INTIMATE PARTNER ATTACHMENT STYLE AND ANTENATAL DEPRESSION SYMPTOMS IN NULLIPARAS: RESULTS FROM THE ZRNO STUDY

Background: The purpose of this study was to examine the relationship between the important indicators that define mental health functioning during the first pregnancy: the level of depression, anxiety and fear of childbirth in the context of null intimate pa Subjects and methods: A group of 325 nulliparas in the third trimester of pregnancy were enrolled at the Childbirth preparation Division of Gynaecology and Obstetrics. The following instruments were applied: Experiences in Close Relationships-Revised, The Edinburgh Depression Scale, two aspects of anxiety - Zung Anxiety Scale and a questionnaire regarding fear of childbirth. Attachment anxiety and avoidance scales were recoded into four categories of a prototypical attachment style: secure, fearful, preoccupied and dismissive. Two-way ANOVA and the chi-square test were used for the statistical analysis. Results: All indicators of mental health functioning of our sample of nulliparas differed significantly regarding their partner attachment style. Nulliparas with a fearful, but also with a preoccupied type of attachment, showed less optimal mental health indicators compared to those with a secure/dismissive type of attachment. A significant interactive effect of partner attachment and emotional support from the older generation was found on the level of depression. Partner attachment styles and emotional support from the older generation were found to be statistically dependent. Conclusions:In our sample a secure attachment seems to represent a protective buffer for the level of depression, even when a lower emotional support of the older generation was included. Screening and intervening on intimate attachment style as a protective factor for antenatal depression and different forms of anxiety is proposed

Individual and contextual protective and risk factors of primiparas\u27 mental health in pregnancy and postpartum

