Journal of Psychosomatic Obstetrics & Gynecology最新文献

Purpose: Whilst the antenatal period is well established as a period of increased vulnerability to mental health difficulties, restrictions resulting from COVID-19 lockdown in the UK are likely to have negatively affected psychosocial outcomes in these women.

Materials and Methods: This study aimed to describe prevalence rates of clinically relevant antenatal anxiety and depression, and explore whether psychosocial changes as a result of the pandemic were predictive of clinically relevant anxiety and depression. Antenatal women (N = 684) completed an online survey of psychosocial measures during the UK government's initial lockdown restrictions.

Results: Descriptive statistics indicate women experienced high levels of anxiety and depression and that changes resulting from restrictions were perceived negatively. Whilst 11.7% of women reported a current, clinical diagnosis of depression, 47.8% reported a score of ≥13 on the EPDS, indicating clinically relevant depression. Similarly, 18.7% of women reported a current, clinical diagnosis of anxiety, but 68.1% scored ≥40 on the STAI, indicating clinically relevant anxiety. After controlling for known demographic risk factors, only psychosocial change because of COVID-19 restrictions predicted clinically relevant anxiety (28%) and depression (27%).

Conclusions: This study highlights the importance of considering antenatal women as a high-priority group, and ensuring antenatal care remains accessible and uninterrupted in any future crises.

Background: Identifying women with secondary tokophobia and offering effective counseling can reduce the psychological burden of their negative experience's childbirth. In light of Iran's population incentive policies, this research will compare the effects of two telemedicine-based counseling methods on secondary tokophobia in single-child women.

Methods/design: This study will be conducted in two phases. Phase 1 will identify women with secondary tokophobia through a cross-sectional descriptive study using the Fear of Childbirth Prior to Pregnancy (FOCPP) tool. Phase 2 will be a three-arm randomized controlled trial (RCT), enrolling 102 single-child women with secondary tokophobia, block-randomized in blocks of six to receive either Acceptance and Commitment Therapy (ACT - arm 1), motivational counselling (MC - arm 2), or standard care (control). The study will follow CONSORT-EHEALTH guidelines. Outcomes, including tokophobia, anxiety, depression, and postnatal PTSD, will be assessed at weeks four and eight using standardized questionnaires. Data will be analyzed using statistical tests in SPSS-24.

Discussion: Negative past experiences can lead to secondary tokophobia, where women fear future pregnancies, sometimes avoiding them altogether. Research shows that those with tokophobia may face anxiety, depression, and PTSD, necessitating counseling to encourage future pregnancies. This study will be aim to investigate two counseling interventions for single-child women with secondary tokophobia through a telemedicine approach in the context of Iranian population policies.

Trial registration: Current Controlled Trials IRCT20240207060923N1. Registered 18 May 2024.

Background: Infertility affects many reproductive-aged couples, with assisted reproductive technology (ART) offering hope but also significant emotional stress due to invasive procedures, hormonal fluctuations, uncertainty, and financial and emotional burden of repeated cycles. Ovarian hyperstimulation syndrome (OHSS), a common ART complication, may further aggravate psychological distress, yet its mental health impact remains understudied.

Methods: This longitudinal study included 1,429 women undergoing their first ART cycle at a reproductive center in China. Psychological assessments were conducted at four critical time points: before ART, post-surgery (early pregnancy), mid-pregnancy and late pregnancy. Validated scales (SAS, CES-D, CPSS, PSQI) measured anxiety, depression, stress, and sleep quality. OHSS was diagnosed per clinical guidelines. Generalized estimating equations (GEEs) assessed changes over time and the moderating effects of OHSS, adjusting for age, education level and income.

Results: OHSS occurred in 9.2% of participants, who tended to be younger and have higher socioeconomic status. Anxiety peaked after surgery and remained elevated; stress declined steadily; sleep quality improved; depression rebounded slightly in late pregnancy. OHSS significantly intensified anxiety and stress but had no clear impact on depression or sleep.

Conclusions: Emotional responses during ART are dynamic. OHSS amplifies anxiety and stress, warranting integrated psychological support within ART programs, particularly for OHSS-affected women.

