Women's perinatal depression: Anhedonia-related symptoms have increased in the COVID-19 pandemic

Background: The prevalence of perinatal depression increased during the COVID-19 pandemic, which may be due to changes in the profile of specific depressive symptoms.Aims: To analyze the impact of the COVID-19 pandemic on the (1) prevalence and severity of specific depressive symptoms; and on the (2) prevalence of clinically significant symptoms of depression during pregnancy and postpartum.Methods: Pregnant and postpartum women recruited before (n = 2395) and during the COVID-19 pandemic (n = 1396) completed a sociodemographic and obstetric questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). For each item, scores & GE;1 and & GE; 2 were used to calculate the prevalence and severity of depressive symptoms, respectively.Results: The prevalence and severity of symptoms of depression were significantly higher during the COVID-19 pandemic. The prevalence of specific symptoms increased by >30%, namely being able to laugh and see the funny side of things (pregnancy 32.6%, postpartum 40.6%), looking forward with enjoyment to things (pregnancy 37.2%, postpartum 47.2%); and feelings of sadness/miserable or unhappiness leading to crying during postpartum (34.2% and 30.2%, respectively). A substantial increase was observed in the severity of specific symptoms related to feelings that things have been getting on top of me during pregnancy and the postpartum period (19.4% and 31.6%, respectively); feeling sad or miserable during pregnancy (10.8%); and feeling scared/panicky during postpartum (21.4%).Conclusion: Special attention should be paid to anhedonia-related symptoms of perinatal depression to ensure that they are adequately managed in present and future situations of crisis.This study was and supported by the Psychology Research Centre (UID/PSI/01662/2013) , University of Minho, by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Education and Science through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement, under the Grant No. POCI-01-0145-FEDER-007653. This research was supported by the FEDER Funds through the Programa Operacional Factores de Competitividade (COMPETE) and by National Funds through FCT (Fundacao para a Ciencia e a Tecnologia) under the Grant No. PTDC/SAU/SAP/116738/2010. Fundacao Bial, under the project with the reference 157/12 and by the FCT- Fundacao para a Ciencia e a Tecnologia, I.P., under the projects PTDC/PSI-PCL/119152/2010, HEI-Lab R & amp;D Unit UIDB/05380/2020, UIDB/04750/2020, and LA/P/0064/2020. It was supported by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) . Raquel Costa was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016 [RC] . Tiago Miguel Pinto [TMP] was supported by the FSE and FCT under the individual grant SFRH/BD/115048/2016. Ana Conde was supported a doctoral grant for Science in Measure IV.3 and co-funded under the 2010 Science and Innovation Operational Program (POCI 2010) from Science and Technology Foundation, Government of the Portuguese Republic (Ref. SFRH/BD/13768/2003) [AC] . The work developed by ProChild CoLAB was supported by: (i) NORTE-06-3559-FSE-000044, integrated in the invitation NORTE-59-2018-41, aiming to hire Highly Qualified Human Resources, co-financed by the Regional Operational Programme of the North 2020, thematic area of Competitiveness and Employment, through the European Social Fund (ESF) and (ii) Mission Interface Program from the Resilience and Recuperation Plan, notice no 01/C05-i02/2022, aiming to guarantee public core funding to strengthen the network of interface institutions, as defined in the legal regime in force, approved by Decree-Law no. 63/2019, of May 16th, as well as in its 1st review on 'Technology and Innovation Centres-CTI' and 'Collaborative Laboratories-CoLABs', approved by Decree-Law no. 126-B/2021, of December 31st. Ana Mesquita is supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program-IF/00750/2015. This article is based upon work from COST Action CA18138 Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD) , supported by COST (European Cooperation in Science and Technology; https:// www.cost.eu/) . The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication

Implementation of the eira 3 intervention by targeting primary health care practitioners: Effectiveness in increasing physical activity

The World Health Organization (WHO) estimated that physical inactivity (PI) is responsible for 20 to 30% of all non-communicable diseases. We aimed to analyze the effectiveness of a multiple health behavior change (MHBC) intervention to increase physical activity (PA) in patients 45 to 75 years old who had at least 2 of 3 unhealthy behaviors (tobacco use, reduced fruit and vegetable consumption, and insufficient PA). The MHBC intervention is based on the Transtheoretical Model and the conceptual framework of the “5 A’s” and includes an individually tailored intervention, group sessions, and the use of community resources. We included 3062 participants, 1481 in the intervention group and 1581 in the control group. After 12 months, there were no differences in PA intensity measured by metabolic_equivalent_of_task_minutes/week (adjusted mean difference: 284.093, 95% CI: -298.24, 866.42) nor in the proportion of participants who increased PA levels to moderate or high (OR: 1.02, 95% CI: 0.85, 1.23; p = 0.822), and no differences in blood pressure, weight loss, or waist circumference. We found an increased proportion of patients in the intervention group who followed the WHO recommendations for PA (OR: 1.29; 95% CI: 1.04, 1.60; p = 0.02). We concluded that the intervention did not lead to a significant increase in PA. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data

