Depression and Anxiety in Women During Pregnancy in Slovenia

Objective

The aim of the study was to evaluate the prevalence of elevated depression and anxiety among pregnant women and to examine its correlation with medical complications and socio-demographic characteristics.

Methods

The study is based on a cross-sectional design of a sample of 348 women in three trimesters of pregnancy who received routine obstetrical care at the University Medical Centre Ljubljana, Department of Obstetrics and Gynaecology. The responding women filled out a questionnaire on socio-demographic variables, the Centre for Epidemiologic Studies Depression Scale CES-D and the State Trait Anxiety Inventory STAI.

Results

21.7% of pregnant women were identified as suffering from elevated depression symptomatology, 15.7% reported high state anxiety and 12.5% had high trait anxiety. No significant differences in depression and anxiety across pregnancy trimesters were found. The women who have suffered from health complications during previous pregnancies showed higher state anxiety; those experiencing complications during their current pregnancy reported more intense symptoms of depression and of state and trait anxiety than women free of complications. Less educated, lower income and mothers of many children in the third pregnancy trimester reported more intensive symptoms of depression and trait anxiety.

Conclusions

Elevated depression and anxiety are frequent among pregnant women. The results draw attention to the need for early detection and treatment of depression and anxiety during pregnancy.     

Impact of a physical activity program on the anxiety,depression, occupational stress and burnout syndrome of nursing professionals

Objective

to assess the effects of a workplace physical activity (WPA) program on levels of anxiety, depression, burnout, occupational stress and self-perception of health and work-related quality of life of a nursing team in a palliative care unit.

Methods

the WPA was conducted five days per week, lasting ten minutes, during three consecutive months. Twenty-one nursing professionals were evaluated before and after the intervention, with the Hospital Anxiety and Depression Scale, the Maslch Burnout Inventory, and the Job Stress Scale. The changes in self-perceived health and work-related quality of life were measured using a semi-structured questionnaire.

Results

the WPA did not yield significant results on the levels of anxiety, depression, burnout or occupational stress. However, after the intervention, participants reported improved perceptions of bodily pain and feeling of fatigue at work.

Conclusion

the WPA did not lead to beneficial effects on occupational stress and psychological variables, but it was well accepted by the nursing professionals, who reported improvement in perceptions of health and work-related quality of life.     

Severe physical punishment: risk of mental health problems for poor urban children in Brazil

Objective

To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors.

Methods

We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15–49 years with a son or daughter < 18 years of age), we randomly selected one mother–child pair per household (n = 813; attrition rate: 17.6%). This study focused on children aged 6–17 years (n = 480). Child Behaviour Checklist CBCL/6–18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity). Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon. We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status). The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7). Backward logistic regression analysis identified independent correlates and significant interactions.

Findings

Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment.

Conclusion

Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem. Its influence persists in the presence of family stressors such as the father’s absence and maternal anxiety or depression.     

Peer Reviewed: Self-Rated Depression and Physician-Diagnosed Depression and Anxiety in Florida Adults: Behavioral Risk Factor Surveillance System, 2006

Introduction

Our purpose was to determine the prevalence and correlates of self-reported symptoms of depression and physician-diagnosed depression and anxiety in Florida adults by using the 2006 Florida Behavioral Risk Factor Surveillance System (BRFSS).

Methods

The BRFSS is an ongoing, state-based telephone health survey of noninstitutionalized adults that uses random-digit dialing. In 2006, an Anxiety and Depression Module was administered in Florida. Eight questions were used to examine current depression. Two additional questions assessed health care provider diagnosis of depressive and anxiety disorders. We used SUDAAN version 9.0 to evaluate the data to accommodate the complex sampling design.

Results

Approximately 9% of Florida adults experienced current depression; about 13% had had a diagnosis of depression in their lifetime and 11% had a diagnosis of anxiety in their lifetime. Approximately 44% of respondents with current depression had not had a diagnosis of depression. Current depression and lifetime diagnosis of depression and anxiety were independently associated with sociodemographic variables (being a woman, young, previously married or never married, or unemployed or unable to work), adverse health behaviors (current or former smoking, physical inactivity, or obesity), and chronic health conditions (history of a stroke, diabetes, or asthma). Although the prevalence of depression among non-Hispanic blacks and people with low education levels is higher, members of these groups are less likely than members of other sociodemographic groups to have had depression diagnosed by a physician.

