scholarly journals Women’s Experiences in the Antenatal and Perinatal Period Following a Stillbirth or Neonatal Death: A Multicentre Cohort Study

2021 ◽  
Author(s):  
Suzanne Thomas ◽  
Louise Stephens ◽  
Tracey A Mills ◽  
Christine Hughes ◽  
Alan Kerby ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Mixed Methods ◽  
Process Model ◽  
Perinatal Death ◽  
Dual Process ◽  
Psychological State ◽  
Depression Symptoms ◽  
Hair Cortisol ◽  
Specialist Service ◽  
Cortisol Levels

Abstract Background The death of a baby before or shortly after birth is a profoundly distressing experience for women and their families. Although grieving the death of their baby, most women will embark on another pregnancy. Specialist antenatal services have been proposed to address the increased biomedical and psychological risks in pregnancies after perinatal death. This study aimed to explore the experiences of women in and shortly after pregnancy after loss to determine the psychological and economic impact and the effect of a specialist service. Methods This study adopted a mixed-methods approach using several sources of data: i) validated measures of psychological state (Cambridge Worry Score, Edinburgh Postnatal Depression Score (EPDS), Generalized Anxiety Disorder 7-item score), ii) measurement of hair cortisol, iii) face-to-face semi-structured interviews to explore women’s views and experiences of care during their pregnancy, and iv) a Social Return on Investment (SROI) analysis with a subgroup of women and staff participants at the lead site. Results In total 112 women participated in the study. Measures of anxiety and depressive symptoms decreased from the highest levels at 15 weeks’ gestation to 6-weeks postnatal (for example mean GAD-7: 15 weeks 8.2 ± 5.5, 6 weeks postnatal 4.4 ± 5.0, p < 0.001). Hair cortisol levels fell in a similar profile to anxiety and depression symptoms (p < 0.05). Thematic analysis of interviews (n = 20) described how stillbirth was a quiet, unspoken subject and that navigating subsequent pregnancies relied on expecting the worst and hoping for the best; mapping these themes onto the Dual Process Model of Bereavement found being pregnant complicated the grieving process as increased awareness of the risk of stillbirth drew parents focus back to loss. Attendance at a specialist service was valued; SROI analysis found that for £1 invested, £6.10 of value was generated, mostly relating to reduced negative psychological symptoms. Conclusions This mixed-methods study demonstrated heightened anxiety and depressive symptoms and elevated cortisol levels which decrease as pregnancy progresses. Specialist care was viewed favourably, and is cost-effective, but comparative studies are required to determine whether this model is superior to routine high-risk care and to identify which components are most valued.

scholarly journals Measures of anxiety, depression and stress in the antenatal and perinatal period following a stillbirth or neonatal death: a multicentre cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suzanne Thomas ◽  
Louise Stephens ◽  
Tracey A. Mills ◽  
Christine Hughes ◽  
Alan Kerby ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Health Status ◽  
Neonatal Death ◽  
Perinatal Death ◽  
Psychological State ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Hair Cortisol ◽  
Cortisol Levels ◽  
Anxiety Depression

