Suicidal ideation and intentional self-harm in pregnancy as a neglected agenda in maternal health; an experience from rural Sri Lanka

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.

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Prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170466 ◽

2017 ◽

Vol 6 (3) ◽

pp. 797 ◽

Cited By ~ 1

Author(s):

Renji S. R. ◽

Sujatha Thankappan Lekshmi ◽

Nirmala Chellamma

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Statistical Tests ◽

Care Center ◽

Tertiary Care ◽

First Trimester ◽

Adverse Outcomes ◽

Tertiary Care Center ◽

Family History Of Diabetes ◽

History Of

Background: Number of pregnant women with preexisting diabetes is increasing. Hence the detection and management of diabetes from the beginning of pregnancy itself will help to improve the fetal and maternal outcome. Aim of the study was to determine the prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center and to study the associated factors.Methods: This was a cross sectional study conducted in SAT hospital, Government Medical College, Trivandrum, Kerala, India for one year. HbA1C was the test used to diagnose diabetes. 400 women attending the OP in their first trimester were selected after informed consent. Socio demographic factors assessed by a structured questionnaire. Blood samples were taken for HbA1C. Diagnosis of diabetes was made at levels of HbA1C ≥6.5%. Statistical tests used were mean, standard deviation, chi-square and odds ratio.Results: Prevalence of pre-gestational diabetes was 3.8%.in our study. Main associations were age more than 25 years, body mass index, family history of diabetes, history of intra uterine death, gestational diabetes in previous pregnancy, candidiasis and thyroid disease.Conclusions: Screening of all pregnant women in first trimester itself for diabetes will help in early detection of pre-gestational diabetes, so that anticipation of adverse outcomes and proper management can be done in such cases.

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Depression during Pregnancy in a Tertiary Care Center of Eastern Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.311 ◽

2008 ◽

Vol 47 (171) ◽

Cited By ~ 3

Author(s):

Rabi Shakya ◽

S Sitaula ◽

P M Shyangwa

Keyword(s):

Pregnant Women ◽

Care Center ◽

Tertiary Care ◽

Depression Scale ◽

Antenatal Depression ◽

Cross Sectional Study ◽

Hamilton Depression Scale ◽

Cross Sectional ◽

The Family ◽

Work Up

This is a cross sectional study, conducted in 45 pregnant women coming for antenatal check ups in the eastern regional hospitals in Nepal. Hamilton -Depression Scale (HAM-d) was applied after initial psychiatry work up to all women who were selected for the interview. Analysis revealed about half of the pregnant women having some form of depression. Life events (e.g. chronic illness in the family, marital disharmony, economic crisis to sustain the family) were found to be important risk factors (P<0.05). Antenatal depression is a more common than generally thought.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):128-131.

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Depressive Symptoms and it Correlate among Children with Epilepsy at Single Center Study in Oman

Oman Medical Journal ◽

10.5001/omj.2021.112 ◽

2021 ◽

Author(s):

Hamood Al Kiyumi ◽

Salim Al Huseini ◽

Hassan Mirza ◽

Naser Al Balushi ◽

Khalid Al-Risi ◽

...

Keyword(s):

Depressive Symptoms ◽

Care Center ◽

Tertiary Care ◽

Depression Scale ◽

Epidemiologic Studies ◽

Clinical Factors ◽

Recurrent Seizure ◽

History Of ◽

Tertiary Care Institution ◽

Antiepileptic Medications

Objectives:Epilepsy is the most common neurological disorder in children and comorbid depression is common. This study aimed to assess the frequency of depressive symptoms along with demographic and clinical factors in children diagnosed with epilepsy in a tertiary care institution in Oman. Methods:This cross-sectionalstudy was conducted between June 2016 and August 2018 and constituted children (n=75) with age group from 6 to 12 years old, attending the epilepsy clinic at a tertiary care center during the study period. The cohort constituted of children with epilepsy (CWE) following up at a dedicated unit. The instrument, Center for Epidemiologic Studies Depression Scale for Children (CESDC),was utilized to assess the presence of depressive symptoms. Associated factors including history of seizure in the last three months, compliance with antiepileptic medications,and type of epilepsy were also examined. Results:Depressive symptoms were endorsed in 52%of CWE and 96% of them were compliant to medications. The recurrent seizure was present in the last three months among 48% of the CWE. The type of epilepsy was significantly associated with the presence of depressive symptoms. Conclusions:The present study found that depression is prevalent among Omani CWE. Certain clinical factors appeared to increase the risk of depression among this population. The findings of this study fill a gap in the existing literature and call for further work aiming to explore possible tailored recognition and CWE.

