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Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime.In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated.At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined-all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes.Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Objectives Early first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change. Methods The study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions-when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care. Results On average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card. Conclusions for practice This study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted. WHAT IS ALREADY KNOWN ON THIS SUBJECT?: Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit. WHAT THIS STUDY ADDS?: Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.

BACKGROUND: A standard format for depression management has long been the in-person group-based intervention, yet recent calls for scalable interventions have increased interest in individual online formats. However, the perspectives and preferences of women are largely missing in the literature. METHODS: This secondary qualitative data analysis using a phenomenological method of inquiry explored the lived experiences of pregnant and non-pregnant women with depressive symptoms (n=44) who participated in two studies involving group-based face-to-face mindful physical activity interventions for depressive symptom self-management. RESULTS: Four main themes emerged regarding the group format: shared experiences enhanced the feeling of safety and impact of the group interventions; group instructors played a key role in fostering a safe environment; participants wished for more group interactions; and, participants preferred a synchronous group-based intervention over a technology-based or asynchronous alternative for depressive symptom management. CONCLUSION: The findings from this study suggest that women with depression enjoy synchronous group-based interventions and find them to be beneficial for the shared experiences with other women and the safe environment created by group instructors. Future research should include study designs that consider these factors in the context of hybrid or fully online intervention formats for depression management.

Background Nearly 20% of women in the United States experience depressive symptoms during the perinatal period, with known detrimental effects for the mother, child, and family. Depressive symptoms affect motivation to engage in healthy behaviors and self-management of symptoms. Purpose The purpose of this study was to explore the experiences of women with depressive symptoms who participated in a 12-week mindful physical activity intervention (Mindful Moms) throughout their pregnancy. Study design In this qualitative study, we explore the lived experience of women with depressive symptoms who participated in Mindful Moms, a self-management intervention involving nurse-led motivational sessions and group-based mindful physical activity (yoga). Methods Semistructured interviews conducted at approximately 6 weeks postpartum provided rich qualitative data that was analyzed using a phenomenological approach. Results Twenty-five women participated. Findings suggest that participants in Mindful Moms felt empowered to manage their depressive symptoms through the combination of four key factors: a newly recognized need for help, a felt sense of physical and emotional benefit from participation, the power of shared safe space with other pregnant women, support from study staff, and an overall sense of empowerment. Clinical implications Mindful Moms appears to be a feasible and acceptable approach to enhancing motivation to self-manage depressive symptoms in pregnant women. Nurses working with childbearing women should be aware of the potential benefits of self-management strategies, such as mindful physical activity and motivational interviewing, for women facing perinatal depressive symptoms.

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals’ relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human–animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI–HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

Mid-career nurse scientists in academia are at risk for burnout and departing scientific careers, particularly those in research-intensive academic settings. With the shortage of nursing faculty and the public health need for high-quality nursing research, it is critical to retain current research-focused individuals in nursing. In this paper, we discuss definitions and expectations of mid-career scientists, challenges and barriers faced by mid-career scientists, and opportunities for mid-career scientists, informed by both nursing and non-nursing literature. Finally, we focus on definitions and expectations, challenges, and opportunities specifically related to mid-career nurse scientists in research-intensive academic settings.

Anxiety is a common mood symptom that may be experienced by some menopausal women; however, few studies have explored the concept of anxiety in the context of menopause. Consequently, the anxiety experience in menopause is not well defined and raises the question: Is menopausal anxiety a unique and distinctly different syndrome? The aim of this qualitative study was to gain an in-depth understanding of the experience of new-onset anxiety in menopausal women.

Background: It is well-documented that the mental health of pregnant and postpartum women is essential for maternal, child, and family well-being. Of major public health concern is the perinatal mental health impacts that may occur during the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is essential to explore the symptom experience and predictors of mental health status, including the relationship between media use and mental health. Materials and Methods: The purpose of this study is to evaluate the experiences of pregnant and postpartum women (n = 524) in the United States in the early phase of the COVID-19 pandemic. This cross-sectional online observational study collected psychosocial quantitative and qualitative survey data in adult pregnant and postpartum (up to 6 months postdelivery) women in April–June 2020. Results: Multivariable linear regression models were used to evaluate predictors of depressive symptoms, anxiety, and post-traumatic stress disorder. The most common predictors were job insecurity, family concerns, eating comfort foods, resilience/adaptability score, sleep, and use of social and news media. Qualitative themes centered on pervasive uncertainty and anxiety; grief about losses; gratitude for shifting priorities; and use of self-care methods including changing media use. Conclusions: This study provides information to identify risk for anxiety, depression, and PTSD symptoms in perinatal women during acute public health situations. Women with family and job concerns and low resilience/adaptability scores seem to be at high risk of psychological sequelae. Although use of social media is thought to improve social connectedness, our results indicate that increased media consumption is related to increased anxiety symptoms.

