledge about the decline in fertility with age. DESIGN Self-report survey. Questions pertained to participant demographics and childbearing intentions, and knowledge of the decline in fertility and increased risk of pregnancy loss with age. SETTING The University of British Columbia in Vancouver, British Columbia, Canada. PATIENTS Female undergraduate students (N = 360). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge of fertility over the life span, predictors of age of intended childbearing. RESULT(S) Although most women were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline. Surprisingly, women overestimated the chance of pregnancy loss at all ages, but did not generally identify a woman's age as the strongest risk factor for miscarriage. CONCLUSION(S) Education regarding the rate at which reproductive capacity declines with age is necessary to avoid unintended childlessness among female academics and professionals.
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Affiliation(s)
- Karla L Bretherick
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia V5Z 1L3, Canada.
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Fairbrother N, Hutton EK, Stoll K, Hall W, Kluka S. Psychometric evaluation of the Multidimensional Assessment of Fatigue Scale for use with pregnant and postpartum women. Psychol Assess 2008; 20:150-8. [DOI: 10.1037/1040-3590.20.2.150] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fairbrother N, Woody SR. Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder. J Psychosom Obstet Gynaecol 2007; 28:239-42. [PMID: 17966050 DOI: 10.1080/01674820701495065] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This prospective study examined psychological and obstetrical predictors of enduring postpartum symptoms of depression and post-traumatic stress disorder. Contrary to prediction, prenatal fear of childbirth did not significantly predict symptoms of depression or post-traumatic stress disorder at one month postpartum, but anxiety sensitivity was an unexpected predictor that merits further investigation. Several obstetrical and neonatal variables significantly predicted symptoms of post-traumatic disorder, but not depression.
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Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther 2006; 45:2155-63. [PMID: 17084810 DOI: 10.1016/j.brat.2006.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 09/15/2006] [Accepted: 09/26/2006] [Indexed: 11/21/2022]
Abstract
Research on emotional disturbance during pregnancy and the postpartum period has focused primarily on mood disorders and psychosis, yet preliminary evidence suggests that early parenthood is also associated with an increased risk for the development and exacerbation of obsessional problems. In this article we describe the nature of "postpartum obsessive-compulsive disorder" (ppOCD) and present a cognitive-behavioural model to account for these signs and symptoms. The model outlines features of early parenthood that might increase vulnerability to ppOCD and proposes a conceptual framework similar to that described in cognitive-behavioural models of OCD in general. The empirical status of the model described herein is discussed, along with suggestions for future research and implications for treatment.
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Affiliation(s)
- Nichole Fairbrother
- Centre for Healthcare Innovation and Improvement, E414A 4480 Oak Street, Vancouver, BC, Canada V6 H 3V4.
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Fairbrother N, Rachman S. PTSD in victims of sexual assault: test of a major component of the Ehlers-Clark theory. J Behav Ther Exp Psychiatry 2006; 37:74-93. [PMID: 16563306 DOI: 10.1016/j.jbtep.2004.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Revised: 03/03/2004] [Accepted: 08/10/2004] [Indexed: 10/26/2022]
Abstract
We investigated a major component of the Ehlers-Clark theory of post-traumatic stress disorder (PTSD) in a sample of 50 female victims of sexual assault. In particular, we tested the hypothesis that the victims' appraisals of the trauma and its consequences contribute significantly to the persistence of PTSD symptoms. The results indicated that the victims' appraisals of the sexual assault and its sequelae are strongly and positively related to PTSD symptoms. This finding remained significant after statistically controlling for the perceived severity of the assault. Most of the results are consistent with the Ehlers-Clark theory.
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Affiliation(s)
- Nichole Fairbrother
- Interdisciplinary Women's Reproductive Health Research Training Program, BCRICWH Department of Health Care and Epidemiology Faculty of Medicine, University of British Colombia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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Abstract
An experiment was carried out in order to test the hypothesis that feelings of mental pollution can be induced without physical contact. A sample of 121 female university undergraduates were asked to imagine experiencing a non-consensual kiss at a party, as described on an audiotape, or a consensual kiss described on a comparable audiotape. The manipulation succeeded and participants in the non-consensual kiss condition reported significant feelings of mental pollution, negative emotions and cognitions, as well as the urge to wash. Further, eight participants in the non-consensual kiss condition engaged in washing/rinsing behaviour to counteract feelings of mental pollution. The results are consistent with the hypothesis and with reports from an earlier study of victims of sexual assault, a majority of whom described feelings of mental pollution post-assault. The results are also compatible with case descriptions of the onset of mental pollution and OCD subsequent to sexual trauma. Some possible implications of the results, clinical and theoretical are adumbrated.
