2,671 research outputs found
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The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework
There is evidence that 3.17% of women report posttraumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its etiology. Systematic searches were carried out on PsychInfo, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least one month after birth. 50 studies (N=21,429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (.51), fear of childbirth (.41), poor health or complications in pregnancy (r = .38), and a history of PTSD (.39) and counselling (.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (.59), having an operative birth (assisted vaginal or caesarean, .48), lack of support (-.38), and dissociation (.32). After birth, PTSD was associated with poor coping and stress (.30), and was highly comorbid with depression (.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the etiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care
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Factor Structure of the Edinburgh Postnatal Depression Scale in a Population-Based Sample
To demonstrate validity, questionnaires should measure the same construct in different groups and across time. The Edinburgh Postnatal Depression Scale (EPDS) was designed as a unidimensional scale, but factor analyses of the EPDS have been equivocal, and demonstrate other structures: this may be because of sample characteristics and timing of administration. We aimed to examine the factor structure of the EPDS in pregnancy and postpartum at 4 time-points in a large population-based sample. We carried out exploratory and confirmatory factor analysis on the Avon Longitudinal Study of Parents and Children sample (n = 11,195–12,166) randomly split in 2. We used data from 18 and 32 weeks pregnancy gestation; and 8 weeks and 8 months postpartum. A 3-factor solution was optimal at all time-points, showing the clearest factor structure and best model fit: Depression (4 items) accounted for 43.5–47.2% of the variance; anhedonia (2 items) 10.5–11.1%; and anxiety (3 items) 8.3–9.4% of the variance. Internal reliability of subscales was good at all time points (Cronbach’s αs: .73–.78). The EPDS appears to measure 3 related factors of depression, anhedonia, and anxiety and has a stable structure in pregnancy and the first postnatal year
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A systematic review of measures of mental health and emotional wellbeing in parents of children aged 0-5
BACKGROUND: A significant proportion of women with young children experience mental health problems and recent research suggests fathers may also be affected. This may have a long term negative impact on the child's development with significant costs to society. Appropriate measures are therefore needed to identify parents and children at risk.
METHOD: This literature review aimed to identify the most reliable, evidence based global measures of mental health for parents of infants from pregnancy to 5 years postpartum (0-5 years). Literature searches were conducted on online databases and hand searches of reference lists were also carried out. Studies were included in the review if they reported information on measures of global psychological distress or wellbeing from 0 to 5 years postpartum.
RESULTS: A total of 183 studies were included in the review, 19 of which directly examined the psychometric validity of an outcome measure. These studies reported information on 23 outcome measures, 4 of which had been validated in parents of children from 1 to 5. These were: the General Health Questionnaire (GHQ), the Symptom Checklist (SCL), the Self-Reporting Questionnaire (SRQ) and the Kessler scale (K10/6). Reliability and validity varied across studies.
LIMITATIONS: Only a small number of studies included fathers and examined psychometric validity across the entire period of early childhood.
CONCLUSIONS: The GHQ was the most frequently validated but results suggest poor reliability and validity. The SRQ and K10/6 were the most promising measures in terms of psychometric properties and clinical utility
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Pregnancy related risk perception in pregnant women, midwives & doctors: a cross-sectional survey
Background: Risk perception in relation to pregnancy and birth is a complex process influenced by multiple personal, psychological and societal factors. Traditionally, the risk perception of healthcare professionals has been presented as more objective and authoritative than that of pregnant women. Doctors have been presented as more concerned with biomedical risk than midwives. Such dichotomies oversimplify and obscure the complexity of the process. This study examines pregnancy-related risk perception in women and healthcare professionals, and what women and professionals believe about each other’s risk perception.
Methods: A cross sectional survey of set in UK maternity services. Participants were doctors working in obstetrics (N = 53), midwives (N = 59), pregnant women (N = 68). Participants were recruited in person from two hospitals. Doctors were also recruited online. Participants completed a questionnaire measuring the degree of perceived risk in various childbirth-related scenarios; and the extent to which they believed others agreed with them about the degree of risk generally involved in childbirth. Main outcome measures were the degree of risk perceived to the mother in baby in pregnancy scenarios, and beliefs about own perception of risk in comparison to their own group and other groups.
Results: There were significant differences in total risk scores between pregnant women, doctors and midwives in perception of risk to the mother in 68/80 scenarios. Doctors most frequently rated risks lowest. Total scores for perceived risk to the baby were not significantly different. There was substantial variation within each group. There was more agreement on the ranking of scenarios according to risk. Each group believed doctors perceived most risk whereas actually doctors most frequently rated risks lowest. Each group incorrectly believed their peers rated risk similarly to themselves.