Uvod: Depresija, anksioznost in strah pred porodom imajo številne posledice za nosečnice in razvijajoče se otroke. Za mnoge nosečnice je poporodna depresija prva razpoloženjska epizoda v življenju, etiologija poporodne depresije (PPD) in drugih peripartalnih motenj pa še vedno ostaja nejasna. Ne-varne oblike navezanosti v intimnih partnerskih odnosih predstavljajo dejavnik tveganja za simptome depresije. Analize kompleksne povezanosti poglavitnih kazalcev duševnega zdravja prvorodk z njihovimi individualnimi in kontekstualnimi značilnostmi, s poudarkom na intimni navezanosti v tem ključnem časovnem obdobju v slovenskem prostoru nimamo, prav tako ne glede drugih pomembnih medosebnih odnosov. Namen dela: Namen doktorske disertacije je analiza povezanosti določenih individualnih in kontekstualnih dejavnikov (navezovalni odnosi s partnerjem in drugi pomembni medosebni odnosi, doživljanje stresa) s posameznimi kazalci duševnega zdravja (raven depresivnosti, anksioznosti) pri prvorodkah v razponu časa od zadnje tretjine nosečnosti do poporodnega obdobja šestih tednov po porodu. Hipoteza: Osnovna hipoteza je, da so določene napovedne spremenljivke (individualne, s pomembnimi odnosi in s stresom povezane značilnosti prvorodk) povezane s tveganjem za depresivnost in anksioznost pred porodom in tudi s tveganjem za poporodno depresivnost. Zasnova raziskave, opis metod, preiskovancev: Sodelovale so prvorodke v zadnji tretjini nosečnosti, vodene v Porodnišnici Ljubljana UKC LJ (Šola za starše Porodnišnice Ljubljana ter redne ginekološke ambulante Porodnišnice Ljubljana). Vključili smo 325 nosečnic. Retestirane so bile cca 6 tednov po porodu (ko je na vprašalnik odgovorilo 181 nosečnic). Vprašalniki so zajemali osnovne podatke v zvezi z nekaterimi značilnostmi demografskega, socio-ekonomskega in socio-kulturnega statusa, parametre duševnega zdravja pa smo merili s samoocenjevalnimi vprašalniki: vprašalnik o strahu pred porodom, doživljanje navezovalnih odnosov s partnerjem ECR-R (Experience in Close Relationships – Revised) (Fraley, Waller in Brennan, 2000), raven anksioznosti z vprašalnikom Zung (Zung\u27s Self – rating Anxiety Scale) (Zung, 1971) in raven depresije z Edinburško lestvico depresije (Edinburgh Postpartum Depression Scale (EPDS) (Koprivnik in Plemenitaš, 2005). Psihosomatsko stanje smo analizirali z lastnimi konstruiranimi vprašanji glede doživljanja poroda, duševnega doživljanja telesnih težav v nosečnosti ter izpostavljenosti intenziteti stresorjem v zvezi z življenjsko situacijo v zadnjem letu. S tremi modeli linearne regresije smo analizirali povezave med demografskimi, socialnimi in navezovalnimi spremenljivkami in izbranimi kazalci (depresivnostjo, anksioznostjo in strahom pred porodom). Z univariatno logistično regresijo smo testirali povezave med demografskimi, socialnimi in drugimi variablami ter poporodno depresijo prvesnic. Slednjo smo merili z EPDS 10 točk ali več. Rezultati: V tretjem trimesečju smo pri bolj izobraženih prvesnicah in pri tistih z višjo stopnjo čustvene podpore sodelavcev ugotavljali nižjo raven anksioznosti (medtem ko so ostali prediktorji v modelu konstantni). Od vseh prediktorjev v modelu sta bili le navezovalna anksioznost in pa čustvena podpora sodelavcev značilno povezani z nivojem depresije. Navezovalna anksioznost v tretjem trimesečju je bila pomembno povezana z vsemi tremi kazalci duševnega zdravja (nivojem depresije, anksioznosti in strahom pred porodom). Pri 16% (25/156) prvesnic je bilo tveganje za depresijo povišano v zadnjem trimesečju (EPDS 10) in pri 16,2% (27/166) 6 tednov po porodu. Povečano tveganje za poporodno depresijo (PPD) je bilo povezano z nivoji depresivnosti med nosečnostjo, nivoji anksioznosti med nosečnostjo in po porodu, anksioznostjo v partnerskem navezovanju v zadnji tretjini in po porodu in pa povišanim stresom zaradi izgube zaposlitve ali neuspešnim iskanjem zaposlitve v zadnjem letu. Podpora sodelavcev v zadnjem trimesečju je bila zaščitni dejavnik oz. povezana z manjšim tveganjem za PPD. EPDS po porodu pa je bil višji pri bolj izobraženih in bolj anksioznih nosečnicah. Zaključek: Rezultati nakazujejo, da je med obravnavanimi spremenljivkami anksioznost v partnerskem navezovanju lahko ključni kontekstualni dejavnik pri doživljanju anksioznih in depresivnih simptomov v tretjem trimesečju in tudi pomemben dejavnik pri nastanku poporodne depresije. Z usmerjenimi terapevtskimi pristopi je navezovalna anksioznost dostopna modifikaciji. Vključitev oz. upoštevanje stilov navezanosti med partnerjema se lahko izkaže uporabno tudi pri antenatalnem presejanju za poporodne simptome depresije, hkrati pa bi naši rezultati lahko pripomogli k oblikovanju intervenc za zmanjševanje depresivnih simptomov v obporodnem obdobju. Zato je pomembno, da bi PPDS obravnavali v kontekstu individualnih, pomembnih bližnjih in s stresom povezanih dejavnikov. Stres, povezan z zaposlitvijo, pa je pomemben dejavnik, ki bi ga v sodobni obravnavi žensk, ki prvič rojevajo tudi morali upoštevati.Background: Depression, anxiety and fear of childbirth during pregnancy have numerous consequences for women and their developing offspring. For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. In Slovenia we lack an analysis of the complex connection of primiparas’ main mental health risk factors to the individual and contextual factors, with an emphasis on intimate attachment or regarding other important interpersonal relations in the crucial time period of peripartum. Study aim: This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas during the third trimester of pregnancy until 6 weeks postpartum regarding the main demographic and important contextual–relational factors, with an emphasis on partner attachment. Hypothesis: We hypothesized that for nulliparous women there would be a significant prediction of levels of anxiety, depression and fear of childbirth scores in the third trimester of pregnancy and prediction levels of depression postpartum by prediction variables (nulliparas’ chosen individual and contextual factors). Methods: A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpatum Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning. In the second analysis, 181 nulliparas in the third trimester of pregnancy were included. Univariate logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS 10). A multiple linear regression model was built with the postpartum EPDS as a dependent variable. Results: 16% (25/156) nulliparas were evaluated as being at risk for depression (EPDS 10) in the last trimester and 16.2% (27/166) at six weeks postpartum. During the third trimester, highly educated nulliparas and those with a higher level of co-workers’ emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers’ support were statistically significantly associated with the level of depression during the third trimester of pregnancy. Attachment anxiety during pregnancy was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth). In the postpartum period, increased risk for developing PPDS was associated with depression level during pregnancy, anxiety levels during pregnancy and postpartum, intimate-partner-attachment anxiety during pregnancy and postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. Support from co-workers in the last trimester of pregnancy was a beneficial factor for PPD. The EPDS after giving birth was higher for more educated and more anxious primiparas. Conclusions: The results of our study suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy and an important factor for PPDS development. With appropriate interventions, anxious attachment style is accessible to change. The results suggest that PPDS should be evaluated in the context of individual, important relational and stress-connected factors. The inclusion of attachment styles in assessments of perinatal depressive disorders might prove useful in antenatal screening for high risk of PPDS. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms. Work- and career-related stress is an important factor that should be taken into account by experts who deal with nulliparas’ mental health

