Archives of Women's Mental Health最新文献

Purpose: Substantial evidence suggests a downstream impact of maternal mental health on birth outcomes. The roles of comorbid maternal physical health and familial confounding underlying this association remain unclear.

Methods: This cohort study included a random sample of children born 1997-2008 within a health maintenance organization (HMO) in Israel, their parents, and siblings. Outcomes were ICD-9 diagnoses of neonatal adversities (birth complications and congenital anomalies) and exposures were maternal diagnoses of mental health disorders. Odds ratios (ORs) and their 95% confidence intervals for the associations between maternal mental health diagnoses and measures of neonatal adversity were calculated using logistic regression, adjusting for maternal age, child's year of birth, socioeconomic status, and maternal physical morbidity burden. We examined potential familial confounding using a negative control approach based on paternal exposure.

Results: In our sample of 74,533 children, 6,674 (9.1%) were born after birth complications and 14,569 (19.9%) with a congenital anomaly. Maternal mental health diagnosis around pregnancy was significantly associated with these measures of neonatal adversity after adjustment for potential confounders (birth complications: OR = 1.3 (1.2-1.4), p < 0.001; congenital anomalies: OR = 1.2 (1.1-1.3), p < 0.001). These associations became attenuated and non-significant after further adjustment for maternal physical morbidity burden. In a joint model, maternal and paternal diagnosis of a mental health disorder were independently associated with neonatal adversity (birth complications: OR_mat=1.3 (1.1-1.4), p < 0.001; OR_pat=1.2 (1.1-1.3), p = 0.004; congenital anomalies: OR_mat=1.2 (1.1-1.3), p < 0.001; OR_pat=1.1 (1.0-1.2), p = 0.01).

Conclusion: Physical health and familial factors play a role in the associations between maternal mental health and neonatal adversity.

Purpose: The perinatal period is a critical phase in a woman's life, marked by unique mental health challenges. This study focuses on Syrian mothers in Lebanon, a vulnerable population often exposed to displacement and conflict-related stressors. The aim is to identify risk factors for perinatal distress, including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), among Syrian mothers within one year of giving birth.

Methods: Data collection included quantitative assessments using the Refugee Health Screener-13 (RHS-13), and qualitative insights from in-depth interviews. The assessment period was extended to cover the year following childbirth to provide a broader perspective on perinatal distress.

Results: The study revealed significant risk factors, specifically a history of mental illness and chronic disease. While maternal age and number of children were considered potential risk factors, they were not statistically significant in the quantitativeanalysis but were highlighted in the qualitative interviews.

Conclusions: This research offers valuable insights for healthcare providers, policymakers, and organizations working with Syrian refugee women in Lebanon. Addressing these risk factors can improve mental health outcomes for perinatal women affected by war and displacement, underscoring the need for proactive mental health screening during pregnancy and postpartum.

Objective: This study aimed to uncover difficulties, living conditions, and post-traumatic stress disorder (PTSD) symptoms among women victims of the Kahramanmaras earthquake sequence on February 6, 2023.

Methods: The data was collected from 388 participants using an online survey between November 1-30, 2023. We collected the data using a survey form with a 48-question sociodemographic information form and the 9-item Post-Traumatic Stress Disorder (PTSD)-Short Scale.We analyzed the data using independent samples t-test, Chi-square test, and binary logistic regression analysis.

Results: While 59.5% of participants reported post-earthquake headaches, 77.8% had difficulty sleeping. Apart from the primary impacts of the disaster, 53.6% of participants reported post-earthquake financial difficulties, and 53.4% had to be employed to generate income. Besides, 22.2% of participants experienced violence, and 38.1% had PTSD symptoms. Furthermore, having to work in a paid job increased their probability of developing PTSD symptoms by 3.4 times. Our analysis showed that singles, smokers, those with a disaster-damaged home and financial difficulties, those who had to work, those receiving psychological support, and those with anxiety had significantly higher PTSD scores (p < 0.05). Despite all such difficulties, 43.3% of them participated in aid activities.

Conclusion: It seems imperative to devise and implement efficient strategies to address women's physical and mental health challenges in the wake of the disaster. Moreover, it is of the utmost importance to integrate gender-sensitive approaches into disaster preparedness plans by fostering collaborations among all relevant bodies.

Purpose: Obsessive-compulsive disorder (OCD) has an elevated prevalence among pregnant and postpartum women, with negative impacts on both mother and child. There is a need for brief, efficient screening tools for OCD in perinatal care because OCD is underrecognized. We evaluated the psychometric properties of the 4-item Obsessive Compulsive Inventory (OCI-4), and investigated it as a screening measure, in a perinatal sample.

Methods: Pregnant women were assessed at 20- and 34-weeks' gestation, 6 weeks postpartum, and 6 months postpartum. Reliability was assessed via test-retest analyses, and validity was examined through correlations with established measures. Criterion-related validity and diagnostic sensitivity were also examined.