Background The mid-career nurse scientist, defined as an associate professor with/without tenure, is often faced with a multitude of challenges and opportunities Purpose This paper shares strategies to assist mid-career scientists as they juggle required career demands and navigate the mid-career phase in pursuit of the rank of full professor. Method A review of the literature was performed on mid-career nurse scientists. Discussion A combination of increased research responsibilities, increased institutional teaching and service demands, and dwindling support can result in a sense of overwhelm and burnout. The mid-career nurse scientist must balance several balls in the air at one time to remain successful. Conclusion Strategies aligned with the Ecological Framework, focus on intrapersonal, interpersonal, institutional, organizational, and public policy domains to provide a wide scope of strategies that target the mid-career scientist and engage the larger nursing community.

Nurse burnout is a threat to safe, efficient health care delivery, yet estimated rates of nurse burnout are above 40 %. A critical step in reducing burnout is identifying phenomena that are amenable to intervention. Loneliness may be one such factor, yet the relationship between loneliness and burnout is not clearly described. This review aims to summarize existing literature documenting this connection. A systematic search was performed to identify studies reporting a relationship between burnout and loneliness with social support serving as a proxy construct. Twenty-four articles met inclusion criteria: 18 quantitative, two mixed-methods, and four qualitative studies. These studies identified a relationship between burnout and social support, with social support explaining approximately a third of the variability in burnout. Qualitative data suggest that social support is critical to coping with work stressors and is likely related to burnout. This review provides evidence that reducing nurse loneliness is a promising strategy for improving nurse wellbeing.

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women. This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1β, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population. Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response.

Maternal stress exposure during the COVID-19 pandemic may have transgenerational effects, adversely affecting both the pregnant woman and her offspring. Therefore, there is an urgent need to characterize the coping styles and psychosocial distress of pregnant and postpartum women during the COVID-19 pandemic to help mitigate lasting sequalae on both mothers and infants. Here we use latent profile analysis to examine patterns of behavioral coping strategies associated with risk and resiliency to adverse mental and physical health outcomes. Leveraging a large U.S. sample of perinatal women (N = 2,876 pregnant women, N = 1,536 postpartum women), we identified four behavioral phenotypes of coping strategies: (1) passive-coping, characterized by primarily engaging in high levels of screen time, social media use, and eating comfort foods; (2) active-coping, characterized by primarily engaging in high levels of self-care, social support, and limiting media exposure; (3) low-coping, characterized by low levels of all coping strategies; (4) high-coping, characterized by high levels of both active and passive coping strategies. Critically, we found that passive-coping phenotypes were associated with higher levels of depression and anxiety and worsening stress and energy levels in both pregnant and postpartum women. Supplementing passive coping strategies with high levels of active coping strategies (the high-coping profile) lessened adverse outcomes in postpartum women. These behavioral coping phenotypes highlight potential risk and protective factors for perinatal women, which is critical in helping to identify and treat perinatal women most at risk for experiencing mood and affective disorders resulting from the COVID-19 pandemic.

Background: Adequate perinatal care is essential for maternal and infant health. The novel coronavirus (COVID-19) pandemic is potentially the largest natural disruption to perinatal care in recent history, but these disruptions have yet to be characterized in a rigorous and systematic manner. Our goal was to document COVID-19 induced disruptions to perinatal care across the United States (US) using analyses sensitive to the temporal and geographical variability of the pandemic, and to examine the impact of these healthcare disruptions on maternal mental health. Methods: We performed an observational cross-sectional study of 1,922 postpartum and 3,868 pregnant individuals during the 2020 COVID-19 pandemic. Perinatal individuals were recruited from 15 academic institutions across the US, resulting in a geographically diverse sample. We conducted (1) descriptive analyses on the prevalence and timing of perinatal care disruptions, (2) group difference analyses to compare perinatal care disruptions depending on when and where individuals gave birth, (3) cross correlations to assess the temporal linkage between perinatal care disruptions and COVID-19 infection rates, and (4) hierarchical linear regressions to evaluate the impact of prenatal care and birth protocol disruptions on maternal psychological health. Findings: The COVID-19 pandemic significantly altered perinatal care across the US, both through restriction of in-person support and by shifting the focus of care. These changes occurred unevenly over time and across geographic locations. Changes in COVID-19 infection rates explained 65 to 78% of the variance in perinatal care disruptions from August 2019 to August 2020. Moreover, disruptions to perinatal care were robustly associated with heightened psychological distress in mothers, even after controlling for mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Interpretation: Our analyses reveal widespread disruptions to perinatal care across the US that fluctuated depending on where and when individuals gave birth, demonstrating reactivity and elasticity of the US healthcare system. In addition to influencing health outcomes, disruptions to perinatal care may also exacerbate mental health concerns during the COVID-19 pandemic. Funding Information: This research was supported by the NYU COVID-19 Research Catalyst rant, R34DA050287-S1, R34DA050287-S2, R34DA050254-01S2, R01MH126468, R01MH125870, the Nathaniel Wharton Fund, the Columbia University Population Research Center, R34DA050255, R34DA050255-01S2, the Fralin Biomedical Research Institute at VTC, the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016, the University of Utah Center for Clinical and Translational Science COVID-19 Research Award, Virginia Commonwealth University School of Nursing Internal Grants Program, Sarah P. Farrell Legacy Research Endowment-Virginia Commonwealth University, 5R03HD096141-02, R01HD085990, R34DA050283-01S2, the USC Center for the Changing Family, the Stanford Institute for Research in the Social Sciences, R34DA050291, R01MH119070, R01MH117177, R34 DA050272-01S1, R01 MH113883, R01 DA046224, R21 MH111978, and R21 HD090493, R37 MH10149, UH3OD023279, and National Center for Advancing Translational Sciences (NCATS) Grant UL1TR001881 Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: This study has received Institutional Review Board approval from theNYU Langone Health IRB as well as the local IRBs at each data collection site. All data was collected in accordance with the Helsinki Declaration.

Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, non-pharmacologic, and inexpensive self-management approaches, such as via internet and mobile-based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally-funded large-scale randomized controlled study to evaluate “Mamma Mia,” a self-guided program with 44 modules that women use throughout pregnancy to six months postpartum. The program contains a novel combination of components designed to enable women to enhance self-efficacy, emotional self-regulation, and perceived social support. The overall goal of this three-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in diverse women in the U.S. (n=1,950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) “Mamma Mia” alone, which is self-guided; (2) “Mamma Mia Plus” in which participants engage in the “Mamma Mia” modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well-being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self-Management Theory, the third aim is to evaluate possible mediators (self-efficacy, emotion self-regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self-management approach.

Complementary and integrative health approaches are increasingly recognized as important for prevention of or intervention in health concerns in general, and many women in the United States seek accessible approaches for specifically enhancing mental wellness. In this chapter, we review briefly the key terminology regarding, classifications of, and important resources for complementary and integrative health approaches. We present findings from three recent research studies about the use of mind-body approaches (guided imagery, tai chi, and yoga) specifically for women’s mental health. A discussion of clinical and research implications of these studies is intended to inform healthcare professionals’ knowledge about these increasingly accessible, safe, and effective complementary approaches for self-care and management of stress and depression in women.

Background Mid-career nurse scientists in academia face many challenges that can lead to burnout and exiting the profession. Finding ways to increase satisfaction and support will help retain these critical faculty in research positions. Purpose Describe areas of satisfaction and challenges to success in the faculty role for mid-career nurse scientists in academia. Method Cross-sectional, descriptive. A total of 65 self-identified mid-career nurse scientists completed an online survey. Findings Mid-career nurse scientists were most satisfied with their role at their organization, least satisfied with time for research and opportunities to receive mentoring. They felt moderately supported by colleagues and deans, least supported by their ADR. Differences in satisfaction among nurse scientists in different levels of research institutions were noted. Discussion Challenges to success in mid-career nurse scientists exist. Loss of nurse scientists at mid-career threatens to undermine the knowledge base of the individuals who mentor the next generation of scientists. The discipline must support mid-career scientists in their efforts to be successful in research.

Background/Purpose A qualitative study was designed to explore facilitators and barriers to success from the perspectives of self-identified mid-career nurse scientists. Methods Data were collected from 84 respondents using open-ended items as part of an electronic survey of self-identified mid-career nurse scientists who were members of regional nursing research societies. Discussion/Conclusion Two main themes emerged: “Perceived Realities” and “What's Needed to Achieve Career Success.” Mid-career nurse scientists experience both joy from teaching and research roles and dissatisfaction with research support; difficulty balancing heavy teaching workload, administrative responsibilities, and research, and ineffective mentoring. Based on the challenges in their environment, respondents identified numerous ways to enhance career success including (1) increasing or enhancing release time for research activities, (2) formal infrastructure to support research activities, and (3) targeted, effective mentoring by senior scientists.

