Archives of Women's Mental Health最新文献

Purpose

To assess postpartum changes in dyspareunia, and to explore the prediction of postpartum dyspareunia by obstetrical outcomes and peripartum emotional reactions.

Methods

In this longitudinal observational study, postpartum women were recruited at the maternity ward of a single medical center (T1) two days postpartum, during April 2018-August 2020. Participants filled questionnaires addressing demographic and reproductive background, pre-partum dyspareunia, pain during labor, peripartum dissociation, sense of control and birth-induced acute stress disorder (ASD). Three months postpartum (T2), participants who reported resuming sexual activity filled questionnaires addressing dyspareunia, breastfeeding and depression. Obstetrical information was obtained from clinical records.

Results

At T1, we recruited 440 participants, among whom 240 (54%) reported resuming sexual activity at T2 and filled the dyspareunia questionnaire at both times. At T2, 52 (21.7%) women reported dyspareunia. Thirty-four (14.2%) women experienced new-onset dyspareunia, 18 (7.5%) had persistent dyspareunia, and 23 (9.6%) reported dyspareunia resolution. ASD symptoms at T1 predicted dyspareunia severity at T2 (B = 0.59, SE = 0.28, p = 0.004). Women with persistent dyspareunia reported greater dyspareunia severity, more dissociation, birth-induced ASD, lower sense of control during labor. At T2, nineteen (59.4%) women with new-onset dyspareunia reported breastfeeding vs. four (22.2%) women with persistent dyspareunia (p = 0.02).

Conclusion

We observed an association between negative peripartum experiences and postpartum dyspareunia. This finding highlights the importance of incorporating sexual history into prenatal care. Improving obstetric practices enhancing women’s control during childbirth and early detection of ASD symptoms, could lead to interventions reducing postpartum dyspareunia.

Objectives

This study aimed to examine the relationship between perceived social support and anxiety among mothers of infants. Further, it explored the mediating and moderating role of self-compassion in the relationship between perceived social support and anxiety among mothers of infants.

Methods

Using a convenience sampling approach recruited 272 mothers of infants. They completed a set of surveys evaluating demographic characteristics, perceived social support, self-compassion and anxiety.

Results

Correlation analysis revealed that both perceived social support and self-compassion were negatively correlated with anxiety, while perceived social support was positively correlated with self-compassion. Path analysis results showed a negative association between perceived social support and anxiety. Additionally, self-compassion played a mediating role between perceived social support and anxiety, while also playing a potential moderating effect within this pathway.

Conclusions

Perceived social support could negatively effect on anxiety in mothers of infants through the mediating role of self-compassion. Compared to mothers with low self-compassion, mothers with high self-compassion showed a reduced negative effect of perceived social support on anxiety. This study revealed the relationship between perceived social support and anxiety, along with the mediating and potential moderating mechanisms of self-compassion, which provided theoretical and practical insights for alleviating anxiety in mothers of infants.

Purpose

Mother-infant bonding is crucial for the child’s development and the parent’s well-being, but research in this area in low- and middle-income countries is rare. We sought to evaluate the psychometric properties of the Urdu version of the Postpartum Bonding Questionnaire (PBQ) among women with prenatal anxiety symptoms in Pakistan.

Methods

This validation study used cross-sectional data within the context of a large randomized clinical trial, called Happy Mother, Healthy Baby (HMHB), conducted from April 2019 to October 2022 among women with at least mild prenatal anxiety symptoms receiving antenatal care from a large tertiary care hospital in Rawalpindi, Pakistan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and analysis of convergent validity were performed.

Results

The analysis included 720 mothers with a mean age of 25.23 years (SD = 4.61). The EFA suggested that 19 items (the five-factor model) out of 25 original items (the four-factor model) provided a good fit for the data, explaining a total variance of 64.7%. The CFA demonstrated poor fit for the four-factor model, but acceptable fit for the five-factor model of the PBQ (i.e., Love and affection [eight-item], Rejection [four-item], Withdrawal [two-items], Anger [three-items], and Irritation [two-items]) (CFI = 0.94, TLI = 0.93, RMSEA = 0.07, SRMR = 0.04), with good reliability (ordinal alpha = 0.71–0.93). A moderate positive correlation between impaired bonding and depressive symptoms supported convergent validity; and a negative correlation between impaired bonding and maternal-infant responsiveness supported convergent validity. Potential limitations are that test-retest validity and cutoff specification were not carried out.

