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Several studies have revealed that homeless people suffering from mental health problems are more vulnerable than homeless without those mental health problems. Nevertheless, there is a lack of evidence describing the real circumstances of homeless women. This paper explores the differences between homeless women at high risk of mental ill-health compared with those who do not present this risk. The sample consisted of a group of 120 homeless women in Madrid (Spain). For this study, we collected data on background information (trajectory of homelessness and stressful life events experienced) and current aspects (living conditions, physical health, and social support). The risk of mental ill-health has been measured by the short version of the General Health Questionnaire (GHQ-28). The results showed that homeless women with higher risk of mental ill-health had become homeless at a younger age, had experienced more stressful life events in their lives, had a poorer physical health, felt less happy, had less social support, and a greater feeling of loneliness when compared with homeless women who did not present risk of mental ill-health. Improving knowledge about the risk of mental ill-health among homeless women is essential for the design of specific psychological interventions within this population. [ABSTRACT FROM AUTHOR]

Little research has examined the usefulness of positive well-being factors during pregnancy. Recent mindfulness research demonstrates that inconsistencies and the suitability of extant measures have yet to be examined in pregnancy. Effects of gratitude during pregnancy have yet to be examined despite consistently reported benefits in non-pregnant groups. The aims of this paper were to develop the Gratitude during Pregnancy (GDP) scale, validate the Mindfulness Awareness Attention Scale (MAAS) and examine the importance of gratitude and mindfulness during pregnancy. In study 1, 375 pregnant women completed gratitude and mindfulness measures. The one-factor structure of the MAAS was retained and demonstrated good reliability α = 0.88. Using exploratory factor analysis, an 18-item GDP scale was developed, demonstrating good reliability α = 0.89. The four GDP factors are as follows: general gratitude, physical changes, antenatal care and social support. In study 2, 87 pregnant women completed well-being questionnaires, including the GDP and MAAS. Gratitude correlated with positive affect, life satisfaction and pregnancy uplifts ( p < .001); mindfulness correlated negatively with negative affect and pregnancy hassles ( p < .001) and positively correlated with positive affect and pregnancy uplifts ( p < .05). These findings highlight the importance of mindfulness and gratitude and provide a reliable means to measure both constructs during pregnancy. [ABSTRACT FROM AUTHOR]

Considerable attention has been focused on women's mental health in the perinatal period and the subsequent impacts on children. Comparatively, we know much less about maternal depression at later time points and the potential implications for child mental health. The objective of this paper was to explore the association between maternal depression and child emotional/behavioural difficulties at 4 years postpartum, taking into account earlier episodes of perinatal depression. The Maternal Health Study is a prospective cohort study of 1,507 nulliparous women. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy and at 3, 6 and 12 months postpartum and again at 4 years postpartum. Maternal depressive symptoms at 4 years postpartum were associated with significantly increased odds of child emotional/behavioural difficulties (odds ratio (OR) = 3.46, 95 % confidence interval (CI) = 2.21-5.43). This remained significant after adjusting for earlier episodes of perinatal depression and socio-demographic characteristics (OR = 2.07, 95 % CI = 1.18-3.63). We also observed a robust association between child difficulties at age 4 and measures of socio-economic disadvantage. Our findings suggest a pressing need to rethink current paradigms of maternal health surveillance and extend mental health surveillance and support to at least 4 years postpartum. [ABSTRACT FROM AUTHOR]

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this paper are to examine: (1) the relationship between high pre-pregnancy BMI and antenatal depression; (2) whether BMI and antenatal depression interact to predict diet and gestational weight gain (GWG). Methods: Data came from the Avon Longitudinal Study of Parents and Children (ALSPAC). Underweight women were excluded. Pre-pregnancy BMI was self-reported and antenatal depression was assessed using the Edinburgh Postnatal Depression Scale at 18 and 32 weeks' gestation to identify persistently elevated depressive symptoms (EPDS>12). Dietary patterns were calculated from food frequency questionnaires at 32 weeks' gestation. GWG was categorised using the USA Institute of Medicine guidelines. Results: This study included 13,314 pregnant women. Obese women had significantly higher odds of antenatal depression than normal weight controls after adjusting for socio-demographics and health behaviours (aOR 1.39, 95%CI 1.05-1.84). Every unit increase in pre-pregnancy BMI was associated with approximately 3% higher odds of antenatal depression (aOR 1.03, 95%CI 1.01-1.05). Antenatal depression was not meaningfully associated with dietary patterns after adjusting for confounders and was not associated with inadequate or excessive GWG. There was no evidence for an interaction of depression and BMI on either diet or GWG. Conclusions: Healthcare professionals should be aware of the dose-response relationship between high pre-pregnancy BMI and antenatal depression. [ABSTRACT FROM AUTHOR]

Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period. [ABSTRACT FROM AUTHOR]

Pregnant women with preterm labour (PTL) in pregnancy often experience increased distress and anxieties regarding both the pregnancy and the child's health. The pathogenesis of PTL is, among other causes, related to the stress-associated activation of the maternal-foetal stress system. In spite of these psychobiological associations, only a few research studies have investigated the potential of psychological stress-reducing interventions. The following paper will present an online anxiety and stress management self-help program for pregnant women with PTL. Structure and content of the program will be illustrated by a case-based experience report. L.B., 32 years (G3, P1), was recruited at gestational week 27 while hospitalized for PTL for 3 weeks. She worked independently through the program for 6 weeks and had regular written contact with a therapist. Processing the program had a positive impact on L.B.'s anxiety and stress levels, as well as on her experienced depressive symptoms and bonding to the foetus. As PTL and the risk of PTB are associated with distress, psychological stress-reducing interventions might be beneficial. This study examines the applicability of an online intervention for pregnant women with PTL. The case report illustrates how adequate low-threshold psychological support could be provided to these women. [ABSTRACT FROM AUTHOR]

