Postpartum Depression Risk following Prenatal Diagnosis of Major Fetal Structural Anomalies

2021 ◽  
Author(s):  
Christina L. Herrera ◽  
John J. Byrne ◽  
David B. Nelson ◽  
Rachel C. Schell ◽  
Jodi S. Dashe
Keyword(s):  
Mental Health ◽  
Prenatal Diagnosis ◽  
Postpartum Depression ◽  
Depressive Disorder ◽  
Structural Anomaly ◽  
Depression Risk ◽  
Organ Systems ◽  
Increased Risk ◽  
Structural Anomalies

Objectives Our primary objective was to evaluate how prenatal diagnosis of a major fetal structural anomaly and resulting pregnancy outcome affected postpartum depression risk, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Secondary objectives were to review the rate of mental health follow-up and subsequent diagnosis of postpartum depression in screen-positive women. Study Design Singleton pregnancies with prenatal diagnosis of one or more major fetal structural anomalies were ascertained from prospectively maintained databases that included perinatal outcomes and subsequent EPDS responses from January 2010 to May 2018. EPDS scores of 13 or higher were considered positive and prompted referral for mental health follow-up, which was verified by medical record review. Statistical analyses were performed using Student's t-test, χ2, and odds ratios (ORs) with p < 0.05 considered significant. Results A total of 1,306 women had a prenatal diagnosis of one or more major fetal structural anomalies, 896 (68%) also had a postpartum EPDS screening, and 82 (9.2%) screened positive. Positive EPDS screening was more common with anomalies of multiple organ systems (16.5 vs 7.8%, p = 0.002) and aneuploidy (17.1 vs 9.3%, p = 0.02). Pregnancies complicated by fetal death, neonatal death, and termination for anomaly were significantly more likely to screen positive than those with neonatal survival to discharge (OR, 3.1 [95% confidence interval [CI], 1.6–6.2], 3.0 [95% CI, 1.5–5.8], and 4.4 [95% CI, 2.1–8.9], respectively, p ≤ 0.002). Of the 35 (43%) screen-positive women who attended follow-up appointments with mental health providers, 18 (51%) were diagnosed with a depressive disorder, accounting overall for 22% of those with a positive EPDS screen. Conclusion Among women with a prenatal diagnosis of a major fetal structural anomaly, those experiencing a perinatal loss or pregnancy termination have an increased risk of positive EPDS screen result compared with who have a neonate surviving to discharge. A depressive disorder was diagnosed postpartum in 22% of these women with a positive EPDS screen. Our findings highlight the mental health needs in this vulnerable population. Key Points

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

Early life family disadvantages and major depression in adulthood

1999 ◽  
Vol 174 (2) ◽  
pp. 112-120 ◽  
Author(s):  
Hartwin S. Sadowski ◽  
Blanca Ugarte ◽  
Israel Kolvin ◽  
Carole E. Kaplan ◽  
Jacqueline Barnes
Keyword(s):  
Mental Health ◽  
Major Depressive Disorder ◽  
Major Depression ◽  
Depressive Disorder ◽  
Early Life ◽  
Major Depressive ◽  
Adult Depression ◽  
Increased Risk ◽  
Quality Of Parenting

BackgroundThere is evidence that exposure to social and family disadvantages in childhood are a risk factor for adult depression.AimsTo explore the effects of multiple adversity in early childhood on adult depression, and the relative effects of the different adversities.MethodThis study utilises data from the Newcastle Thousand Family Study. Information on childhood disadvantages was collected when the participants were 5 years old, and information on mental health was gathered when they were 33 years old. Mental health data were scrutinised blind to the evidence of early disadvantage, and best-estimate diagnoses of major depressive disorder were made according to DSM–III–R criteria.ResultsMultiple family disadvantages in childhood substantially increase the risk of suffering a major depressive disorder in adulthood. Such disadvantages include family or marital relationship instability, a combination of poor mothering and poor physical care, and a combination of dependence on social welfare and overcrowding. For females major depression was linked in particular to the quality of parenting in early life.ConclusionsSocial and family (especially multiple family) disadvantages during childhood predispose individuals to an increased risk of major depression in adulthood.

