Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey

BACKGROUND: Women worldwide experience pregnancy-related nausea and vomiting yet tolerate this significant prenatal stressor. The physical and emotional stress caused by pregnancy-related nausea and vomiting may influence maternal psychosocial adaptation yet few studies have examined these relationships. OBJECTIVES: The purpose of the study was to examine the relationships between nausea and vomiting, perceived stress, social support and their ability to predict maternal psychosocial adaptation among Taiwanese women during early pregnancy. DESIGN: A correlational, cross-sectional research design. SETTING: Four prenatal clinics in Taiwan. PARTICIPANTS: Women (n=243) who had completed the 6-16 week of gestation consented to participate. METHODS: Subjects completed four self-report questionnaires in additional to providing demographic data: Index of Nausea, Vomiting, and Retching (INVR), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL), and the Prenatal Self-Evaluation Questionnaire (PSEQ). RESULTS: Pregnancy-related nausea and vomiting was experienced in varying degrees by 188 (77.4%) women. Stepwise multiple regression analysis revealed that 37.6% of the variance in maternal psychosocial adaptation was explained by the severity of nausea and vomiting, perceived stress, social support, and pregnancy planning. CONCLUSIONS: Women at higher risk for poor maternal psychosocial adaptation have not planned their pregnancy and experience severe pregnancy-related nausea and vomiting. Severe pregnancy-related nausea and vomiting associated with high-perceived stress levels may be mediated by social support.     

Fatigue and Relatedness Experiences of Inordinately Tired Women

Purpose: To examine the association of fatigue and interpersonal relatedness of fatigued women.
Design: Hermeneutics.
Methods: Seventeen fatigued American women, recruited through purposive sampling, were interviewed. Questions were based on data from previous research of women's fatigue and on characteristics of the theory of relatedness.
Findings: Relatedness was significantly linked to fatigue. Participants moved toward disconnectedness, parallelism, comfortable noninvolvement, or through enmeshment and then toward parallelism. A spiral of intrapersonal and interpersonal changes, sense of emotional absence, lack of energy and motivation, and depression-like symptoms were reported by fatigued participants, particularly those whose state of relatedness shifted toward disconnectedness. Depression-like symptoms were associated with fatigue, but were differentiated from diagnosed depression. Participants noted that physical movement was helpful to them in mediating their fatigue.
Conclusions: Findings from this study indicate the need for a database to describe the interplay among biological, psychosocial, and behavioral components of fatigue and to clarify its association with medical diagnoses, particularly depression.     

Isolation from "being alive": coping with severe nausea and vomiting of pregnancy

BACKGROUND: Despite ongoing investigations into specific causes of and treatments for pregnancy-related nausea and vomiting, it remains a common phenomenon of varying intensity that affects the quality of life for both affected women and their families. OBJECTIVE: To understand how women cope with severe nausea, vomiting, and/or retching during pregnancy. METHOD: Women hospitalized with severe symptoms (N = 24) were purposely selected to participate in 24 semistructured interviews and one focus group (N = 4). RESULTS: A process was identified wherein women experienced severe and unrelenting nausea and related symptoms which became progressively more debilitating, leaving them feeling uncertain about when and if they would recover. This caused the women to isolate themselves from their world in an effort to cope with symptoms. CONCLUSIONS: Severe nausea and vomiting of pregnancy is a complex and overwhelming syndrome. Rather than emphasizing a specific treatment for a particular symptom (e.g., vomiting), nurses can intervene to reduce the impact of factors that affect the magnitude of nausea, vomiting, and retching.     

A Comparative Study of Sleep Quality Between Pregnant and Nonpregnant Taiwanese Women

Purpose: This study explored (a) differences in sleep quality, depression, and stress among second- and third-trimester pregnant and nonpregnant women, and (b) relationships among depression, stress, and sleep quality of pregnant women in Taiwan.
Design: Cross-sectional.
Methods: A convenience sample of 150 second-trimester and 150 third-trimester pregnant women was recruited from two medical centers in Taiwan. A comparison group of 300 nonpregnant women was recruited by the acquaintance technique. Data were collected from October 2006 to September 2007 using a demographic form, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale, and Perceived Stress Scale.
Findings: The prevalence of poor sleepers (PSQI score>5) was 60.0% for second- and third-trimester pregnant women and 48.0% for nonpregnant women. After controlling for significant covariates, pregnant women reported worse global sleep quality, habitual sleep efficiency, and sleep disturbances than nonpregnant women, and poorer sleep quality and sleep latency were most prevalent during their third trimester. A high prevalence of antenatal depression (27.3% to 36.0%) was found in pregnant women, depressed women had worse sleep quality than nondepressed women in all groups, and stress affected sleep quality in pregnant women but not in nonpregnant women.
Conclusions: This cross-sectional study provides preliminary evidence that pregnant women suffer significantly more poor sleep quality than nonpregnant women, and that sleep quality of pregnant women was related to stress and depression.
Clinical Relevance: Evaluation for sleep quality and depression should be part of routine prenatal check-ups. Information on women's sleep quality, stress, and depressive status can be used to individualize interventions for pregnancy-associated sleep disorder.     