The study aimed to explore barriers to mental health service attainment among Bedouin women living in different residential environments in southern Israel. We hypothesized that emotional distress and the utilization of mental health services would be influenced by the living environment and ethnic identity factors. The sample included 376 Arab-Bedouin women, 126 Arab-Bedouin women from the recognized and unrecognized villages, and 250 Arab-Bedouin women from the central localities. Quantitative methods were used, including emotional distress (GHQ12), ethnic identity scale (EIS), mental health literacy (MHLS), and barriers to mental health services attainment (BACE). Results indicated that participants from the central localities demonstrated a greater inclination to seek and utilize mental health services. Furthermore, higher rates of affirmation of ethnic identity were also found to be a predictive factor for the willingness to attain mental health services. These findings further support the role of residential environment and ethnic identity in shaping mental health service utilization patterns. Current research explored barriers to mental health services seek and attainment for Arab-Bedouin women in different residential environments in southern Israel. Ethnic identity factors and barriers such as stigma and access to resources predicted the tendency to seek help. Findings emphasize the need to address barriers to seeking help and the role of ethnic identity in mental health service attainment for Arab-Bedouin women. [ABSTRACT FROM AUTHOR]

This study aimed to identify the prevalence of common mental disorders (CMD) and associated factors in female shift workers. A cross-sectional study was conducted with a sample of 450 female workers, aged 18 years or older (± 36.1 years), from an industry located in Southern Brazil. CMD was assessed using the self-reporting questionnaire (SRQ-20 ≥ 8 points), and sociodemographic, occupational, behavioral, morbidity, and self-rated health characteristics were assessed using a questionnaire survey. The prevalence of CMD was 47.3% (95% CI: 42.6–52.1). After adjusting, female workers with black/brown race/skin color had a 22% higher probability of CMD than white workers (prevalence ratio (PR) = 1.22; 95% CI: 1.01–1.49), and workers with sleep disorders or poor sleep quality were 147% more likely to have CMD compared with those with good sleep quality (PR = 2.47; 95% CI: 1.70–3.58), and workers with fair/poor self-rated health were twice as likely to have CMD (PR = 2.00; 95% CI: 1.43–2.80) compared to those with excellent/very good self-rated health. A high prevalence of CMD was observed in female shift workers, especially in workers with a black/brown race/skin color and with poor sleep quality and self-rated health. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) afflicts up to 15 % of Canadian women following childbirth. Minimal research has focused on therapist-assisted internet-delivered cognitive behavior therapy (ICBT) for PPD. The purpose of this paper was to illustrate this novel treatment approach that was offered to a woman afflicted with PPD. A first-time mother participated in therapist-assisted ICBT for PPD. She completed the seven-module intervention in 12 weeks, sent seven emails to her therapist, and received 13 therapeutic emails. Therapeutic exchanges are presented. Treatment progress, therapeutic alliance, and treatment satisfaction were assessed. Symptom reduction was observed on all measures at post-treatment. Treatment satisfaction and a strong therapeutic alliance were also reported. The case will expand clinician understanding in therapist-assisted ICBT for PPD and may serve to stimulate clinician interest. Future research directions stemming from this case are presented. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyse postpartum depressive symptoms as related to baby gender, maternal region of birth, stress, perception of child difficult temperament and some demographic factors. The setting was 36 Swedish child health centres. Mothers of 1,848 19-month-old children completed a questionnaire, including an item about recall of postpartum sadness. A subsample of 360 answered the Edinburgh Postnatal Depression Scale (EPDS). Overall, significantly more mothers of boys than of girls recalled postpartum sadness. The same was found in mothers born in Sweden and in other regions, except for the Middle East (no significant result). Among those born in Sweden and in other regions, more mothers of boys than of girls scored ≥12 on the EPDS, except for Middle East mothers with the opposite pattern (no significant finding). More mothers of 'difficult' boys than of 'difficult' girls recalled postpartum sadness. Our findings are tentative but may inspire future research. Immigrant mothers in Sweden seem rather like the majority population, possibly with the exception of Middle East mothers. The significance of parents' knowledge of their child's gender in advance is an important area for research. Future parents could benefit from discussing gender expectations with a nurse or other professional. [ABSTRACT FROM AUTHOR]

This is a validation of a self-rating questionnaire designed to detect disorders of the mother-infant relationship. 125 subjects filled in the questionnaire, and were also interviewed using the 5th Edition of the Birmingham Interview for Maternal Mental Health. On the basis of these interviews and the case records, we made consensus diagnoses of various forms and degrees of mother infant relationship disorder, according to criteria published in this paper. We calculated specificity, sensitivity and positive predictive value of the four scale scores generated by the questionnaire. Scale 1 (a general factor) had a sensitivity of 0.82 for all mother-infant relationship disorders. Scale 2 (rejection and pathological anger) had a sensitivity of 0.88 for rejection of the infant, but only 0.67 for severe anger. The performance of scale 3 (infant-focused anxiety) was unsatisfactory. Scale 4 (incipient abuse) selected only a few mothers, but was of some value in identifying those at high risk of child abuse. Revision of the thresholds can improve sensitivity, especially of scale 2, where a cut-off point of 12 = normal, 13 = high better identifies mothers with threatened rejection. These new cut-off points would need validation in another sample. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups—50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy. [ABSTRACT FROM AUTHOR]

