Association between subjective feelings of distress,plasma cortisol,anxiety, and depression in pregnant women

Objective

Psychosocial stressors are consistently associated with antenatal anxiety and depression, while the impact of cortisol has proved inconsistent. Most studies have focused either on psychological or physiological stress indices. We investigated both subjective and endocrinologic indices of distress in the same subjects.

Study design

We performed a cross-sectional study in late pregnancy in 79 women to investigate associations between the factors involved in anxiety and depression. Outcome measures were the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale, a Likert-like scale for fear of delivery, a structured interview to assess health and socioeconomic status, and fasting plasma cortisol levels measured in the morning.

Results

High BDI and STAI scores were associated with high levels of perceived stress and fear of delivery, but not with levels of plasma cortisol typical of the gestation phase. A multiple regression analysis revealed that subjective feelings of distress explained over 50% of the variation in BDI and STAI scores. Plasma cortisol was not a significant predictor of psychometric scores and did not show significant correlation with them in correlation analyses, and subjects with low and high cortisol levels showed similar psychometric scores.

Conclusion

Antenatal depression and anxiety were significantly associated with subjective feelings of distress but not with increased cortisol. This finding may be explained by the blunted cortisol stress responses characteristic of pregnancy. The mechanisms mediating the effects of subjective distress remain obscure: likely candidates include monoamine neurotransmission, and/or stress-induced changes in glucocorticoid receptor expression or distribution.     

The prevalence of anxiety and depression among people with infertility referring to Royan Institute in Tehran,Iran: A cross-sectional questionnaire study

Background and objective

Infertility is a global public health issue and is a low control stressor often leading to increased level of anxiety and depression. The objective of this study was to determine the prevalence of anxiety and depression and their related factors among Iranian infertile patients.

First trimester depression and/or anxiety disorders increase the risk of low birthweight in IVF offspring: a prospective cohort study

Research questionAre maternal depression and/or anxiety disorders (MDAD) before and during pregnancy associated with IVF outcomes?DesignA total of 5661 women starting their first IVF cycle between 15 August 2014 and 31 December 2015 were pooled from a prospective cohort of IVF-conceived children. The self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to determine MDAD. IVF outcomes were compared between MDAD+ and MDAD– groups.ResultsA total of 10.3% (572/5556) of women had MDAD before IVF (bMDAD). The fertilization rate was lower in the bMDAD+ group (59.41 ± 22.11% versus 61.72 ± 22.18%, P_adjust < 0.05). No difference was found in the other IVF outcomes. Pregnancy and neonatal outcomes in women with singleton live births were similar between the two groups. A total of 17.4% (347) women with singleton live births had MDAD during the first trimester (pMDAD). Birthweight (3383 ± 556 g versus 3447 ± 518 g, P_adjust < 0.05) was lower and incidence of low birthweight (LBW) (6.9% versus 3.3%, P_adjust < 0.01) was higher in the pMDAD group. After adjustment for potential confounders (gestational age, maternal age, maternal pre-pregnancy body mass index, threatened abortion, hypertensive disorder complicating pregnancy and gestational diabetes mellitus), pMDAD remained significantly associated with LBW (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.16–5.42, P_adjust < 0.05). The preconception psychological state in the pMDAD group did not demonstrate any additional impact on neonatal outcomes.ConclusionsMDAD during the first trimester is associated with increased risk of LBW in offspring, whether preconception MDAD exists or not.     

Effects of baduanjin exercise on blood glucose,depression and anxiety among patients with type II diabetes and emotional disorders: A meta-analysis

BackgroundDiabetes mellitus (DM) is a group of metabolic disorders reflected by high blood glucose levels and lack of hormone insulin. Notably, T2DM patients are three times more likely to report depression than the general population. Conventional exercise training programs have been shown to be beneficial for T2DM, but less is known regarding the effects of Baduanjin exercise on hemoglobin A1c (HbA1c) and psychological measures among this unique group. Therefore, this systematic review and meta-analysis aimed to investigate the effects of Baduanjin exercise on HbA1c, depression, and anxiety among type 2 diabetes mellitus (T2DM) patients with emotional disorders.MethodsThe potential literature was searched from six electronic databases (PubMed, MEDLINE, CINAHL, Scopus, Wanfang, and CNKI) from their inception to July 2022. The randomized controlled studies that investigated the effects of Baduanjin on HbA1c, depression , and anxiety in T2DM with emotional disorders were included. The effect sizes were calculated using the random-effect models with a 95% confidence interval (CI). The Physiotherapy Evidence Database (PEDro) scale was employed to assess the study quality.ResultsEleven studies involving 755 T2DM participants with emotional disorders were analyzed in this study. The pooled results showed that Baduanjin had significant improvements in HbA1c (SMD = 0.75, 95% CI 0.46 to 1.04, p < 0.001), depression (SMD = 0.69, 95% CI 0.30 to 1.08, p < 0.01) and anxiety (SMD = 0.98, 95% CI 0.44 to 1.53, p < 0.01) compared to the control group.ConclusionFindings suggest that Baduanjin exercise may effectively alleviate HbA1c, depression, and anxiety among T2DM patients with emotional disorders. However, more well-designed studies are required to further substantiate the promising findings.     