To determine the prevalence of depression and anxiety among infertile women in Zanzibar and explore their risk factors, infertile female patients were recruited from Mnazi Mmoja Hospital in Zanzibar. The questionnaire survey was adopted. Ordinal univariate and multivariate logistic regression analyses were separately conducted to identify the risk factors associated with depression and anxiety in this sample. Among 330 infertile women, the overall prevalence of depression among patients with infertility was 40.3% and the incidence of anxiety was 66.06%. Older age (odds ratios (ORs): 1.056, 95%CI: 1.004-1.112, p = .035) and low education level (OR: 0.685, 95%CI: 0.475-0.987, p = .042) were the independent risk factors for depression. Low educational level (OR: 0.678, 95%CI: 0.482-0.954, p = .026) and primary infertility (OR: 1.546; 95%CI: 1.028-2.324, p = .036) were the risk factors for anxiety. Low educational level is a risk factor for both depression and anxiety in infertile women. Older age is a risk factor for depression and primary infertility is a risk factor for anxiety.

Objective: To deeply explore the psychosocial adaptation experience of hysterectomy patients at various stages, with the aim of constructing a conceptual model to describe the complex experience of psychosocial adaptation.

Methods: Semi-structured in-depth interviews were conducted on twelve patients undergoing hysterectomy using hermeneutical phenomenological methods, and the data were analyzed using the Smith analysis method.

Results: were refined into four stages and ten sub-themes: (1) Shock and Confusion Stage: shock and unwillingness, fear and anxiety; (2) Physical and Mental Dilemma Stage: surgical trauma, self-cognitive impact, and increasing dependence on social support; (3) Adjustment and Exploration Stage: correcting self-efficacy, self-cognitive reconstruction, and exploring social boundaries; (4) Integration and Adaptation Stage: returning to social roles and achieving closed-loop psychosocial adaptation.

Conclusion: The conceptual model of psychosocial adaptation offers amore systematic and comprehensive consideration and reveals a comprehensive panorama of how women undergoing hysterectomy gradually adapt and integrate into society. Medical staff are reminded to pay close attention to the psychological change requirements of hysterectomy patients at different stages, provide healthcare-emotional-knowledge-economic support, strengthen physiological-psychological-behavioral linkage management, reduce or eliminate negative emotions, and promote their early integration into society.

Objective: To assess the impact of low-dose intravenous esketamine on postpartum depression scores in women undergoing cesarean section.

Methods: In a randomized, double-blind, placebo-controlled trial, 186 women aged 20-50 years receiving epidural anesthesia for cesarean section were divided into three groups: Group A (0.25 mg/kg esketamine intraoperatively + esketamine in PCIA), Group B (0.25 mg/kg esketamine intraoperatively + PCIA without esketamine), and Group C (placebo intraoperatively + PCIA without esketamine). The primary outcome was the change in Edinburgh Postnatal Depression Scale (EPDS) scores. Secondary outcomes included Pittsburgh Sleep Quality Index (PSQI) scores, Visual Analogue Scale (VAS) scores, PCIA bolus frequency, and adverse events.

Results: EPDS and PSQI scores decreased significantly post-surgery across all groups (p < 0.05). Groups A and B showed greater EPDS score reductions than Group C at 5, 7 and 14 days postoperatively (p < 0.01). No significant differences were observed in PSQI scores, VAS scores or PCIA bolus frequency between groups. Adverse events though mild and transient, were more frequent in Group A (p < 0.01).

Conclusion: Low-dose intravenous esketamine, reduces postpartum depression scores post-cesarean section, with a safe profile despite increased mild adverse events when combined with PCIA.

Purpose: Loss of control while eating (LOC) or feeling unable to control the amount or type of food consumed during an eating episode, is the core psychopathology in binge eating disorders. Yet, the impact of LOC on other psychiatric symptoms during pregnancy is not known. This study evaluated the contribution of prenatal LOC to psychological distress and disordered eating attitudes.

Methods: Pregnant individuals with BMI ≥ 25 (N = 312) recruited for a perinatal health promotion trial self-reported past-month LOC; eating, shape, and weight concerns; prenatal depressive symptoms, anxiety, and stress. Propensity scores were used to reduce bias associated with cross-sectional data.

Results: Overall, 34.3% (n = 107) reported LOC. Individuals with prenatal LOC, relative to those without, endorsed more eating disorder symptoms (ps<.001) as well as more symptoms of depression (7.1$\pm$0.3 vs. 5.4$\pm$4.9) and anxiety (38.1 ± 11.7 vs. 33.4 ± 11.7) and greater perceived stress (25.0 ± 7.9 vs. 22.0$\pm$9.9, ps<.001). LOC frequency was associated with significantly more prenatal psychological distress, beyond the effect of other factors that increase the likelihood of LOC. (ps<.005).