Purpose Severe asthma is an inflammatory illness associated with adverse health outcomes and behaviors in children, such as decreased quality of life, impaired sleep, and increased medical costs and morbidity. Conclusions Children with severe asthma frequently exhibit a cycle of health and behaviors which contribute to these adverse health outcomes, consisting of decreased physical activity, increased stress, and increased airway inflammation and asthma exacerbations. School-age children, in particular, are a vulnerable population because they not only rely on others for their care but also suffer from a chronic illness and are at risk for unequal healthcare access and health outcomes. Practice implications Currently, there is no one nursing theory that adequately addresses the vulnerability, cycle of health and behaviors, and adverse health outcomes of children with severe asthma. By integrating key concepts from three vulnerability theories and presenting a modified conceptual framework, this paper aims to demonstrate how the use of this new conceptual framework may assist nurses in evaluating the unique needs of school-age children with severe asthma to provide best practices and develop appropriate interventions.

Prenatal maternal depression increases the risk of negative maternal-infant health outcomes but often goes unrecognized. As a result, biomarker screening tests capable of identifying women at risk for depression are highly desirable. This study tested how demographic and clinical factors affect the predictive validity of a DNA methylation-based screening test for postpartum major depression (MD) using data from a longitudinal study of birth outcomes. Lifetime history of MD and current levels of postpartum depressive symptoms were assessed using an extended self-report version of the Composite International Diagnostic Interview Short Form and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Predictive validity of the test was estimated in the PREG cohort using the area under the receiver operator characteristic curve (AUC), and sensitivity analyses were performed to assess the impact of self-reported race, age, and pre-pregnancy history of MD. Data for N=103 pregnant participants (African-American=49; European-American=54) were available. The prediction model identified women who would develop high levels of postpartum depressive symptoms better within the subset of women with previous histories of MD (AUC = 0.94, 95% CI 0.79-1.00) compared to the full pregnant cohort (AUC = 0.62, 95% CI 0.46-0.79). This observation prompted secondary analyses to test the model specificity for postpartum depression. The model predicted lifetime history of MD moderately well in never-pregnant, mixed-sex cohort of adolescents (N=150; ages 15-20; AUC = 0.75, 95% CI 0.57-0.92) and performed slightly better in males versus females. Additional sensitivity analyses are needed to determine the extent of the model’s specificity for MD subtypes and if demographic or clinical factors influence the predictive validity of this model.

Purpose: To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind–body self-care approaches in at-risk women. Method: Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. Findings: Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. Conclusions: The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind–body self-care approaches into practice.

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

Introduction: Major depression during the peripartum (MDP) period carries significant public health impact due to the potential adverse effects on maternal, infant, and family outcomes. Methods: As part of a larger longitudinal study, this cross-sectional observational study sought to build upon the current literature on the prevalence and predictors of depression in the early second trimester of pregnancy, as related to generally accepted risk factors and other less explored risk factors. Results: The findings from this study suggest that in this sample of 230 black and white women at ∼14 weeks gestation, ∼19% endorsed depressive symptoms and that the most important predictors of depression in pregnancy were a preconception history of a mental health issue (e.g., lifetime depressive episode) and perceived stress. Other relevant predictors were pregnancy-related anxiety, income, and stressful life events. Conclusion/Clinical Relevance: It is important for clinicians not only to screen for MDP during prenatal visits by asking about current depressive, stress, and anxiety symptoms but also to identify patients at risk for MDP by asking simple questions about history of preconception/lifetime episodes of depression and stressful life events. Given the variance accounted for by lifetime depression, additional research into how clinicians may approach this important topic is warranted. For example, checklists given in the waiting room may be less likely to elicit endorsement compared with conversations aimed to normalize the range of depressive histories that may have relevance to obstetric health.

Objective To conduct an integrative review to evaluate current literature about nonpharmacologic, easily accessible management strategies for pregnancy-related low back and pelvic pain (PR-LBPP). Data Sources PubMed, CINAHL, Cochrane Database of Systematic Reviews. Study Selection Original research articles were considered for review if they were full-length publications written in English and published in peer-reviewed journals from 2005 through 2015, included measures of pain and symptoms related to PR-LBPP, and evaluated treatment modalities that used a physical exercise or yoga-based approach for the described conditions. Data Extraction Electronic database searches yielded 1,435 articles. A total of 15 articles met eligibility criteria for further review. Data Synthesis These modalities show preliminary promise for pain relief and other related symptoms, including stress and depression. However, our findings also indicate several gaps in knowledge about these therapies for PR-LBPP and methodologic issues with the current literature. Conclusion Although additional research is required, the results of this integrative review suggest that clinicians may consider recommending nonpharmacologic treatment options, such as gentle physical activity and yoga-based interventions, for PR-LBPP and related symptoms.

