Specific Populations

Author(s):  
Anna R. Brandon ◽  
Geetha Shivakumar ◽  
Elizabeth H. Anderson ◽  
Anne Drapkin Lyerly

It is estimated that more than 500,000 women annually experience a mental illness during pregnancy. Although approximately a third of these women will be prescribed medication, the majority receives no treatment, partly because ethical challenges to including pregnant women in research protocols have impeded studies necessary to establish maternal and fetal effects of medication, appropriate dosing, and the relative risks of undertreated mental illness. Because mental illness is a frequent complication of pregnancy (particularly anxiety and depression), clinicians will be called upon to ethically navigate uncertain treatment recommendations with sensitivity to patient values. The following discussion reviews the history of current guidelines to research with pregnant women, common clinical presentations of women experiencing mental illness in the perinatal context, and relevant ethical frameworks to inform patient care.

2009 ◽  
Vol 15 (5) ◽  
pp. 590-597
Author(s):  
I. R. Gaisin ◽  
R. M. Valeeva ◽  
N. I. Maksimov

Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analyzed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were separately investigated in patients with different gestational hypertension (HT) depending on the diagnostic method: 13 with isolated clinic HT (1CHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement methods (clinic, ambulatory, and home BP). The number of RF (age, family history of CVD and pre-eclampsia, pre-pregnancy history of smoking, lack of physical exercise, and oral contraception, BP levels, abdominal obesity, dyslipidaemia, anxiety and depression, oxidative stress, altered fasting plasma glucose, metabolic syndrome), signs of subclinical organ damage (cell membrane destabilization, left ventricular hypertrophy, intima-media thickening, slight increase in serum creatinine, hyperuricaemia, endothelial dysfunction, albuminuria, low glomerular filtration rate), and total cardiovascular risk progressively increased from the condition of being normotensive at the time of office, home, and 24-hour measurements to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum «healthy pregnant women - ICHT - IAHT - gestational HT». Assessment of cardiorenal state in all pregnant women allowed to compose the cline «healthy pregnants- gestational HT- stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia» with the growing risk of CVD and CKD and potential danger of cardiovascular events and chronic renal failure.


2007 ◽  
Vol 38 (10) ◽  
pp. 1495-1503 ◽  
Author(s):  
R. T. Webb ◽  
A. R. Pickles ◽  
S. A. King-Hele ◽  
L. Appleby ◽  
P. B. Mortensen ◽  
...  

BackgroundFew large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses.MethodA population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973–1998 (n=1.45 m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression.ResultsRisk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45–3.77], which also represented a significant excess risk compared with all other admitted maternal disorders (p=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis.ConclusionsThere are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication toxicity, and gene–environment interactions. Further research is needed to elucidate the causal mechanisms.


2017 ◽  
Vol 45 ◽  
pp. 212-219 ◽  
Author(s):  
L. Salih Joelsson ◽  
T. Tydén ◽  
K. Wanggren ◽  
M.K. Georgakis ◽  
J. Stern ◽  
...  

AbstractBackground:Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.Methods:Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.Results:The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).Conclusions:Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.


