Journal of Psychosomatic Obstetrics & Gynecology最新文献

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.

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.

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.

The diagnosis gestational trophoblastic disease (GTD) is known to have a significant psychological impact on women. Our objective was to provide insight in the psychological and physical consequences of women with GTD, while also reflecting on their coping strategies and their experiences of received care. A qualitative study was carried out using semi-structured interviews among women recently diagnosed with GTD. Interviews were audio-recorded, transcribed verbatim and analyzed using a thematic network approach. Eight interviews were analyzed. The abruptness of the diagnosis resulted in women feeling sad, uncertain and powerless. Coping strategies included seeking emotional support, accurate information, peer connections and distraction. Women were generally satisfied with care, emphasizing personalization, empathy, medical expertise and feeling heard as important aspects. They appreciated offered psychological support from specialized nurses. Nevertheless, aspects such as provided information, communication and logistical issues need improvement. The results of this study emphasize the importance of comprehensive patient information, the need for personalized psychological support and more frequent consultations at reference centers, while treatment is conducted locally.

Long working hours and psychological distress have each been related to adverse maternal health and birth outcomes. Understanding the potential psychological health impacts of long working hours among pregnant workers may support the implementation of maternity work protections in the United States (U.S.). This cross-sectional study among a weighted sample of 3637 pregnant workers from the U.S. population-based National Health Interview Survey (NHIS) 1997-2018 aimed to examine the association of working hours with psychological distress. Multivariable linear regression models analyzed associations between categories of weekly working hours and continuous scores of psychological distress measured by the Kessler 6 (K6) scale, while accounting for demographic, socioeconomic, behavior and health characteristics. In the fully adjusted model, compared to the standard workweek of 35-40 h/week, working ≥49 h/week was associated with higher psychological distress [β (SE): 0.59 (0.21); p = .0058]. This initial evidence connecting excessive working hours with increased psychological distress among a U.S. sample of pregnant women supports clinical practices in prenatal assessments of occupational risk factors, and the provision of work-related resources and work accommodations. Future research is warranted to investigate potential occupational effects on maternal mental health throughout the course of pregnancy and postpartum using cohort studies.

Childbirth-related posttraumatic stress symptoms (CB-PTSS) affect around 12% of postpartum individuals. While the subjective experience of childbirth is a key predictor of CB-PTSS, the specific defining characteristics of negative birth experiences remain poorly understood. This study aims to refine our understanding of negative birth experiences by investigating intrapartum hotspots, i.e. moments of extreme distress, and their association with CB-PTSS. In a cross-sectional study of N = 1,140 individuals who had given birth eight to ten weeks before, we examined the following: the types of hotspots, differences in hotspot-related distress, interpersonal difficulties during the hotspot, and CB-PTSS between the various types of hotspots and whether hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Participants completed several items based on previous qualitative work [1] to assess the worst hotspot, hotspot-related distress, and interpersonal difficulties during the hotspot and the City Birth Trauma Scale to measure CB-PTSS, alongside relevant pregnancy- and birth-related questions. Medical interventions were the most frequently experienced worst hotspot and separation from the child was associated with the highest levels of hotspot-related distress, interpersonal difficulties, and CB-PTSS. Hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Examining intrapartum hotspots poses a promising approach to define highly negative birth experiences.