Subthreshold premenstrual symptoms can be impairing even if the diagnostic criteria for premenstrual dysphoric disorder (PMDD) are not reached. Previous research suggests shared psychological risk factors without a clear differentiation of premenstrual syndrome (PMS) from PMDD. This study focuses on a sample with a wide range of premenstrual symptoms not reaching PMDD-criteria and aims to investigate within-person associations of premenstrual symptoms with daily rumination and perceived stress during the late luteal phase as well as cycle-phase specific associations of habitual mindfulness including present-moment-awareness and acceptance with premenstrual symptoms and impairment. Fifty-six naturally cycling women with self-reported premenstrual symptoms completed an online diary on premenstrual symptoms, rumination and perceived stress over two consecutive menstrual cycles, and baseline questionnaires on habitual present-moment-awareness and acceptance. Multilevel analyses revealed cycle-related variations in premenstrual symptoms and impairment (all ps <.001). Higher within-person levels of core and secondary premenstrual symptoms during the late luteal phase predicted increased daily rumination and perceived stress (all ps <.001) and increased somatic symptoms predicted increased rumination (p ≤.018). Higher habitual present-moment-awareness was linked to lower premenstrual symptom and impairment levels toward the late luteal phase whereas higher habitual acceptance was associated with lower premenstrual functional impairment (p ≤.015). Premenstrual symptom increases during the late luteal phase in women with PMS seem to be linked to increased daily rumination and perceived stress. Trait present-moment-awareness and acceptance in turn seem to reflect protective factors against premenstrual distress and may represent useful targets for interventions. [ABSTRACT FROM AUTHOR]

To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24–69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family. [ABSTRACT FROM AUTHOR]

Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2–3.1 for first trimester; 3.7, 95% CI 1.5–11.5 for second trimester; 3.4, 95% CI 1.9–6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8–65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts. [ABSTRACT FROM AUTHOR]

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1–4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8–10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela. [ABSTRACT FROM AUTHOR]

Obsessive–compulsive disorder (OCD) symptoms are more likely to develop or be exacerbated during pregnancy and the postpartum period, which can cause significant distress and impairment. However, the disorders grouped with OCD in the DSM-5, obsessive–compulsive and related disorders (OCRD; e.g., hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (TTM), excoriation disorder (ED)), have rarely been examined in the perinatal period. This study aimed to explore (1) the prevalence of all clinically significant OCRD symptoms in pregnancy and the postpartum period and (2) the correlations between OCRD psychopathology and postpartum functioning. Participants were recruited during their second trimester of pregnancy from a Midwestern medical center. Participants completed an online questionnaire and a semi-structured clinical interview during pregnancy (28–32 weeks' gestation, N = 276) and the postpartum period (6–8 weeks, N = 221). BDD and OCD symptoms were the most prevalent. In pregnancy, 14.9% (N = 41) of participants endorsed clinically significant BDD symptoms and 6.2% (N = 17) endorsed clinically significant OCD symptoms. In the postpartum period, 11.8% (N = 26) endorsed clinically significant BDD symptoms and 14% (N = 31) endorsed clinically significant OCD symptoms. Poorer postpartum functioning was associated with elevated OCRD symptoms in pregnancy and postpartum. OCRD symptoms occur during pregnancy and the postpartum period at rates similar or higher than other life periods. Elevated OCRD symptoms are associated with poorer postpartum functioning across domains. Future research should explore how all OCRD symptoms may affect functioning in the perinatal period, not only OCD symptoms. [ABSTRACT FROM AUTHOR]

Due to shortage of childcare facilities while high social expectations for mothering, becoming a mother is a big life challenge for most women in urban China. The understandings on Chinese postpartum women's affective well-being and its relation with spousal support and maternal role adaptation remain limited. This study aims to investigate the affective well-being (including both positive and negative affect) of Chinese urban postpartum women and how it is associated with spousal support and maternal role adaptation. A cross-sectional survey was conducted in Shanghai, China, between June and July 2019. A total of 498 urban mothers whose babies were 0 to 1 year old participated in this survey. They completed the Postpartum Social Support Questionnaire (PSSQ), the Maternal Role Adaptation Scale, and the Positive and Negative Affect Scale (PANAS), and reported socio-demographic information. Results showed that positive and negative affect of postpartum women were not significantly associated with each other. Positive affect had a positive correlation with spousal support and maternal role adaptation. Negative affect was negatively associated with maternal role adaptation, while not significantly associated with spousal support. Maternal role adaptation partially mediated the relationship between spousal support and positive affect of the participants, controlling for age, household income, education, birth order, and inter-generational support. The findings indicate that intervention programs towards mental health of postpartum women should focus more on positive affect cultivation; moreover, clinical services should help postpartum women to adapt to maternal role by encouraging new fathers' or partners' involvement in daily childcare-giving. [ABSTRACT FROM AUTHOR]

Summary: 'Indigenous peoples' across the globe suffer a disproportionate burden of mental illness. However, this burden is not fully explored in India despite having the second largest absolute concentration of indigenous peoples in the world. We did a secondary analysis of data from a cross-sectional survey in indigenous populations from the Nilgiri Biosphere Reserve in South India. Symptoms suggestive of psychological distress were reported by 39.9% participants. Being alone, tobacco use, hypertension, hypertension in family member, and violent conflict in household were independently associated with psychological distress. More epidemiological studies need to be conducted to map the burden and elaborate the relationships between mental health problems and socio-cultural factors in indigenous populations in India. [ABSTRACT FROM AUTHOR]

Exposure to adverse childhood experiences (ACEs) is associated with oxytocin dysregulation in women, such as decreased peripheral oxytocin concentrations, but little is known about vulnerability markers for oxytocin dysregulation in mothers exposed to ACEs. Identifying vulnerability markers may help inform future targets for prevention and intervention programmes. This study provided a preliminary examination of emotion regulation as a potential moderator of the association between maternal ACEs and peripheral oxytocin levels. The current study included a sample of 38 postpartum women. Women completed questionnaires on exposure to ACEs and difficulties with emotion regulation. At a clinic visit at 9 months postpartum, women provided plasma and salivary oxytocin samples anchored around a mother-infant interaction. Associations between maternal ACEs, three dimensions of difficulties with emotion regulation, and peripheral oxytocin concentrations were examined. Linear regression analyses showed that greater difficulties engaging in goal-directed behaviour (β = − 0.50, p = 0.01) and more limited access to effective emotion regulation strategies (β = − 0.68, p < 0.001) were related to reduced plasma oxytocin concentrations in postpartum women. Furthermore, in postpartum women reporting greater exposure to ACEs, higher levels of nonacceptance of emotional responses (β = − 0.55, p = 0.01) and more limited access to effective emotion regulation strategies (β = − 0.54, p = 0.01) were associated with reduced salivary oxytocin response (i.e. decreased change in oxytocin concentrations from baseline) following mother-infant interaction. Difficulties with emotion regulation may serve as a vulnerability marker for oxytocin dysregulation in postpartum women exposed to ACEs, and this suggests that emotion regulation may be an important target for future clinical interventions. Future research is recommended which replicates these preliminary results and which examines how emotion regulation and peripheral oxytocin levels in mothers exposed to ACEs are associated with parenting and child development outcomes. [ABSTRACT FROM AUTHOR]