2018 ◽  
Vol 30 (3) ◽  
pp. 10-19

Background and objectives: There is a high coexistence between mental disorders and chronic noncommunicable diseases (NCD). Patients with chronic illnesses have higher rates of depression and anxiety when compared to the healthy individuals. The study aimed to estimate the prevalence of depression and anxiety and to explore the associated risk factors. Methods: A cross sectional study conducted in the NCD clinics of five health centers in the Kingdom of Bahrain included all patients attending these clinics from January 2016 to March 2016. Hospital anxiety and depression scale (HADS) was used to screen patients for depression and anxiety. Logistic regression analyses were used to identify risk factors associated with anxiety and depression. All the analyses were conducted using STATA 12; P < 0.05 was considered statistically significant. Results: A total of 456 patients were included in the study. Mild and moderate to severe type of depression were observed in 71 (15.6%) and 53 (11.6%) patients, respectively. According to the multivariable model, the odds of having high depression score was significantly higher in patients aged < 45 years (adjusted odds ratio (OR) = 2.01; P = 0.01), with low income (adjusted OR = 1.99; P = 0.02), with personal history of mental illness (adjusted OR = 5.13; P = 0.001), and with lower educational levels (P = 0.02). Mild and moderate to severe anxiety scores were observed in 55 (12.1%) and 34 (7.5%) patients, respectively. According to the multivariate model, the odds of having high anxiety score was significantly higher in females (adjusted OR = 2.85; P < 0.001), patients aged < 45 years (adjusted OR = 2.41; P = 0.005), in patients with low income (adjusted OR = 3.62; P < 0.001), and in those with personal history of mental illness (adjusted OR = 4.5; P = 0.004). Conclusion: There is a high prevalence of depression and anxiety among patients attending NCD clinics in the Kingdom of Bahrain. Therefore, screening of mental health diseases should be established.


2018 ◽  
Vol 16 (2) ◽  
pp. 195-204
Author(s):  
Krishna Kumar Aryal ◽  
Astrid Alvik ◽  
Narbada Thapa ◽  
Suresh Mehata ◽  
Tara Roka ◽  
...  

Background: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk.Methods: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling. Results: Among pregnant women, the study found that 21.3% (95%CI:15.7–28.3) had anxiety and 23.8% (95%CI:17.8–31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7–22.1) had anxiety and 15.2% (95%CI:12.4–18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression.Conclusions: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing.


2018 ◽  
Vol 16 (2) ◽  
pp. 195-204
Author(s):  
Krishna Kumar Aryal ◽  
Astrid Alvik ◽  
Narbada Thapa ◽  
Suresh Mehata ◽  
Tara Roka ◽  
...  

Background: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk.Methods: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling. Results: Among pregnant women, the study found that 21.3%(95%CI:15.7–28.3) had anxiety and 23.8% (95%CI:17.8–31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7–22.1) had anxiety and 15.2% (95%CI:12.4–18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression.Conclusions: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing.Keywords: Anxiety; depression; mothers of children under one year; Nepal; pregnant women.


2018 ◽  
Author(s):  
Nimna Sachini Mallawa Archchi ◽  
Ranjan Ganegama ◽  
Abdul Wahib Fathima Husna ◽  
Delo Lashan Chandima ◽  
Nandana Hettigama ◽  
...  

AbstractBackgroundSuicide only present the tip of the iceberg of maternal mental health issues. Only a fraction of pregnant women with suicidal ideation proceeds to intentional self-harm (ISH) and even a smaller proportion are fatal. The purpose of the present study was to determine the prevalence of depression, suicidal ideation (present and past) and history of ISH among pregnant mothers in rural Sri Lanka.MethodsWe have conducted a hospital based cross sectional study in the third largest hospital in Sri Lanka and a another tertiary care center. Pregnant women admitted to hospital at term were included as study participants. The Edinburgh Postpartum Depression Scale (EPDS), a self-administered questionnaire for demographic and clinical data and a data extraction sheet to get pregnancy related data from the pregnancy record was used.ResultsThe study sample consisted of 475 pregnant women in their third trimester. For the tenth question of EPDS “the thought of harming myself has occurred to me during last seven days” was answered as “yes quite a lot” by four (0.8%), “yes sometimes” by eleven (2.3%) and hardly ever by 13 (2.7%). Two additional pregnant women reported that they had suicidal ideation during the early part of the current pregnancy period though they are not having it now. Four (0.8%) pregnant women reported having a history of ISH during the current pregnancy. History of ISH prior to this pregnancy was reported by eight women and five of them were reported to hospitals, while others were managed at home. Of the 475 pregnant females included in the study, 126 (26.5%) had an EPDS score more than nine, showing probable anxiety and depression. Pregnant women who had primary/post-primary or tertiary education compared to those who were in-between those two categories were at higher risk of high EPDS with a OR of 1.94 (95% CI 1.1-3.3). Reported suicidal ideation prior to pregnancy had a OR of 6.4 (95% CI 2.3-17.5).ConclusionsBased on our data, we conservatively estimate around 3000 ISH annually in Sri Lanka, which should be considered as a high priority for an urgent intervention.Plain English SummaryMental disturbances are common during pregnancy. Most of the time, these are normal. However, these disturbances may become serious and lead to self-harm and suicide. In this study, we estimated the proportion of pregnant women who had depression and idea of self-harming during pregnancy.Respondents were pregnant women admitted to two large hospitals for the childbirth. They answered a list o questions about the thought of self-harm and attempts of self-harm during the present as well as past pregnancies.Respondents included 475 pregnant women. Of them, 3.1% reported that “the thought of self-harming has occurred to them during last seven days quite a lot (0.8%) or sometimes” (2.3%). Four (0.8%) pregnant women reported that they actually did it to some extent. Of the 475 pregnant women included in the study, 126 (26.5%) had symptoms of anxiety/depression. Level of education seemed to have an association with anxiety and depression. When women reported that they had thought of self-harm prior to pregnancy, they were about 6.4 times more likely to have depression/anxiety during the pregnancy. Adding a simple screening question (as we used in this study) during the initial pregnancy assessment to detect history of suicidal thoughts will be helpful in identification of high-risk mothers for depression and suicide.