General psychopathology,anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

Objective

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine “UMR” in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia.

Study design

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

Result(s)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

Conclusion(s)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.     

Anxiety and depression in patients with advanced ovarian cancer: a prospective study

Introduction: Survival of ovarian cancer patients is still unsatisfactory despite the introduction of new diagnostic and therapeutic methods. Women with advanced ovarian cancer with long-term survival are at persistent risk of anxiety and reactive depression due to poor prognosis and risk of burdensome symptoms. The aim of the study was to assess changes in anxiety and depression during multimodality ovarian cancer treatment and to identify correlates of anxiety and depression.

Method: The study included 106 consecutive patients with advanced ovarian cancer. Mean age of the study group was 53.9 years (SD = 10.8, range: 23–79). The participants completed Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory four times: prior to and one week after surgery, and before the second and the fourth course of adjuvant chemotherapy. Multivariate analysis was performed to identify the independent determinants of distress at various stages of treatment.

Results: The level of anxiety and the prevalence of pathological anxiety (74%) were the highest prior to surgery and gradually decreased thereafter. Irrespective of the treatment stage, the level of anxiety was higher than the corresponding level of depression. History of abortion, presence of intestinal stoma, poor general status, residual disease and time from the initial diagnosis were the main determinants of distress in ovarian cancer patients.

Conclusions: Significant changes in the level of anxiety and slight fluctuations in the depression level experienced during ovarian cancer treatment are mostly determined by clinical variables. Identification of individuals with psychological comorbidities is a vital component of patient-oriented multidisciplinary care.     

Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study

Objective

Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies.

Study design

In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies–Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearson's χ² test and binary logistic regression were used for statistical analyses.

Results

Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p < 0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p < 0.05) and depression symptoms (p < 0.05) during the first trimester. Women with an interpregnancy interval of 7–12 months had a 2.511-fold higher risk of depression (p < 0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index.

Conclusions

Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health.     

Psychiatric problems of anxiety and depression disorder are associated with medical service utilization and survival among patients with cervical cancer

ObjectiveThere are few nationwide studies regarding the long-term analysis of cervical cancer patients in Taiwan. Thus, this study aimed to evaluate medical service utilization, and survival among cervical cancer patients initially diagnosed with or without anxiety and/or depressive disorders.Materials and methodsThis was a retrospective longitudinal study using data from the National Health Insurance Research Database from 1996 to 2010. The study subjects were cervical cancer patients identified by ICD-9-CM codes 180.X, while subjects with anxiety and/or depressive disorders were identified using the following codes: 300.0X–300.9X (minus 300.4X) for anxiety disorder, and 296.2X, 296.3X, 300.4, and 311.X for depressive disorder. The cervical patients with anxiety or/and depression disorder were classified as anxiety/depression (AD) group or the non-disorder (ND) group. Propensity score matching (PSM) was used to adjust for differences between the AD and ND groups. T-tests were used to evaluate differences in medical utilization and the Kaplan–Meier method was used to evaluate survival conditions between the two groups. Statistical analyses were performed using SPSS Statistics 20.0.ResultsA total of 3664 patients were identified, with 862 (23.5%) having anxiety, 149 (4.1%) with depression, and 349 (9.5%) having both anxiety and depression. In total, 1360 cervical cancer patients had anxiety/depression disorders. After PSM, the AD group had significantly more outpatient department (OPD) visits than the ND group (p < 0.001) but the survival status was better in the AD group than the ND group (p < 0.001).ConclusionsCervical cancer patients with anxiety/depression disorders visited the OPD more frequently than those without anxiety/depression disorders but had better survival status. Gynecologists should also consider cancer patients’ mental status during follow-up, referring patients to psychiatric professionals for appropriate psychiatric care if appropriate.     

Recurrent endometriosis following total hysterectomy with oophorectomy mimicking a malignant neoplastic lesion: a diagnostic and therapeutic challenge

Case report  A woman with a previous hysterectomy and bilateral salpingo-oophorectomy for endometriosis presented with painless vaginal bleeding. Imaging revealed a heterogeneous soft tissue pelvic mass suggestive of a malignant neoplastic lesion. Radical surgery was performed including excision of the pelvic mass and anterior resection of the sigmoid colon. Histopathology revealed endometriosis. Conclusion  The risk of malignant transformation and the difficulty in achieving a preoperative diagnosis make radical surgery inevitable in the management of recurrent endometriosis. The use of hormone replacement therapy after bilateral salpingo-oophorectomy for endometriosis remains controversial and requires careful counseling about recurrence and close follow-up.     

Anxiety and depression in hyperemesis gravidarum: prevalence,risk factors and correlation with clinical severity

Objective

To evaluate prevalence, risk factors and clinical severity correlates of anxiety and depression caseness in hyperemesis gravidarum (HG).

