Pregnancy-related claustrophobia

A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks’ gestation. Symptoms were preceded by a nightmare about her upcoming labour. She developed repetitive intrusive thoughts of being trapped emotionally and physically in her pregnancy. Her symptoms were suggestive of new-onset claustrophobia associated with pregnancy, which has not been previously reported on. Her symptoms ameliorated with a combination of cognitive–behavioural therapy and pharmacotherapy (sertraline and low dose quetiapine). The later stages of pregnancy were associated with minimal symptoms and the resolution of her subjective ‘entrapment’. A subsequent pregnancy resulted in similar although less severe symptomatology. No postpartum anxiety symptoms were demonstrated on both occasions. Anxiety symptoms can adversely impact both the mother and fetus, and thus correct identification and management of pregnancy-related claustrophobia improved symptomatology and functioning and allowed for earlier detection and reduced symptomatology in a subsequent pregnancy.

Investigation of the Relationship Between Postpartum-Specific Anxiety and Maternal Attachment and Affecting Factors in a Turkish Sample

Aim: Postpartum-specific anxiety is associated with impaired mother-infant attachment, postpartum depression, reduced probability of breastfeeding, increased risk of infant abuse, and increased probability of anxiety in children and may lead to psychological, cognitive, and psycho-motor disorders in child development. This descriptive and cross-sectional study aims to determine the effect of anxiety level in the postpartum period in women on maternal attachment. Methods: The participants were 384 postpartum women who have a 1-3-month old baby. Data were collected using a personal information form, Postpartum Specific Anxiety Scale, and Maternal Attachment Inventory. Results: It was found that the Postpartum Specific Anxiety Scale in women was at a medium level, while maternal attachment was at a high level. While the Postpartum Specific Anxiety Scale was at higher levels in those who were younger, unemployed, and had no other children, the younger age of the partner increased the Postpartum Specific Anxiety Scale score. No statistically significant relationship was found between Postpartum Specific Anxiety Scale and maternal attachment. Conclusion: It is seen that to evaluate women in terms of anxiety in the postpartum period and to provide the necessary psychosocial support is necessary. The fact that maternal attachment in women was high may have had a positive effect on her relationship with postpartum anxiety. Keywords: postpartum, anxiety, children, bonding

A Cognitive—Behavioral Intervention for Postpartum Anxiety and Depression: Individual Phone vs. Group Format

Cognitive–behavioral interventions can effectively treat symptoms of perinatal mood and anxiety disorders (PMADs). We assessed the acceptability and effectiveness of a workbook-based intervention (What Am I Worried About? (WAWA)) comprising of cognitive–behavioral and mindfulness techniques and weekly professional guidance to address symptoms of depression, anxiety, and stress among postpartum mothers. We compared the efficacy of group versus individual telephone consultation using a pre-and post-test single group, open trial, research design in replication pilot study. A convenience sample of community-residing postpartum women (n = 34) chose between group intervention (n = 24) or individual phone consultation with a mental health professional (n = 10). Outcome measures were anxiety (GAD-7), depression, anxiety, and stress (DASS21), and postpartum depression (PPD-EPDS). After four weeks intervention, significant reductions were observed in postpartum depression, anxiety, and stress scales. Cohen’s d statistics showed medium effect sizes (0.35–0.56). A small but significantly larger change in PPD-EPDS and DASS stress scores was reported among participants who opted for the phone intervention compared to those in the group intervention. Most participants felt that the intervention was highly beneficial and would recommend it to other postpartum women. In conclusion, the WAWA intervention showed efficacy for reducing postpartum anxiety, distress, and depressive symptoms among postpartum women, with a slightly greater reduction in PPD-EPDS and stress symptoms found among those who opted for individual phone consultation. Definitive evaluation of the intervention requires a larger sample and a RCT research design with two treatment arms: telephone and group intervention.

