Mental health recovery for survivors of modern slavery: Grounded theory study protocol

© 2020 Author(s). Published by BMJ. Introduction Slavery and human trafficking are crimes involving the violation of human rights and refer to exploitative situations where an individual cannot refuse or leave due to threats, coercion or abuse of power. Activities involving slavery include forced labour exploitation, forced sexual exploitation, forced marriage and servitude. Epidemiological studies show high levels of mental health need and poor provision of appropriate support for survivors. What mental health recovery means to victims/survivors and how it could be promoted is under-researched. Methods and analysis A grounded theory study based on individual interviews will be undertaken. Survivors across the UK will be identified and recruited from non-governmental organisations and via social media. As per grounded theory methodology, data collection and analysis will be undertaken concurrently and recruitment will continue until theoretical saturation is reached. It is anticipated that approximately 30 participants will be recruited. Interviews will be audio recorded, transcribed verbatim and uploaded to NVivo V.11. The constant comparative method will be used to analyse the data, in order to produce a theoretical framework for mental health recovery that is grounded in the experiences of survivors. Ethics and dissemination Ethical approval has been obtained from the Faculty of Medicine and Health Sciences Ethics Committee at the University of Nottingham. The findings of the study will be disseminated to academic, professional and survivor-based audiences to inform future policy developments and the provision of mental health recovery support to this population

Acceptance Mindfulness-Trait as a Protective Factor for Post-Natal Depression: A Preliminary Research

(1) Background: the prevalence of postnatal depression (PND) reaches up to 20%. PND could be based on the interaction between a psychological vulnerability and chronic stress that pregnancy would activate. Vulnerability factors reflect a psychological profile mirroring mindfulness-trait (MT). A high level of MT is associated with an efficient regulation of both physiological and psychological stress, especially negative moods. Interestingly, mindfulness level can be improved by program based on mindfulness meditation. We hypothesize that MT is a protective factor for PND. We also postulate that negative moods increase during the pregnancy for women who develop a PND after delivery (2) Methods: we conducted a multicentric prospective longitudinal study including 85 women during their first trimester of their pregnancy and 72 from the childbirth to the baby’s first birthday”. At the inclusion, presence and acceptance of MT and various variables of personality and of psychological functioning were assessed. Mood evolution was monitored each month during the pregnancy and a delivery trauma risk was evaluated after delivery. PND detection was carried out at 48 h, 2, 6 and 12 months after the delivery with the Edinburgh Postnatal Depression Scale with a screening cut-off >11. (3) Results: high-acceptance MT is a protective factor for PND (OR: 0.79). Women without PND displayed less negative mood during pregnancy (p < 0.05 for Anxiety, Confusion and Anger). (4) Conclusions: these results suggest the value of deploying programs to enhance the level of mindfulness, especially in its acceptance dimension, before, during and after pregnancy, to reduce the risk of PND. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

BMJ Open

INTRODUCTION: The prevalence of postnatal depression (PND) is significant: reaching up to 20% in the general population. In mechanistic terms, the risk of PND lies in an interaction between a maternal psychophysiological vulnerability and a chronic environmental context of stress. On the one hand, repetition of stressor during pregnancy mimics a chronic stress model that is relevant to the study of the allostatic load and the adaptive mechanisms. On the other hand, vulnerability factors reflect a psychological profile mirroring mindfulness functioning (psychological quality that involves bringing one's complete and non-judgemental attention to the present experience on a moment-to-moment basis). This psychological resource is linked to protective and resilient psychic functioning. Thus, PND appears to be a relevant model for studying the mechanisms of chronic stress and vulnerability to psychopathologies.In this article, we present the protocol of an ongoing study (started in May 2017). METHODS AND ANALYSIS: The study is being carried out in five maternities and will involve 260 women. We aim to determine the predictive psychobiological factors for PND emergence and to provide a better insight into the mechanisms involved in chronic stress during pregnancy. We use a multidisciplinary approach that encompasses psychological resources and biophysiological and genetic profiles in order to detect relevant vulnerability biomarkers for chronic stress and the development of PND. To do so, each woman will be involved in the study from her first trimester of pregnancy until 12 months postdelivery. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ile de France III Ethics Committee, France (2016-A00887-44). We aim to disseminate the findings through international conferences and international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03088319; Pre-results