Understanding if maternal depression is a predictor of infant-parent attachment classification is important to furthering knowledge about the early pathways and predictors of socio-emotional development. Yet few studies that have utilised the Strange Situation Procedure, the gold standard for measurement of infant-parent attachment, have examined antenatal depression as a predictor of attachment, and none has also included a measure of maternal trauma. This study uses data on 224 women recruited in early pregnancy and followed up until 12 months postpartum. Maternal depression was measured in pregnancy using the Structured Clinical Interview for the DSM and repeat Edinburgh Postnatal Depression Scale as well as Stressful Life Events scale across pregnancy and postpartum including items on domestic violence. A past history of trauma was measured using the Childhood Trauma Questionnaire. Attachment was measured using the Strange Situation Procedure (SSP) at 12 months postpartum. We found that maternal depression was not associated with insecure or disorganized attachment. However, a maternal history of childhood trauma and current domestic violence both predicted insecure-avoidant attachment at 12 months, whereas increased number of stressful life events prior to conception and in pregnancy was associated with insecure-resistant attachment. Neither trauma, past or current, nor depression predicted disorganized attachment. In the first study to have included measures of antenatal depression, maternal childhood trauma, and current stressful events as predictors of infant attachment measured using the SSP, we found maternal experiences of past and current trauma but not depression were significant predictors of infant-parent attachment security. [ABSTRACT FROM AUTHOR]

Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles "real-life interpersonal interactions." Although gender influences social functioning in "real-life situations," little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers' individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women. [ABSTRACT FROM AUTHOR]

In light of the impact of gender roles on health, the aims of the present study are (1) to assess the associations between femininity/masculinity and gender typologies, and health indicators (mental health, wellbeing, and self-perceived health) and (2) to identify patterns of gender roles and health indicators, thus exploring new tendencies in gender and health in Spanish university students in the framework of the androgyny model. The sample was made up of 795 university students from Madrid and Toledo. Data collection was completed during 2019. Measures of self-rated health, mental health (GHQ12), and wellbeing (MHC-SF) were considered as health indicators, while the Bem Sex Roles Inventory (BSRI) was used to measure gender roles. Multilevel analysis was employed to value associations between masculinity and femininity and gender typologies with self-rated health, mental health, and wellbeing. Furthermore, cluster analysis was used to explore general tendencies in gender roles and health, while also considering biological sex composition. The best predictor of mental health was found to be masculinity, rather than femininity. Cluster analysis showed a dominance of androgyny and undifferentiated typologies with proportionally similar biological sex composition. Results confirmed the androgyny model, highlighting the role of androgyny and masculinity as protective factors of mental health. Cluster analysis suggested less gender-typed individuals and more flexible ways of adapting to gender roles in university students. Health systems, governments, and public institutions must take these results into account when designing health prevention and intervention policies. Social agents, educators, and the media must also collaborate in the achievement of equalitarian gender roles, which could result in a minimization of gender-related health differences. [ABSTRACT FROM AUTHOR]

Becoming a mother is a fundamental life-transforming event characterized by high psychosocial distress. Most prenatal programming leaves women feeling unprepared for the realities of early parenthood. The purpose of this study was to design, implement, and evaluate a brief enhancement to existing prenatal programming, Welcome to Parenthood® (W2P). Using a single-group, longitudinal design, we implemented W2P with a community sample of 454 primiparous women via 11 Parent Link Centres in Alberta, Canada. The women completed questionnaires during late pregnancy, and 2 and 6 months postpartum to capture adverse childhood experiences (ACE), depressive symptoms (Edinburgh Postpartum Depression Scale; EPDS), and infant development (Ages and Stages Questionnaires; ASQs). Outcomes were compared with the naturalistic values from All Our Families community cohort from the same province and to the ASQ reference samples. By the end of W2P, depressive symptoms decreased significantly (p <.0001). The number of women with high depressive symptoms (EPDS ≥ 10) decreased almost by half, from 80 (17.6%) at enrollment to 41 (9.0%) at 6 months postpartum. Women with higher ACE had the greatest decrease in depressive symptoms. Infants in W2P had significantly better development than infants in reference samples. W2P is associated with improved maternal mood and infant development. Given that W2P is brief and uses natural supports, it may be integrated into existing prenatal programming for first-time mothers. [ABSTRACT FROM AUTHOR]

The purpose of the study is to explore changes in resilience and physical and psychological distress and their related factors over time in women with endometrial cancer. This study adopted a repeated measures design using purposive sampling and was conducted in a hospital in Taiwan. Data were collected before surgery, 2 weeks after surgery, and 3 months after surgery. The measured variables consisted of demographic and disease characteristics, social support, resilience, and physical and psychological distress. A total of 48 women participated in the study, of whom 42 (mean age = 54.2 years old) completed all of the questionnaires. The results showed that resilience and physical distress in women with endometrial cancer was not statistically significantly changed over time. Rather, their psychological distress was significantly alleviated 2 weeks and 3 months after surgery as compared to before surgery. Women with less social support showed a lower level of resilience. In addition, those with a lower level of resilience experienced greater psychological distress. Compared with those who received only surgical treatment, women who had undergone surgery combined with chemotherapy and radiotherapy had more physical distress. Clinical medical staff should conduct continuing assessments of the resilience, physical distress, and psychological distress of women with endometrial cancer. Interventions related to resilience-enhancing and self-care should be implemented to avoid worsening or to improve women's resilience and distress. [ABSTRACT FROM AUTHOR]