scholarly journals Psychiatric Comorbidities among People Who Inject Drugs in Hai Phong, Vietnam: The Need for Screening and Innovative Interventions

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Khue Pham Minh ◽  
Roselyne Vallo ◽  
Huong Duong Thi ◽  
Oanh Khuat Thi Hai ◽  
Don C. Des Jarlais ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
People Who Inject Drugs ◽  
Community Based Interventions ◽  
Major Depressive ◽  
Psychiatric Comorbidities ◽  
Methamphetamine Use ◽  
Increased Risk

The objective of this study is to describe psychiatric comorbidities, associated factors, and access to psychiatric assessment and care in a cohort of people who inject drugs (PWID) in Hai Phong, Vietnam. Mental health was assessed after 12 months’ follow-up using the Mini International Neuropsychiatric Interview questionnaire (MINI 5.0.0). PWID medical history, drug use, and sociodemographic and clinical characteristics were also collected. Among 188 PWID who participated in the assessment, 48 (25.5%) had at least one psychiatric disorder and 19 (10.1%) had 2 or more psychiatric disorders. The most common current psychiatric disorders were major depressive episode (12.2%) and psychotic disorder (4.8%), reaching 10.1% for the latter when lifetime prevalence was considered. Females were more likely than males to have at least one psychiatric disorder, a major depressive disorder, or an anxiety disorder. Methamphetamine use was associated with an increased risk of presenting a lifetime psychotic syndrome. Problematic alcohol consumption was associated with an increased risk of having at least one psychiatric disorder. Psychiatric comorbidities are frequent among PWID in Vietnam. These results highlight the need for routine assessment and innovative interventions to address mental health needs among PWID. Community-based interventions targeting mental health prevention and care should be strongly supported.

scholarly journals Cannabis and suicide: longitudinal study

2009 ◽  
Vol 195 (6) ◽  
pp. 492-497 ◽  
Author(s):  
Ceri Price ◽  
Tomas Hemmingsson ◽  
Glyn Lewis ◽  
Stanley Zammit ◽  
Peter Allebeck
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Suicidal Ideation ◽  
Military Service ◽  
Mental Health Problems ◽  
Strong Association ◽  
Cannabis Use ◽  
Completed Suicide ◽  
Increased Risk

BackgroundSome studies suggest that cannabis use is associated with suicidal ideation, but no detailed longitudinal study has examined suicide as an outcome.AimsTo examine the association between cannabis use and completed suicide.MethodA longitudinal study investigated 50 087 men conscripted for Swedish military service, with cannabis use measured non-anonymously at conscription. Suicides during 33 years of follow-up were identified by linkage with the National Cause of Death Register.ResultsThere were 600 (1.2% of cohort) suicides or deaths from undetermined causes. Cannabis use was associated with an increased risk of suicide (crude OR for ‘ever use’ 1.62, 95% CI 1.28–2.07), but this association was eliminated after adjustment for confounding (adjusted OR = 0.88, 95% CI 0.65–1.20).ConclusionsAlthough there was a strong association between cannabis use and suicide, this was explained by markers of psychological and behavioural problems. These results suggest that cannabis use is unlikely to have a strong effect on risk of completed suicide, either directly or as a consequence of mental health problems secondary to its use.

Demonstration of automated non-adherence and service disengagement risk monitoring with active follow-up for severe mental illness

2021 ◽  
pp. 000486742199880
Author(s):  
Niranjan Bidargaddi ◽  
Geoffrey Schrader ◽  
Hannah Myles ◽  
K Oliver Schubert ◽  
Yasmin van Kasteren ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Health Service ◽  
Health Service ◽  
Mental Illnesses ◽  
Health Clinic ◽  
Risk Monitoring ◽  
Medicare Data ◽  
Increased Risk

