scholarly journals Psychosocial Stratification of Antenatal Indicators to Guide Population-Based Programs in Perinatal Depression

2020 ◽  
Author(s):  
John Eastwood ◽  
Andy Wang ◽  
Sarah Khanlari ◽  
Alicia Montgomery ◽  
Jean Yee Hwa Yang

Abstract Background: There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. Methods: This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroups differences in antenatal and postnatal depressive symptoms were then assessed, as measured by Edinburgh Postnatal Depression Scale scores recorded at antenatal booking and early postnatal assessments, respectively.Results: Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported ‘local’ women who speak English as their primary language (Group L), another of socially supported ‘migrant’ women who speak a language other than English as their primary language (Group M), another of socially stressed ‘local’ women who speak English as their primary language (Group Ls), and socially stressed ‘migrant’ women who speak a language other than English as their primary language (Group Ms). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while Ms group was over five times more likely, to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms respectively). Conclusions: This study demonstrates that it is possible to stratify pregnant women into subpopulations using their demographic and psychosocial characteristics, to identify those at greatest risk of suboptimal mental health in the antenatal and postnatal periods. The application of empirical subgrouping analysis permits an informed approach to targeted resource allocation for optimising perinatal maternal wellbeing.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Eastwood ◽  
Andy Wang ◽  
Sarah Khanlari ◽  
Alicia Montgomery ◽  
Jean Yee Hwa Yang

Abstract Background There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. Methods This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Results Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported ‘local’ women who speak English as their primary language (Group L), another of socially supported ‘migrant’ women who speak a language other than English as their primary language (Group M), another of socially stressed ‘local’ women who speak English as their primary language (Group Ls), and socially stressed ‘migrant’ women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10–3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13–15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47–1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22–1.84; and OR 5.28, 95%CI 2.63–10.63, for M and Ms. respectively). Conclusions The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.


Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1118
Author(s):  
Ralf Wagner ◽  
David Peterhoff ◽  
Stephanie Beileke ◽  
Felix Günther ◽  
Melanie Berr ◽  
...  

SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.


2021 ◽  
Vol 8 ◽  
Author(s):  
Leila Jahangiry ◽  
Mahdieh Abbasalizad Farhangi ◽  
Mahdi Najafi ◽  
Parvin Sarbakhsh

Background: Coronary heart disease (CHD) is the major cause of mortality in the world with a significant impact on the younger population. The aim of this study was to identify prematurity among patients with coronary artery bypass graft surgery (CABG) based on the clustering of CHD risk factors.Methods: Patients were recruited from an existing cohort of candidates for CABG surgery named Tehran Heart Center Coronary Outcome Measurement (THC-COM). A latent class analysis (LCA) model was formed using 11 potential risk factors as binary variables: cigarette smoking, obesity, diabetes, family history of CHD, alcohol use, opium addiction, hypertension, history of stroke, history of myocardial infarction (MI), peripheral vascular disease (PVD), and hyperlipidemia (HLP). We analyzed our data to figure out how the patients are going to be clustered based on their risk factors.Results: For 566 patients who were studied, the mean age (SD) and BMI of patients were 59.1 (8.9) and 27.3 (4.1), respectively. The LCA model fit with two latent classes was statistically significant (G2 = 824.87, df = 21, p &lt; 0.0001). The mean (SD) age of patients for Class I and Class II was 55.66 (8.55) and 60.87 (8.66), respectively. Class I (premature) was characterized by a high probability of smoking, alcohol consumption, opium addiction, and a history of MI (P &lt; 0.05), and class II by a high probability of obesity, diabetes, and hypertension.Conclusion: Latent class analysis calculated two groups of severe CHD with distinct risk markers. The younger group, which is characterized by smoking, addiction, and the history of MI, can be regarded as representative of premature CHD.


Author(s):  
Bruce G Taylor ◽  
Weiwei Liu ◽  
Elizabeth A. Mumford

The purpose of this study is to understand the availability of employee wellness programs within law enforcement agencies (LEAs) across the United States, including physical fitness, resilience/wellness, coping skills, nutrition, mental health treatment, and substance use treatment. The research team investigated whether patterns of LEA wellness programming are identifiable and, if so, what characteristics describe these patterns. We assess using latent class analysis whether there are distinct profiles of agencies with similar patterns offering different types of wellness programs and explore what characteristics distinguish agencies with certain profiles of wellness programming. Data were from a nationally representative sample of 1135 LEAs: 80.1% municipal, 18.6% county and 1.3% other agencies (state-level and Bureau of Indian Affairs LEAs). We found that many agencies (62%) offer no wellness programming. We also found that 23% have comprehensive wellness programming, and that another group of agencies specialize in specific wellness programming. About 14% of the agencies have a high probability of providing resilience coping skill education, mental health and/or substance use treatment services programming. About 1% of the agencies in the United States limit their programming to fitness and nutrition, indicating that fitness and nutrition programs are more likely to be offered in concert with other types of wellness programs. The analyses revealed that agencies offering broad program support are more likely to be large, municipal LEAs located in either the West, Midwest or Northeast (compared with the southern United States), and not experiencing a recent budget cut that impacted wellness programming.


2020 ◽  
Author(s):  
Fei Wang

BACKGROUND The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. OBJECTIVE This study aims to identify subgroups of medical students based on mental health status and explore the influencing factors during the COVID-19 epidemic in China. METHODS A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Latent class analysis of the mental health of medical students was performed using M-plus software to identify subtypes of medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors. RESULTS In this study, three distinct subgroups were identified, namely, the high-risk group, the low-risk group and the normal group. Therefore, medical students can be divided into three latent classes, and the number of students in each class is 4325, 9321 and 16,017. The multinomial logistic regression results showed that compared with the normal group, the factors influencing mental health in the high-risk group were insomnia, perceived stress, family psychiatric disorders, fear of being infected, drinking, individual psychiatric disorders, sex, educational level and knowledge of COVID-19, according to the intensity of influence from high to low. CONCLUSIONS Our findings suggested that latent class analysis can be used to categorize different medical students according to their mental health subgroup during the outbreak of COVID-19. The main factors influencing the high-risk group and low-risk group are basic demographic characteristics, disease history, COVID-19 related factors and behavioral lifestyle, among which insomnia and perceived stress have the greatest impact. School administrative departments could utilize more specific measures on the basis of different subgroups, and provide targeted measures.


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