Abstract Background The grief associated with the death of a baby is enduring, however most women embark on another pregnancy, many in less than a year following their loss. Symptoms of anxiety and depression are reported to be increased in pregnancies after perinatal death, although effect on maternal stress is less clear. Variation between individual studies may result from differences in gestation at sampling, the questionnaire used and the type of antecedent perinatal death. We aimed to describe quantitative measures of anxiety, depression, stress and quality of life at different timepoints in pregnancies after perinatal death and in the early postnatal period. Methods Women recruited from three sites in the North-West of England. Women were asked to participate if a previous pregnancy had ended in a perinatal death. Participants completed validated measures of psychological state (Cambridge Worry Score, Edinburgh Postnatal Depression Score (EPDS), Generalized Anxiety Disorder 7-item score) and health status (EQ-5D-5L™ and EQ5D-Visual Analogue Scale) at three time points, approximately 15 weeks’ and 32 weeks’ gestation and 6 weeks postnatally. A sample of hair was taken at approximately 36 weeks’ gestation for measurement of hair cortisol in a subgroup of women. The hair sample was divided into samples from each trimester and cortisol measured by ELISA. Results In total 112 women participated in the study. Measures of anxiety and depressive symptoms decreased from the highest levels at 15 weeks’ gestation to 6-weeks postnatal (for example mean GAD-7: 15 weeks 8.2 ± 5.5, 6 weeks postnatal 4.4 ± 5.0, p<0.001). Hair cortisol levels fell in a similar profile to anxiety and depression symptoms (p<0.05). In contrast, the median EQ-5D index, measuring health status was 0.768 at 15 weeks’ gestation (Interquartile range (IQR) 0.684-0.879), 0.696 at 32 weeks’ (IQR 0.637-0.768) and 0.89 (0.760-1.00) at 6 weeks postnatal. There was a negative relationship between EPDS and perceived health status. Conclusions This study demonstrated heightened anxiety and depressive symptoms and elevated cortisol levels in women in pregnancies after a stillbirth or neonatal death which decrease as pregnancy progresses. Further studies are needed to determine optimal care for women to address these negative psychological consequences.

scholarly journals Experiences of Parental Suicide-Bereavement: A Longitudinal Qualitative Analysis Over Two Years

2021 ◽  
Vol 18 (2) ◽  
pp. 564
Author(s):  
Lorenza Entilli ◽  
Victoria Ross ◽  
Diego De Leo ◽  
Sabrina Cipolletta ◽  
Kairi Kõlves
Keyword(s):  
Qualitative Analysis ◽  
Thematic Analysis ◽  
Process Model ◽  
Meaning Making ◽  
Dual Process ◽  
Sense Making ◽  
Depression Symptoms ◽  
Mothers And Fathers ◽  
Parental Suicide ◽  
Suicide Bereavement

Limited research exists on the experiences of parents bereaved by suicide. Our earlier qualitative analysis examined the experiences of parents’ suicide bereavement at 6 and 12 months after their loss. The current study aimed to extend the analysis over 24 months, outlining the key themes of parents’ suicide bereavement experience. In the frames of a longitudinal study of suicide bereavement in Queensland, Australia, parents were interviewed at 6, 12, and 24 months after their loss. Thematic analysis was used to further explore new themes and three key themes identified in earlier analyses: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Results at 24 months revealed a clearer differentiation between strategies adopted by mothers and fathers. Anger and blame had changed towards feelings of depression. A polarization was observed between parents still oscillating in brooding rumination and those who have shifted towards sense-making. The former more frequently reported depression symptoms, and the latter reported a more positive attitude towards life and acceptance of their loss. Consistent with the dual-process model, parents managed to reach acceptance after oscillating between sense-making and meaning making. Findings provide insights how suicide loss affects parents, with implications for postvention.

scholarly journals Overlap of burnout-depression symptoms among Chinese neurology graduate students in a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Zhou ◽  
Juncai Pu ◽  
Xiaogang Zhong ◽  
Wensong Yang ◽  
Teng Teng ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Medical Students ◽  
Graduate Students ◽  
Family Income ◽  
Multinomial Logistic Regression ◽  
Maslach Burnout Inventory ◽  
Psychological State ◽  
Depression Symptoms ◽  
Diagnostic Model ◽  
Cross Sectional