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services. [ABSTRACT FROM AUTHOR]

Early maternal-infant bonding problems are often forerunners of later emotional and behavioural difficulties. Interventions typically target the perinatal period but many risks may be established well before pregnancy. Here we examine the extent to which adolescent and young adult depression and anxiety symptoms predict perinatal maternal-infant bonding difficulties. The Victorian Intergenerational Health Cohort Study (VIHCS, est. 2006) is following offspring born to the Victorian Adolescent Health Cohort Study (VAHCS; est. 1992). VAHCS participants were assessed for depression and anxiety symptoms nine times during adolescence and young adulthood (age 14–29 years), and then contacted bi-annually (from age 29–35 years) to identify pregnancies. The Postpartum Bonding Questionnaire (PBQ) was administered to mothers at 2 and 12 months postpartum. A total of 395 women (606 infants) completed the 2-month and/or 12-month postpartum interviews. For most infants (64%), mothers had experienced depression and/or anxiety before pregnancy. Preconception depression and anxiety symptoms that persisted from adolescence into young adulthood predicted maternal-infant bonding problems at 2 months (β = 0.30, 95% CI 0.04, 0.55) and 12 months postpartum (β = 0.40, 95% CI 0.16, 0.63). Depression and anxiety symptoms occurring in young adulthood only, also predicted bonding problems at 12 months postpartum (β = 0.37, 95% CI 0.02, 0.71). Associations between preconception depression and anxiety symptoms and anxiety-related maternal-infant bonding problems at 12 months postpartum remained after adjustment for antenatal and concurrent postpartum depressive symptoms. This study puts forward a case for extending preconception health care beyond contraception and nutrition to a broader engagement in supporting the mental health of young women from adolescence. [ABSTRACT FROM AUTHOR]

Women face a high degree of pressure to breastfeed. However, some women are not able to breastfeed, or choose not to. Few studies have examined the experiences of non-breastfeeding mothers, including their challenges, supports, and mental health sequelae. We sought to identify women's experiences with breastfeeding, specifically their reasons for not breastfeeding, challenges faced, and supports received, and the association between breastfeeding and postpartum mental health. Self-identified postpartum women (N = 70) completed a questionnaire investigating perinatal health. Open-ended responses were analyzed using thematic analysis and quantitative measures were analyzed using descriptive statistics and multivariate analysis of variance (MANOVA). Qualitative analysis identified two main themes reflecting reasons for not breastfeeding (maternal factors and infant factors) and three primary challenges associated with not breastfeeding (emotional health, physical health, and perceived lack of support). Authors identified two main themes categorizing non-breastfeeding mothers' experiences with support (sources of support and type of support). A MANOVA revealed significantly greater levels of distress, anxiety, and depression, and lower levels of social support, among non-breastfeeding, relative to breastfeeding mothers. Findings reveal limitations in the availability of information and resources for non-breastfeeding mothers. It is possible that the pressure women may experience regarding breastfeeding may contribute to increased psychological distress for mothers who cannot or choose not to breastfeed. Based on our findings, future research and applied action should target the development and evaluation of informational resources and supports for non-breastfeeding women. [ABSTRACT FROM AUTHOR]

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40–56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β =.39, p <.001, adj. R2 =.20), lower perceived stress (PSS-10; β = −.55, p <.001, adj. R2 =.30), lower psychological distress (BSI-18; β = −.49, p <.001, adj. R2 =.22), better general psychological health (GHQ-12; β = −.49, p <.001, adj. R2 =.22), milder menopausal complaints (MRS II; β = −.41, p <.001, adj. R2 =.18), and lower depressive symptoms (ADS-L; β = −.32, p <.001, adj. R2 =.26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause. [ABSTRACT FROM AUTHOR]

Depression is one of mental health consequences that present in women with obstetric fistula. It is estimated that over 264 million people of all ages suffer from depression globally. The objective of this systematic review and meta-analysis was to synthesize the epidemiologic evidence from previous studies on the prevalence of depression among women with obstetric fistula in low-income African countries. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines to conduct this meta-analysis. The common databases (PubMed, SCOPUS, EMBASE, Psych INFO, Google Scholar, African Index Medicus, and African Journals Online (AJOL)) were searched for the relevant literature. We used a random-effect meta-analysis model to estimate the overall prevalence of depression and the Q -and I2 -statistics were used to assess the heterogeneity between the studies included in the meta-analysis. Egger's test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias. The pooled estimated prevalence of depression among women with obstetric fistula in low-income African countries was 56.2% (95% CI 43.1–68.4). The prevalence of depression among women with obstetric fistula was 74.4% in Ethiopia, 72.9% in Kenya, 46.0% in Malawi, 41.0% in Sudan, 34.8% in Nigeria, and 27.7% in Tanzania. Furthermore, the prevalence of depression was higher (97.0%) when it was measured by using Beck's Depression Inventory (BDI) when compared with Patient Health Questionnaire (PHQ9) (62.7%), General Health Questionnaire (GHQ-28) (36.7%), Hamilton Depression Rating Scale (HDRS) (41.0%), and Center for Epidemiologic Studies Depression Scale (CES-D) (27.7%). Moreover, the pooled estimated prevalence of depression among women with obstetric fistula was ranged from 48.1 to 57.7% in a leave-one-out sensitivity analysis. The prevalence of depression among women with obstetric fistula in low-income African countries was high. Screening and appropriate management of depression among women with obstetric fistula are warranted. [ABSTRACT FROM AUTHOR]

The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30–60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60–100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine. [ABSTRACT FROM AUTHOR]

Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973–1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13 years. The current study includes children aged 0–12 years (N = 5532, M = 6.99 years, SD = 3.22 years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0–4 years (unstandardized regression coefficient (B) = − 0.26, 95%CI − 0.38, − 0.13) and children aged 5–12 years (B = − 0.25, 95%CI − 0.34, − 0.16), and by post-birth maternal stress (B = − 0.04, 95%CI − 0.08, − 0.01), and parenting (B = − 0.03, 95%CI − 0.04, − 0.02) in children aged 5–12 years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the predictive value of dyspareunia, general chronic pain, and metacognitive beliefs to sexual distress in a sample of women with endometriosis. Ninety-six women (mean age = 34.60 ± 6.44 years) with a diagnosis of endometriosis took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Metacognitive beliefs and sexual distress were assessed by means of the Metacognitions Questionnaire (MCQ30) and the Female Sexual Distress Scale-R (FSDS-r). General chronic pain intensity was collected by means of a Numeric Rating Scale. Data were subjected to Hierarchical logistic regression. We found high percentages of dyspareunia and sexual distress (i.e., 66% and 76%). Findings suggested that dyspareunia and chronic pain did not predict sexual distress, while negative beliefs about worries predicted sexual distress over and above them (p =.040, odd ratio 1.159). In the target population, metacognitive beliefs may have more influence on sexual distress than pain symptomatology. [ABSTRACT FROM AUTHOR]

In the general population, sleeping problems can precede an episode of depression. We hypothesized that sleeping problems during pregnancy, including insomnia symptoms, shortened sleep, and daytime tiredness, are related to maternal postnatal depressiveness. We conducted a prospective study evaluating sleep and depressive symptoms, both prenatally (around gestational week 32) and postnatally (around 3 months after delivery) in the longitudinal CHILD-SLEEP birth cohort in Finland. Prenatally, 1667 women returned the questionnaire, of which 1398 women participated also at the postnatal follow-up. Sleep was measured with the Basic Nordic Sleep Questionnaire (BNSQ) and depressive symptoms with a 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D). Altogether, 10.3% of the women had postnatal depressiveness (CES-D ≥ 10 points). After adjusting for main background characteristics and prenatal depressiveness (CES-D ≥ 10), poor general sleep quality (AOR 1.87, 95% CI 1.21–2.88), tiredness during the day (AOR 2.19, 95% CI 1.41–3.38), short sleep ≤ 6 and ≤ 7 h, sleep latency > 20 min, and sleep loss ≥ 2 h were associated with postnatal depressiveness (all p <.050). Postnatally, after the adjustment for background characteristics, virtually all sleeping problems (i.e., difficulty falling asleep (AOR 7.93, 95% CI 4.76–13.20)), except frequent night awakenings per week or severe sleepiness during the day, were related to concurrent postnatal depressiveness. Thus, several prenatal and postnatal sleeping problems are associated with increased depressive symptoms 3 months postnatally. Screening of maternal prenatal sleeping problems, even without depressive symptoms during pregnancy or lifetime, would help to identify women at an increased risk for postnatal depressiveness. [ABSTRACT FROM AUTHOR]

Health-related quality of life (HRQoL) in patients with schizophrenia is related to the severity of psychiatric symptoms. The objective of this study is to analyze whether the symptoms that influence HRQoL are similar in women and men. Data were part of the Pattern study, an international observational investigation which collected data from 1379 outpatients with schizophrenia. Patients were evaluated with the Mini International Neuropsychiatric Inventory, the Clinical Global Impression-Schizophrenia, and the Positive and Negative Syndrome Scale (PANSS), and reported their quality of life using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D). Men reported higher HRQoL on all scales. PANSS total score was 80.6 (SD 23.6) for women and 77.9 (SD 22.1) for men. In women, a higher PANSS negative score and a higher PANSS affective score were associated with a lower SQLS score. In men, a higher PANSS positive score and a higher PANSS affective score were associated with a lower SQLS score. The same pattern appeared with EQ-VAS and EQ-5D tariff. In women, greater age and higher PANSS affective score were associated with a lower SF-36 mental component score. In men, higher PANSS affective, positive, and cognitive scores were associated with a lower SF-36 mental component score. This study shows that HRQoL is influenced by different psychiatric symptoms in women and men. This may have significant implications when deciding the main treatment target in patients with schizophrenia. ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT01634542 [ABSTRACT FROM AUTHOR]

The goals of this research were to characterize suicidal behavior among a cohort of pregnant Peruvian women and identify risk factors for transitions between behaviors. The World Health Organization Composite International Diagnostic Interview suicide questionnaire was employed to assess suicidal behavior. Discrete-time survival analysis was used to study the cumulative age-of-onset distribution. The hazard function was calculated to assess the risk of onset of each suicidal behavior. Among 2062 participants, suicidal behaviors were endorsed by 22.6% of participants; 22.4% reported a lifetime history of suicidal ideation, 7.2% reported a history of planning, and 6.0% reported attempting suicide. Childhood abuse was most strongly associated with suicidal behavior, accounting for a 2.57-fold increased odds of suicidal ideation, nearly 3-fold increased odds of suicide planning, and 2.43-fold increased odds of suicide attempt. This study identified the highest prevalence of suicidal behavior in a population of pregnant women outside the USA. Diverse populations of pregnant women and their patterns of suicidal behavior transition must be further studied. The association between trauma and suicidal behavior indicates the importance of trauma-informed care for pregnant women. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to investigate how post-surgery multifaceted body image predicts negative affect (NA) 6 months post-surgery among women undergoing mastectomy. In total, 310 Chinese women undergoing mastectomy were recruited from a hospital in the Hunan province between 2012 and 2013. Upon enrollment (T1), all women were administered the Chinese version of Body Image after Breast Cancer Questionnaire (BIBCQ) (BIBCQ-C), NA subscale of Positive and Negative Affect Schedule (PANAS), Multidimensional Scale of Perceived Social Support (MSPSS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). Two weeks later, BIBCQ-C was re-administered. Six months later (T2), the NA subscale was administered again. We first evaluated the psychometric properties of BIBCQ-C, and then investigated the long-term impact of different aspects of body image on NA using forced entry hierarchical regression analyses. The BIBCQ-C scores demonstrated acceptable internal consistency (all Cronbach’s α > 0.70) and test-retest reliability (all ICC > 0.86). Confirmatory factor analysis supported the six-factor model (CFI = 0.93, TLI = 0.94, RMSEA = 0.04). Regression analysis showed that two dimensions of body image, vulnerability (β = 0.217) and body concern (β = 0.119) at T1, significantly predict NA at T2 (all p < 0.05). BIBCQ-C was a good instrument for measuring multifaceted body image. Improvement of vulnerability and body concern, two aspects of body image, may reduce post-surgery NA among Chinese women undergoing mastectomy. [ABSTRACT FROM AUTHOR]