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Suicide by unusual methods: a rare case of complex suicide

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20215065 ◽

2021 ◽

Vol 10 (1) ◽

pp. 273

Author(s):

Bedanta Sarma ◽

Senthil Kumaran M. ◽

Arun Kumar S. ◽

Shreemanta Kumar Dash

Keyword(s):

Mental Illness ◽

Rare Case ◽

Care Center ◽

Tertiary Care ◽

External Genitalia ◽

Review Literature ◽

Self Mutilation ◽

Complex Suicide ◽

History Of ◽

Self Harm

Genital Self-Mutilation (GSM) is usually associated with mental illness. It is considered as the most brutal form of self-harm. Many cases of such self-harm have been described by various authors in different times. However, its existence in absence of any mental illness and using it as a method of suicide is a matter of question. Although, some cases are reported; its incidence is very low. Its association with complex suicide is even much lower. Usually, in complex suicide, the victim chooses some methods which are less painful. Such a complicated case of complex suicide was brought to the tertiary care center of Dibrugarh, Assam for post mortem examination. The deceased, a 36 years old male was brought with history of cutting his external genitalia followed by hanging. The case has been described in this paper with relevant review literature.

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Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

Otolaryngology ◽

10.1177/01945998211008915 ◽

2021 ◽

pp. 019459982110089

Author(s):

Quinn Dunlap ◽

James Reed Gardner ◽

Amanda Ederle ◽

Deanne King ◽

Maya Merriweather ◽

...

Keyword(s):

Neck Dissection ◽

Surgical Complications ◽

Chart Review ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Neck Surgery ◽

Continuous Variables ◽

Significant Difference ◽

History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

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The hidden burden of adolescent pregnancies in rural Sri Lanka; findings of the Rajarata Pregnancy Cohort

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03977-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Thilini Chanchala Agampodi ◽

Nuwan Darshana Wickramasinghe ◽

Hemali Gayathri Jayakodi ◽

Gayani Shashikala Amarasinghe ◽

Janith Niwanthaka Warnasekara ◽

...

Keyword(s):

Mental Health ◽

Sri Lanka ◽

Pregnant Women ◽

Adolescent Mothers ◽

Depression Scale ◽

Ultra Sound ◽

Physical And Mental Health ◽

Pregnancy Cohort ◽

Contraceptive Usage ◽

Adolescent Pregnancies

Abstract Background Adolescent fertility is a main indicator of the Sustainable Developmental Goal (SGD) three. Although Sri Lanka is exemplary in maternal health, the utilization of Sexual and Reproductive Health services (SRH) by adolescents is less documented. We describe the hidden burden, associated biological and psychosocial factors and utilization patterns of pre-conceptional services among pregnant adolescents in rural Sri Lanka. Methods The study is based on the baseline assessment of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. Pregnant women newly registered from July to September 2019 were recruited to the study. The period of gestation was confirmed during the second follow-up visit (around 25–28 weeks of gestation) using ultra sound scan data. A history, clinical examination, anthropometric measurements, blood investigations were conducted. Mental health status was assessed using the Edinburgh Postpartum Depression Scale (EPDS). Results Baseline data on gestation was completed by 3,367 pregnant women. Of them, 254 (7.5%) were adolescent pregnancies. Among the primigravida mothers (n = 1037), 22.4% (n = 233) were adolescent pregnancies. Maternal and paternal low education level, being unmarried, and less time since marriage were statistically significant factors associated with adolescent pregnancies (p < 0.05). Contraceptive usage before pregnancy, utilization of pre-conceptional health care services, planning pregnancy and consuming folic acid was significantly low among adolescents (p < 0.001). They also had low body mass index (p < 0.001) and low hemoglobin levels (p = 0.03). Adolescent mothers were less happy of being pregnant (p = 0.006) and had significantly higher levels of anxiety (p = 0.009). Conclusion One fifth of women in their first pregnancy in this study population are adolescents. Nulli-parous adolescents exert poor social stability and compromised physical and mental health effects. The underutilization and/or unavailability of SRH services is clearly associated with adolescent pregnancies.

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Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03525-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chitkasaem Suwanrath ◽

Sopen Chunuan ◽

Phawat Matemanosak ◽

Sutham Pinjaroen

Keyword(s):

Qualitative Study ◽

Pregnant Women ◽

Risk Perceptions ◽

Care Center ◽

Tertiary Care ◽

Cesarean Birth ◽

Positive Attitudes ◽

Cesarean Births ◽

Medical Indications ◽

Superstitious Beliefs

Abstract Background Increasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications. Methods A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis. Results Maternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion Several reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth in order to prevent or diminish unnecessary cesarean births.

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Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽

10.1177/2473974x20975020 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2097502

Author(s):

Joseph Chang ◽

Sen Ninan ◽

Katherine Liu ◽

Alfred Marc Iloreta ◽

Diana Kirke ◽

...

Keyword(s):

Virtual Reality ◽

Local Anesthesia ◽

Controlled Trial ◽

Care Center ◽

Tertiary Care ◽

Depression Scale ◽

Control Group ◽

Procedure Time ◽

Pain Scores ◽

Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

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