The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online):Randomized Controlled Trial

Background: Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. Objective: This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. Methods: This randomized controlled trial included pregnant women (16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). Results: Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ2 1=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. Conclusions: Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective

Pre-Readers at the Alien Zoo: A Preregistered Study of the Predictors of Dyslexia and Linguistic Sound Symbolism in 6-year-olds

Recent studies suggest that multisensory linkages betweenspeech and vision are implicated in the development ofdyslexia. Current data only address a relationship in adultswith existing diagnoses, but do not inform us about thedevelopmental trajectory of the association. We conducted apre-registered study of multisensory matching in 388 pre-readers in Singapore (Age: 5y 10m) using an adaptation of thebouba-kiki task (the Alien Zoo), and compared children’sperformance on this task to their earlier scores on measuresknown to predict dyslexia: phonological awareness,vocabulary size and letter knowledge. As reported elsewhere,children’s Alien Zoo scores were lower than adults’(Woon &Styles, 2017a). The language measures were strongly inter-correlated, suggesting persistent language skills acrossmultiple domains, However we found no significantrelationship between performance on the Alien Zoo task andany of the predictors of dyslexia. This may mean that therelationship is yet to emerge in this population. The childrenin this cohort will be tracked and tested at a later time point toestablish the developmental trajectory of this relationship

The Effect of Older Sibling, Postnatal Maternal Stress, and Household Factors on Language Development in Two-to Four-Year-Old Children

Previous literature has shown that family structure affects language development. Here, factors relating to older siblings (their presence in the house, sex and age gap), mothers (maternal stress) and household size and residential crowding were examined to systematically examine the different role of these factors. Data from mother-child dyads in a Singaporean birth cohort, (677-855 dyads; 52% males; 58-61% Chinese, 20-24% Malay, 17-19% Indian) collected when children were 24-, 48-, and 54-months old, were analysed. There was a negative effect of having an older sibling, moderated by the siblings’ age gap, but not by the older sibling’s sex, nor household size or residential crowding. Maternal stress affected language outcomes in some analyses but not others. Implications for understanding the effect of family structure on language development are discussed

Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients

Objective: Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. Methods: This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. Results: In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45–2.06) p = .007 and Hazard Ratio 1.65 (1.15–2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. Conclusion: This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes

Treatment of current depressive symptoms in dialysis patients: A systematic review and meta-analysis

Objective: Symptoms of depression are highly prevalent and undertreated in dialysis patients. To aid clinicians in offering treatment to patients with depression, we conducted a systematic review and meta-analysis on the treatment of current depressive symptoms in dialysis patients. Methods: Nine databases were searched on January 8th 2020 for randomized controlled trials on the treatment of depressive symptoms in dialysis patients. In contradiction to previous reviews, we only included studies who selected patients with a score above a defined cut-off for depressive symptoms and used an inactive control group, to investigate the effectiveness of treatments in currently depressed patients. All interventions aimed to treat depressive symptoms were accepted for inclusion. Standardized mean differences were calculated in a random effect meta-analysis. Results: Seventeen studies were included in the systematic review (1640 patients). Nine studies could be included in the meta-analysis. A pooled analysis of 7 studies on psychotherapy showed a standardized mean difference of −0.48 [−0.87; −0.08], with a moderate heterogeneity (I2 = 52%, X2 = 12.56, p = .05). All studies on psychotherapy performed a per protocol analysis and scored high on potential bias. A pooled analysis of two studies on SSRI's showed no statistically significant improvement of depressive symptoms (SMD −0.57 [−6.17; 5.02], I2 = 71%, X2 = 0.2474, p = .06). Conclusions: Psychotherapy is a promising treatment for currently depressed dialysis patients, although quality of evidence is low. More evidence is needed regarding the efficacy of SSRI's, exercise therapy and dietary supplements in this population. PROSPERO: CRD4201807396