Symptom priority and course of symptomatology in specialized palliative care

The study aim was to explore which symptoms/problems cancer patients in palliative care consider most distressing, and to investigate how prioritization at first contact was associated with patient-assessed symptom intensity and change in intensity over time. Initially, 175 patients named and prioritized their five most distressing symptoms. Weekly, they completed the following self-assessment questionnaires: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Edmonton Symptom Assessment System, and the Hospital Anxiety and Depression Scale. Initial symptom intensity scores and weekly changes were calculated and compared with prioritization of the same symptom. Pain, fatigue, physical function, appetite, nausea/vomiting, dyspnea, and depression were the symptoms most often prioritized. Priority was associated with initial scoring of pain, appetite, nausea/vomiting, dyspnea, constipation, depression, and anxiety, but not with fatigue, physical function, role function, or inactivity. Priority was associated with change in symptom intensity for pain, reduced appetite, nausea/vomiting, and constipation. Symptom prioritization may be a useful guide to choice of treatment as well as to longitudinal symptom evaluation.     

Social stressors associated with antepartum depressive symptoms in low-income African American women

ABSTRACT Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women. Design and Sample: Cross‐sectional study of 119 women receiving care at 2 prenatal clinics in Northern California. Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress. Results: In this sample, mean CES‐D score was 15.88. Forty‐two percent of the women had CES‐D scores ≥16 (possible risk), and 23% had CES‐D scores ≥23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES‐D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms. Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study

PurposeThe aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6–8 weeks.MethodsThis study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6–8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale.ResultsForty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ² = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms.ConclusionsPsychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.     

Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study

OBJECTIVE: To find out whether acupressure wristband can alleviate nausea and vomiting in early pregnancy. DESIGN: Double-blind, placebo-controlled study. SUBJECTS: 97 women with mean gestational length completed 8-12 weeks. MAIN OUTCOME MEASURES: Symptoms were recorded according to intensity, duration and nature of complaints. RESULTS: 71% of women in the intervention group reported both less intensive morning sickness and reduced duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms. However, a significance level of 5% was reached only in the case of duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.018). CONCLUSIONS: Acupressure wristband might be an alternative therapy for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered.     

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.     

Psychosocial diagnoses occurring after patients present with fatigue

ObjectiveTo discover the frequency of psychosocial and other diagnoses occurring at the end of a visit when patients present to their FPs with concerns about fatigue.DesignCross-sectional study of patient-FP encounters for fatigue.SettingTen FP practices in southwestern Ontario.ParticipantsA total of 259 encounters involving 167 patients presenting to their FPs between March 1, 2006, and June 30, 2010, with concerns about fatigue.ResultsPsychosocial diagnoses were made 23.9% of the time. Among psychosocial diagnoses made, depressive disorder and anxiety disorder or anxiety state were diagnosed more often in women (P = .048). Slightly less than 30% of the time, the cause of patients’ fatigue remained undiagnosed at the end of the encounter. A diagnosis was made more often in men.ConclusionCauses of fatigue frequently remain undiagnosed; however, when there is a diagnosis, psychosocial diagnoses are common. Therefore, it would be appropriate for FPs to screen for psychosocial issues when their patients present with fatigue, unless some other diagnosis is evident. Depression and anxiety could be considered particularly among female patients with fatigue.     

Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay

Title.  Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay.
Aim.  This paper is a report of a study to explore gender differences in psychosocial aspects in the year prior to first-time myocardial infarction, and the association between these aspects and pre-hospital delay.
Background.  The time from symptom onset to hospital admission is critical for patient survival; therefore influences on pre-hospital delay are of interest. The prevalence of stressful psychosocial factors is higher among patients before acute myocardial infarction than among healthy controls.
Method.  Patients diagnosed with first-time acute myocardial infarction were recruited from five Norwegian hospitals over a 13-month period in 2003–2004. Of 738 eligible patients, 149 women and 384 men completed a self-administered questionnaire (response rate 72%).
Findings.  Depression, high family stress, high work stress and major life events had no statistically significant impact on patient delay or total pre-hospital delay. Depression, sleep disturbances and high family stress were reported among more women than men in the year prior to the event. Women and men aged 65 years and younger were more likely to report major depression and major life events than those older than 65. Low education and low partner education predicted prolonged patient delay in men but not in women. Low partner education also predicted prolonged total pre-hospital delay in men.
Conclusion.  The process between symptom onset and hospital admittance is complex, and more knowledge about factors influencing this process is vital to reduce pre-hospital delay. Significant others should be included in information-giving in relation to myocardial infarction as they seem to play a vital role in patients' decision-making processes.     