2018 ◽  
Vol 18 (1) ◽  
pp. 499-534
Author(s):  
Fernanda Jorge Guimaraes ◽  
Francyelle Juliany Da Silva Santos ◽  
Antônio Flaudiano Bern Leite ◽  
Viviane Rolim De Holanda ◽  
Girliani Silva De Sousa ◽  
...  

Introdução: a gestação é um período na vida da mulher que a expõe a diversas alterações físicas e psíquicas. É neste momento de sua vida que a mulher esta mais susceptível a desenvolver transtornos mentais, os quais podem estar relacionados a baixo nível de escolaridade e/ou socioeconômico, ser do sexo feminino, estar solteiro ou separado, não ter emprego, ser tabagista, etilista e ter história familiar de doença mental.Objetivo: analisar a ocorrência de adoecimento mental em gestantes e os fatores associados ao mesmo.Método: estudo transversal, com abordagem quantitativa. A população do estudo foi constituída por gestantes cadastradas em Unidades de Saúde da Família. Para a coleta dos dados foi utilizado questionário com dados de identificação das participantes e o questionário Self-Reporting Questionnaire (SRQ-20). Para análise dos dados, utilizou-se frequência absoluta e relativa, como também o teste de qui-quadrado sem correção, teste de qui-quadrado de tendência com extensão de Mantel-Haenzel e o teste de qui-quadrado com correção de yates para analisar a associação entre o adoecimento mental e as variáveis sócio-demográficas, gestacionais e de saúde. Estudo aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco (CAAE 64945317.1.0000.5208).Resultados: a proporção de sugestão de adoecimento mental em gestantes foi de 31,9% e esteve associada com estar solteira, ter estudado até o ensino fundamental, não ter planejado a gravidez e possuir doença crônica.Conclusões: portanto, o adoecimento mental identificado nas gestantes participantes do estudo pode estar associado a variáveis estado civil, escolaridade, planejamento da gravidez e possuir doença crônica. Introducción: La gestación es un período en la vida de la mujer que la expone a diversos cambios físicos y psíquicos. Es en este momento de su vida cuando la mujer es más susceptible a desarrollar trastornos mentales, los cuales pueden estar relacionados con bajo nivel de escolaridad y / o socioeconómico, ser del sexo femenino, estar soltero o separado, no tener empleo, ser fumadora, alcoholica y tener antecedentes familiares de enfermedad mental.Objetivo: Analizar la ocurrencia de trastornos mentales en gestantes y los factores asociados al mismo.Método: Estudio transversal, con abordaje cuantitativo. La población del estudio fue constituida por gestantes registradas en Unidades de Salud de la Familia. Para la recolección de los datos se utilizó el cuestionario con datos de identificación de las participantes y el cuestionario Self-Reporting Questionnaire (SRQ-20). Para el análisis de los datos, se utilizó una frecuencia absoluta y relativa, como también la prueba de chi-cuadrado sin corrección, prueba de chi-cuadrado de tendencia con extensión de Mantel-Haenzel y la prueba de chi-cuadrado con corrección de yates para analizar la asociación entre la enfermedad mental y las variables socio demográficas, gestacionales y de salud. Estudio aprobado por el Comité de Ética en Investigación de la Universidad Federal de Pernambuco (CAAE 64945317.1.0000.5208).Resultados: La proporción de sugerencia de enfermedad mental en gestantes fue de 31,9% y estuvo asociada con estar soltera, haber estudiado hasta la enseñanza básica, no haber planeado el embarazo y tener enfermedad crónica.Conclusiones: Por lo tanto, la enfermedad mental identificada en las gestantes participantes del estudio puede estar asociada a