Archives of Women's Mental Health最新文献

Background

In Southern Africa, Lesotho reports the highest estimated rates of depression, with women disproportionately affected. Cultural, societal, familial, and spousal pressure on women to become pregnant is a substantial public health concern linked with an increased risk of depression. However, there is limited evidence on the impact of pressure to become pregnant on depression in Lesotho using propensity score matching (PSM) analysis. Therefore, this study employed PSM to estimate the effect of pressure to become pregnant on depression among married women in Lesotho.

Method

A total of 1600 unweighted married women were included in the analysis using the recent 2023/24 Lesotho Demography and Health Survey (LDHS). The analysis used a propensity score matching analysis (PSM) with a logit model using the psmatch2 package in Stata to estimate the average treatment effect on the population (ATE), the treated (ATT), and the untreated (ATU) for the effect of pressure to become pregnant on depression. Kernel matching with a caliper width of 0.01 was used to match individuals in the two groups. The quality of the matches was evaluated statistically and graphically. Sensitivity analysis was performed to test the robustness of the PSM results, using the Mantel-Haenszel test statistics.

Result

The overall prevalence of depression among married women in Lesotho was 6.83% (95% CI: 5.68%, 8.20%). The PSM analysis showed that experiencing pressure to become pregnant increased the likelihood of depression by 6.3% (ATT = 0.063, 95% CI: 0.0138, 0.1122). The average treatment effect (ATE = 0.058, 95% CI: 0.0443, 0.0721) indicated that pressure to become pregnant significantly increased the risk of depression in the overall population by 5.8%. The average treatment effect for untreated (ATU = 0.0515) underscored that women who had not experienced pressure to become pregnant would have a 5.15% higher risk of developing depression if they had been exposed. Overall, these findings highlight that pressure to become pregnant significantly increases the risk of depression.

Conclusion and recommendation

This evaluation found that spouse or family pressure to become pregnant significantly increases the risk of depression. These findings underscore pregnancy pressure, pressing attention to reproductive coercion and community-based initiatives to mitigate its mental health consequences. Thus, policymakers and programmers should strengthen reproductive autonomy protection in mental health policies. Additionally, health care providers should screen for reproductive coercion during routine antenatal visits and offer counseling services to decrease the risk of depression. Community-based education campaigns and peer support groups involving men and families are also recommended to help reduce fertility-related pressures.

Purpose

Use of medications to treat attention-deficit/hyperactivity disorder (ADHD) is increasingly prevalent among women of reproductive age, but little is understood about their potential cardiometabolic effects in pregnancy. We aimed to examine associations between ADHD medication use and cardiometabolic conditions during pregnancy (gestational hypertension, preeclampsia, and gestational diabetes) and the pharmacological treatment thereof.

Methods

Linking statewide hospital and dispensing data, we conducted a population-based matched cohort study of women who gave birth between January 2014 and June 2021 in New South Wales, Australia (n = 312,697). We compared the incidence of cardiometabolic conditions and cardiometabolic medication use during pregnancy among women who used ADHD medications during pregnancy (n = 336) with a 1:10 matched cohort of unexposed women, and with women who used ADHD medications in the 12 months before pregnancy (n = 252). We used Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI), adjusting for sociodemographic and pregnancy-related factors.

Results

Compared with unexposed women, women who used ADHD medications during pregnancy had an increased risk of gestational hypertension (adjusted RR: 1.76, 95% CI: 1.20–2.57) and gestational diabetes (aRR: 1.41, 95% CI: 1.09–1.82), with slightly elevated risk estimates for preeclampsia (aRR: 1.30, 95% CI: 0.82–2.05) and cardiometabolic medication use (aRR: 1.40, 95% CI: 0.97–2.01). Compared with women who used ADHD medications before pregnancy only, risk estimates attenuated for all outcomes except gestational diabetes (aRR: 1.76, 95% CI: 1.06–2.93).

Conclusions

Women using ADHD medications had an elevated incidence of cardiometabolic conditions during pregnancy, but it remains unclear to what extent this is attributable to medications rather than the underlying ADHD.

Aims

To investigate the trends in prevalence of mental disorders – schizophrenia, depressive disorders, bipolar disorder, anxiety disorders, eating disorders, autism spectrum disorders, attention-deficit/hyperactivity disorder, conduct disorder, idiopathic developmental intellectual disability, and other mental disorders – among women of childbearing age at global, regional and national level from1992 to 2021, and further to examine the independent effects of age, period, and birth cohort on mental disorders.

Methods

Data were derived from the Global Burden of Disease Study (GBD) 2021. An age-period-cohort analysis was adopted to investigate the annual percentage change in prevalence rate overall (net drifts, % per year) and by age (local drifts, % per year), and age-, period-, and cohort-effect on the prevalence rate among participants between 1992 and 2021.