Pszichoterápia a szülészeten: lehetőségek alacsony intenzitású kognitív viselkedésterápiás intervenciókra

Összefoglaló. A szülés utáni időszakban megjelenő aggodalmak természetesnek tekinthetők, az anyák jelentős részénél azonban klinikai szintű szorongásos megbetegedés alakulhat ki. A postpartum időszakban a szorongásos tünetek gyakori előfordulása ronthatja az anya életminőségét, pszichés állapotát, s ezáltal kedvezőtlen hatást gyakorol az anya-gyermek kapcsolatra, a gyermek mentális fejlődésére, a párkapcsolatra, valamint a családi rendszer egyensúlyára. Kutatási eredmények igazolják, hogy a szorongásos zavar a későbbiekben megjelenő anyai depresszió előrejelzője lehet. A nemzetközi irányelvek (NICE) a peri- és postnatalis időszakban jelentkező szorongásos zavarok kezdeti kezelésében az alacsony intenzitású pszichoterápiás módszereket javasolják. Tanulmányunk elsődleges célja, hogy egy esetismertetésen keresztül, kérdőívekkel követve az állapot változását, bemutassuk a szülészet-nőgyógyászat területén alkalmazható, kis intenzitású pszichológiai intervenciók eszköztárát. Az utóbbi a kognitív viselkedésterápia alapmódszereit használja kórházi osztályos, illetve ambuláns keretek között. A pszichoedukációt, normalizálást és átkeretezést, problémafókuszú keresztmetszeti konceptualizálást, szisztematikus deszenzitizálást és problémamegoldó technikákat tartalmazó intervenciók hatására az anya jelentős szenvedést okozó szorongásos panaszai már négy pszichoterápiás találkozást követően csökkentek, az anya képessé vált arra, hogy gyermekét ellássa. A terápia hatékonyságát, a szorongás és a depresszió csökkenését a páciens szubjektív megélésén túlmenően az állapotkövető kérdőívek eredményei is teljesen mértékben alátámasztották. Eredményeink megerősítik, hogy az alacsony intenzitású pszichológiai intervenciók hatékonyan alkalmazhatók a kórházi osztályokon a szorongásos, depressziós panaszok csökkentésében és ezáltal költségkímélő módon a pszichés zavarok megelőzésében. Orv Hetil. 2021; 162(44): 1776–1782. Summary. The occurrence of postpartum worries is considered a normative phenomenon, although the threshold of anxiety reaches clinical level and can lead to the development of postpartum anxiety disorder for a significant number of new mothers. Frequent occurrence of anxiety-related symptoms can negatively influence the mother’s quality of life, psychological status, the mother-child relationship, the newborn’s mental development, the relationship of the couple as well as the balance of the family system as a whole. Studies show that postpartum anxiety disorder can lead to depression later on. International guidelines (NICE) suggest peri- and postnatal anxiety disorders to be treated using low intensity psychological interventions (LIPIs). The aim of this study is to present the different methods of LIPIs used in obstetrics and gynecology through a clinical case study, while monitoring the outcomes in the mothers’ psychological status by the use of questionnaires. LIPIs contain the basics of cognitive behavioural therapy used in hospitals in both in- and outpatient care. After only four psychotherapy sessions using psychoeducation, normalizing and reframing, problem-centered cross-sectional conceptualisation, systematic desensitization and problem solving techniques, the mother’s severe symptoms of anxiety decreased significantly, enabling her to take proper care of the newborn. The efficacy of the therapy was confirmed thoroughly not only by the subjective experience of the patient, but the results of the questionnaires used to follow the psychological status of the patient. Our results show that LIPIs can be effectively used as a cost-effective method to reduce symptoms of anxiety or depression, and to prevent the development of mental health problems among hospital patients. Orv Hetil. 2021; 162(44): 1776–1782.

A Systematic Review and Meta-analysis of the Effects of Music Therapy on Postpartum Anxiety and Pain Levels

Introduction: Postpartum anxiety may be associated with depression, postpartum blues, and maternal mood disorders. This systematic review investigated the effects of music therapy on postpartum anxiety and pain levels. Methods: English databases including Cochrane, Medline, Embase, Web of Science, Scopus, and PubMed and Persian databases including Scientific Information Database (SID) and the Iranian Registry of Clinical Trials (IRCT) were searched. The data were analyzed in RevMan 5.3 and reported as forest plots. The present study was conducted on postpartum women (i.e., the participants). All randomized controlled trials comparing the effects of music (i.e., the intervention) and placebo or routine care (i.e., the control) on postpartum anxiety and pain (i.e., the outcome) were included in the study. Results: Out of a total of 60 retrieved articles, four eligible articles were selected and entered the meta-analysis process. According to the results, anxiety (MD=-0.68, 95% CI=-1.90 to -0.54, P<0.001) and pain (MD=-1.85, 95% CI=-3.96 to 0.26, P<0.001) levels of patients in the music therapy group were reduced more significantly than those in the control group. Conclusion: The results showed that music therapy can significantly reduce both postpartum anxiety and pain scores. However, due to the high heterogeneity of the studies, more randomized trials using a standard tool such as the Consolidated Standards of Reporting Trials (CONSORT) statement are needed.