Difficultés psychologiques périnatales : facteurs de risque et développement d’un modèle multifactoriel en population générale. Résultats de l’Etude Longitudinale Française depuis l’Enfance (ELFE)

Mother’s psychological problems during the perinatal period are frequent and potentiallyserious for both mother and child. Depressive disorders appear to be particularly poorly identifiedand access to mental health care for women in the perinatal period remains a major public healthissue. Few studies have focused on interrelationships between risk factors for occurence ofpostpartum depressive symptoms. The main objective of our work was to study the impact ofvarious risk factors for occurrence of psychological problems during pregnancy and / orpostpartum, in a large sample of mothers in general population. The second objective was todevelop a "multifactorial model of postnatal depressive symptoms" based on the theoretical workof Milgrom, Martin & Negri (1999).Two studies were conducted using data from the ELFE cohort (Etude LongitudinaleFrançaise depuis l’Enfance - French longitudinal study from childhood). The first study (n=15143) showed that socioeconomic vulnerabilities and some characteristics of pregnancy,particularly those concerning antenatal care and obstetrical complications, were independentlyassociated with prenatal psychological distress. About 13% of women report having presentedsuch difficulties and a quarter of them had consulted a mental health specialist. Young age,intermediate educational level and being foreign-born were independently associated with a lowerprobability of access to mental health care. The second study (n=11 643) enabled the developmentof a multifactorial model of postnatal maternal depressive symptomatology. The results show adirect effect of prenatal support from the spouse and baby's self-regulatory capacities on theintensity of postnatal depressive symptoms. Indirect effects of socioeconomic status and maternalunderstanding of the baby’s crying mediated by respectively prenatal support and baby’s selfregulationcapacity are shown.Despite public health strategies to promote an organized screening and psychosocialvulnerabilities perinatal prevention strategies, lack of access to mental health care during theperinatal period remains a major public health issue. Our work confirms the hypothesis thatpostnatal depressive symptoms have multifactorial origins, evolving within a complex interactivemodel. Prenatal support from the spouse and baby-related characteristics seem to have a centralLes difficultés psychologiques pouvant apparaître chez les mères au cours de la périodepérinatale se révèlent fréquentes et potentiellement graves pour la mère et l’enfant. Ces troublessemblent être insuffisamment repérés et l’accès aux soins psychiques des femmes en périodepérinatale reste un enjeu de santé publique majeur. Peu de travaux se sont intéressés auxinterrelations et processus sous jacents entre des facteurs de risque de survenue de symptômesdépressifs postnataux. L’objectif principal de notre travail était d’étudier l’impact de diversfacteurs de risque de survenue de difficultés psychologiques au cours de la grossesse et/ou lepostpartum, au sein d’un vaste échantillon de mères en population générale. Le second objectifétait de développer un « modèle multifactoriel de la symptomatologie dépressive postnatale »,basé sur les travaux théoriques de Milgrom, Martin & Negri (1999).Deux études ont été menées à partir des données de la cohorte ELFE (Etude LongitudinaleFrançaise depuis l’Enfance). La première étude (n=15 143) a permis de mettre en évidence quedes vulnérabilités socioéconomiques et un ensemble de caractéristiques de la grossesse,notamment celles concernant le suivi prénatal et les complications obstétricales, étaientindépendamment associées à la présence de difficultés psychologiques prénatales. Environ 13%des femmes déclaraient avoir présenté de telles difficultés et un quart d’entre elles avaientconsulté un spécialiste de la santé mentale. Le jeune âge, un niveau éducatif intermédiaire et êtrenée à l’étranger étaient indépendamment associés à une plus faible probabilité d’accéder à dessoins de santé mentale. La seconde étude (n=11 643) a permis le développement d’un modèlemultifactoriel de la symptomatologie dépressive maternelle postnatale. Les résultats montrent uneffet direct du soutien anténatal de la part du conjoint et des capacités d’autorégulation du bébésur l’intensité de la symptomatologie dépressive postnatale. Des effets indirects du niveausocioéconomique et de la compréhension maternelle des pleurs du bébé médiés respectivementpar le soutien anténatal et les capacités d’autorégulation du bébé sont démontrés.En dépit des stratégies de santé publique visant à promouvoir un dépistage organisé et desstratégies de prévention des vulnérabilités psychosociales périnatales, le manque d’accès auxsoins psychiques au cours de la période périnatale demeure un enjeu majeur de santé publique.Notre travail confirme l’hypothèse que les symptômes dépressifs postnataux ont des originesmultifactorielles, qui évoluent au sein d’un modèle interactif complexe. Le soutien anténatal de lapart du conjoint et les caractéristiques liées au bébé semblent avoir une place centrale