Anksioznost v peripartalnem obdobju

Nosečnost je za ženske občutljivo obdobje, ki ga spremljajo pomembne fiziološke in duševne spremembe tako na čustveni kot na biološki, tj. hormonski ravni. Anksioznost je v obdobju tako velikih sprememb do neke mere normalen in prilagoditveni odgovor na situacijo. Vendar pa nekatere nosečnice izkusijo visoko raven anksioznosti, ki doseže stopnjo klinično pomembne motnje. Anksiozne motnje, ki se v peripartalnem obdobju najpogosteje pojavljajo, so generalizirana anksiozna motnja, panična motnja, fobije, obsesivno-kompulzivna motnja in posttravmatska stresna motnja. Pretekla anamneza razpoloženjskih in/ali anksioznih motenj je med najmočnejšimi napovedovalci razvoja peripartalne anksioznosti. Čeprav raziskovalno zanimanje za anksiozne motnje v peripartalnem obdobju narašča in vemo več o značilnostih in diagnosticirani ravni, pa so dokazi o klinični obravnavi – tako farmakološki kot nefarmakološki – še vedno omejeni. Tveganje in korist uvedbe farmakološkega zdravljenja vedno individualno pretehtamo. Prepoznavanje in obravnava anksioznosti med nosečnostjo sta bistvenega pomena in delujeta preventivno za psihiatrične motnje po porodu. Poporodna anksioznost matere lahko tudi pomembno ovira proces navezovanja matere in otroka, kar posredno tudi vpliva na razvoj otroka. Pri nosečnicah, ki so v psihiatrično obravnavo že vključene zaradi obravnavane duševne motnje, pa je sledenje, podpora in dobro interdisciplinarno sodelovanje lečečega psihiatra in ginekološke službe nujno potrebno

Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries – A bifactor ESEM representation

AimsTo measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe.Materials and methodsThe OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures.ResultsA total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042–0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of ‘attitude,’ ‘disclosure and help-seeking,’ and ‘social distance’ could be treated as a single dimension of stigma. Among the specific factors, the ‘disclosure and help-seeking’ factor explained a considerable unique proportion of variance in the observed scores.ConclusionThis international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak

INTIMATE PARTNER ATTACHMENT STYLE AND ANTENATAL DEPRESSION SYMPTOMS IN NULLIPARAS: RESULTS FROM THE ZRNO STUDY

Background: The purpose of this study was to examine the relationship between the important indicators that define mental health functioning during the first pregnancy: the level of depression, anxiety and fear of childbirth in the context of null intimate pa Subjects and methods: A group of 325 nulliparas in the third trimester of pregnancy were enrolled at the Childbirth preparation Division of Gynaecology and Obstetrics. The following instruments were applied: Experiences in Close Relationships-Revised, The Edinburgh Depression Scale, two aspects of anxiety - Zung Anxiety Scale and a questionnaire regarding fear of childbirth. Attachment anxiety and avoidance scales were recoded into four categories of a prototypical attachment style: secure, fearful, preoccupied and dismissive. Two-way ANOVA and the chi-square test were used for the statistical analysis. Results: All indicators of mental health functioning of our sample of nulliparas differed significantly regarding their partner attachment style. Nulliparas with a fearful, but also with a preoccupied type of attachment, showed less optimal mental health indicators compared to those with a secure/dismissive type of attachment. A significant interactive effect of partner attachment and emotional support from the older generation was found on the level of depression. Partner attachment styles and emotional support from the older generation were found to be statistically dependent. Conclusions:In our sample a secure attachment seems to represent a protective buffer for the level of depression, even when a lower emotional support of the older generation was included. Screening and intervening on intimate attachment style as a protective factor for antenatal depression and different forms of anxiety is proposed