Aims: Medication cessation and service disengagement often precedes relapse in people with severe mental illnesses but currently specialist mental health services only become involved after a relapse. Early detection of non-adherence is needed to enable intervention to avert relapse. This paper aims to demonstrate how digitally automated non-adherence risk monitoring from Medicare data with active follow-up can work and perform in practice in a real-world mental health service setting. Methods: AI2 software is an automated risk monitoring tool to detect non-adherence using Medicare data. It was implemented prospectively in a cohort of 354 registered patients of a community mental health clinic between July 2019 and February 2020. Patients flagged as at risk by the software were reviewed by two clinicians. We describe the risks automatically flagged for non-adherence and the clinical responses. We examine differences in clinical and demographic factors in patients flagged at increased risk of non-adherence. Results: In total, 46.7% (142/304) were flagged by the software as at risk of non-adherence, and 22% (31/142) received an intervention following clinician review of their case notes. Patients flagged by the software were older in age and had more prior mental health treatment episodes. More alerts were associated with patients who had been transferred from the mental health service to the care of their general practitioners, and those with more alerts were more likely to receive a follow-up intervention. Conclusion: Digitally automated monitoring for non-adherence risk is feasible and can be integrated into clinical workflows in community psychiatric and primary care settings. The technology may assist clinicians and services to detect non-adherence behaviour early, thereby triggering interventions that have the potential to reduce rates of mental health deterioration and acute illness relapse.

scholarly journals Risk of Mental and Sleep Disorders After the Diagnosis of Adrenal Adenomas: A Population-Based Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A94-A95
Author(s):  
Sumitabh Singh ◽  
Catherine Zhang ◽  
Elizabeth Atkinson ◽  
Sara Achenbach ◽  
Andreas Ebbehoj ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Sleep Disorders ◽  
Adrenal Adenoma ◽  
Cortisol Secretion ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Increased Risk ◽  
Substance Abuse Disorders

Abstract Background: Adrenal adenomas are incidentally diagnosed in 7% of adults undergoing abdominal imaging. Mild autonomous cortisol secretion is present in 50% of adrenal adenomas, and even “nonfunctioning” adrenal adenomas demonstrate abnormal steroid profile. We aimed to 1) investigate the prevalence of mental and sleep disorders in patients with adrenal adenomas and to 2) determine the risk of mental and sleep disorders after the diagnosis of adrenal adenoma in patients compared to the referent subjects from the same population Methods: Using a medical records linkage system, we identified adult patients living in the Olmsted County, MN diagnosed with an adrenal adenoma during 1995–2017. Patients with overt hormone excess were excluded. Every patient with adenoma was matched by sex and age to a referent subject from the same population. Subjects were followed until death or end of the study. Mental health related comorbidities and sleep disorders were assessed at baseline and during follow up. Results: Our cohort included 1004 patients with adrenal adenomas and 1004 referent subjects (58% women, median age of 63 years). Patients were more likely to smoke (70% vs 54%, p &lt;0.001) and had a higher BMI (30 kg/m2 vs 28 kg/m2, p &lt; 0.001). Within 5 years prior to the index date (diagnosis of adenoma), and after adjusting for BMI and smoking, patients demonstrated a higher prevalence of depression (Odds ratio, OR of 1.3 (CI95% 1.1–1.6), p=0.02), anxiety (OR of 1.4 (CI95% 1.1–1.8, p=0.003), substance abuse disorders (OR of 2.4 (CI 95% 1.7–3.4), p&lt;0.001), but not insomnia (OR of 1.2 (CI95% 0.9–1.7) and sleep related breathing disorders (OR of 1.3 (CI 95% 0.9–1.7). During follow-up, starting 1 year after the diagnosis, patients demonstrated a higher risk of new onset depression (HR of 1.9, CI95%1.5–2.4), anxiety (HR of 1.5,CI95% 1.2–1.9), schizophrenia (HR of 1.7, CI95% 1.2–2.4), and substance abuse disorders (HR of 1.6, CI95% 1.2–2.0). Risk of sleep disorders 1 year after diagnosis was also high for insomnia (HR of 1.4, CI95% 1.1–1.9), sleep-related breathing disorders (HR of 1.8, CI95% 1.4–2.3), hypersomnias of central origin (HR of 2.0, CI95%1.04–3.96), parasomnias (HR of 2.4, CI95%1.2–4.7), and sleep-related movement disorders(HR of 1.9, CI95%1.3–2.6). Conclusion: Patients with adenomas are at increased risk for mental and sleep disorders, possibly explained by the underlying subtle cortisol secretion. Further prospective studies with an in-depth characterization of both hormonal secretion and mental/sleep disorders are needed. Reversibility or improvement of mental health and sleep disorders with adrenalectomy should be investigated.