Problem Asthma affects almost 15% of children in the United States. Despite the availability of treatments and educational methods, children with asthma continue to report an impaired quality of life, including symptoms of anxiety and inability to participate in physical activity. As complementary health approaches are becoming more popular and show promise in the management of many chronic diseases, the purpose of this integrative review is to examine the state of the science regarding popular complementary health approaches- yoga and mindfulness- for children and adolescents with asthma. Eligibility criteria A comprehensive search of five databases for peer reviewed articles was performed to identify experimental and non-experimental studies. The search for each database was performed from the inception of each to January 2020 and limited to the English language. The search included terminology that addressed the concepts of “asthma”, “yoga” and “mindfulness”. Sample A total of eleven articles met the criteria for review from the years 1991 to 2019. Results Nine publications focused on the use of yoga in children and adolescents with asthma and two publications focused on mindfulness in adolescents with asthma. Conclusions Interventions involving either mindfulness or yoga may be effective in reducing stress and anxiety and improving quality of life and lung function in this population. Implications Mindfulness intervention studies in the pediatric and adolescent asthma population are warranted as are additional studies that include the use of yoga with skills in mindfulness in order to evaluate their physiological and psychological effects.

Subjective well-being (SWB) may buffer against psychosocial stressors such as the birth of a child. To assess the effectiveness of an unguided internet intervention (‘Mamma Mia’) on SWB among perinatal women, we investigated (1) whether the intervention group reported higher levels of SWB, (2) whether the effect of Mamma Mia changed over time (i.e. whether the intervention was more effective at some time points), (3) and potential moderators. In total, 1342 pregnant women were randomized to the Mamma Mia or control group. Data were collected at gestational weeks 21–25 and 37, and 1.5, 3, and 6 months after birth. Cognitive well-being was measured using the Satisfaction with Life Scale. Affective well-being was measured using the Positive and Negative Affect Schedule. There were no significant differences in reported life satisfaction and positive affect between the groups. However, participants in the Mamma Mia group showed less negative affect during follow-up, suggesting that Mamma Mia can enhance the affective component of perinatal women’s sense of SWB.

BackgroundPerinatal depressive symptoms have been linked to adverse maternal and infant health outcomes. The etiology associated with perinatal depressive psychopathology is poorly understood, but accumulating evidence suggests that understanding inter-individual differences in DNA methylation (DNAm) patterning may provide insight regarding the genomic regions salient to the risk liability of perinatal depressive psychopathology.ResultsGenome-wide DNAm was measured in maternal peripheral blood using the Infinium MethylationEPIC microarray. Ninety-two participants (46% African-American) had DNAm samples that passed all quality control metrics, and all participants were within seven months of delivery. Linear models were constructed to identify differentially methylated sites and regions, and permutation testing was utilized to assess significance. Differentially methylated regions (DMRs) were defined as genomic regions of consistent DNAm change with at least two probes within 1kb of each other. Maternal age, current smoking status, estimated cell-type proportions, ancestry-relevant principal components, days since delivery, and chip position served as covariates to adjust for technical and biological factors. Current postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Ninety-eight DMRs were significant (False Discovery Rate < 5%) and overlapped 92 genes. Synaptic signaling, neural development, and platelet formation were the most represented biological processes in gene set analysis, and comparison to the 44 loci discovered in the latest Psychiatric Genomics Consortium meta-analysis of depression revealed 3 overlapping regions and significant enrichment (pConclusionsMany of the genes identified in this analysis corroborate previous allelic, transcriptomic, and DNAm association results related to depressive phenotypes. Future work should integrate data from multi-omic platforms to understand the functional relevance of these DMRs and refine DNAm association results by limiting phenotypic heterogeneity and clarifying if DNAm differences relate to the timing of onset, severity, duration of perinatal mental health outcomes of the current pregnancy or to previous history of depressive psychopathology.

Background Health-care professional (HCP) students experience high levels of burnout, characterized by work- and school-related stress. Burnout is associated with a host of negative psychological and health outcomes. It may also contribute to cognitive dysfunction and decreased work productivity and may be related to trait mindfulness. This study cross-sectionally explored psychological distress and its correlates in a sample of interdisciplinary HCP students using cluster analysis. Method Fifty-seven interdisciplinary HCP students completed validated measures of burnout, depressive and anxiety symptoms, perceived stress, and rumination, which were entered into a cluster analysis. A neuropsychological test measured executive function; validated questionnaires assessed work productivity and trait mindfulness. Relationships between cluster membership and classroom productivity, executive function, and trait mindfulness were investigated. Results Burnout, depressive symptoms, and perceived stress were reported at high rates in this sample. The cluster analysis yielded 4 clusters, categorized as follows: Healthy, Ruminative Healthy, Moderate Distress, and High Distress. Cluster membership significantly differed based on trait mindfulness and classroom productivity. Trait mindfulness was related to classroom productivity. Although not significant, there were small to medium associations between executive function and both cluster membership and trait mindfulness. Discussion Cluster membership was highly related to trait mindfulness and classroom productivity, suggesting these are important correlates of psychological distress in HCP students. Taken together, these results underscore the need for interventions, especially ones that are mindfulness-based, to manage stress and work-relevant functioning in HCP students.