Perinatal psychological problems : Risk factors and development of a multifactorial model in general population. Results of the French longitudinal study from childhood

Les difficultés psychologiques pouvant apparaître chez les mères au cours de la périodepérinatale se révèlent fréquentes et potentiellement graves pour la mère et l’enfant. Ces troublessemblent être insuffisamment repérés et l’accès aux soins psychiques des femmes en périodepérinatale reste un enjeu de santé publique majeur. Peu de travaux se sont intéressés auxinterrelations et processus sous jacents entre des facteurs de risque de survenue de symptômesdépressifs postnataux. L’objectif principal de notre travail était d’étudier l’impact de diversfacteurs de risque de survenue de difficultés psychologiques au cours de la grossesse et/ou lepostpartum, au sein d’un vaste échantillon de mères en population générale. Le second objectifétait de développer un « modèle multifactoriel de la symptomatologie dépressive postnatale »,basé sur les travaux théoriques de Milgrom, Martin & Negri (1999).Deux études ont été menées à partir des données de la cohorte ELFE (Etude LongitudinaleFrançaise depuis l’Enfance). La première étude (n=15 143) a permis de mettre en évidence quedes vulnérabilités socioéconomiques et un ensemble de caractéristiques de la grossesse,notamment celles concernant le suivi prénatal et les complications obstétricales, étaientindépendamment associées à la présence de difficultés psychologiques prénatales. Environ 13%des femmes déclaraient avoir présenté de telles difficultés et un quart d’entre elles avaientconsulté un spécialiste de la santé mentale. Le jeune âge, un niveau éducatif intermédiaire et êtrenée à l’étranger étaient indépendamment associés à une plus faible probabilité d’accéder à dessoins de santé mentale. La seconde étude (n=11 643) a permis le développement d’un modèlemultifactoriel de la symptomatologie dépressive maternelle postnatale. Les résultats montrent uneffet direct du soutien anténatal de la part du conjoint et des capacités d’autorégulation du bébésur l’intensité de la symptomatologie dépressive postnatale. Des effets indirects du niveausocioéconomique et de la compréhension maternelle des pleurs du bébé médiés respectivementpar le soutien anténatal et les capacités d’autorégulation du bébé sont démontrés.En dépit des stratégies de santé publique visant à promouvoir un dépistage organisé et desstratégies de prévention des vulnérabilités psychosociales périnatales, le manque d’accès auxsoins psychiques au cours de la période périnatale demeure un enjeu majeur de santé publique.Notre travail confirme l’hypothèse que les symptômes dépressifs postnataux ont des originesmultifactorielles, qui évoluent au sein d’un modèle interactif complexe. Le soutien anténatal de lapart du conjoint et les caractéristiques liées au bébé semblent avoir une place centrale.Mother’s psychological problems during the perinatal period are frequent and potentiallyserious for both mother and child. Depressive disorders appear to be particularly poorly identifiedand access to mental health care for women in the perinatal period remains a major public healthissue. Few studies have focused on interrelationships between risk factors for occurence ofpostpartum depressive symptoms. The main objective of our work was to study the impact ofvarious risk factors for occurrence of psychological problems during pregnancy and / orpostpartum, in a large sample of mothers in general population. The second objective was todevelop a "multifactorial model of postnatal depressive symptoms" based on the theoretical workof Milgrom, Martin & Negri (1999).Two studies were conducted using data from the ELFE cohort (Etude LongitudinaleFrançaise depuis l’Enfance - French longitudinal study from childhood). The first study (n=15143) showed that socioeconomic vulnerabilities and some characteristics of pregnancy,particularly those concerning antenatal care and obstetrical complications, were independentlyassociated with prenatal psychological distress. About 13% of women report having presentedsuch difficulties and a quarter of them had consulted a mental health specialist. Young age,intermediate educational level and being foreign-born were independently associated with a lowerprobability of access to mental health care. The second study (n=11 643) enabled the developmentof a multifactorial model of postnatal maternal depressive symptomatology. The results show adirect effect of prenatal support from the spouse and baby's self-regulatory capacities on theintensity of postnatal depressive symptoms. Indirect effects of socioeconomic status and maternalunderstanding of the baby’s crying mediated by respectively prenatal support and baby’s selfregulationcapacity are shown.Despite public health strategies to promote an organized screening and psychosocialvulnerabilities perinatal prevention strategies, lack of access to mental health care during theperinatal period remains a major public health issue. Our work confirms the hypothesis thatpostnatal depressive symptoms have multifactorial origins, evolving within a complex interactivemodel. Prenatal support from the spouse and baby-related characteristics seem to have a centra