variables estado civil, escolaridad, planificación del embarazo y tener enfermedad crónica. Introduction: Gestation is a period in the life of the woman that exposes her to various physical and psychic changes. It is at this point in her life that a woman is more likely to develop mental disorders, which may be related to low level of schooling and/or socioeconomic status, being female, being single or separated, having no job, being a smoker, and have a family history of mental illness.Objective: to analyze the occurrence of mental illness in pregnant women and the associated factors.Method: cross-sectional study with quantitative approach. The study population consisted of pregnant women enrolled in Family Health Units. To collect the data, a questionnaire was used with identification data of the participants and the Self-Reporting Questionnaire (SRQ-20). Absolute and relative frequency were used to analyze the data, as well as the chi-square test without correction, chi-square test with Mantel-Haenzel extension and the chi-square test with yacht correction to analyze the association between mental illness and socio-demographic, gestational and health variables. Study approved by the Research Ethics Committee of the Federal University of Pernambuco (CAAE 64945317.1.0000.5208).Results: the proportion of suggestion of mental illness in pregnant women was 31.9% and was associated with being single, having studied until elementary school, not having planned pregnancy and having a chronic illness.Conclusions: therefore, the mental illness identified in pregnant women participating in the study may be associated with variables marital status, schooling, pregnancy planning, and chronic illness.


Author(s):  
Jia Qu ◽  
Xueling Weng ◽  
Ling-ling Gao

Abstract Background: Women with a history of recurrent miscarriage(RM) are a more vulnerable population, caring for the pregnant women with a history of RM is quite needed. Although evidence suggests an association among anxiety, depression and social support. Yet, it is unclear about changes in and relationships between anxiety, depression and social support among the pregnant women with a history of RM throughout the pregnancy period. The aim of this study was to examine the changes in and relationships among anxiety, depression and social support across three trimesters of pregnancy in Chinese women with a history of RM. Methods: A prospective, longitudinal study was employed. The study was carried out between September 2016 and October 2017 in a teaching hospital in Guangzhou, China. A convenience sample of 166 pregnant women with a history of RM completed the measures at their 6-12, 20-24 and 32-36 gestational weeks. data were collected by a master student with Zung Self-Rating Anxiety Scale, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale. Results: Anxiety decreased from the early pregnancy to late pregnancy while depression first declined from early pregnancy to mid-pregnancy then remained to late pregnancy. Social support increased from early pregnancy to mid-pregnancy and then remained to late pregnancy. There were correlations in anxiety, depression and social support across the three trimesters of pregnancy. Conclusions: Anxiety and depression are highly prevalent in pregnant women with a history of RM, especially in early pregnancy, which merits clinical attention. Social support was an important buffer against anxiety and depression across the pregnancy. Interventions targeting women with RM may improve the health outcomes of women and their children.


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