Conclusions

Findings indicate that the 19-item Urdu version of the PBQ is valid and reliable to assess postpartum bonding among Pakistani women with prenatal anxiety symptoms.

Background

Postpartum depression (PPD) affects a significant proportion of birthing people worldwide, with rising rates in the United States. Food insecurity, a recognized social determinant of health, has been independently associated with adverse maternal and child outcomes. Although individual studies have examined links between food insecurity and PPD, the evidence base is fragmented, with variation in populations studied, measurement tools, and conceptual approaches.

Objective

This scoping review examined the relationship between food insecurity and postpartum depression (PPD), synthesizing available evidence to inform research, clinical practice, and policy.

Methods

Guided by the Arksey and O’Malley framework and the PRISMA-ScR checklist, a systematic search of PubMed, CINAHL, PsychINFO, Scopus, and GreenFILE were searched for peer-reviewed, English-language primary studies.

Results

Twenty studies met inclusion criteria (18 quantitative, 2 qualitative), with six conducted in the United States and 14 in other countries. Nineteen of 20 studies demonstrated an association between food insecurity and PPD. However, diversity in measurement tools and study designs limited comparability. Most studies used symptom-based screening rather than diagnostic criteria, and few applied the validated tools currently recommended by ACOG and USPSTF. While findings consistently indicate food insecurity as a significant correlate of PPD, the directionality of the relationship remains unclear, and existing measures often overlook physical access to food.

Conclusion

The evidence indicates a robust association between food insecurity and PPD across diverse populations, though methodological limitations constrain interpretation. Future research should prioritize standardized PPD measures, explore causal and bidirectional pathways, and integrate physical access to food into food insecurity assessment. Clinically, integrating food insecurity screening with PPD screening could strengthen early detection. Policy strategies that reduce economic and geographic barriers to food access may play a critical role in mitigating PPD risk.

Purpose

Intimate partner violence is a pervasive issue deeply affecting public health, and its escalation during the COVID-19 pandemic has raised serious concerns. While the escalating impact of intimate partner violence during the COVID-19 pandemic has been widely acknowledged, there remains a need for a comprehensive systematic review that synthesizes existing literature. This review seeks to address this gap by providing an inclusive assessment of the global landscape of intimate partner violence during and after the pandemic, thereby informing more effective prevention and intervention strategies.

Methods

A systematic literature search was conducted on PubMed, Google Scholar, and Scopus databases using different MeSH terms. A total of 445 relevant articles were identified initially, and after thorough screening, 54 articles were included in the review.

Results

The lockdown had several negative consequences, including job losses, economic vulnerability, and health issues due to prolonged loneliness and uncertainty. An increase in emergency hotline or Women’s Helpline calls was observed. Globally, intimate partner violence surged during the lockdown and persisted into 2023, causing severe and lasting health, psychological, and reproductive consequences for victims. Our results showed that COVID-19 increased the risk of partner violence: post-COVID intimate partner violence risk greater than pre-COVID risk (0.33 vs. 0.28, respectively).

Conclusion

Although COVID-19 increased the risk of intimate partner violence, this review also stresses a high global prevalence of intimate partner violence, not restricted to the pandemic and lockdowns. To prevent partner violence and reduce long-lasting severe health, psychological, and reproductive consequences of partner violence, broad cooperation between governments, communities, health professionals, and the media is necessary.

Purpose

Obsessive-compulsive disorder (OCD) can emerge during pregnancy and the postpartum and may adversely affect mother and newborn. However, little is known about potential risk factors for the onset of OCD in the perinatal period. Therefore, we investigated the onset of diagnosed DSM-5 OCD in women followed from the second trimester of pregnancy to 6-months postpartum.

Methods

We followed 256 women from the 20-24th week of pregnancy to 6-month postpartum. Participants had psychiatric diagnostic interviews at baseline and 6-month postpartum and completed self-report instruments. We compared women with and without incident OCD on sociodemographic characteristics and clinical features.

Results

Of the 143 participants without past or current OCD at baseline, 12 (8.4%) were diagnosed with DSM-5 OCD at 6-month postpartum. The incident cases had a broad range of types of obsessions and compulsions. Compared to those who did not develop OCD, the incident cases were significantly less likely to be married, to have a college degree, or have an annual household income above $50,000, and they were more likely to be receiving public assistance and to have an unplanned pregnancy. The incident cases also had significantly higher mean scores on measures of obsessional beliefs, anxiety, and perceived stress.