scholarly journals The impact of migration on women’s mental health in the postpartum period

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Lígia Moreira Almeida ◽  
Cristina Costa-Santos ◽  
José Peixoto Caldas ◽  
Sónia Dias ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Postpartum Depression ◽  
Perceived Stress ◽  
Psychological Health ◽  
Postpartum Period ◽  
Depression Scale ◽  
Public Hospitals ◽  
Increased Risk ◽  
The Impact

ABSTRACT OBJECTIVE To assess the influence of I mmigration on the psychological health of women after childbirth. METHODS In this cross-sectional study, immigrant and Portuguese-native women delivering in the four public hospitals of the metropolitan area of Porto, Portugal, were contacted by telephone between February and December 2012 during the first postpartum month to schedule a home visit and fill in a questionnaire. Most immigrant (76.1%) and Portuguese mothers (80.0%) agreed to participate and with the visits, thus a total of 89 immigrants and 188 Portuguese women were included in the study. The questionnaire included the application of four validated scales: Mental Health Inventory-5, Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Scale of Satisfaction with Social Support. Statistical analysis included t-test and Chi-square or Fisher’s test, and logistic regression models. RESULTS Immigrants had an increased risk of postpartum depression (OR = 6.444, 95%CI 1.858–22.344), and of low satisfaction with social support (OR = 6.118, 95%CI 1.991–18.798). We did not perceive any associations between migrant state, perceived stress, and impoverished mental health. CONCLUSIONS Immigrant mothers have increased vulnerabilities in the postpartum period, resulting in an increased risk of postpartum depression and lesser satisfaction with the received social support.

Postpartum Depression Risk Following Prenatal Diagnosis of Major Fetal Anomalies [29E]

2020 ◽  
Vol 135 ◽  
pp. 57S
Author(s):  
Christina L. Herrera ◽  
John J. Byrne ◽  
Rachel C. Schell ◽  
David B. Nelson ◽  
Jodi S. Dashe
Keyword(s):  
Prenatal Diagnosis ◽  
Postpartum Depression ◽  
Fetal Anomalies ◽  
Depression Risk

scholarly journals Are volunteering and caregiving associated with suicide risk? A Census-based longitudinal study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Michael Rosato ◽  
Foteini Tseliou ◽  
David M. Wright ◽  
Aideen Maguire ◽  
Dermot O’Reilly
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Record Linkage ◽  
Suicide Risk ◽  
Linkage Study ◽  
Poor Mental Health ◽  
Cox Models ◽  
Good Mental Health ◽  
Increased Risk

Abstract Background Opposing risks have been identified between different prosocial activities, with volunteering having been linked to better mental health while caregiving has been associated with higher prevalence and incidence of depression. This study explored suicide risk of people engaged in prosocial activities of caregiving and/or volunteering. Methods A Census-based record linkage study of 1,018,000 people aged 25–74 years (130,816 caregivers; 110,467 volunteers; and 42,099 engaged in both) was undertaken. Caregiving (light: 1–19; intense: ≥20 h/week), volunteering and mental health status were derived from 2011 Census records. Suicide risk (45 months follow-up) was assessed using Cox models adjusted for baseline mental health. Results Intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18) and volunteering with better mental health (OR = 0.87: 95%CI = 0.84, 0.89). For those engaged in both activities, likelihood of poor mental health was determined by caregiving level. There were 528 suicides during follow-up, with those engaged in both activities having the lowest risk of suicide (HR = 0.34: 95%CI = 0.14, 0.84). Engaging in either volunteering or caregiving was associated with lower suicide risk for those with good mental health at baseline (HR = 0.66: 95%CI = 0.49, 0.88) but not for their peers with baseline poor mental health (HR = 1.02: 95%CI = 0.69, 1.51). Conclusions Although an increased risk of poor mental health was identified amongst caregivers, there was no evidence of an increased risk of suicide.

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