Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

BackgroundThe relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period.ObjectivesWe investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms.DesignA prospective cohort study design was used.SettingMaternity unit of a medical center.ParticipantsThis study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.MethodsPain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression.ResultsAfter adjusting for covariates, women who had perineal pain at 4–6 weeks postpartum showed an increased risk for depression at 4–6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4–6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β = 0.63, p = 0.02). Any pain intensity score at 3–5 days postpartum predicted depression at 3 months (β = 0.01, p = 0.04). Women with high depression scores at 3–5 days had a two- or three-fold higher risk for depression at 4–6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively).ConclusionsOur study provides robust evidence that perineal pain 4–6 weeks postpartum is associated with depressive symptoms 4–6 weeks and 6 months postpartum; pain at 3–5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3–5 days postpartum, predict depressive symptoms during the 6-month postpartum period.     

A Pilot Randomized Controlled Trial Evaluating Essential Oils for Chemotherapy-Induced Peripheral Neuropathy

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a painful, debilitating consequence of cancer treatment affecting up to 60% of patients. Pharmacological approaches to CIPN are often ineffective and cause adverse effects. Essential oils are an underutilized non-pharmacological approach to pain reduction.AimsTo ascertain the efficacy of an essential oil intervention to reduce CIPN.DesignA single-blind, pilot randomized controlled trial.MethodsParticipants (n = 27) were stratified by baseline pain scores and randomized to intervention (n = 13) and placebo groups (n = 14). Participants topically-applied the essential oil intervention or placebo every eight hours for six weeks. Pain was assessed using the Short-Form-McGill Pain Questionnaire-2 weekly and the Visual Analogue Scale daily. Quality-of-life was assessed using the Quality-of-Life: CIPN-20 and Quality-of-Life Adult Cancer Survivor questionnaires. Data were analyzed in SPSS using generalized estimating equations.ResultsNo significant difference was observed between groups in pain or quality-of-life scores over seven weeks, but improvement was observed in both groups. Participants using the intervention with pain medications showed a significant reduction in pain compared to placebo (p = .001). Educational level (p = .041) and annual income (p = .005) were significant covariates mirroring these social determinates of pain. Older participants felt less negatively about their CIPN (p = .002). Positive placebo effect and spatiotemporal interactions were observed.ConclusionsThis pilot study demonstrated that participants adhered to the intervention for six weeks. Essential oils have potential direct and adjuvant pain-reducing effects and should be studied further.     

Effects of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women at 3-month follow up: randomised controlled trial

BackgroundDeveloping a sense of well-being and achieving maternal role competence are considered critical components of maternal adaptation. Given the growing evidence of postpartum depression and its devastating effects, effective childbirth psychoeducation programme to promote maternal role competence, psychological well-being and prevent postpartum depression is essential and of an urgent priority.ObjectiveTo examine the effects of an interpersonal psychotherapy oriented childbirth education programme on social support, maternal role competence, postpartum depression and psychological well-being in Chinese first-time childbearing women at three-month postpartum.Design, setting and participantsRandomised controlled trial in a regional teaching hospital, Guangzhou, China with 194 first-time pregnant women, of whom 96 received interpersonal-psychotherapy-oriented childbirth education programme and 98 standard care. The intervention was developed from principles of interpersonal psychotherapy which consisted of two 90-min antenatal classes and a telephone follow-up within two weeks after delivery. Outcomes measurements included Perceived Social Support Scale, Parenting Sense of Competence Scale-Efficacy subscale, Edinburgh Postnatal Depression Scale and General Health Questionnaire, were compared over three-month follow up.ResultsThe study group had significantly better improvement on perceived social support (p < 0.01), maternal role competence (p < 0.01), postpartum depressive symptoms (p < 0.01) and psychological well-being (p < 0.01) when compared with the control group. The study group also had significantly higher level of social support (t = 2.33, p = 0.021), maternal role competence (t = 2.43, p = 0.016) and less depressive symptoms (t = ?2.39, p = 0.018) at three-month postpartum when compared with the control group.DiscussionThe childbirth psychoeducation programme can substantially benefit first time Chinese mothers. It could be implemented as a routine care with ongoing evaluation. Future studies could focus on women in lower social classes, with multiple pregnancy and complicated pregnancy.     