Results: The OCI-4 demonstrated good test-retest reliability, convergent and discriminant validity, and criterion-related validity. The measure also showed moderate to high diagnostic sensitivity. A score of 3 provided the best balance of sensitivity and specificity for screening.

Conclusion: The OCI-4 is an effective screener that should be used for identifying OCD symptoms in perinatal settings. Despite the need for further study, its ease of use and quick administration make it a valuable tool for early detection and referral for assessment intervention.

Purpose: Despite the well-established association between Eating Disorders (EDs) and menstrual disorders, menstrual distress in women with EDs has not been thoroughly investigated. This study aimed to compare menstrual distress between patients with EDs and healthy controls (HCs), explore correlations between menstrual distress and ED psychopathology, and examine the differential impact of hormonal contraception on perceived menstruation-related distress in patients compared to HCs.

Methods: A total of 132 patients with EDs and 105 HCs were recruited. Socio-demographic, anthropometric, and menstrual cycle data were collected. Self-administered questionnaires were used to evaluate premenstrual symptoms, ED psychopathology, and general psychopathology. The Menstrual Distress Questionnaire (MEDI-Q) was adopted for the assessment of menstrual distress.

Results: Patients with EDs had higher scores in all menstrual distress subscales of MEDI-Q and higher premenstrual symptoms as compared to HCs, without differences between different ED diagnoses. Approximately 65% of distress was specific of the menstrual phase in both groups. Patients experienced particular symptoms as more distressful: muscle and osteoarticular pain, breast tenderness and widespread swelling sensation, headache, constipation, feeling of being impure, impulsiveness, anxiety, insomnia, and fatigue. Greater menstrual distress correlated with higher ED psychopathology. Hormonal contraceptive use predicted reduced menstrual distress in individuals with low ED psychopathology, but not in those with high ED psychopathology.

Conclusion: These results highlighted the profound interplay between menstrual distress and psychopathology in women with EDs, with important clinical implications for both the therapeutic path of patients with EDs and the gynecological assessment of women experiencing menstrual distress.

Article highlights: • Patients with eating disorders had higher MEDI-Q menstrual distress than controls. • 65% of menstrual distress was specific to the menstrual phase. • Patients found swelling, constipation and anxiety particularly distressful. • Greater menstrual distress correlated with higher eating disorder psychopathology. • Hormones did not reduce distress in presence of high eating psychopathology.

Purpose: Menstrually related mood disorder (MRMD) is marked by severe affective symptoms in the late luteal phase of the menstrual cycle. We hypothesized that women with MRMD experience relative neuroactive steroid deficiency, specifically low allopregnanolone levels due to reduced conversion of progesterone, in association with the onset of affective symptoms in the late luteal phase.

Methods: Nine subjects with MRMD and 14 healthy controls were studied. Daily Record of Severity of Problems was used to diagnose MRMD by DSM-5 criteria for premenstrual dysphoric disorder. Depression and anxiety symptom severity (16-Item Quick Inventory of Depressive Symptomatology Self Report, Generalized Anxiety Disorder 7-Item Scale) and levels of plasma neuroactive steroids by mass spectrometry were assessed at the mid-follicular, mid-luteal, and late luteal phases.

Results: Depression severity was greater in women with MRMD than healthy controls in the late luteal phase only, as expected. In the mid-follicular phase, the mean allopregnanolone level and allopregnanolone/progesterone ratio were higher in women with MRMD than healthy controls. There were no differences between groups in luteal phase allopregnanolone levels. Higher follicular phase allopregnanolone sulfate and allopregnanolone levels were associated with greater depression severity in the mid-luteal and late luteal phases and greater anxiety severity in the late luteal phase.

Conclusion: Levels of allopregnanolone, which have antidepressant effects, were higher in the mid-follicular phase in women with MRMD compared to healthy controls. In MRMD, increased conversion of progesterone to allopregnanolone in the mid-follicular phase may be a compensatory response to luteal phase depression and anxiety, or increased allopregnanolone levels could paradoxically trigger depression and anxiety.

Purpose: The self-reported health status (SRHS) is a subjective evaluation of an individual's health and has been connected to mortality and future health outcomes in numerous studies. However, the determinants of SRHS among women in Nepal remain largely unclear. In Nepal, traditional gender norms often result in women bearing greater responsibilities in terms of household chores, child-rearing, and taking care of elderly family members, all of which may potentially contribute to lower self-perceived health. Therefore, this study aims to identify the factors influencing SRHS among women in Nepal.

Methods: The study utilized data from 7,442 women aged between 15 and 49 who participated in the Nepal Demographic and Health Survey (NDHS) 2022. Both univariate and multiple linear regression analyses were employed to ascertain the factors influencing self-rated health status (SRHS) among women in Nepal.