Psychiatric illness can pose serious risks to pregnant and postpartum women and their infants. There is a need for screening tools that can identify women at risk for postpartum psychosis, the most dangerous perinatal psychiatric illness. This study used exploratory factor analysis (EFA) and Rasch item response theory (IRT) models to evaluate the psychometric properties and construct validity of the Spanish language version of the 16-item Prodromal Questionnaire (PQ-16) as a screening tool for psychosis in a population of pregnant Peruvian women. The EFA yielded a four-factor model, which accounted for 44% of the variance. Factor 1, representing “unstable sense of self,” accounted for 22.1% of the total variance; factor 2, representing “ideas of reference/paranoia,” for 8.4%; factor 3, representing “sensitivity to sensory experiences,” accounted for 7.2%; and factor 4, possibly representing negative symptoms, accounted for 6.3%. Rasch IRT analysis found that all of the items fit the model. These findings support the construct validity of the PQ-16 in this pregnant Peruvian population. Also, further research is needed to establish definitive psychiatric diagnoses to determine the predictive power of the PQ-16 as a screening tool. [ABSTRACT FROM AUTHOR]

Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women’s psychological reactions. This study examined the influence of perceived and internalized stigma on women’s long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore gender differences in the level of health-related quality of life (HRQoL) and coping strategies among people living with the human immunodeficiency virus (HIV) (PLWH). In particular, the moderating role of participants’ gender on the relationship between coping strategies and HRQoL was explored, while controlling for socio-medical data. A total of 444 HIV-infected men and 86 HIV-infected women were recruited to participate in the study. This was a cross-sectional study with the HRQoL assessed by the World Health Organization (WHO) Quality of Life-BREF (WHOQOL-BREF) and the coping strategies measured by the Brief COPE inventory. Although the HIV-infected men and HIV-infected women differed in terms of some HRQoL domains, these differences disappeared in the regression analysis after controlling for socio-demographic data (employment and higher education). In addition, several statistically significant interactions between participants’ gender and coping strategies in relation to HRQoL domains were observed. Future research on gender differences in HRQoL among PLWH should take into account unique differences between HIV-infected men and HIV-infected women across, not only in respect to socio-medical factors but also regarding psychosocial variables. [ABSTRACT FROM AUTHOR]

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women’s depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health. [ABSTRACT FROM AUTHOR]

Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy. [ABSTRACT FROM AUTHOR]

Studies of pregnancy-specific anxiety suggest that it is a distinct construct which predicts perinatal outcomes more effectively than other general measures of anxiety. In response, a novel measure of postpartum-specific anxiety (PSAS) has been developed and validated, but it is not yet clear whether it possesses the same predictive power as its pregnancy-specific counterparts. The aim of this short-term prospective study was to (a) test the predictive validity of the PSAS in the context of one specific perinatal outcome, infant-feeding, and (b) examine whether the PSAS may be more efficacious at predicting infant-feeding outcomes and behaviours than the more commonly used general measures. Eight hundred mothers of infants aged between 0 and 6 months completed the PSAS alongside general measures of anxiety and depression at baseline. A subsample (n = 261) returned to complete a follow-up questionnaire examining infant-feeding outcomes and behaviours two weeks later. Hierarchical regression models revealed that the PSAS was associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum. PSAS scores were also significantly associated with infant-feeding behaviours including a lower perceived enjoyment of food, and greater perceived food responsiveness and satiety responsiveness in the infant. As hypothesised, the PSAS was a stronger predictor of infant-feeding outcomes and behaviours than general anxiety and depression. The findings provide evidence for the predictive validity of the PSAS and call for the use of childbearing specific measures of mood when attempting to predict perinatal outcomes. Replication of these findings across other indices of maternal and infant health is now necessary. [ABSTRACT FROM AUTHOR]

Depression during pregnancy is highly prevalent and is associated with increased risk of a variety of negative psychological and medical outcomes in both mothers and offspring. Antenatal depression often co-occurs with significant anxiety, potentially exacerbating morbidities for women and their children. However, screening during the antenatal period is frequently limited to assessment of depression so that other significant comorbid disorders may be missed. Follow-up assessment by clinicians has similarly focused primarily on detection of depressive symptoms. Anxiety, obsessive compulsive disorder, and post-traumatic stress disorder, among others, often go undetected in perinatal care settings, even when depression is identified. Failing to recognize these comorbid diagnoses may lead to inadequate treatment or only partial alleviation of distress. Consequently, screening for and assessment of comorbid disorders is warranted. In this study, 382 pregnant women ( M age = 25.8 [SD = 5.3] years, 85.0% Caucasian) receiving care at a university hospital clinic and Maternal Mental Health Care centers in eastern Iowa and who screened positive for depression on the Beck Depression Inventory completed the Structured Clinical Interview for DSM-IV to assess comorbid mental health symptoms and diagnoses. Overall, findings demonstrate high rates of anxiety disorders among women both with and without current major depression, although depressed women reported higher rates of generalized anxiety disorder and post-traumatic stress disorder. Notably, however, incidence-specific symptoms were comparable across groups. Routine screening of both anxiety and depression during pregnancy should be conducted. [ABSTRACT FROM AUTHOR]