Results

In 2021, the global prevalence cases of overall mental disorders in women at childbearing age were 343.22 million. Over the past three decades, the largest increase in case number was observed in low socio-demographic index (SDI) region (144.21%), while the most significant increase in age-standardized prevalence rate (ASPR) was identified in high SDI region (18.30%). The global net drift in prevalence rate of mental disorders among participants was estimated as -0.02 (95%CI: -0.04 to -0.00) annually. Moreover, prevalence trends were highly heterogeneous across all the global 204 countries/territories. Anxiety disorders and depression disorders were the top two contributors of overall prevalence of mental disorders, accounting for the largest proportion of total prevalence (66.2% in 1992 and 70.4% in 2021) among all types of mental disorders. For overall global population, an increasing age effect, V-shape pattern of period effect, and stable cohort effect were separately identified upon mental disorder burden. Notably, the V-shape period effect may reflect that positive mental health policy gains (pre-2016) were disrupted by COVID-19 pandemic.

Conclusions

The global burden of mental disorders among women at childbearing age remained high during 1992 and 2021, especially after the COVID-19 pandemic. Notably, anxiety disorders, and depressive disorders were more prevalent in this population. Disparities of mental disorders existed in regions, countries and sub-populations with different age. These findings imply that mental health issue has become a significant public health challenge worldwide. This study has important policy and population health implications, suggesting that country-specific and subpopulation-tailored intervention strategies should be implemented for the purpose to reduce the burden of mental disorders among women at childbearing age worldwide.

Introduction

Postpartum Psychosis (PP) is a severe form of perinatal mental illness and may have profound consequences for the well-being of mothers, infants, and families.

Aim

This systematic review explores the experiences, needs, perspectives, and expectations of women with postpartum psychosis and that of their families.

Design

A systematic review used the meta-aggregation method.

Method

A systematic search was conducted using 5 electronic databases—PubMed, ProQuest, Scopus, Google Scholar, and Web of Science to identify relevant studies published between 01 January 2012 and 31 December 2024. The review adhered to PRISMA guidelines and included peer-reviewed studies in English. Study quality was independently assessed by two investigators using Covidence software and the Mirza and Jenkins checklist (2004). Qualitative, explorative, and descriptive studies employing thematic or interpretative analyses were included.

Results

Twenty-two studies were included in this synthesis. Findings reveal a complex interplay between postpartum psychosis and family dynamics, which is also shaped by cultural narratives surrounding motherhood. These narratives show how women and families perceive illness and seek help. Five key themes and fifteen subthemes emerged: (1) An understanding of postpartum psychosis, (2) Baby being central to recovery, (3) The importance of support and network systems, (4) Being overwhelmed with responsibilities, and (5) Future plans and plans related to future pregnancy. Poor awareness and systemic barriers often leave families feeling unsupported. Mothers experience emotional exhaustion, viewing the baby as both a comfort and a stressor. Fathers report a need for professional support and struggle with shifting family roles, particularly during separation in mother-baby unit admissions.

Conclusion

The review underscores the importance of timely, family-centered care in the management of postpartum psychosis. Mothers and families appear to be overwhelmed at a vulnerable time of their lives and have to navigate systemic barriers to care. Active involvement of families in treatment with culturally sensitive interventions can foster coping, facilitate maternal recovery, and promote maternal-infant bonding.

Purpose

Polycystic ovary syndrome (PCOS) presents psychological challenges in women due to persistent symptoms such as hirsutism, irregular menstruation, and weight gain, and long-term complications like infertility. Women with PCOS face higher risks of depression, anxiety, body image dissatisfaction, and social challenges. Research often overlooks the psychological burden of PCOS, despite its documented effects. This systematic review aims to explore the lived psychological experiences of women with PCOS, encompassing mental health challenges, emotional well-being, and psychosocial factors. It also aims to identify sociocultural variations in psychosocial challenges.

Methods

A systematic search was conducted across six bibliographic databases (MEDLINE, Web of Science, Cochrane, CINAHL, PubMed, and SCOPUS) from inception to April 2024. Qualitative and mixed-methods studies in English exploring the psychological experiences of women with PCOS were included. Study quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI), and findings were synthesized using a JBI-guided pragmatic meta-aggregation approach.

Results

A total of 43 studies were included, yielding 240 unequivocal findings and 46 credible findings which were meta-aggregated into two themes: (1) Mental Health Challenges associated with PCOS (2) Psychosocial Challenges associated with PCOS.