Conclusions

A considerable proportion of pregnant women have onset of OCD during pregnancy and the postpartum, with multiple types of obsessions and compulsions. Socioeconomic circumstances, and cognitive and psychological vulnerabilities, may increase the risk of developing OCD in the peripartum.

Article highlights

• 256 women were followed from the 20-24th week of pregnancy to 6-month postpartum.

• 12 (8%) of the women had onset of OCD during the follow-up period.

• The women with OCD-onset reported fewer socioeconomic resources.

• The women with OCD-onset had more psychological vulnerabilities.

Purpose

Valproate is an efficacious treatment for several neurologic and psychiatric disorders, but it carries a grave risk of teratogenicity. Despite warnings from regulatory bodies, prescribing guidelines from professional associations, and expert opinion against the practice, the medication continues to be commonly prescribed to persons with childbearing potential for psychiatric indications.

Methods

A quality improvement focused educational intervention on the conduct and documentation of informed consent and contraceptive counseling when prescribing the teratogen valproate to individuals aged 12–55 who may become pregnant was implemented in the Psychiatry Department of an urban community hospital. Documentation from 3 months before and after the intervention was qualitatively assessed for notation of informed consent, including the patient’s expressed understanding of risks as well as specific counseling on teratogenicity and the need for contraception, in acute care and outpatient charts that had a prescription from a psychiatric provider for valproate in that time frame.

Results

While statistically significant improvement was found in the documentation of general informed consent and patients’ responses to counseling in outpatient charts, there was no improvement in acute care charts and no significant increase in valproate-specific counseling in charts from either care setting.

Conclusion

The minimal impact of an educational initiative on documentation of informed consent in the present study suggests that education alone may not be sufficient to address the crucial safety concern of valproate prescribing practices in psychiatric patients who may become pregnant.

Purpose

There is a need to balance maternal mental health treatment with fetal safety when prescribing antipsychotic medications during pregnancy. Physiological changes during pregnancy markedly influence drug pharmacokinetics, making it difficult to achieve therapeutic efficacy without compromising on the risks.

Methods

A systematic review was performed to identify trimester-specific physiological changes impacting antipsychotic pharmacokinetics. A retrieval of relevant studies published between inception to October 3, 2023 was conducted through PubMed, Web of Science, Cochrane Library, and Embase. Key pharmacokinetic parameters examined include bioavailability, volume of distribution, clearance, half-life, and area under the curve.

Results

Pregnancy-related physiological changes, such as increased plasma volume, enhanced hepatic blood flow, and altered protein binding, can significantly affect the pharmacokinetics of antipsychotics. For instance, plasma concentrations of Haloperidol, a first generation antipsychotic (FGA), have been reported to decrease by up to 52% in the third trimester. Similarly, Quetiapine and Aripiprazole, both second generation antipsychotics (SGAs), show substantial reductions in plasma levels during the same period, by 76.2% and 76.8%, respectively. These findings suggest a potential need for dose adjustments to maintain therapeutic drug exposure as pregnancy progresses. Physiologically based pharmacokinetic (PBPK) models further support this adjustment to ensure continued clinical efficacy.

Conclusions

Significant changes in pharmacokinetics are observed for antipsychotic drugs during pregnancy, underlining the importance of developing a personalized dosing strategy and therapeutic drug monitoring to maximize therapeutic efficacy and at the same time keep the treatment safe for mother and fetus.

Purpose

This study aimed to examine the effects of reproductive coercion and violence on women with unplanned pregnancies in Türkiye.

Methods

This descriptive and cross-sectional study was conducted between 2021 and 2022 with women who applied to the obstetrics and gynecology outpatient clinic. Data were collected using the “Descriptive Information Form,” the “Women Abuse Screening Tool (WAST),” and the “Reproductive Coercion Scale (RCS).

Results

A total of 380 women were included in the study. It was found that 18.7% of women had experienced reproductive coercion, and 17.1% had been exposed to violence. A significant difference was observed between scores on the Reproductive Coercion Scale and the Violence Scale (X² = 25.173, p < 0.001). Spouse’s alcohol consumption, reproductive coercion, residence, marital status, type of marriage, and pregnancy status together explained 27.8% of the variance in participants’ levels of violence.

Conclusion

The study demonstrated that women in Türkiye experienced reproductive coercion during their reproductive years and that there was an association between violence against women and reproductive coercion. Notably, reproductive coercion and violence appeared to be significantly influenced by regional and cultural factors, reflecting variations observed across different countries and societies.