Pelvic floor muscle training as a persistent nursing intervention: Effect on delivery outcome and pelvic floor myodynamia

PurposeTo evaluate the effect of pelvic floor muscle training as a nursing intervention on delivery outcomes and postpartum pelvic floor myodynamia.MethodsIn total, 106 nulliparas were randomised into an intervention group and control group. All nulliparas participated in a pelvic floor training programme led by a midwife. A pelvic floor physical therapist measured the women's pelvic floor myodynamia and taught them how to correctly perform pelvic muscle contractions before the intervention. A registered nurse monitored the intervention group via twice-weekly telephone checkups. The control group did not receive individual direction.ResultsThere were no differences in the rate of Caesarean section or elective Caesarean section between the two groups (χ² = 3.446, p = 0.076 and χ² = 2.343, p = 0.185, respectively). There was a difference in the timing of the second stage of labour between the two groups (t = 2.101, p = 0.040); no difference was observed in the timing of the other two stages of labour (t = 1.771, p = 0.081 and t = 1.142, p = 0.263, respectively). In addition, no differences were observed in the gestational weight gain (t = 0.196, p = 0.845), neonatal weight (t = 0.113, p = 0.911), rate of episiotomy (χ² = 0.932, p = 0.351) or rate of perineal laceration (χ² = 0.022, p = 0.982) between the two groups. The pelvic floor myodynamia of the intervention group had improved to a greater degree than that in the control group at 6 weeks and 3 months after delivery (p < 0.005).ConclusionPersistent nursing intervention for pregnant/postpartum women helped to shorten the second stage of labour and contributed to the recovery of postpartum pelvic floor myodynamia. The influence of this intervention on the delivery mode, and rates of episiotomy and perineal laceration remains unknown. Medical staff should strengthen health education programmes that involve pelvic floor functional rehabilitation.     

Postpartum depression: Mental health literacy of Indian mothers

BackgroundPostpartum depression is a significant public health issue. It is important to understand new mothers' awareness on depression during the postpartum period.AimThis study was aimed to understand the postpartum depression literacy of postpartum women.MethodsThis was a cross-sectional survey carried out among randomly selected mothers (N = 279) attending a paediatric tertiary care center. The data was collected through face-to-face interview technique using a structured questionnaire.ResultsOur findings revealed that merely 50.7% of the postpartum mothers had an adequate level of knowledge on postpartum depression. Postpartum depression literacy was significantly associated with participants' age (P < 0.01), income (p < 0.006) and occupational status (P = 0.013).ConclusionThe findings of the present study highlight specific gaps in postpartum depression literacy which may compromise the help-seeking behaviours of postpartum mothers. The findings also suggest an urgent need to sensitize women about postpartum depression.     

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

ObjectiveCompare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.DesignRandomized controlled trial.SettingOne long-term care facility in Taiwan.Participants86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n = 30), or usual activity (n = 30).InterventionOne certified trainer provided the intervention group with 40 min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.Main outcome measuresQuality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)ResultsParticipants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].ConclusionsThe findings highlight the importance of Tai Chi in improving QOL and depression in this population.     

Supplementation of EPA and DHA in pregnant women with type 1 diabetes mellitus

Background/objectiveLower proportions of n-3 PUFAs have been observed in neonates born to diabetic mothers. We aimed to investigate the association between DHA and EPA supplementation during pregnancy complicated with type 1 diabetes on concentration and proportion of fatty acids in maternal and foetal blood.Subjects and methodsWe conducted a prospective randomized, single-blinded, placebo-controlled trial of 111 eligible pregnant women with type 1 diabetes and presented the results of 84 (intervention arm and control arm comprised 42 participants each) of them who successfully finished the trial in an academic hospital. The initiation of EPA and DHA supplementation or placebo started at randomization visit on gestational week 11–12. Blood samples were taken on the first (screening) visit to the clinic (1st trimester, between 8th and 10th gestational week, GW), then in the second trimester (19–24th GW) and third trimester (30th–33rd GW). On the delivery day, a blood sample was taken on fasting just before birth. The umbilical vein blood sample was taken shortly after the delivery.ResultsWe found a significant increase in the intervention group when compared the first and the third trimester for n-3 PUFAs concentration, 4.3 mg/L (3.3–7.6): 10.0 mg/L (7.1–13.7), p < .001. In the intervention group, the concentration of DHA in maternal vein serum was 11.4 mg/L (7.7–17.5), and in umbilical vein serum, it was 5.1 mg/L (3.0–7.7), which was significantly higher than that in the control group, maternal vein serum: median 9.2 mg/L(6.0–12.3), p = .03 and umbilical vein serum: median 3.4 mg/L (2.1–5.6), p = .009.ConclusionThe increased weight gain in pregnancy and concentration and proportions of DHA, n-3 PUFAs with a decreased proportion of AA, n-6 PUFAs, and AA/DHA ratio in maternal and umbilical vein serum summarize the effect of supplementation with EPA and DHA.     