Conclusions: Among individuals with elevated BMI, prenatal LOC is common and relates to eating disorder and other psychiatric symptoms. Prenatal LOC may represent a behavioral mechanism for improved psychological health.

Infertility, affecting one in six individuals worldwide, poses substantial emotional and physical challenges. Its impact on quality of life (QoL), mental health and social relationships is well documented. However, qualitative insights into the lived experiences of those affected remain limited, as do the perspectives of health professionals involved in their care. This study presents qualitative findings from a mixed-method approach. Data were collected through 23 semi-structured interviews with 26 affected individuals and three focus group discussions with 20 healthcare professionals. The results underscore the multifaceted burden of infertility, including emotional distress, relationship strain and a pervasive sense of social exclusion. Participants expressed a clear need for more empathetic and individualized care, while healthcare professionals pointed to structural barriers. The study also identified a lack of societal recognition for infertility and the complex challenges. In some narratives, spirituality emerged as a personal coping resource - though one that is often overlooked or insufficiently addressed in clinical practice. Key recommendations include the expansion of peer support networks, public awareness raising, flexible treatment models and interprofessional collaboration. Future research should evaluate the effectiveness of peer support systems and interdisciplinary care models in addressing the complex and diverse needs of individuals affected by infertility.

Background: Endometriosis (EMS) is associated with a markedly increased incidence of depression and anxiety, primarily due to cyclic pain, concerns about infertility from impaired ovarian function, and fear of disease recurrence. Surgery and its associated pain may trigger both emotional and physiological stress responses. Young, nulliparous patients with fertility intentions often experience additional psychological burdens related to surgical safety, postoperative recovery, and the potential impact on future fertility. Music has been shown to promote relaxation, reduce tension and anxiety, and alleviate pain. However, no studies have evaluated the postoperative effects of music therapy in this specific patient population.

Objective: To investigate whether music therapy can effectively reduce postoperative pain and alleviate perioperative anxiety in young patients with fertility desires undergoing laparoscopic cystectomy for endometriotic ovarian cysts, and to explore its potential as a simple, non-pharmacological intervention.

Methods/design: A single-center, two-arm, single-masked randomized controlled trial (RCT).

Setting: The Third Affiliated Hospital of Sun Yat-sen University (a teaching hospital).

Participants: A total of 149 patients were included for analysis, with 75 assigned to the music group and 74 to the control group.

Intervention: Perioperative music therapy administered to young, nulliparous patients with fertility intentions undergoing laparoscopic cystectomy for EMS.

Results: One participant withdrew during follow-up, and 149 patients were included in the final analysis. Baseline characteristics-including age, BMI, marital status, preoperative VAS scores, and GAD-7 scores and anxiety levels-showed no significant differences between groups. Postoperative VAS scores at 6 h (p = 0.20), Day 1 (p = 0.438), Day 3 (p = 0.714), and Day 7 (p = 0.899) revealed no significant differences. Similarly, GAD-7 scores and anxiety severity levels on postoperative Day 1 (p = 0.541; p = 0.984), Day 3 (p = 0.287; p = 0.436), and Day 7 (p = 0.468; p = 0.703) showed no statistical significance between groups.

Conclusion: Music therapy may serve as an adjunctive intervention for young, nulliparous patients with fertility intentions undergoing laparoscopic cystectomy for endometriosis; however, no significant effects were observed in reducing perioperative anxiety or postoperative pain in this population.

PCOS is one of the most prevalent endocrine disorders among women of reproductive age, often involving obesity, insulin resistance, and mental health challenges that reduce health-related quality of life (HRQOL). Although metformin has been shown to improve HRQOL in PCOS patients, it is unclear whether this effect is due to the drug itself or its metabolic benefits. This study included 66 PCOS patients from the University Medical Center Mainz, in two groups: 31 received metformin (M-group) and 35 received alternative or no treatment (C-group). HRQOL and distress were assessed at baseline and after 6 months using the Modified PCOS-Questionnaire (MPCOSQ) and the Hospital Anxiety and Depression Scale (HADS). At baseline, the M-group had significantly worse metabolic markers, including HOMA-IR, waist circumference, Visceral Adiposity Index, and Fatty Liver Index. By follow-up, this group showed greater improvements in these markers. However, both groups improved similarly in HRQOL and distress. Regression analysis revealed that improvements in HOMA-IR and BMI were associated with better HRQOL scores. Group assignment was not a significant predictor. These findings may indicate that improvements in HRQOL and reduced distress are linked to metabolic changes associated with metformin use, underscoring the potential relevance of addressing metabolic health in treatment approaches.