Introduction Children with severe asthma may benefit from non-pharmacological approaches to symptom management, yet little is known regarding the impact of mind-body approaches such as mindful yoga in this population. This pilot study examined the tolerability, feasibility, acceptability and immediate effects of a mindful yoga intervention in children with severe asthma. Method Fifteen children ages 7–11 with severe asthma participated in a single mindful yoga session, followed by semi-structured interviews with the child and caregiver. Vital signs and pulmonary function tests were collected pre- and post-intervention. Results All children reported positive experiences and caregivers were generally supportive of their participation. One child experienced self-limited bronchoconstriction with asthma symptoms. There was no significant change in lung function or vital signs after the mindful yoga session. Discussion Our results warrant additional larger studies to evaluate the safety and benefits of mindful yoga in children with severe asthma.

Objectives To fill gaps in the literature on the effects of mindfulness for healthcare professionals (HCPs), the current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professional (MIHP) students on stress and work-relevant outcomes in the absence of offering school-based incentives. Design A partially randomized waitlist-controlled design (intention-to-treat sample: 22 in the mindfulness group, 26 in the control group) was employed. Intervention MIHP is an eight-week intervention that incorporates meditation training, yoga, and discussion on the application of mindfulness principles to stressors commonly faced by HCPs and students. Main outcome measures Domains of feasibility and acceptability; Maslach Burnout Inventory and other validated measures of psychological functioning; cognitive task performance on the Trail Making Test A & B; and the Work Productivity and Activity Impairment plus Classroom Impairment Questionnaire. Results Results supported the feasibility and acceptability of MIHP but found randomization to be unacceptable. Small to large effects were found for MIHP, relative to the control group, on outcomes of burnout, perceived stress, mindfulness, and activity impairment. No effect of MIHP was found on cognitive performance or work productivity outcomes. Conclusions Preferential group allocation improved retention relative to randomization in the absence of school-based incentives. Results suggest that MIHP is feasible and acceptable and may have benefit for improving mindfulness and reducing burnout, stress, and activity impairment. Cognitive performance, work absenteeism, and work impairment did not change following MIHP. Results support future investigations into the effects of participant compensation on MIHP’s dissemination and effectiveness.

Background Burnout and work-related stress in health-care professionals (HCPs) is a growing concern to the optimal functioning of the health-care system. Mindfulness-based interventions may be well-suited to address burnout in HCPs. Objective The purpose of this study was (1) to quantitatively evaluate the effect of a mindfulness-based intervention for interdisciplinary HCPs over time and at a long-term follow-up and (2) to explore perceived benefits, facilitators, and barriers to the practice of mindfulness at the long-term follow-up. Design A mixed-method, repeated measures, within-subjects design was used to investigate Mindfulness for Interdisciplinary HCPs (MIHP) at baseline, post-MIHP, and a follow-up (6 months to 1.5 years after MIHP). MIHP is an 8-week, group-based course for interdisciplinary HCPs and students, with weekly meditation training, gentle yoga, and discussions on the application of mindfulness to common stressors faced by HCPs. Main outcome measures were the Maslach Burnout Inventory—Health Services Survey and the Five Facet Mindfulness Questionnaire. A semistructured interview was used to explore participants’ perceptions of sustained effects and practice in the context of HCP work at the long-term follow-up. The study protocol was registered with ClinicalTrials.gov (NCT02736292). Results Eighteen HCPs (88% female) participated in the study. Significant reductions were found after the intervention for 2 subscales of burnout: depersonalization, F(2, 17) = 5.98, P = .01, and emotional exhaustion, F(2, 17) = 2.64, P = .10. Three facets of dispositional mindfulness showed significant increases at long-term follow-up, act aware: F(2, 15) = 4.47, P = .03, nonjudge: F(2, 15) = 4.7, P = .03, and nonreactivity: F(2, 15) = 3.58, P = .05. Continued practice of skills long term was facilitated by the use of informal practice and perceived improvement in work and personal life. Conclusion In sum, MIHP improved subscales of burnout and mindfulness. These findings should be further explored with a larger, controlled study. Interventions should focus on developing mindfulness practice that can be integrated into the work of HCPs.