Depression, Anxiety, Stress, and Suicidality Levels in Young Adults Increased Two Years into the COVID-19 Pandemic

Background. The severity of both the COVID-19 clinical picture and confinement measures in Slovenia was higher during the initial phase of the pandemic in 2020 than during the Omicron wave in 2022. This could lead us to expect a higher level of distress during the initial phase. On the other hand, prolonged stress can have a detrimental effect on mental health. This study aimed to explore how the prolonged stress of the COVID-19 pandemic and the accompanying changes affected the mental health of young adults in Slovenia. We analyzed and compared the levels of depression, anxiety, stress, and suicidal ideation in young adults during the initial phase of the pandemic and the Omicron wave, as well as between the COVID-19-infected and non-infected individuals. Methods. An online survey was used to survey 587 young adults in the first wave (July–December 2020) and 511 in the Omicron wave (January–February 2022). Levels of depression, anxiety, stress, and suicidal ideation were compared using Mann–Whitney U test. Results. Results show that the Omicron wave significantly worsened depression, anxiety, stress, and suicidal ideation. Young adults who had tested positive for COVID-19 reported no worse or only slightly worse mental health than those who never tested positive. Conclusions. The current study provides new evidence about the mental health of young adults during the Omicron wave. Our results show that two years into the pandemic, they expressed more negative emotions and suicidal thoughts than at the beginning

Risk of depression, anxiety, and stress during the second wave of COVID-19 in Slovenia

The spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) pandemic has led to numerous negative consequences on the mental health of the population throughout the world. The main aim of our study was to compare the risk for depression, anxiety, and stress during the second wave of the pandemic in Slovenia. An additional goal was to analyze the association of depression, anxiety, and stress, with the most relevant subjective factors that define the quality of life. Furthermore, we aimed at determining whether health workers have a higher risk for depression following the course of the pandemic. The study was conducted on the general population, between July 2020 and January 2021 through an online survey. The data of 1,728 respondents in two samples of respondents (782 at baseline – first measurement point and 946 during the second measurement point) of the second wave were analyzed using zero-inflated negative binomial regression and Mann-Whitney U-test. The findings of this study show that the rise the second wave was associated with a higher risk for depression, anxiety and stress. The risk for all three was higher for younger participants. Women showed a higher risk for anxiety and stress. Finances, relationships, and housing dissatisfaction were relevant predictors for depression, anxiety and stress. Health workers in our sample showed a higher risk for stress, but not for depression or anxiety, than the general population. Our findings highlight the urgent need for coordinating and developing mental health services and tailored interventions to reduce the mental health burden, especially in the younger

Depression, anxiety, stress, and suicidality levels in young adults increased two years into the COVID-19 pandemic

Background. The severity of both the COVID-19 clinical picture and confinement measures in Slovenia was higher during the initial phase of the pandemic in 2020 than during the Omicron wave in 2022. This could lead us to expect a higher level of distress during the initial phase. On the other hand, prolonged stress can have a detrimental effect on mental health. This study aimed to explore how the prolonged stress of the COVID-19 pandemic and the accompanying changes affected the mental health of young adults in Slovenia. We analyzed and compared the levels of depression, anxiety, stress, and suicidal ideation in young adults during the initial phase of the pandemic and the Omicron wave, as well as between the COVID-19-infected and non-infected individuals. Methods. An online survey was used to survey 587 young adults in the first wave (July–December 2020) and 511 in the Omicron wave (January–February 2022). Levels of depression, anxiety, stress, and suicidal ideation were compared using Mann–Whitney U test. Results. Results show that the Omicron wave significantly worsened depression, anxiety, stress, and suicidal ideation. Young adults who had tested positive for COVID-19 reported no worse or only slightly worse mental health than those who never tested positive. Conclusions. The current study provides new evidence about the mental health of young adults during the Omicron wave. Our results show that two years into the pandemic, they expressed more negative emotions and suicidal thoughts than at the beginning

Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment

‘An apple a day’?: psychiatrists, psychologists and psychotherapists report poor literacy for nutritional medicine: international survey spanning 52 countries /

Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of individuals with mental disorders was poorer compared to the general population (p < 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as ‘very good.’ Almost all (92.9%) stated they would like to expand their knowledge regarding ‘Nutritional Psychiatry.’ There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care