Conclusions: Individuals cannot assume others share their perception of risk or that they make correct assessments regarding others’ risk perception. Further research should consider what factors are taken into account when making risk assessments
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Assessing physical symptoms during the postpartum period: reliability and validity of the primary health questionnaire somatic symptom subscale (PHQ-15)
© 2017 Informa UK Limited, trading as Taylor & Francis GroupIntroduction: This study aimed at establishing the reliability and validity of the primary health questionnaire (PHQ-15) somatic symptom severity subscale for postpartum women. Methods: Women (N = 495) completed the PHQ-15 approximately 6 weeks postpartum during the baseline phase of a randomized controlled trial evaluating a writing intervention for postnatal health in England. Reliability was assessed using internal consistency statistics and convergent validity by comparing differences in self-reported physical health, health-related quality of life (QoL) and primary care usage by PHQ-15 symptom severity category. Results: Cronbach’s α for the PHQ-15 was 0.73 and item-total statistics met recommended guidelines. Validity analyzes showed 6% of women reported severe symptoms, 17% medium, 50% low and 27% minimal symptoms. Women with severe symptoms reported poorer overall physical health, poorer physical health-related QoL and greater use of primary care. Women with severe symptoms also rated their baby’s health as worse and used primary care more for their baby. Discussion: This study suggests the PHQ-15 has the potential to be a useful and valid measure of physical symptoms in postpartum women in high-income countries
Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research
Objective:
This paper aimed to report the current status of research in the field of post-traumatic stress disorder following childbirth (PTSD FC), and to update the findings of an earlier 2008 paper.
Background:
A group of international researchers, clinicians and service users met in 2006 to establish the state of clinical and academic knowledge relating to PTSD FC. A paper identified four key areas of research knowledge at that time.
Methods:
Fourteen clinicians and researchers met in Oxford, UK to update the previously published paper relating to PTSD FC. The first part of the meeting focused on updating the four key areas identified previously, and the second part on discussing new and emerging areas of research within the field.
Results:
A number of advances have been made in research within the area of PTSD FC. Prevalence is well established within mothers, several intervention studies have been published, and there is growing interest in new areas: staff and pathways; prevention and early intervention; impact on families and children; special populations; and post-traumatic growth.
Conclusion:
Despite progress, significant gaps remain within the PTSD FC knowledge base. Further research continues to be needed across all areas identified in 2006, and five areas were identified which can be seen as ‘new and emerging’. All of these new areas require further extensive research. Relatively little is still known about PTSD FC
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A social model of posttraumatic stress disorder: Interpersonal trauma, attachment, group identification, disclosure, social acknowledgement, and negative cognitions
In response to calls for social models of posttraumatic stress disorder (PTSD) (Charuvastra & Cloitre,), we hypothesize relationships between interpersonal/non-interpersonal traumatic events, fearful attachment style, emotional disclosure, group identification, social acknowledgment, posttraumatic cognitions, and core trauma symptoms. The utility of social support versus social acknowledgement is also briefly considered. To test this exploratory model, a cross-sectional survey of participants (N = 298) with varying levels of traumatic symptoms following mixed traumas was conducted. Structural equation modeling (SEM) was used to analyze the model. Results support a mediational model, with group identification appearing to mediate the relationship between fearful attachment and social acknowledgement, emotional disclosure appearing to mediate the relationship between interpersonal trauma and social acknowledgment, and posttraumatic cognitions appearing to mediate the relationship between social acknowledgement and core trauma symptoms. Results suggest that, within this exploratory model, social acknowledgment and social support explain a similar amount of variance in traumatic symptoms, but acknowledgment explains considerably more variance in cognitions than social support. The paper successfully applies current theoretical insights on group identification processes to the posttraumatic environment. This theoretical application is relatively novel within the PTSD literature and helps stimulate new theory in this domain. It also provides further evidence of the “social cure” theory. More broadly, the findings highlight the utility of social psychological constructs in helping explain trauma symptoms. We discuss the implications of our findings, the study limitations and suggest avenues for further research
An analytic expression for the electronic correlation term of the kinetic functional
We propose an analytic formula for the non-local Fisher information
functional, or electronic kinetic correlation term, appearing in the expression
of the kinetic density functional. Such an explicit formula is constructed on
the basis of well-founded physical arguments and a rigorous mathematical
prescription
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The City Infant Faces Database: A validated set of infant facial expressions
Adults need to be able to process infants' emotional expressions accurately to respond appropriately and care for infants. However, research on processing of the emotional expressions of infant faces is hampered by the lack of validated stimuli. Although many sets of photographs of adult faces are available to researchers, there are no corresponding sets of photographs of infant faces. We therefore developed and validated a database of infant faces, which is available via e-mail request. Parents were recruited via social media and asked to send photographs of their infant (0-12 months of age) showing positive, negative, and neutral facial expressions. A total of 195 infant faces were obtained and validated. To validate the images, student midwives and nurses (n = 53) and members of the general public (n = 18) rated each image with respect to its facial expression, intensity of expression, clarity of expression, genuineness of expression, and valence. On the basis of these ratings, a total of 154 images with rating agreements of at least 75% were included in the final database. These comprise 60 photographs of positive infant faces, 54 photographs of negative infant faces, and 40 photographs of neutral infant faces. The images have high criterion validity and good test-retest reliability. This database is therefore a useful and valid tool for researchers
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