Objective Major depression with peripartum onset (MDP) has been associated with multiple adverse offspring health outcomes. The biological mechanisms underlying this relationship remain unclear, but DNA methylation (DNAm) represents a plausible mechanism for mediating MDP exposures and changes in offspring development, behavior, and health. Advances in DNAm research necessitate reevaluating the MDP-DNAm literature to determine how well past studies conform with current best practices. Method Five databases were searched to identify studies of prenatal-onset MDP and DNAm. Quality scores were assigned to each article independently by two raters using a novel scale specific for MDP-DNAm research. Results Nineteen studies met inclusion criteria. Quality scores ranged from 10 to 17 out of 24 points (M = 12.8; SD = 1.9), with higher scores indicating increased study rigor. Poor covariate reporting was the most significant contributor to lower scores. Conclusion No longitudinal MDP-DNAm studies exist. Earlier MDP-DNAm studies should be interpreted with caution, and future research must commit to sharing methodology and data to facilitate cross-study comparisons and maximize dataset utility.

Background: Tai Chi, Qigong, and Yoga are recognized as the most popular complementary approaches for alleviating musculoskeletal pain, improving sleep quality, and reducing blood pressure. The therapeutic effects of these meditative movements for treating major depressive disorder (MDD) is yet to be determined. Therefore, we examined whether meditative movements (Tai Chi, Qigong, and Yoga) are effective for treating MDD. Seven electronic databases (SPORTDiscus, PubMed, PsycINFO, Cochrane Library, Web of Science, CNKI, and Wanfang) were used to search relevant articles. Randomized controlled trials (RCT) using Tai Chi, Qigong or Yoga as intervention for MDD were considered for the meta-analysis (standardized mean difference: SMD). Results: Meta-analysis on 15 fair-to-high quality RCTs showed a significant benefit in favor of meditative movement on depression severity (SMD = −0.56, 95% CI −0.76 to −0.37, p < 0.001, I2 = 35.76%) and on anxiety severity (SMD = −0.46, 95% CI −0.71 to −0.21, p < 0.001, I2 = 1.17%). Meditative movement interventions showed significantly improved treatment remission rate (OR = 6.7, 95% CI 2.38 to 18.86, p < 0.001) and response rate (OR = 5.2, 95% CI 1.73 to 15.59, p < 0.001) over passive controls. Conclusions: Emphasizing the therapeutic effects of meditative movements for treating MDD is critical because it may provide a useful alternative to existing mainstream treatments (drug therapy and psychotherapy) for MDD. Given the fact that meditative movements are safe and easily accessible, clinicians may consider recommending meditative movements for symptomatic management in this population.

Background: Persistent low back pain is a significant problem worldwide. Early identification and treatment of individuals at high risk for persistent low back pain have been suggested as strategies to decrease the rate of disability associated with this condition. Purpose: To examine and compare demographic, pain-related, psychological, and somatosensory characteristics in a cohort of participants with acute low back pain who later went on to experience persistent low back pain or whose pain resolved within the first 6 weeks after initial onset. Methods: A descriptive study was conducted among men and women 18–50 years of age who had an acute episode of low back pain. Study questionnaires were administered to collect demographic information and measures of pain, coping, reactivity, mood, work history and satisfaction, and disability. A standardized protocol of quantitative sensory testing was performed on each participant at the painful area of their low back and at a remote site on their arm. Results: The sample consisted of 48 participants, of whom 19 went on to develop persistent low back pain and 29 resolved. Compared to the resolved group, the persistent low back pain group was significantly older and had a lower level of educational attainment, a higher body mass index, and higher mean “least” pain score on the Brief Pain Inventory–Short Form. Significantly higher thermal detection thresholds at the painful and remote sites as well as signs of central sensitivity differentiated the persistent pain group from the resolved group during the acute stage of low back pain.

African American women may be especially vulnerable to antepartum depression, a major health concern during pregnancy. This study investigated the prevalence and predictors of depressive symptoms in a sample of African American women who were between 14-17 weeks pregnant, a timeframe that is typically thought to be a time of general well-being. Two-thirds reported a CES-D score ≥ 16 indicative of depressive symptomatology. Age, perceived stress (as measured by the Perceived Stress Scale [PSS]), and anxiety (as measured by the State Trait Anxiety Inventory [STAI]) predicted depressive symptoms; the interaction between PSS and STAI scores was also a significant predictor. Our study findings suggest that early identification of stress and anxiety, in addition to depressive symptoms, is vital for intervention with this group.

BACKGROUND: Approximately 20% of women in the United States practice prenatal yoga, but there is a paucity of information about the experience of these women. OBJECTIVE: This study examines women’s experiences participating in community-based prenatal yoga. METHOD: A qualitative descriptive exploratory design used focus groups with a convenience sample of pregnant and postpartum women ( n = 14) who engaged in prenatal yoga within the previous 6 months. Content analysis was employed to identify key themes and subthemes. RESULTS: Three themes arose: (a) stress and depressive symptoms commonly instigate women’s interest in prenatal yoga, (b) prenatal yoga is perceived to be psychologically and physically beneficial, and (c) prenatal yoga is perceived as more beneficial than other group classes. CONCLUSIONS: Pregnant women with stress and depressive symptoms may be drawn to prenatal yoga for the psychological and physical benefits. It is imperative that health care providers and researchers focus on these needs, particularly when designing prevention and intervention strategies with this population.