Conclusion

Depression and anxiety are associated with sociodemographic disadvantages and chronic conditions and risk factors. Knowing the prevalence of depression and anxiety, both self-rated and physician-diagnosed, is useful in identifying unmet mental health needs among subpopulations.     

Self – Reported Depression,Anxiety and Evaluation of Own Pain in Clinical Sample of Patients with Different Location of Chronic Pain

Background

Depression, anxiety and chronic pain are frequent co-occurrent disorders. Patients with these mental disorders experience more intense pain that lasts for a longer time.

Method

Questionnaire with 228 variables was applied to 109 randomly chosen patients that were treated at an outpatient clinic for treatment of chronic pain of the University Clinical Centre Ljubljana from March to June 2013. 87 patients responded to the questionnaire (79.8%). Location of pain considering diagnosis was the criterion in the discriminant analysis (soft tissue disorders; headache; symptoms not elsewhere classified; back pain) and following summative scores as predictors: level of depression and anxiety (The Zung Self-Rating Depression/Anxiety Scale), evaluation of pain and perceptions of being threatened in social relations.

Results

Average age of participants was M = 52.7 years (SD 13.9), with 70.9% female, 29.1% male participants. 63% of respondents achieved clinically important level of depression and 54% clinically important level of anxiety. On univariate level, the highest level of depression and anxiety was found for back pain and the lowest for headache. No significant difference was found in evaluation of pain and perceptions of being threatened in social relations regarding location of pain. Self-evaluation of depression has, in the framework of discriminant analysis, the largest weight for prediction of differentiation between different locations of pain.

Conclusion

Different locations of pain have different connections with mood levels. The results of research on a preliminary level indicate the need to consider mental experience in the treatment of chronic pain.     

Abbreviated Mindfulness Intervention for Job Satisfaction,Quality of Life,and Compassion in Primary Care Clinicians: A Pilot Study

PURPOSE

Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians.

METHODS

A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures.

RESULTS

Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales—Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale.

CONCLUSIONS

In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.     

A six-month follow-up study of maternal anxiety and depressive symptoms among Japanese

Background

Maternal psychological distress has been widely studied, but epidemiologic data based on follow-up studies of maternal psychological distress remain insufficient in Japan. The objective of this study was to estimate the prevalence of anxiety and depressive symptoms among child-rearing women in Japan at two time-points after childbirth.

Methods

A self-administered questionnaire was delivered on two occasions to 2,657 women who had given birth in 2004: first when their infants were 3-4 months old and then again when their infants were 9-10 months old. The questionnaire included the Hospital Anxiety and Depression Scale (HADS; Japanese version) to estimate the level of maternal psychological distress.

Results

The total percentage of women with anxiety symptoms as assessed by a HADS score of 8+ was 26.2 % at 3-4 months of age, and 26.1 % at 9-10 months. Among the women without anxiety symptoms at 3-4 months, 11.6 % showed anxiety symptoms at 9-10 months. The total percentage of depressive symptoms was 19.0 % at 3-4 months, and 24.0 % at 9-10 months. Among the women without depressive symptoms at 3-4 months, 14.0 % showed depressive symptoms at 9-10 months.

Conclusion

Anxiety symptoms in mothers appeared to persist from 3-4 months to 9-10 months after childbirth, while depressive symptoms tended to be more common at 9-10 months after childbirth. Nevertheless, the prevalence of anxiety symptoms was higher than that of depressive symptoms.Key words: Maternal Welfare, Anxiety, Depression, Asian Continental Ancestry Group     

Anxiety,Self-Esteem and Coping with Stress in Secondary School Students in Relation to Involvement in Organized Sports

Aim

The objective of the study was to examine self-esteem, anxiety level and coping strategies among secondary school students in relation to their involvement in organized sports.

Methods

The sample included 280 Slovenian male and female secondary school students aged between 15 and 19 years. The participants completed The Adolescent Coping Scale, the Spielberger State-Trait Anxiety Inventory, and the PSDQ Selfesteem Scale.