The Effect of Older Sibling, Postnatal Maternal Stress, and Household Factors on Language Development in Two- to Four-Year-Old Children

Previous literature has shown that family structure affects language development. Here, factors relating to older siblings (their presence in the house, sex and age gap), mothers (maternal stress) and household size and residential crowding were examined to systematically examine the different role of these factors. Data from mother-child dyads in a Singaporean birth cohort, (677-855 dyads; 52% males; 58-61% Chinese, 20-24% Malay, 17-19% Indian) collected when children were 24-, 48-, and 54-months old, were analysed. There was a negative effect of having an older sibling, moderated by the siblings’ age gap, but not by the older sibling’s sex, nor household size or residential crowding. Maternal stress affected language outcomes in some analyses but not others. Implications for understanding the effect of family structure on language development are discussed

Changes in depression symptom profile with gender-affirming hormone use in transgender persons

Background: Women show higher prevalence of depression and different symptomatology than men, possibly influenced by sex hormones. Many transgender persons, who face a high risk of depression, use Gender-Affirming Hormone Therapy (GAHT), but the impact of GAHT on depressive symptom profiles is unknown. Methods: This study examined depressive symptoms in transgender persons before GAHT and after 3- and 12 months of GAHT. We used the Inventory of Depressive Symptomatology-Self Report to assess depressive symptoms, exploratory factor analysis (EFA) to assess symptom clusters, and linear mixed models to assess changes in symptom clusters. Results: This study included 110 transmasculine (TM) and 89 transfeminine (TF) participants. EFA revealed four symptom clusters: mood, anxiety, lethargy, and somatic symptoms. Changes in total depressive symptoms significantly differed between TM and TF groups. After 3 months of GAHT, TM participants reported improvement in lethargy (−16 %; 95%CI: −29 %; −2 %), and after 12 months TF participants reported worsening in low mood (24 %; 95%CI: 3 %; 51 %), but absolute score changes were modest. Neither group showed changes in anxiety or somatic symptoms. Limitations: This study had limited sample sizes at 12 months follow-up and did not include relevant biological or psychosocial covariates. Discussion: Changes in depressive symptoms after GAHT use differ in TM and TF persons: TM persons report slight improvements in lethargy, whereas TF persons report a slight increase in low mood. Starting GAHT represents a significant life event with profound social and physical effects, and further research should assess social and biological effects of GAHT on mood-related symptoms.</p

Variations in longitudinal sleep duration trajectories from infancy to early childhood

Objective: This study investigates variations in night, day, and total sleep trajectories across infancy and childhood in Asian children. Participants: Participants consisted of a subset of 901 children, within the Growing Up in Singapore Towards healthy Outcomes cohort, which recruited 1247 pregnant women between June 2009 and September 2010. Design: We used a novel conditional probabilistic trajectory model: a probabilistic model for mixture distribution, allowing different trajectory curves and model variances among groups to cluster longitudinal observations. Longitudinal sleep duration data for the trajectory analyses were collected from caregiver-reported questionnaires at 3, 6, 9, 12, 18, 24, and 54 months. Results: We found 3 patterns of night sleep trajectories (n = 356): long consistent (31%), moderate consistent (41%), and short variable (28%); and 4 patterns of day sleep trajectories (n = 347): long variable (21%), long consistent (20%), moderate consistent (34%), and short consistent (25%). We also identified 4 patterns of total sleep trajectories (n = 345): long variable (19%), long consistent (26%), moderate consistent (28%), and short variable (27%). Short, moderate, and long trajectories differed significantly in duration. Children with consistent trajectories also displayed sleep patterns that were significantly more representative of typical developmental sleep patterns than children with variable trajectories. Conclusions: This is the first study to describe multiple sleep trajectories in Singaporean children and identify between-individual variability within the trajectory groups. Compared to predominantly Caucasian samples, night/total sleep trajectories were generally shorter, while day sleep trajectories were longer. Future studies should investigate how these variations are linked to different developmental outcomes