Key wordsChronic liver disease, symptom clusters, symptom management, symptomsAbstractPurpose: Chronic liver disease affects over 30 million people worldwide, and despite advances in medical management that have increased survival, a majority of these individuals report multiple symptoms that severely impair function and quality of life. The purpose of this integrative review was to examine and summarize the current literature focused on self-reported symptoms in individuals with chronic liver disease in order to inform the development and delivery of symptom management strategies in clinical practice.Design and Methods: Combinations of search terms related to the symptom experience were used to search three electronic databases. Inclusion criteria were empirical studies that measured self-reported symptoms in populations with chronic liver disease published in English between 2003 and 2014. The literature search initially yielded 112 results; 26 quantitative studies met the inclusion criteria.Findings and Conclusions: The symptom of fatigue was commonly reported across chronic liver disease populations and was often found to co-occur with other distressing symptoms, including depression, sleep disturbance, pain, cognitive impairment, and dizziness associated with autonomic dysfunction. Due to the high prevalence and persistence of these "core" symptoms, the use of core symptom measures integrated longitudinally across populations would inform the development and delivery of symptom management interventions as well as enhance the ability of nurses to incorporate population-level symptom management programs.Clinical Relevance: Nurses play an important role in symptom assessment and may use the findings from the integrative review to incorporate core symptom measures across chronic liver disease populations and advance the development and delivery of symptom management interventions.Chronic liver disease (CLD) is a condition characterized by damage to hepatocytes that can alter normal liver function, with advanced stages of disease marked by fibrosis and cirrhosis (Lozano et al., 2012). The trajectory of CLD can originate from a wide range of etiologies, including viral hepatitis, autoimmune hepatitis, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), cholestatic diseases (primary biliary cirrhosis [PBC] and primary sclerosing cholangitis [PSC]), alcohol-related liver disease, as well as genetic conditions (hemochromatosis and alpha-1-antitrypsin deficiency). Importantly, NAFLD/NASH is now the number one cause of liver disease in Western countries, whereas the prevalence of other CLD subtypes have remained stable or even decreased (World Gastroenterology Organisation, 2012). Presently CLD is one of the ten leading causes of death worldwide and can affect all ages, genders, and racial and ethnic groups, as well as socioeconomic classes; however, lower socioeconomic groups and disadvantaged individuals are disproportionately affected (National Institutes of Health, 2009).Advances in the medical management of CLD have substantially improved the rate of survival by preventing or delaying disease progression; however, a majority of individuals living with CLD frequently report multiple symptoms that significantly impair quality of life and functional capacity (Elliot, Frith, Pairman, Jones, & Newton, 2011; Patanwala et al., 2010). The impact of these symptoms, which include fatigue and cognitive impairment, was once thought to be directly related to the pathophysiological consequences of cirrhosis and endstage liver disease (Swain, 2006). However, with more people living long-term with CLD, it is now recognized that symptoms can occur throughout the disease course, are frequently unrelated to disease severity, and often do not improve with treatment of the underlying disease process (Newton & Jones, 2012).Nurses play a significant role in the assessment of symptoms and provision of symptom management strategies for individuals with CLD. …

Purpose Perinatal health disparities are of particular concern with pregnant, urban, African-American (AA) adolescents, who have high rates of stress and depression during pregnancy, higher rates of adverse pregnancy and neonatal outcomes, and many barriers to effective treatment. The purpose of this study was to explore pregnant, urban, AA teenagers' experience of stress and depression and examine their perceptions of adjunctive nonpharmacologic management strategies, such as yoga. Methods This community-based, qualitative study used nontherapeutic focus groups to allow for exploration of attitudes, concerns, beliefs, and values regarding stress and depression in pregnancy and nonpharmacologic management approaches, such as mind–body therapies and other prenatal activities. Findings The sample consisted of pregnant, AA, low-income adolescents (n = 17) who resided in a large urban area in the United States. The themes that arose in the focus group discussions were that 1) stress and depression symptoms are pervasive in daily life, 2) participants felt a generalized sense of isolation, 3) stress/depression management techniques should be group based, interactive, and focused on the specific needs of teenagers, and 4) yoga is an appealing stress management technique to this population. Conclusions Findings from this study suggest that pregnant, urban, adolescents are highly stressed; they interpret depression-like symptoms to be signs of stress; they desire group-based, interactive activities; and they are interested in yoga classes for stress/depression management and relationship building. It is imperative that health care providers and researchers focus on these needs, particularly when designing prevention and intervention strategies.