Results

Participants engaged in organized sports exhibited higher self-esteem scores and lower anxiety scores in comparison to non-sport participants. Differences between the two groups have also been identified with respect to the use of certain coping strategies. Sport participants reported more productive coping than non-sport participants, which represents an active and problem-focused approach to dealing with everyday problems. Gender differences in the referred variables have also been studied, with female athletes exhibiting higher levels of anxiety than male athletes. Female participants were also found to use more non-productive coping than males, focused mainly on reducing emotional effects of stress.

Conclusions

Organized youth sports have an important role in improving and maintaining a favorable sense of self-worth, reducing anxiety, and promoting productive coping strategies in adolescents when dealing with everyday problems.     

Health Literacy,Cognitive Ability,and Functional Health Status among Older Adults

Objective

To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/Study Setting

Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Study Design

Study participants completed structured, in-person interviews administered by trained research assistants.

Data Collection

Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.

Principal Findings

All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.

Conclusions

Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.     

Psychopathological Correlates of Child Sexual Abuse: The Case of Female Students in Jimma Zone,South West Ethiopia

Background

Arguably, the sexual abuse of children raises a number of important questions for researchers at different times. Thus, the present study was aimed to examine psychopathological correlates of child sexual abuse.

Methods

This cross-sectional survey study compared the degree of vulnerability to psychopathological variables among respondents with a history of sexual abuse and their unabused counter parts in Jimma Zone. To this end, 400 female students were selected from five high schools as the sample population using multi-stage sampling procedure. Data were gathered using Reynold''s Adolescent Depression Scale (RADS), Adolescent Panic Anxiety Scale, and Posttraumatic stress disorder test. The collected data via self-administered questionnaire were analyzed through the two sample t-test statistical procedure.

Results

The study revealed a result of t=3.83 for depression, t=2.46 for panic episode, and t=4.23 for PTSD score, whereas, the critical value of all the three psychopathological variables showed t (52) =1.676 at P=0.05. Results illustrate the presence of statistically significant differences in the mean scores of the above mentioned psychopathologies between females with history of sexual abuse and females who were not victims of this sexual attack at df =52 and P=0.05.

Conclusion

The findings of the present study indicate that history of childhood sexual abuse has adverse consequences on the future psychological wellbeing of females. Specifically, females with experience of sexual abuse were found to be more susceptible to develop depression, panic anxiety, and post-traumatic stress disorders than unabused females. Thus, parents, and teachers should give the necessary care and protection to female children. Primary bio-psychosocial care services need to be established in the school system, and both the Ministry of Health and the Ministry of Education should work together against sexual exploitation of female children.     

Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001

Background

Effects of the World Trade Center (WTC) disaster on children’s respiratory health have not been definitively established.

Objective

This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health.

Methods

Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003–2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates.

Results

Among 3,184 children enrolled, 28% were < 5 years of age on 9/11; 34%, 5–11 years; and 39%, 12–17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3; 95% confidence interval, 1.5–3.5).

Conclusions

Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.     

Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis

Objective

To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis.

Methods

Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies.

Findings

Seventeen studies including a total of 13 923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2–1.8) or stunted (OR: 1.4; 95% CI: 1.2–1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5–3.2) and for stunting, 2.0 (95% CI: 1.0–3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted.

Conclusion

Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.     

Screening for depressive symptoms in older adults in the Family Health Strategy,Porto Alegre,Brazil

OBJECTIVE

To analyze the prevalence of depression in older adults and associated factors.

METHODS

Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity.

RESULTS

The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression.

CONCLUSIONS

A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.     

Association between maternal antenatal depression and infant development: a hospital-based prospective cohort study

Objective

To examine the association between antenatal depression and infant development after controlling for confounding factors.

Methods

A hospital-based prospective cohort study (Hokkaido Study on Environment and Children’s Health) was conducted between July 2002 and October 2005 in Sapporo, Japan. Of 309 mothers who delivered at Sapporo Toho Hospital during the study period and who agreed with the clinical assessment of depression, 154 mother–infant pairs were eligible for analysis. Antenatal depression was assessed between the second and third trimesters using the Edinburgh Postnatal Depression Scale (EPDS), and infant development was assessed at 6 months by the Bayley Scales of Infant Development II (BSID-II). Data on potential confounders, including socioeconomic status, birth complications, postnatal depression and child care environment, were obtained from medical records and self-administered questionnaires. Univariable and multivariable analyses were conducted in which the EPDS score was entered as an independent variable and the BSID-II scores as a dependent variable, adjusting for confounders.