Effects of group reminiscence on elderly depression: A meta-analysis

Background/purposeThe present meta-analysis was performed to evaluate the effectiveness of group reminiscence on depression in elderly patients.MethodsPublished and unpublished randomised controlled trials that assessed the effects of group reminiscence on depression in elderly patients were systematically reviewed using multiple electronic databases. Relative risks for dichotomous data and weighted mean differences for continuous data were calculated with 95% confidence intervals.ResultsTen trials were evaluated. Group reminiscence provided significantly greater relief of depressive symptoms than did the control intervention immediately after and 3 months after the intervention (p < 0.00001). However, this advantage disappeared 6 months after the intervention (p = 0.14). Group reminiscence significantly improved self-esteem and life satisfaction (p < 0.01).ConclusionGroup reminiscence was associated with short-term depression relief among elderly patients with depression and effectively improved self-esteem and life satisfaction. Higher-quality large-scale randomised controlled trials are needed to confirm these findings.     

Group antenatal intervention to reduce perinatal stress and depressive symptoms related to intergenerational conflicts: A randomized controlled trial

BackgroundIntergenerational conflicts are a major source of stress, which might lead to depression in new mothers. The conflict is heightened when grandparents are involved in childcare.ObjectivesTo examine the effectiveness of an interpersonal psychotherapy oriented group intervention to reduce stress and depressive symptoms in new mothers and enhance happiness and self-efficacy in managing intergenerational conflict in childcare. This study is one of the intervention projects of FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust.DesignMultisite randomized controlled trial with two arms: an intervention group attended an additional 4-week program and a control group who received usual care only.SettingSix Maternal and Child Health Centres in Hong KongParticipantsFrom September 2009 to January 2010, 156 pregnant women who would have grandparents involved in childcare were recruited at their 14–32 weeks’ gestation.MethodsParticipants were randomized to groups using computer generated random sequences by blinded recruitment staff. Primary outcomes were stress and depressive symptoms immediately after the intervention and 6–8 weeks after delivery. Secondary outcomes were happiness and self-efficacy in managing conflict.ResultsAfter screening 2870 pregnant women, 156 eligible participants were randomized. Intention-to-treat analysis showed that the intervention group (n = 78) had significantly lower perceived stress (p = 0.017; Cohen d = 0.38) and greater happiness (p = 0.004; Cohen d = 0.41) than the control group (n = 78) immediately after the intervention. However, the effects were not sustained at postnatal follow-up. Subgroup analysis showed that participants with depressive symptoms (EPDS > 12) at baseline reported significantly lower stress, greater happiness (p = 0.035 and 0.037, respectively; both Cohen d = 0.61), greater self-efficacy in managing conflict (p = 0.012; Cohen d = 0.76) than the control group after the intervention. Also, after delivery, they had significantly greater self-efficacy in managing conflict (p = 0.025; Cohen d = 0.61) and more able to cooperate with grandparents in childcare (p = 0.046; Cohen d = 0.59) than the control group.ConclusionThe intervention was effective in reducing stress and enhancing happiness among new mothers, particularly those with higher EPDS scores. Postnatal follow-up contacts as booster interventions may be needed to achieve lasting effects of the intervention.     

Associations between social determinants of health,perceived discrimination,and body mass index on symptoms of depression among young African American mothers

PurposeThe association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers.MethodsSecondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression.ResultsInitial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017).ConclusionThe findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

Smartphone based music intervention in the treatment of episodic migraine headaches – A pilot trial

ObjectivesMigraine headaches are a prevalent and burdening disorder for the public worldwide. Both traditional preventive drugs and behavioral-based interventions have been used as treatment in the prevention of migraine attacks. However, benefits of alternative interventions in patients with primary headache disorders have not yet been fully explored.The present investigation sought to examine the impact of a patient controlled music intervention (MUSIC CARE) on episodic migraine headache.DesignA sample of 20 episodic migraine patients (17 females, mean age of 42 years) was included in the pilot trial. Patients completed a pre-treatment assessment on headache severity, associated psychopathological distress (anxiety and depression) and functional impairment, and provided reports on their medication intake. During the 3-months intervention period, patients required 1–2 music sessions (based on the “U” sequence) per day with a minimum of 15 per month.ResultsFollowing the intervention, patients reported a significant reduction in the frequency of migraine attacks (M_Diff = −2.8, p = .01). Ten patients reported a 50% reduction in the frequency of migraine attacks. Additionally, there was a significant reduction in medication intake (M_Diff = −2.85, p = .02), the duration of migraine attacks (M_Diff = −5.45, p = .002), anxiety (M_Diff = −1.65 (2.88), p = .02) and depression (M_Diff = −2.45 (3.5), p = .002).ConclusionThese data provide evidence that music intervention may significantly prevent migraine attacks. Moreover, this method is easily accessible and administered. Future well-controlled clinical trials are necessary to further explore the efficiency of the intervention.     