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Affiliation(s)
- Nichole Fairbrother
- Anxiety Disorders Unit, Department of Psychiatry, University of British Columbia Hospital, Purdy Pavilion, M42, 2221 Westbrook Mall, Vancouver, BC, Canada V6T 2B5.
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Misri S, Oberlander TF, Fairbrother N, Carter D, Ryan D, Kuan AJ, Reebye P. Relation between prenatal maternal mood and anxiety and neonatal health. Can J Psychiatry 2004; 49:684-9. [PMID: 15560315 DOI: 10.1177/070674370404901006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the relation between the mood and anxiety of pregnant, psychiatrically treated women and neonatal health outcomes after birth. METHOD We prospectively assessed 46 women treated with psychotropic medications for anxiety and depression during pregnancy. We compared measures of maternal mental health with infant outcomes, in particular, the outcomes of infants with symptoms of poor neonatal adaptation. RESULTS The mothers of babies who demonstrated poor neonatal adaptation reported higher levels of anxiety and depression at study entry than did the mothers of healthy babies. This relation was not related to the presence or absence of treatment with clonazepam, an anxiolytic used to treat symptoms of anxiety. Further, increased psychiatric comorbidity in the mother was associated with a greater likelihood of transient symptoms in the newborn. CONCLUSIONS Despite psychiatric treatment, the intensity and degree of comorbid symptoms appear to be related to poor transient neonatal health outcome. Our data suggest that, in addition to the impact of pharmacologic factors, maternal psychiatric status influences infant outcomes.
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Affiliation(s)
- Shaila Misri
- Department of Psychiatry, University of British Columbia, Vancouver.
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Fairbrother N, Rachman S. Feelings of mental pollution subsequent to sexual assault. Behav Res Ther 2004; 42:173-89. [PMID: 14975779 DOI: 10.1016/s0005-7967(03)00108-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2002] [Revised: 03/17/2003] [Accepted: 03/23/2003] [Indexed: 11/26/2022]
Abstract
This paper describes an investigation of the phenomenon of mental pollution in a sample of 50 female victims of sexual assault. Feelings of mental pollution were assessed using an interview and a questionnaire. An experimental procedure was employed to determine if feelings of dirtiness and the urge to wash could be provoked by deliberate attention to the assault memory. Thirty (60%) of the 50 participants reported some feelings of mental pollution subsequent to the assault, and feelings of mental pollution were related to post-assault washing behaviour. Deliberate recall of the assault resulted in stronger feelings of dirtiness and the urge to wash than did deliberate attention to a pleasant memory or scene. Nine women reported washing their hands in response to deliberate recall of the assault. These findings suggest that feelings of mental pollution may be prominent in victims of sexual assault.
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Affiliation(s)
- Nichole Fairbrother
- Anxiety Disorders Unit, Department of Psychiatry, UBC Hospital, A Site of Vancouver Hospital and Health Sciences Centre, Detwiller Pavillion, 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
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Abstract
An important early work by the French psychiatrist, Paul Hartenberg, Les Timides et la Timidité, published in 1901, has been overlooked in the English language literature on Social Phobia. Hartenberg's understanding of the phenomenology of social phobia is surprisingly similar to modern conceptualizations of the disorder. His description of the disorder corresponds very closely to the current DSM-IV criteria of social phobia. For example, he recognizes that socially anxious people feel anxious and ashamed in situations where there is no actual danger, and that these emotions occur only in the presence of others. Hartenberg clearly differentiates between social fears and other fears, noting that socially anxious people may be quite courageous in non-social situations. He also describes with considerable accuracy the typical symptoms of rapid onset anxiety. In a number of respects, Hartenberg approaches social phobia from a cognitive behavioral perspective, and describes an approach to treating social fears that is essentially graduated exposure to feared social situations. Hartenberg anticipated many advances in the area of social anxiety, and provided a number of insights that remain valuable.
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Affiliation(s)
- Nichole Fairbrother
- Department of Psychology, University of British Columbia, 2136 West Mall, BC V6T 1Z4, Vancouver, Canada.
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