Abstract Background The overlap of burnout and depression is a phenomenon that can effectively reflect the psychological state of a group. However, whether burnout is a type of depression is still debated in current research. The high incidence of burnout and depressive symptoms among medical students indicates that it is urgent to provide appropriate health services for them. However, the proportion of burnout and depression in the overlapping symptoms experienced by medical students, and the characteristics of the relative influencing factors, remain unclear. Therefore, we addressed these issues for neurology graduate students in China. Methods Using data from a cross-sectional survey of Chinese neurology graduate students, a diagnostic model was established according to their burnout and/or depression symptoms. Burnout was assessed by using the Maslach Burnout Inventory. Depression symptoms were assessed with a two-item depression screening tool for primary care evaluation of mental disorders. Univariate analyses with chi-squared tests were conducted to assess associations between variables. Multinomial logistic regression models were used to analyze the effects of multiple factors on dependent variables. The factors included demographic information and three medical-study related problems. Results In total, 32.2% of surveyed students evidenced overlapping burnout and depression symptoms. Students with depressive symptoms tended to be included in the burnout students’ category. In the regression model, being unmarried, having children, and career choice regret were related to students who had only burnout, while the students with overlapping symptoms were affected by more factors such as family income, the consideration of dropping out once. Conclusions The symptoms and related factors of burnout and depression among Chinese neurology postgraduates have obvious overlap and show a significant trend. The occurrence of depressive symptoms among medical students is closely related to whether they are burned out. Students with only burnout were common, but students with only depressive symptoms were uncommon. Finally, burnout may be a pre-depression state.

scholarly journals Women’s Experiences of a Specialist Antenatal Service for Pregnancies After a Stillbirth or Neonatal Death: A Qualitative Interview Study and Social Return on Investment Analysis

2021 ◽  
Author(s):  
Suzanne Thomas ◽  
Louise Stephens ◽  
Tracey A Mills ◽  
Christine Hughes ◽  
A. Michael Arundale ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Return On Investment ◽  
Process Model ◽  
Perinatal Death ◽  
Dual Process ◽  
Dual Process Model ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Social Return On Investment ◽  
Qualitative Interview Study

Abstract Background Pregnancy after the death of a baby is associated with a series of emotional and psychological challenges for pregnant women and their families. Specialist antenatal services have been proposed to address the increased biomedical and psychological risks in pregnancies after perinatal death. This study aimed to explore the pregnancy and postnatal experiences of women in a pregnancy after a perinatal death who were attending a specialist antenatal service and to evaluate the economic impact of the service.Methods To explore women’s views and experiences of care during their pregnancy this study used face-to-face semi-structured interviews following a topic guide comprising of four sections (history leading to care pathway, their experience of coping with new pregnancy after loss, support and advice for others). Following inductive thematic analysis, a deductive approach was taken to map themes to Stroebe and Schutt’s Dual Process Model of Grief.A Social Return on Investment (SROI) analysis informed by contributions from a subgroup of women and staff participants. Information was obtained from focus groups discussions, questionnaires and interviews. The SROI was reported as the ratio of the value generated by the clinic and the costs of providing the service.Results Thematic analysis of interviews (n=20) described how perinatal death was a quiet, unspoken subject and that navigating subsequent pregnancies relied on expecting the worst and hoping for the best. Mapping these themes onto the Dual Process Model of Grief found being pregnant complicated the grieving process, as increased awareness of the risk of stillbirth drew parents’ focus back to loss. Attendance at a specialist service was valued; SROI analysis found that for £1 invested, £6.10 of value was generated, mostly relating to the birth of a live baby, reduced negative psychological symptoms and fewer focussed contacts with health professionals.Conclusions Specialist antenatal care in pregnancies after perinatal death was viewed favourably by parents. Women’s experiences can be used to synthesise and develop models of care that aim to meet their needs but comparative studies are required to determine whether these models are superior to routine high-risk care and to identify which components are most valued.

Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

2018 ◽  
Vol 10 (2) ◽  
pp. 20204
Author(s):  
Laetitia Idier ◽  
Aurélie Untas ◽  
Nicole Rascle ◽  
Michèle Koleck ◽  
Maider Aguirrezabal ◽  
...  
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Vascular Access ◽  
Educational Program ◽  
Psychological State ◽  
Control Group ◽  
Dialysis Patients ◽  
Emotional Change ◽  
The Impact ◽  
Experimental Group

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p < 0.01) and depressive symptoms increased in the experimental group (p < 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

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