Result: Women in the age groups 15-24 years (AOR: 5.14, 95% CI: 3.07-8.62) and 25-34 years (AOR: 2.71, 95% CI: 1.99-3.68) were more likely to report good health status compared to older age groups. Additionally, women who were never married (AOR: 4.89, 95% CI: 3.62-5.32) or currently married (AOR: 1.46, 95% CI: 1.11-2.20) and those from wealthy families (AOR: 1.54, 95% CI: 1.07-2.21), also had a higher likelihood of reporting good health status. Other factors associated with a higher probability of reporting good health included not having a history of terminated pregnancy (AOR: 1.48, 95% CI: 1.11-1.97), having no history of genital discharge (AOR: 1.75, 95% CI: 1.29-2.38), not visiting a health facility in the last 12 months (AOR: 2.03, 95% CI: 1.43-2.88), and having no genital ulcers in the previous 12 months (AOR: 2.02, 95% CI: 1.24-3.28). Conversely, women with mild to severe depression and anxiety were less likely to report good health status compared to those with no depression or anxiety.

Conclusion: This study identified several social determinants of SRHS among Nepalese women. These socioeconomic determinants of health should be included in future research and health policy activities in Nepal and other comparable contexts.

Purpose: To explore the experiences of refugee mothers and community health nurses participating in a nurse home visiting program in Denmark, focusing on the program's effects on the psychosocial well-being of refugee mothers during the transition to motherhood.

Methods: The nurse home visiting program was an add-on the public care offered to all families, with extra training of the community health nurses and more time to engage with the families with immigrant and refugee backgrounds. Community health nurses (12) and participating women (9) participated in qualitative interviews between September and December 2020, following the program's conclusion.

Results: Utilizing the Resource-Based Model of refugee adaptation as a theoretical framework, we identified four main themes: (i) negotiating parenting norms and gaining confidence through parenting resources; (ii) finding emotional support to cope with integration pressures; (iii) expanding social resources, (iv) building bridges with welfare state services. These themes captured the resources gained by mothers through the home visiting program, positively influencing their psychosocial well-being, while also acknowledging the impact of the socio-political context on community health nurses' work and mothers' daily lives.

Conclusion: Findings offer insights about the potential and limitations of tailored nurse home visiting programs for refugee families, emphasizing the positive impact on mental health. However, challenges such as assimilation pressures, unwelcoming immigration policies, and discrimination may hinder program effectiveness.

Purpose: We aimed to determine the incidence of mental health diagnoses and associated health and social risk factors among perinatal people in three different COVID-19 phases.

Methods: We conducted a population-based, retrospective cohort study using linked administrative datasets. We included persons with live, in-hospital births in Ontario, Canada from January 1 to March 31 in 2019, 2021, or 2022 (three phases relative to COVID-19 with different public health policy measures). We excluded people with prior mental health diagnoses. We used diagnostic codes to identify new onset of depression, anxiety, or adjustment disorder in the antenatal and postpartum period. We developed multivariable, modified Poisson models to examine associations between sociodemographic and clinical factors and new mental health diagnoses in each phase.

Results: There were 72,242 people in our cohort. Antenatal mental health diagnoses were significantly higher in 2021 (aRR = 1.32; CI = 1.20-1.46) and 2022 (aRR = 1.22; CI = 1.11-1.35) versus 2019. Postpartum diagnoses were significantly greater in 2021 (aRR = 1.16; CI = 1.08-1.25) versus 2019. Antenatal diagnoses were associated with birth year, previous stillbirth, pre-existing hypertension, multiparity, residential instability, and ethnocultural diversity. Postpartum diagnoses were associated with birth year, maternal age, multiparity, care provider profession, assisted reproductive technology, birthing mode, pre-existing hypertension, intensive care admission, hospital readmission, residential instability, and ethnocultural diversity. Family physicians increasingly made mental health diagnoses in 2021 and 2022.

Conclusion: Increased incidence of perinatal mental health diagnoses during COVID-19 suggests complex dynamics involving pandemic and health and social risk factors.

Registration: This study was registered with Clinicaltrials.gov (NCT05663762) on December 21, 2022.

Purpose: Quality sleep is vital for good health. Although it is known that workhours affect sleep quality, it is not known at what point workhours begin to compromise sleep. Few studies consider workhours in the 'other job' (domestic and care work) or address reverse causality between sleep quality and how long people work. This study aimed to estimate the point at which weekly workhours harm sleep, among employed Australians aged 25-64.

Methods: Using Australian data (19,453 observations from 9,826 adults assessed 2013, 2017, and 2021), a maximum likelihood instrumental variable approach modelled the influence of domestic and care hours on workhours and then the effect of workhours on sleep. We tested for a non-linear pattern and a potential tipping point or limit at which sleep quality declines. Sleep quality scores were constructed from sleep duration (hours), quality rating, medications, and problems with onset.

Results: We estimated a population tipping point of 42 workhours per week, beyond which sleep quality deteriorated. Notably, women demonstrated a lower tipping point (36 h) beyond which their sleep quality deteriorated compared to men (47 h), likely linked to their greater care and domestic workhours in the home.

Conclusions: Our methods allowed us to specify the point at which weekly workhours were optimal for sleep quality and the point beyond which they become harmful. By considering unequal hours worked in care and domestic work, we were able to identify distinct gender differences in this relationship.