Blocking phosphoinositide 3-kinase activity in colorectal cancer cells reduces proliferation but does not increase apoptosis alone or in combination with cytotoxic drugs

In response to growth factors, class IA phosphoinositide 3-kinases (PI3Ks) phosphorylate PtdIns(4,5)P(2), converting it to PtdIns(3,4,5)P(3) to activate protein kinase B/Akt. This is widely reported to promote tumorigenesis via increased cell survival, proliferation, migration and invasion and many tumor types, including colorectal cancer, exhibit increased PI3K signaling. In order to investigate the effect of inhibiting PI3K and as an alternative to the use of small molecular inhibitors of PI3K with varying degrees of selectivity, HT29 and HCT116 colorectal cancer cells bearing mutant PIK3CA were generated that could be induced with doxycycline to express synchronously a dominant negative subunit of PI3K, Δp85α. Upon induction, decreased levels of phosphorylated PKB were detected, confirming PI3K signaling impairment. Induction of Δp85α in vitro reduced cell number via accumulation in G(0)/G(1) phase of the cell-cycle in the absence of increased apoptosis. These effects were recapitulated in vivo; HT29 cells expressing Δp85α and grown as tumor xenografts had a significantly slower growth rate upon administration of doxycycline with reduced Ki67 staining without increased levels of apoptotic tissue biomarkers. Furthermore, in vitro Δp85α expression did not sensitize HT29 cells to oxaliplatin- or etoposide-induced apoptosis, irrespective of drug treatment schedule. Further analysis comparing isogenic HCT116 cells with and without mutation in PIK3CA showed no impact of the mutation in either proliferative or apoptotic response to PI-3K inhibition. These data demonstrate in colorectal cancer cells that PI3K inhibition does not provoke apoptosis per se nor enhance oxaliplatin- or etoposide-induced cell death

Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort

BACKGROUND: Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). OBJECTIVE: To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. METHOD: We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks' post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks' post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. RESULTS: Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01-1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. CONCLUSIONS: Antenatal preventive measures may be helpful to prevent PPD at 2 months' post- partum, while PNDS do not seem to be influenced by these actions