Background: The COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country. Methods: Participants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review. Results: Prevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women. Limitations: Participants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds. Conclusions: Our findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world. © 2022Funding text 1: Sara Cruz acknowledges the Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center] ( UID/PSI/04375 ), Lusíada University North, Porto, supported by national funds through the Portuguese Foundation for Science and Technology , I.P., and the Portuguese Ministry of Science, Technology and Higher Education ( UID/PSI/04375/2019 ).; Funding text 2: This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138 . ; Funding text 3: Vera Mateus received financial support from CAPES /PrInt grant no. 88887.583508/2020-00 . ; Funding text 4: Raquel Costa was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016 [RC]. EPIUnit, ITR, and HEI-lab are supported by national funds through the Portuguese Foundation for Science and Technology , I.P., under the projects UIDB/04750/2020 , LA/P/0064/2020 , and UIDB/05380/2020 , respectively. ; Funding text 5: This publication is based upon work from COST Action 18138 - Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), supported by COST (European Cooperation in Science and Technology). www.cost.eu . ; Funding text 6: Ana Osório received financial support from CAPES PROEX grant no. 0426/2021 , process no. 23038.006837/2021-73, CAPES /PrInt grant no. 88887.310343/2018-00 and MackPesquisa Fund . ; Funding text 7: Rena Bina received financial support from the Bar-Ilan Dangoor Centre for Personalized Medicine , grant no. REFU/DANGO/100. ; Funding text 8: This publication is based upon work from COST Action 18138 - Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), supported by COST (European Cooperation in Science and Technology). www.cost.eu.Vera Mateus received financial support from CAPES/PrInt grant no. 88887.583508/2020-00.Ana Osório received financial support from CAPES PROEX grant no. 0426/2021, process no. 23038.006837/2021-73, CAPES/PrInt grant no. 88887.310343/2018-00 and MackPesquisa Fund.Rena Bina received financial support from the Bar-Ilan Dangoor Centre for Personalized Medicine, grant no. REFU/DANGO/100.Raquel Costa was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016 [RC]. EPIUnit, ITR, and HEI-lab are supported by national funds through the Portuguese Foundation for Science and Technology, I.P., under the projects UIDB/04750/2020, LA/P/0064/2020, and UIDB/05380/2020, respectively.This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138. The authors would like to thank all women who participated in the survey. Sara Cruz acknowledges the Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center] (UID/PSI/04375), Lusíada University North, Porto, supported by national funds through the Portuguese Foundation for Science and Technology, I.P. and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/04375/2019)

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health car

El desarrollo de las líneas transversales en el área de Lengua Castellana a través de la investigación cooperativa

This article describes, albeit briefly, an experience carried out by a colaborative research group in relation to the design, implementation and evaluation of croos-curricular themas within the main subject of Language, for which the action-research methodoly has been used. Afer a brief explanation of the topic and methodology of the research, the stages and procedures for the recolection and analysis of data are described. Finally, some of the conclusions of this experience about the conceptualization and design of cross-curricular themes are put forward, as well as the opportunities which action-research methodology offers to train teachers for their best profssional development.; En este artículo se describe brevemente la experiencia realizada por un equipo de investigación cooperativa, en torno al proceso de diseño globalizado, desarrollo y evaluación de las líneas transversales en el área de Lengua, siguiendo la metodología de la investigación acción. Después de una rápida justificación de la selección del tema y metodología de investigación utilizados, se contemplan las fases y procedimientos de recogida y análisis de la información empleados. Finalmente se avanzan algunas de las conclusiones extraidas de esta experiencia, en relación a la conceptualización y diseño de las líneas transversales, así como a las posibilidades de la investigación acción como modelo de formación del profesorado para su mejor desarrollo profesional

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

Background: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. Methods: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). Discussion: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. Trial registration: ClinicalTrials.gov Identifier: NCT04595123.The project is part of the COST Action Riseup-PPD CA 18138 and was supported by COST under COST Action Riseup-PPD CA18138; also, by the Spanish Ministry of Health, the Institute of Health Carlos III, and the European Regional Development Fund «Una manera de hacer Europa» by the Prevention and Health Promotion Research Network ‘redIAPP’ (RD16/0007). Raquel Costa is supported by the FSE and FCT under an individual Post-Doctoral Grant SFRH/BPD/117597/2016. Rena Bina and Drorit Levy received funding from the Bar-Ilan Dangoor Centre for Personalized Medicine, Israel. Ana Mesquita is supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program - IF/00750/2015. Ana Osório received financial support from CAPES/Proex no. 0653/2018 and CAPES/PrInt grant no. 88887.310343/2018-00.The funders of the study had no role in the study design or the writing the protocol. The corresponding author had final responsibility for the decision to submit for publication

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

Background: Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. Methods: An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. Results: The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. Conclusion: The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Trial registration: Clinicaltrials.gov NCT03136211. Registered 02 May 2017 – Retrospectively registered © 2021, The Author(s)

Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Background: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity =50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration: ClinicalTrials.gov, NCT03136211. Registered 2 May 2017, “retrospectively registered”. © 2021, The Author(s)

Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The PredictA-Spain study

Background: There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results: The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions: The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.This study was supported by the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450 and PI06/1442) and the Andalusian Council of Health (grant references: 05/403 and 06/278); as well as the Spanish Network of Primary Care Research ‘redIAPP’ (RD06/0018), the ‘Aragón group’ (RD06/0018/0020), the ‘Baleares group’ (RD07/0018/0033), and the ‘SAMSERAP group’ (RD06/0018/0039)