Associations of dietary intake and plasma concentrations of eicosapentaenoic and docosahexaenoic acid with prenatal depressive symptoms in Japan

The association between depression and omega‐3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive‐symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy‐associated nausea than those with non‐depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy‐associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.     

玻璃体视网膜术后患者眼压的早期监测

目的探讨玻璃体视网膜手术后患者早期眼压变化及术后恶心、呕吐、头痛、眼痛症状与眼压的关系.方法采用非接触性眼压计(NCT)对40例玻璃体视网膜手术后患者进行早期眼压监测,并记录出现恶心、呕吐、头痛、眼痛的情况.结果术后首次眼压升高发生于手术当天者占32.5%,术后第1天占37.5%,术后第2天占5%,第3天占2.5%;术后31例眼压升高患者中有11例无明显症状.结论玻璃体视网膜手术后眼压升高多发生在术后早期,术后恶心、呕吐、头痛、眼痛与眼压升高有关,无症状患者眼压仍然可能升高.术后早期监测眼压有利于及时发现并处理术后高眼压,防止眼压过高造成视功能不可逆的损害.     

Fatigue after stroke

OBJECTIVE: To determine the frequency and outcome of fatigue, its impact on functioning, and its relationship with depression in patients 3 to 13 months poststroke. DESIGN: Survey. SETTING: Community. PARTICIPANTS: Eighty-eight individuals from a pool of 181 consecutive patients previously admitted to an acute stroke service who were willing and able to complete the self-report questionnaires, and 56 elderly controls living independently in the community. MAIN OUTCOME MEASURES: Fatigue Impact Scale (a self-report measure of the presence and severity of fatigue and its impact on cognitive, physical, and psychosocial functions) and the Geriatric Depression Scale. RESULTS: The frequency of self-reported fatigue problems was greater in the stroke group (68%) than in the control group (36%, p < .001) and was not related to time poststroke, stroke severity, or lesion location. Forty percent of the stroke group reported that fatigue was either their worst or one of their worst symptoms. Patients attributed more functional limitations to their fatigue than did control subjects with fatigue. Although the presence of fatigue was independent of depression, the impact of fatigue on functional abilities was strongly influenced by depression. CONCLUSION: Fatigue can contribute to functional impairment up to 13 months after stroke, and its recognition and treatment are important for maximizing recovery.     

Determinants of depressive symptoms in hospitalised men and women with heart failure

BACKGROUND: Depressive symptoms are prominent and related to an increased risk on cardiovascular disease outcomes and all cause mortality in HF patients. AIM: To intervene effectively, factors related to depressive symptoms in men and women should be identified. METHODS: Depressive symptoms of 921 hospitalised HF patients (61% male; age 71+/-11; LVEF 33%+/-14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). RESULTS: Overall 40% of the patients had depressive symptoms (CES-D >or=16), which were more common in women than in men (47% versus 36%, p<0.001). Multivariable analysis in men revealed that depressive symptoms were related to age (OR 0.84, 95% CI 0.71-0.98, p=0.03, per 10 years), physical health (OR 0.76, 95% CI 0.71-0.83, p<0.001, per 10 units) and HF symptoms. In women depressive symptoms were also related to NYHA II-III versus IV (OR 0.60, 95% CI 0.37-0.95, p<0.03) and COPD (OR 2.33, 95% CI 1.20-4.53, p<0.012). CONCLUSION: Depressive symptoms are more common in women than in men. In both men and women depressive symptoms are related to age and physical health. For clinical factors: In men only HF symptoms, but in women also NYHA and COPD were related to depressive symptoms.     

The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: cross-sectional survey with four-week follow-up

This cross-sectional survey aimed to determine the prevalence and remission of depression in patients receiving palliative care and to ascertain the predictive value of somatic symptoms in making the diagnosis. Three hundred consecutive patients were interviewed within one week of their initial assessment by a specialist nurse at a palliative care service with in-patient and homecare facilities in south London, UK. Depression was assessed using the PRIME-MD PHQ-9. Presence of somatic symptoms (fatigue, sleep disturbance, poor appetite) was determined using the EORTC-QLQ-C30 quality of life questionnaire. Fifty-eight (19.3% [15.3 to 23.3]) patients met criteria for Major Depressive Disorder; 109 (36.3% [32.3 to 40.3]) met criteria for 'Any depressive syndrome'. Patients with Major Depressive Disorder were more likely to be male, and to have non-malignant disease, pain, poor performance status and desire for an early death. Of those patients with Major Depressive Disorder at baseline, 69% (27/39) had remitted four weeks later. Of those not depressed at baseline, 11% (19/174) met criteria for depression at follow-up. The positive predictive values of sleep disturbance, poor appetite and fatigue were low (<24%), whereas the negative predictive values of these symptoms were high (>89%). The high prevalence of depression in palliative care attests to the need for psychological assessment and support. Depression in patients receiving palliative care is unstable, suggesting that symptoms should be carefully monitored.