Labour experience and postpartum stress and depression: a quantitative and qualitative examination

Objectives: The purpose of this study was to examine the relationship between qualitatively and quantitatively assessed birth experiences and rates of post-birth distress and depressive symptoms three to four weeks postpartum. Both the rates of post-birth distress and depressive symptoms represented risk factors for subsequent mental health problems in the later postpartum period. Background: Childbirth is accompanied by various stress factors. However, little is known about the relationship between stressors occurring during birth (intrapartum) and the ways women cope with them and women’s development of depressive symptoms or acute stress reactions postpartum. Methods: One hundred and twenty-seven women from two longitudinal studies were interviewed 48–96 h after childbirth. Thirty birth interviews from both samples were additionally examined for qualitative themes related to women’s reported experience in connection with mental health adaptation (i.e. without symptoms (n = 10), symptoms of depression (n = 10) and acute stress reactions (n = 10)) at three to four weeks postpartum. Results: Women with depressive symptoms reported less intimate and helpful contact with their partners and baby during labour compared with women without symptoms or with acute stress reactions. Women with acute stress reactions had less confidence in themselves, and reported disorientation during the birth process, compared with women without symptoms or with depressive symptoms. Conclusions: Recognition of how women cope with intrapartum factors during labour could help to identify psychological distress shortly after delivery, and inform the introduction of timely and appropriate psychological support for affected women.     

Fathers’ parenting self-efficacy during the transition to parenthood

Background: Little is known about the development of fathers’ parenting self-efficacy during the transition to parenthood.

Objectives: To analyse (1) fathers’ parenting self-efficacy developmental path and (2) the effects of anxious and depressive symptoms and coparenting support on fathers’ parenting self-efficacy developmental path, from the first trimester of pregnancy to 6 months postpartum.

Methods: Eighty-six fathers recruited at the first trimester of pregnancy completed self-report measures of anxious and depressive symptoms, coparenting support and parenting self-efficacy at the first and third trimesters of pregnancy, and at 1 and 6 months postpartum. Growth curve models were performed.

Results: An increase in fathers’ parenting self-efficacy was found from the first trimester of pregnancy to 6 months postpartum. The main effects of anxious symptoms and interaction effects of anxious symptoms and time were found on fathers’ parenting self-efficacy. Fathers with higher anxious symptoms revealed lower levels of parenting self-efficacy at the first trimester of pregnancy and a lower increase of parenting self-efficacy from this time to 6 months postpartum. The main effects of coparenting support were found in fathers’ parenting self-efficacy. At the first trimester of pregnancy, fathers who perceived more coparenting support revealed higher levels of parenting self-efficacy.

Conclusion: The present study may contribute to the literature by describing fathers’ parenting self-efficacy developmental path and the effects of anxious symptoms and coparenting support on fathers’ parenting self-efficacy developmental path during the transition to parenthood.     

Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color

Study ObjectiveTo determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color.DesignParticipants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time.SettingFourteen community health centers and hospitals in New York City.ParticipantsThe participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years.Interventions and Main Outcome MeasuresThe main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy.ResultsHigh levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = −7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence.ConclusionScreening and treatment for depression should be available routinely to women at risk for antenatal depression.     

一对一分阶段沙盘游戏干预改善抽动障碍患儿症状研究

目的 探讨沙盘游戏对抽动障碍患儿的干预效果。方法 将40例抽动障碍患儿随机分为观察组和对照组各20例。两组均行规范化药物治疗。对照组同时行常规康复干预;观察组行一对一分阶段沙盘游戏干预。连续6个月后评价效果。结果 观察组行为评分及抽动症状整体评分显著低于干预前及对照组(均P0.01)。结论 针对抽动障碍患儿,在规范药物治疗的同时,采取一对一分阶段沙盘游戏心理干预,可有效矫正患儿行为问题。     

右美托咪定术前滴鼻对全麻患儿术后行为改变的影响

目的观察右美托咪定术前滴鼻对全麻患儿术后行为改变的影响。方法择期在全麻下行疝囊高位结扎术的患儿60例,男46例,女14例,年龄2~5岁,体重10~30kg,ASAⅠ或Ⅱ级。采用随机数字表法,将其均分为三组:对照组(C组)、咪达唑仑组(M组)和右美托咪定组(D组)。麻醉诱导前30min,C组生理盐水0.02ml/kg滴鼻,M组咪达唑仑0.2mg/kg滴鼻,D组右美托咪定2μg/kg滴鼻。记录患儿与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分;记录患儿术后恢复时间、术后并发症及镇痛药补救率等情况。分别在术前1d、术后1、7、30d用术后行为量表(PHBQ)对患儿父母进行术前问卷调查及术后电话随访,观察患儿术后行为改变的情况。结果M组和D组与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分明显高于C组(P0.05)。D组苏醒期躁动、恶心呕吐及镇痛药补救率明显低于C组和M组(P0.05)。术后1、7d时M组和D组行为改变的发生率明显低于C组(P0.05)。结论右美托咪定术前滴鼻可以降低全麻患儿术后行为改变的发生率。     

Fatigue,anxiety and depression overrule the role of oncological treatment in predicting self-reported health complaints in women with breast cancer compared to healthy controls