Conclusion

Depression, anxiety, body image dissatisfaction, and social stigma significantly impact women with PCOS. Hirsutism and being overweight are prominent stressors, particularly affecting psychological well-being in this group. Sociocultural factors play a role in shaping psychological experiences. Effective PCOS care requires mental health support, fertility counselling, and culturally sensitive interventions to improve health outcomes.

Purpose

To evaluate the effect of prenatal education on the fear of childbirth among pregnant women based on previously conducted studies.

Methods

A systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies was conducted following the PRISMA guidelines. The data were pooled through meta-analysis. ROBINS-I and RoB2 were used to assess the quality of the studies. The GRADE approach was used for evaluating the certainty of evidence.

Results

The meta-analysis included 28 studies and the total sample size of the studies was 3073. The results showed that statistically, prenatal education significantly reduced the fear of childbirth during both the antepartum and postpartum period (SMD: -1.12, z = 9.14, p < 0.001; MD: -24.35, z = 6.18, p < 0.001 respectively). The meta-regression performed indicated that the study design, the course of the COVID-19 pandemic, data collection tools, the countries of the studies and features of education had no effect on the results of fear of childbirth in pregnancy. Moreover, the meta-analyses showed that prenatal education increased the likelihood of vaginal birth and the preference for vaginal birth approximately by two times and three times respectively (OR: 2.00, z = 4.82, p < 0.001; OR: 2.87, z = 3.89, p = 0.001 respectively). The certainty of evidence was low for fear of childbirth during pregnancy, moderate for fear of childbirth in the postpartum period and high for vaginal birth and preference for vaginal birth.

Conclusion

This study revealed that prenatal education was effective for reducing the fear of childbirth and therefore, increasing vaginal births.

Registration number

CCRD42022378547

Purpose

Neurocognitive impairments are a core feature of psychosis and impact long-term outcomes. While sex differences in neurocognition have been observed in first-episode psychosis (FEP), findings remain mixed, and little is known about differential responses to metacognitive interventions. This study examined sex differences in the effectiveness of Metacognitive Training (MCT) on neurocognitive outcomes in FEP.

Methods

A total of 122 individuals with FEP were randomized to receive either MCT or psychoeducational intervention. Neurocognitive performance was assessed at baseline and at 6-month follow-up using a comprehensive battery (CPT-II, TMT, WCST, Stroop test, TAVEC, WAIS-III Digit Span). General Linear Models tested the effects of intervention, sex, and their interaction, both unadjusted and adjusted for covariates.

Results

MCT led to greater improvements than psychoeducation in immediate recall, processing speed, cognitive flexibility, inhibitory control, and attention. Improvements in immediate recall and Stroop Interference remained significant after adjustment, with Stroop performance also influenced by diagnosis. Across groups, men performed better in verbal memory, while women showed increased serial clustering in short-term recall, an effect that remained significant after adjustment. Notably, a group-by-sex interaction indicated that women receiving MCT experienced greater gains in short-term recall after controlling for covariates.

Conclusions

MCT enhances specific neurocognitive functions in FEP and shows promising effects for women in verbal memory processes. These findings underscore the importance of incorporating sex and diagnostic factors when tailoring early interventions for psychosis and highlight the potential of MCT as a personalized cognitive strategy.

Purpose

Perinatal depression (PND), occurring during pregnancy or within the first year after childbirth, is a common medical complication with serious consequences when left untreated, including hospitalizations, increased morbidity, and suicide. This study examined the intersection among racial, ethnic, and sociodemographic disparities in PND screening and diagnosis within a Midwestern health system.

Methods

We performed a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) using electronic health record data for 79,992 deliveries. The study included women aged 15–50 who delivered live-born infants between 22 and 44 weeks of gestation. PND screening was identified by the presence of a PHQ-9 or EPDS score, and ICD9/10 codes were used to define depression diagnosis within one year before or after delivery.

Results

Across groups older women (≥ 36 years) were less likely to be screened for PND (OR = 0.65; 95%CI = 0.56–0.75) but not less likely to be diagnosed. Non-Hispanic Black, Hispanic, and Asian women were more likely to receive PND screening (ORs = 1.23–1.31) but less likely to be diagnosed (ORs = 0.16–0.60) compared to Non-Hispanic White women. Enrollment in public insurance was not associated with PND screening but was linked to a higher likelihood of diagnosis (OR = 1.41, CI = 1.24–1.61). Women in rural areas were less likely to be screened for PND (OR = 0.66, CI = 0.58–0.75), with no significant association with diagnosis.

Conclusions

Significant disparities exist in PND screening and diagnosis. Groups facing historic structural inequities are more likely to be screened but less likely to receive a diagnosis, highlighting the need for targeted interventions to address these inequities.