Study design

A prospective study of self-assessment using the Hospital Anxiety and Depression Scale (HADS) was performed. Women at their first hospitalization for HG were recruited as soon as possible after hospital admission. Cut-off at the score of 7/8 was used for both the anxiety and depression subscales of HADS to denote anxiety and depression caseness respectively. Risk factors for anxiety and depression caseness were identified using Chi-square test, Fisher's exact test, Mann–Whitney's U-test or the Student's t-test. Multivariable logistic regression analysis incorporating all co-variables with crude P < 0.1 was performed to identify independent risk factors. Bivariate analyses were performed to identify associations between clinical markers of severity and anxiety and depression caseness. Prolonged hospitalization and a number of biochemical and hematological abnormalities were used as clinical markers of HG severity.

Results

Criteria for anxiety and depression caseness were fulfilled in 98/209 (46.9%) and 100/209 (47.8%) women respectively. 78 (37.3%) participants fulfilled the criteria for both anxiety and depression caseness, 89 (42.6%) neither, 20 (9.6%) anxiety caseness only and 22 (10.5%) depression caseness only. Gestational age at commencement of vomiting, duration of vomiting leading up to hospitalization and paid employment status had crude P < 0.1 in association with anxiety caseness. After adjustment, only paid employment was independently associated with anxiety caseness (AOR 2.9 95% CI 1.3–6.5; P = 0.009). Previous miscarriage, gestational age at commencement of vomiting and duration of vomiting leading up to hospitalization all had P < 0.1 in association with depression caseness. After adjustment, only previous miscarriage was negatively associated with depression caseness (AOR 0.4 95% CI 0.2–0.9; P = 0.022). There was no marker of HG severity associated with anxiety caseness on bivariate analysis. High hematocrit was associated with depression caseness (OR 2.1 95% CI 1.1–3.9; P = 0.027).

Conclusion

Anxiety and depression caseness is common in HG and risk factors can be identified. There is no convincing association between anxiety and depression and more severe illness. Psychological symptoms may be a response to physical illness but further studies are needed.     

Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study

Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients.     

Pregnancy outcomes after recurrent pregnancy loss: a longitudinal cohort study on stress and depression

Published reports have indicated that rates of preimplantation embryo aneuploidy in a control donor population may vary between IVF centres. This suggests that location-specific conditions, in the clinic, IVF or genetics laboratory, may be influencing the chromosome dynamics or diagnosis. More recent reports suggest that rates of embryo mosaicism, representing mitotic errors, may vary between IVF centres. This would suggest perhaps a laboratory-controlled variable is influencing mitotic cell division during preimplantation embryo development. Various IVF laboratory-controlled factors may be impacting chromosome separation and segregation. Variables including type of culture media, pH, temperature, osmolality and oxygen concentration could all be possible factors influencing embryo aneuploidy. Furthermore, laboratory techniques, method of insemination, laser use or handling of biopsied cells may also influence genetic results. These IVF laboratory variables will be reviewed and literature suggesting a possible link to mitotic aneuploidy/mosaicism discussed.     

The Postpartum Partner Support Scale: Development,psychometric assessment,and predictive validity in a Canadian prospective cohort

Backgroundpostpartum depression is a significant public health issue with well-documented negative consequences. A strong risk factor that has been consistently identified in international samples is a poor partner relationship. However, no instrument exists to measure postpartum-specific partner support.Objectivesthe objective of this methodological study was to develop and psychometrically test an instrument to assess the perception of postpartum partner support to guide interventions.Designusing a theoretical model of social relationships and the functional elements of social support, the Postpartum Partner Support Scale was developed and content validity was judged by experts. Following a pilot test, the Postpartum Partner Support Scale was psychometrically assessed.Settingsthe study was conducted in a health region near Vancouver, British Columbia.Participants396 women at 1, 4, and 8 weeks postpartum.Methodsthe psychometric assessment included analysis of internal consistency, exploratory factor analysis, composite reliability, and concurrent and predictive validity.Findingsthe Cronbach's alpha for the Postpartum Partner Support Scale was 0.96, and exploratory factor analysis revealed a unidimensional solution. The Postpartum Partner Support Scale was positively correlated with general partner support and global social support and negatively correlated with perceived stress and child care stress. It also predicted maternal depressive and anxiety symptoms at 8 weeks postpartum among those without depression or anxiety at 1 or 4 weeks postpartum, respectively.Conclusionsfollowing further psychometric testing, the Postpartum Partner Support Scale may be used to (1) identify women with inadequate partner support who are at risk for poor mental health, (2) individualise postnatal care, and (3) evaluate preventive interventions.     

Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

Objective

to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities.

Design

observational prospective cohort study

Setting

primary and secondary obstetric care centres in the Netherlands

Participants

1603 women during their first trimester of pregnancy between May 2010 and May 2012

Measurements and findings

we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36.Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study.

Key conclusions

the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events.

Implications for practice

our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child.