BackgroundWomen with breast cancer often attribute their health problems as side effects caused by oncological treatments. The aim of the study was to examine and compare self-reported health complaints (SHC) in postmenopausal patients with breast cancer to healthy controls.MethodWomen with breast cancer (N = 196) filled in 5 questionnaires 1–2 years after surgery; SHC Inventory, Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES), Fatigue – Functional Assessment of Cancer Therapy-Fatigue subscale (FACIT-F), Fatigue Visual Analog Scale (Fatigue VAS), and Hospital Anxiety and Depression Scale (HADS). Controls comprised 101 blood donors who reported on the questionnaires except for HADS. Bonferroni adjustment and p < 0.0017 was considered statistically significant for SHC Inventory, p < 0.05 for the remaining questionnaires.ResultsThe patients, mean age 58.0 (SD 9.5), reported significantly more self-reported health complaints, whereof 6 of 29 complaints were significantly elevated compared to the controls, mean age 57.0 (SD 5.8) (p < 0.001). HADS scores in patients fell into normal range, mean 6.3 (SD 5.7). A subgroup of 48 patients experienced more frequent and severe symptoms in all the questionnaires compared to the remaining 148 patients, and the 101 controls. Among the patients, fatigue, anxiety and depression explained 49% of the total variance in self-reported health complaints (p ≤ 0.001).ConclusionMost women with breast cancer (76%) reported health complaints equal to the healthy controls. Fatigue, anxiety and depression, not oncological treatments, were significant predictors for the complaints.     

索利那新联合坦索罗辛治疗输尿管支架管置入术后下尿路症状的疗效分析

目的：探讨索利那新联合坦索罗辛治疗输尿管支架管置入术后下尿路症状的疗效。方法选择2014年9月至2015年8月在我院泌尿外科住院治疗的单侧输尿管镜检查或单侧输尿管镜取石术后患者148例进行为期4周的治疗、随访。按照简单随机抽样的方法分为A、B、C三组,A组(n=49)：坦索罗辛胶囊0.2 mg,口服,每天晚上1次;B组(n=49)：索利那新片5 mg,口服,每天1次;C组(n=50)：坦索罗辛缓释胶囊(0.2 mg口服,每天晚上1次)+索利那新片(0.5 mg,口服,每天1次)。总疗程均为4周。所有患者在术后第2天及拔管当日分别完成国际前列腺症状评分(IPSS）、生活质量评估(Qol)和可视化疼痛评分(VAS)。结果三组患者治疗期间均无严重不良反应,均顺利参与研究并配合随访。C组经索利那新联合坦索罗辛治疗4周后IPSS总评分[(7.07±3.21)分]、IPSS刺激性症状评分[(3.75±2.69)分]、Qol评分[(1.48±1.32)分]均有显著的下降,与A组[(12.33±4.63)分、(7.22±3.78)分、(3.12±1.86)分]或B组[(10.95±5.13)分、(5.75±4.32)分、(2.94±1.77)分]比较差异均具有统计学意义(P<0.05)。C组术后4周与其术后第2天[(11.55±4.12)分、(7.42±3.56)分、(2.38±1.49)分]比较,IPSS总评分、IPSS刺激症状评分、Qol评分差异也具有统计学意义(P<0.05)。而C组的IPSS梗阻症状评分(3.98±2.21)分及VAS评分(2.12±1.45)分与A组[(4.56±3.14)分、(2.60±1.96)分]或B组[(5.07±3.10)分、(2.78±1.81)分]差异均无统计学意义(P>0.05)。A组与B组比较,各项评分差异均无统计学(P>0.05)。结论索利那新联合坦索罗辛可有效改善输尿管支架管下尿路症状,优于单独服用坦索罗辛或索利那新,极大地提高了患者的生活质量,值得临床推广应用。     

海南国际旅游岛旅游区居民心理应激影响因素调查

目的：调查海南国际旅游岛旅游区居民心理应激影响因素,为旅游区居民进行心理干预和心理健康教育提供科学依据。方法采用创伤后应激障碍量表(PCL-C)、社会支持评定量表(SSRS)、艾森人格量表(EPQ)、症状自评量表(SCL-90),在2013年1月至2015年12月间对海南国际旅游岛旅游区居民5114名进行问卷调查。结果①创伤后应激障碍(PTSD)阳性率为69.73%(3566/5114);②有无创伤后应激障碍两组间SCL-90总分、EPQ各因子得分和SSRS总分进行比较,结果显示差异均有统计学意义(P<0.05);③多重线性回归分析,进入回归模型的因素有SCL-90总分、E量表分、N量表分、P量表分、SSRS总分;④通径分析结果表明,N量表分对PCL-C总分的总效应最强(0.838),其次是SCL-90总分(0.200),在直接效应中SSRS总分的效应为(-0.260),位居第二。结论影响PTSD发生的危险因素有心理症状、艾森克人格,PTSD的保护因素有社会支持。     

ICU护士心理资本与离职意愿的相关性研究

目的 调查ICU护士心理资本与其离职意愿的现状,并探讨二者之间的相关性.方法 2015年1~6月采用一般资料调查表、护士心理资本问卷和离职意愿问卷对随机抽取的某市6所三级甲等医院的182名ICU护士进行调查.结果 ICU护士心理资本均分为(4.36±0.58)分,处于中度水平;离职意愿总分为(2.18±0.72)分,处在较高水平;ICU护士心理资本与离职意愿呈负相关(P<0.01,r=-0.448).结论 提高护士心理资本是改善其离职意愿的有效途径,护理管理者应该从自我效能和希望两个方面去采取相关措施来提升ICU护士心理资本.