Results

Although the antenatal EPDS score tended to be related to the BSID-II score in the univariable analysis, this correlation was lost in the multivariable analysis. However, based on a series of linear regression analyses, antenatal depression was found to be significantly related to shorter gestational age (β = −0.25, 95 % confidence interval (CI) [−1.20, −0.17]), and shorter gestational age was significantly related to a lower BSID-II (mental development) score (β = 0.23, 95 % CI [0.00, 0.00]).

Conclusions

Gestational age is an important confounder in the association between maternal antenatal depression and infant development. A delay in infant development may be related to a shorter gestational period caused by maternal depression during pregnancy.     

Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model

Objective

To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.

Data Sources

The 2001–2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.

Study Design

Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question “Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health?” Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects.

Principal Findings

Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p = .03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p = .96).

Conclusions

USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries.     

Confirmatory Factor Analysis of the Pain Care Quality Surveys (PainCQ©)

Objective

To examine the reliability and validity and to decrease the battery of items in the Pain Care Quality (PainCQ^©) Surveys.

Data Sources/Study Setting

Patient-reported data were collected prospectively from 337 hospitalized adult patients with pain on medical/surgical oncology units in four hospitals in three states.

Study Design

This methodological study used a cross-sectional survey design. Each consenting patient completed two PainCQ^© Surveys, the Brief Pain Inventory-Short Form, and demographic questions. Clinical data were extracted from the medical record.

Data Collection/Extraction Methods

All data were double entered into a Microsoft Access database, cleaned, and then extracted into SPSS, AMOS, and Mplus for analysis.

Principal Findings

Confirmatory factor analysis using Structural Equation Modeling supported the initial factor structure. Modification indices guided decisions that resulted in a superior, parsimonious model for the PainCQ-Interdisciplinary Care Survey (six items, two subscales) and the PainCQ-Nursing Care Survey (14 items, three subscales). Cronbach''s alpha coefficients all exceeded .80.

Conclusions

Cumulative evidence supports the reliability and validity of the companion PainCQ^© Surveys in hospitalized patients with pain in the oncology setting. The tools may be relevant in both clinical research and quality improvement. Future research is recommended in other populations, settings, and with more diverse groups.     

Comparative influence of self-efficacy, social support and perceived barriers on low physical activity development in patients with type 2 diabetes, hypertension or stroke

Background

Type 2 Diabetes, hypertension and stroke are strongly linked, and patients with any of these disorders are usually advised to be physically active based on existing evidence. However, different psychosocial constructs are found in separate settings to influence the physical activity levels of these different groups of patients. Hence, there is a need to establish the most important of the constructs to influence low physical activity in these groups of patients from Nigeria.

Methods

This cross-sectional study included 509 participants aged 35–80 years from randomly selected health facilities in South-western Nigeria. Physical activity level, self-efficacy, social support and perceived barriers of the participants were assessed using the International Physical Activity Questionnaire, Exercise Self-Efficacy Scale, Medical Outcomes Social Support Scale and Exercise Benefits and Barrier Scale, respectively.

Results

The odds of having low physical activity was highest in those with low social support for Type 2 Diabetes (OR=3.95, 95% CI=3.13–5.24), stroke (OR=2.72, 95% CI=1.98–3.91) and mixed disorders (OR=1.59, 95% CI=1.19–3.15) while high perceived barriers was associated with the highest odds (OR=1.79, 95% CI=1.23–2.87) for low physical activity in hypertensive participants.

Conclusions

Low social support had the highest influence in establishing low physical activity in patients with Type 2 Diabetes, stroke and those with mixed disorders and the amount of influence was highest in those with Type 2 Diabetes. Psychosocial constructs should be considered by giving priority to social support when prescribing physical activity especially for patients with Type 2 Diabetes, stroke and those with mixed disorders.