Psychometric evaluation of the postpartum specific anxiety scale in an Iranian population (PSAS-IR)

Background Anxiety is one of the most prevalent mental health disorders among mothers during the postpartum period, which can lead to maternal and infant physical and psychological consequences. The Postpartum Specific Anxiety Scale (PSAS) predicts unique variance in postnatal outcomes over and above general anxiety tools. It has never been used in Iran and its validity and reliability have not been assessed either. Therefore, the present study aimed to translate and investigate the psychometric properties of the PSAS-IR. Methods 510 women, from six weeks to six months postpartum, were selected through random sampling in 2020. After forward and back-translation, the face validity, content validity, and construct validity of PSAS (through confirmatory factor analysis) were examined. The reliability of the scale was assessed using both internal consistency (Cronbach’s alpha) and test-retest stability methods. Results CVI and CVR values of the PSAS tool were 0.89 and 0.88, respectively. The good fit indices confirmed the validity of four-factor structure. Cronbach’s alpha coefficient and Intra Correlation Coefficient (ICC) equaled 0.93 and 0.92, respectively. Conclusion The Persian version of PSAS is a valid and reliable four-factor scale, it will improve the measurement of postpartum anxiety in an Iranian setting. This will improve the measurement of postpartum anxiety in an Iranian setting.

Kecemasan Pada Ibu Post Partum Primipara Dengan Produksi Asi

ABSTRAK ASI merupakan makanan yang terbaik bagi bayi produksi ASI dipengaruhi oleh beberapa faktor yaitu faktor nutrisi, perawatan payudara, isapan dan frekuensi menyusui, sosial budaya dan faktor psikologis. Data di Kabupaten Lampung Utara yang memberikan ASI secara eksklusif pada tahun 2015 sebesar 45,5% lebih rendah bila dibandingkan tahun 2016 yaitu 48% dari target 80%, bila dibandingkan di Lampung Timur pencapaian ASI eksklusif sebesar 54,3%. (Dinas Kesehatan Kabupaten Lampung Utara, 2017). Data RSD H.M Ryacudu Kotabumi pada Tahun 2016 cakupan pemberian ASI eksklusif sebesar 57,4% lebih tinggi bila dibandingkan Tahun 2017 dari jumlah bayi 73 yang memberikan ASI secara eksklusif sebesar 54,8. Tujuan penelitian untuk mengetahui hubungan tingkat kecemasan ibu post partum primipara dengan produksi asi di ruang nifas RSD H.M Ryacudu Kotabumi Tahun 2019Jenis penelitian kuantitatif dengan pendekatan Crossectional. Populasi seluruh ibu post partum primipara yang ada di Ruang Nifas RSD H.M Ryacudu Kotabumi, sebanyak 87 responden tercatat dari tanggal 2- 29 April 2019.. Pengambilan sampel menggunakan teknik total sampling. Analisa menggunakan analisis univariat dan bivariat menggunakan chi squareHasil prasurvey terhadap 10 orang ibu post partum primipara di RSD H.M Ryacudu Kotabumi menyimpulkan bahwa didapati 4 orang ibu atau (40,0%) tidak mengalami kecemasan paska melahirkan, dan dapat memberikan ASI eksklusif dengan baik kepada anaknya. Sedangkan sebanyak 6 orang ibu atau (60,0%) mengalami kecemasan paska melahirkan yaitu dengan gejala gelisah, gugup, bingung, sangat waspada, ketakutan, dan mengalami hambatan seperti menunda-nunda dalam pemberian ASI kepada anaknya. Kata Kunci : Tingkat kecemasan, Produksi Asi ANXIETY IN PRIMIPHARA POSTPARTUM MOTHERS WITH BREAST MILK PRODUCTION ABSTRACT Breast milk is the best food for babies. Breast milk production is influenced by several factors, namely nutrition, breast care, suction and frequency of breastfeeding, socio-cultural and psychological factors. Data in North Lampung Regency that exclusively provided breast milk in 2015 was 45.5% lower compared to 2016, which was 48% of the target of 80%, compared to in East Lampung the achievement of exclusive breastfeeding was 54.3%. (North Lampung Regency 1Health Office, 2017). RSD Mayjen HM Ryacudu Kotabumi data in 2016 the coverage of exclusive breastfeeding was 57.4% higher compared to 2017 of the number of 73 babies who exclusively provided breast milk at 54.8. The purpose of this study was to determine the relationship of anxiety levels of postpartum primipara mothers with breast milk production in the puerperal room of H.M Ryacudu Hospital in Kotabumi 2019This type of quantitative research with a cross-sectional approach. The population of all primipara postpartum mothers in the post-partum room of RSDH.M Ryacudu Kotabumi, as many as 87 respondents were recorded from 2- 29 April 2019 .. Sampling using total sampling techniques. Analysis using univariate and bivariate analysis using chi-squareThe results of pre-survey of 10 primipara postpartum mothers in H.M Ryacudu Kotabumi Hospital concluded that 4 mothers or (40.0%) did not experience postpartum anxiety, and were able to give exclusive breast milk to their children. While as many as 6 mothers or (60.0%) experience postpartum anxiety that is with symptoms of anxiety, nervousness, confusion, extreme caution, fear, and experiencing obstacles such as procrastinating in giving breast milk to their children. Keywords: Anxiety Level, Breast Milk Production

Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF)

The Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure of postpartum anxiety (PPA). However, it contains 51 items, so is limited by its length. This study aimed to reduce the number of items in the PSAS, produce a small number of high-performing short-form tools, and confirm the factor structure of the most statistically and theoretically meaningful model. A pooled sample of English-speaking mothers (N = 2033) with infants up to 12 months were randomly split into three samples. (1) A principal component analysis (PCA) was conducted to initially reduce the items (n = 672). (2) Four short-form versions of varying length (informed by statistical, theoretical, lay-person, and expert-guided feedback) were developed and their factor structure examined (n = 673). (3) A final confirmatory factor analysis (CFA) was performed to confirm the factor structure of the PSAS Research Short-Form (PSAS-RSF) (n = 688). PCA and theoretical review reduced the items from 51 to 34 (version 1). Statistical review retained 22 items (version 2). Quantitative expert panel data retained 17 items (version 3). Qualitative expert panel data retained 16 items (version 4). The 16-item version was deemed the most theoretically and psychometrically robust. The resulting 16-item PSAS-RSF demonstrated good psychometric properties and reliability. The PSAS-RSF is the first brief research tool which has been validated to measure PPA. Our findings demonstrate it is theoretically meaningful, statistically robust, reliable, and valid. This study extends the use of the measure up to 12 months postpartum, offering broader opportunity for measurement while further enhancing accessibility through brevity.

A study of pregnancy-related anxiety with spiritual health among Cesarean and Vaginal Delivery

Background: One of the most important causes of anxiety during pregnancy is postpartum anxiety and the effects that this anxiety can have on the health of mother and infant and the role that studies have considered for spiritual health in promoting mental health. Objective: The aim of this study is to investigate the correlation between anxiety and spiritual health of mothers with cesarean section and vaginal delivery. Methods: This study was performed on 171 women referred to Amir al-momenin (PB) in Gerash Hospital (Fars, Iran) from August 2017 to October 2018. Convenience sampling was used. Data were collected through Demographic Information Questionnaire, Spielberger Anxiety Inventory, and Pulotzin and Ellison Spiritual Health Questionnaire. Data were analyzed by descriptive statistical methods including mean, standard deviation and frequency percentage and analytical methods such as independent t-test and Pearson correlation. Results: There was no significant difference between the mean of total score of anxiety (P = 0.560) and spiritual health (P = 0.313) in mothers with cesarean section and vaginal delivery). There was no significant correlation between maternal spiritual health, maternal anxiety, cesarean delivery (r = -0.111, p = 0.269) and vaginal delivery (r = 0.152, p = 0.209). Conclusion: In this study, anxiety and spiritual health were not different among cesarean section and vaginal delivery women and unlike other studies, no correlation was found between spiritual health and anxiety. However, further studies in this field and attention to other strategies to control labor anxiety among women seem necessary.