Postpartum thrombotic microangiopathic syndrome

ObjectiveCharacterization of syndromes for patients with life-threatening, progressively worsening hemolysis-elevated-liver-enzymes-and-platelet (HELLP) syndrome-like diseases and with thrombotic microangiopathies.Retrospective study designPatients who underwent postpartum plasma-exchange (PPEX) for preeclampsia-related, and microangiopathy/coagulopathy illnesses unresponsive to medical therapy between 1994 and 2008 in our center and elsewhere.ResultsNine patients were treated with PPEX in our center with 78% maternal survival. Treatment with PPEX increased platelet levels (p = 0.048), decreased serum lactic dehydrogenase (p = 0.0012) and aspartate aminotransferase (p = 0.0001).ConclusionNineteen patients from publications combined with our patients suggest five categories of postpartum thrombotic microangiopathy syndrome that exhibit HELLP syndrome criteria and respond to PPEX.     

The Use of Modified Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy Program for Family Caregivers of People Living with Dementia: A Feasibility Study

PurposeThe aim of this study was to investigate the feasibility and preliminary efficacy of a modified mindfulness-based stress reduction (MBSR) program and mindfulness-based cognitive therapy (MBCT) program for reducing the stress, depressive symptoms, and subjective burden of family caregivers of people with dementia (PWD).MethodsA prospective, parallel-group, randomized controlled trial design was adopted. Fifty-seven participants were recruited from the community and randomized into either the modified MBSR group (n = 27) or modified MBCT group (n = 26), receiving seven face-to-face intervention sessions for more than 16 weeks. Various psychological outcomes were measured at baseline (T0), immediately after intervention (T1), and at the 3-month follow-up (T2).ResultsBoth interventions were found to be feasible in view of the high attendance (more than 70.0%) and low attrition (3.8%) rates. The mixed analysis of variance (ANOVA) results showed positive within-group effects on perceived stress (p = .030, Cohen's d = 0.54), depressive symptoms (p = .002, Cohen's d = 0.77), and subjective caregiver burden (p < .001, Cohen's d = 1.12) in both interventions across the time points, whereas the modified MBCT had a larger effect on stress reduction, compared with the modified MBSR (p = .019).ConclusionBoth the modified MBSR and MBCT are acceptable to family caregivers of PWD. Their preliminary effects were improvements in stress, depressive symptoms, and subjective burden. The modified MBCT may be more suitable for caregivers of PWD than the MBSR. A future clinical trial is needed to confirm their effectiveness in improving the psychological well-being of caregivers of PWD.     

Testing of a prototype Web based intervention for adolescent mothers on postpartum depression

PurposeThis article describes testing of a prototype Web site for adolescent mothers with postpartum depression; providing proof of concept.MethodsParticipants (N = 138) were recruited from a public school-based program for adolescent parents and completed the Mental Health Acceptability Scale, Stigma Scale for Receiving Psychological Help, and Attitudes Towards Seeking Professional Psychological Help Scale before, and after, the Web site intervention. They also provided feedback on the usability of the Web site.ResultsAttitudes related to depression and treatment (ATSPPH) improved after viewing the Web site (p = .023). Feedback on the Web site indicated that it was easy to use (77%), reflecting highly acceptable score for product usability.ConclusionsThe data provide the foundation for the launch of the Web site from prototype to product and more comprehensive testing. The creation and testing of informational text messages will be added to the Web site to increase the interactivity and dose of the intervention.     

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors

BackgroundCentral sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population.AimsThis study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms.DesignA single group pre–post intervention study was conducted.MethodsPatients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale.ResultsA total of 82 breast cancer survivors participated in the study. Pre–post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001).ConclusionsThe current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.     

Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services

BackgroundSomatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services.AimWe focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service.MethodsA cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied.ResultsOf all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ² = 18.4, p < .001), as well as more severe (t = –4.6, p < .001), and prolonged (χ² = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms.ConclusionsIn this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.     

Effects of psychological intervention for Korean infertile women under In Vitro Fertilization on infertility stress,depression, intimacy,sexual satisfaction and fatigue

This quasi-experimental study with a nonequivalent control group pretest-posttest design was conducted to evaluate the effects of a psychological intervention program for 50 women with infertility (experimental group: 26, control group: 24) utilizing assisted reproductive technology. The experimental group received six four-hour sessions of intervention, with outcomes measured at baseline and four weeks post-intervention. The experimental group demonstrated significant improvements in marital intimacy (z = 6.528, p < .001) and sexual satisfaction (z = 3.148, p = .003) and significant reductions in depression (z = −4.850, p < .001) and fatigue (z = −4.597, p < .001). Thus, the program can alleviate depression and fatigue. Further, psychological intervention centered on the marital and personal dimensions may improve marital intimacy and sexual satisfaction.