We examined the utility of screening instruments to identify risk factors for suicidal ideation (SI) in a population of women with neuropsychiatric illnesses at high risk for postpartum depression. Pregnant women with neuropsychiatric illness enrolled prior to 20 weeks of gestation. Follow-up visits at 4-8-week intervals through 13 weeks postpartum included assessment of depressive symptoms with both clinician and self-rated scales. A total of 842 women were included in the study. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore and quantify perceptions and experiences of women with a traumatic childbirth experience in order to identify areas for prevention and to help midwives and obstetricians improve woman-centered care. A retrospective survey was conducted online among 2192 women with a self-reported traumatic childbirth experience. Women were recruited in March 2016 through social media, including specific parent support groups. They filled out a 35-item questionnaire of which the most important items were (1) self-reported attributions of the trauma and how they believe the traumatic experience could have been prevented (2) by the caregivers or (3) by themselves. The responses most frequently given were (1) Lack and/or loss of control (54.6%), Fear for baby's health/life (49.9%), and High intensity of pain/physical discomfort (47.4%); (2) Communicate/explain (39.1%), Listen to me ( more) (36.9%), and Support me ( more/better) emotionally/practically (29.8%); and (3) Nothing (37.0%), Ask for (26.9%), or Refuse (16.5%) certain interventions. Primiparous participants chose High intensity of pain/physical discomfort, Long duration of delivery, and Discrepancy between expectations and reality more often and Fear for own health/life, A bad outcome, and Delivery went too fast less often than multiparous participants. Women attribute their traumatic childbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions. [ABSTRACT FROM AUTHOR]

It was recently reported that pregnant women were more likely to have minor depression as measured by the Patient Health Questionnaire-8 depression scale (PHQ-8), (as reported by Kroenke and Spitzer (Psychiatr Ann 32(9):1-7, 2002), and Kroenke et al. (J Affect 114(1-3):163-173, 2009)) compared to women who were not pregnant (as reported by Ashley et al. (Arch Womens Ment Health 19(2):395-400, 2015)). The present study is designed to investigate if somatic symptoms (energy level, appetite, sleep) associated with both pregnancy and depression were responsible for this increased prevalence of minor depression. A sample of pregnant women ( n = 404) was compared to women who were not pregnant ( n = 6754). Both groups scored within the minor depression range on the PHQ-8 and comparisons were based on participants' responses to PHQ-8 items. Results indicate that of the somatic symptoms of depression, only changes in energy level accounted for the elevated prevalence of minor depression among pregnant women compared to women who are not pregnant. Removing the decreased energy item from the score determination reduces the prevalence of minor depression among pregnant women to a level significantly below that of women who are not pregnant. Emotional symptoms such as feeling down and feeling like a failure were less likely to be reported by pregnant women compared to women who were not pregnant. Implications for depression screening during pregnancy are discussed. [ABSTRACT FROM AUTHOR]

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) reported to affect 3-8 % of women of reproductive age and resulting in marked emotional and occupational impairment. Despite its prevalence, the etiology of PMDD is largely unknown, and patients remain mostly undiagnosed and poorly treated. It has been suggested that PMDD is a manifestation of underlying depressive disorder which is associated with the inability to regulate emotions in an adaptive manner. Therefore, we hypothesized that women with PMDD would exhibit increased difficulty with emotional regulation. A total of 648 female Israeli college students were assessed by the Premenstrual Symptoms Screening Tool (PSST) and the Difficulties in Emotion Regulation Scale (DERS). Of these women, 166 (25.6 %) met the criteria for PMS. Sixty-four (9.9 %) suffered from PMDD. More emotion regulation deficits were observed in the PMDD and PMS groups compared to the control group. Furthermore, there were more emotional regulation deficits among the predominantly psychological and mixed symptom subtype compared to the predominantly physical symptom subtype group. This is the first study to report an association between emotional dysregulation and PMDD. These findings may lead to development of more individually tailored treatment protocols focused on improving emotional regulation techniques. [ABSTRACT FROM AUTHOR]

There is accumulating evidence for the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of depression. However, the role of BDNF in the pathophysiology of post-traumatic stress disorder (PTSD) remains controversial, and no study has assessed BDNF concentrations among pregnant women with PTSD. We examined early-pregnancy BDNF concentrations among women with PTSD with and without depression. A total of 2928 women attending prenatal care clinics in Lima, Peru, were recruited. Antepartum PTSD and depression were evaluated using PTSD Checklist-Civilian Version (PCL-C) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. BDNF concentrations were measured in a subset of the cohort ( N = 944) using a competitive enzyme-linked immunosorbent assay (ELISA). Logistic regression procedures were used to estimate odds ratios (OR) and 95 % confidence intervals (95 % CI). Antepartum PTSD (37.4 %) and depression (27.6 %) were prevalent in this cohort of low-income pregnant Peruvian women. Approximately 19.9 % of participants had comorbid PTSD-depression. Median serum BDNF concentrations were lower among women with comorbid PTSD-depression as compared with women without either condition (median [interquartile range], 20.44 [16.97-24.30] vs. 21.35 [17.33-26.01] ng/ml; P = 0.06). Compared to the referent group (those without PTSD and depression), women with comorbid PTSD-depression were 1.52-fold more likely to have low (<25.38 ng/ml) BDNF concentrations (OR = 1.52; 95 % CI 1.00-2.31). We observed no evidence of reduced BDNF concentrations among women with isolated PTSD. BDNF concentrations in early pregnancy were only minimally and non-significantly reduced among women with antepartum PTSD. Reductions in BDNF concentrations were more pronounced among women with comorbid PTSD-depression. [ABSTRACT FROM AUTHOR]