A prospective examination of depression,anxiety and stress throughout pregnancy

BackgroundPerinatal distress has largely been conceptualised as the experience of depression and/or anxiety. Recent research has shown that the affective state of stress is also present during the perinatal period and thus may add to a broader understanding of perinatal distress.AimThe aims of the present study were to investigate the changes in depression, anxiety and stress symptoms across pregnancy, and to explore the prospective relationships between these symptoms.MethodsTwo-hundred and fourteen pregnant women were recruited when they were less than 16 weeks gestation. Women completed depression, anxiety and stress measures on a monthly basis, from 16 weeks gestation through to 36 weeks gestation. The covariate measures of sleep quality and social support were assessed bi-monthly at 16, 24 and 32 weeks gestation.FindingsLevels of depression, anxiety and stress symptoms were all shown to change over time, with women experiencing fewer symptoms during the middle of their pregnancy. Higher symptoms early in pregnancy predicted higher symptom levels throughout the rest of pregnancy. Higher depression scores early in pregnancy were also shown to predict higher anxiety and higher stress scores in late pregnancy. Increased stress scores during mid pregnancy also predicted higher anxiety scores in late pregnancy.ConclusionCurrent findings indicate that symptom levels of depression, anxiety and stress vary over the course of pregnancy. Increased depression in early pregnancy seemed to be particularly pertinent as it not only predicted later depression symptoms, but also increased anxiety and stress in late pregnancy. Collectively, these results further highlight the importance of emotional health screening early in pregnancy.     

Emotional wellbeing of student midwives during COVID-19

BackgroundMental health of students in higher education was affected during the COVID-19 pandemic.AimTo examine the emotional wellbeing of midwifery students in the Netherlands and Flanders (Belgium) during COVID-19.MethodsA cross-sectional online-based survey with 619 Dutch and Flemish midwifery students. Sociodemographic details were obtained. Anxiety and depression were measured twice (T1, T2) during the COVID-19 pandemic.FindingsFlemish students had significantly higher mean depression and anxiety scores than Dutch students during the total period of study (p < .001; p < .001). Total group mean depression and anxiety scores were significantly higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, there was a significant increase of depression from T1 to T2 (p < .001). In the Flemish student group, both depression and anxiety scores significantly increased from T1 to T2 (p < .001; p < .001). A history of psychological problems predicted both depression and anxiety, irrespective of COVID-19 period or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) predicted depression, irrespective of period or country. A history of psychological problems predicted depression (p.004; p < .001) and anxiety (p.003; p.001) during the total period of study. Being single also predicted depression during T2 (p.024).ConclusionThese findings inform how emotional wellbeing of midwifery students was affected during the COVID-19 pandemic and identify those students that might need extra attention after the pandemic, during another pandemic or similar situations with social restrictions.     

Social Problem Solving as a Predictor of Well-being in Adolescents and Young Adults

Social problem solving is the cognitive-affective-behavioral process by which people attempt to resolve real-life problems in a social environment, and is of key importance in the management of emotions and well-being. This paper reviews a series of studies on social problem solving conducted by the authors. First, we developed and validated the Chinese version of the Social Problem-Solving Inventory Revised (C-SPSI-R) which demonstrated very good psychometric properties. Second, we identified the scope of stressful social situations faced by young adults and their self-efficacy in facing such situations (N = 179). Young adults were generally confident about their basic social skills but found it much more stressful to relate to family members, handle conflicts, handle negative behaviors from others, self-disclose to others, and to express love. Third, in two separate studies, we found that social problem solving was closely linked to measures of depression (n = 200), anxiety (n = 235), and family well-being (N = 1462). Measures of anxiety and depression were found to be significantly related to aspects of social problem solving in expected directions and expected strength. In another study, higher parental social problem solving behavior and lower avoidance behavior were found to be related to indicators of family well-being, including better overall family functioning, and fewer parent–adolescent conflicts.     

Life Satisfaction as a Distinguishing Indicator of College Student Functioning: Further Validation of the Two-Continua Model of Mental Health

The two-continua model of mental health contends that both psychological distress and psychological well-being make related-yet-distinct contributions to our understanding of human health and its relations with other quality of life outcomes. Using self-reported somatization, depression, and anxiety symptoms as indicators of psychological distress and self-reported life satisfaction as an indicator of psychological well-being, the present study classified participants into one of four mental-health-status groups—mentally healthy, mentally unhealthy, symptomatic yet content, or asymptomatic yet discontent—and investigated between-group differences across three key indicators of college student functioning: academic achievement, interpersonal connectedness, and physical health. Findings provide further validation for the two-continua model of mental health among college students, showing that, when considered in conjunction with clinical symptoms, life satisfaction serves as a distinguishing indicator of college students functioning across academic, social, and physical health domains—as well as a strong predictor of the absence or presence of clinical symptoms and comorbidity. Implications for theory, practice, and future research are discussed.     

Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic

ProblemPrenatal depression and anxiety are linked to poor maternal and infant outcomes. We need to understand predictors of poor mental health to identify at-risk women, and targets for support.BackgroundPrevious research has demonstrated a relationship between low levels of perceived social support, and depression and anxiety in pregnant women. However, there is a lack of research into the factors that may mediate this relationship.AimAs social distancing measures (e.g., lockdown) are likely to negatively affect women’s perceived support in the prenatal period, we investigated the relationship between perceived social support and both anxiety and depression in UK-based pregnant women during the COVID-19 pandemic. Further, we examined two potential mediators that may contribute to psychological symptoms: repetitive negative thinking and loneliness.MethodsWe administered a battery of online measures to a sample of pregnant women (N = 205) between May-June 2020, during the first peak of the pandemic in the UK, when perceived social support was likely to be low.ResultsConsistent with predictions, perceived social support was significantly negatively related to depression, anxiety, loneliness and repetitive negative thinking. Furthermore, repetitive negative thinking and loneliness mediated the relationship between perceived social support and both depression and anxiety. Moreover, perceived social support and loneliness were associated with specific types of online behaviours.ConclusionsTaken together, the findings shed light on the processes through which social support may exert its effects on depression and anxiety and highlight potential therapeutic targets for interventions which aim to prevent and treat mood disorders in perinatal cohorts.     

Linking Social Support to Psychological Distress in the Unemployed: The Moderating Role of Core Self-Evaluations

In this study, an integrative analysis involving social support and core self-evaluations (CSE) as concurrent predictors of psychological distress among unemployed adults was conducted. The main aim of this study was to evaluate the relationship between perceptions of social support and CSE with psychological distress among unemployed adults, as well as whether levels of CSE moderated the relations between social support and psychological distress. Results indicated that, along with the expected direct and additional influence, a significant social support × CSE interaction was found in explaining several dimensions of psychological distress beyond the independent effect of socio-demographic variables, social support and CSE independently. Specifically, we found significant interaction for social support × CSE in explaining stress and anxiety symptoms. Our data provide empirical support for theoretical and conceptual work connecting social support, CSE and psychological distress associated with unemployment suggesting that alone, but also in combination, these contextual and personal resources may be particularly relevant for leading to reduced psychological distress during unemployment. Finally, theoretical implications of the joint study of these constructs and their relation with psychological distress in unemployed people are discussed.     

Effects of the COVID-19 pandemic on perinatal mental health in Spain: Positive and negative outcomes

BackgroundPrevious studies have shown that perinatal distress has a negative influence on pregnancy outcome and the physiological development of the baby.ObjectiveThe aim of this study was to describe the effects of the COVID-19 pandemic on maternal perinatal mental health in Spain.MethodsSeven hundred and twenty-four women (N = 450 pregnancy, N = 274 postpartum) were recruited online during the pandemic. The Edinburgh Postnatal Depression Scale, the Positive and Negative Affect Schedule, and the Satisfaction With Life Scale were administered. Variables related to sociodemographic information, the COVID-19 pandemic, and perinatal care were also assessed.FindingsThe results showed that 58% of women reported depressive symptoms. Moreover, 51% of women reported anxiety symptoms. On the other hand, a regression analysis for life satisfaction showed that besides the perception about their own health, marital status or being a health practitioner were also significant predictors during pregnancy. However, perception about baby’s health and sleep, perception about their own health, and marital status were significant predictors of life satisfaction during the postpartum stage.DiscussionWomen assessed during the COVID-19 pandemic reported high rates of psychological distress.ConclusionThese results highlight the need of clinical support during this period. Knowing the routes to both distress and well-being may help maternity services to effectively cope with the pandemic.     

Dimensions of mental health: Life satisfaction,positive affect,anxiety and depression

Psychological well-being and psychological distress are often regarded as distinct, if not orthogonal dimensions of mental health. Based on analyses in this paper, we consider the distinction misleading. Four dimensions seem worth measuring in general population surveys: life satisfaction, positive affect, anxiety and depression. Furthermore, one of the well-being dimensions, life satisfaction, is quite strongly correlated with a distress dimension, depression. A person is unlikely to be both satisfied with life and depressed, but may be satisfied and anxious. The paper is based on convergent validity (exploratory and confirmatory factor analyses) and divergent validity assessments of a range of widely used measures, which were included in the Victorian Quality of Life Panel Survey, 1987.     

The contribution of group prenatal care to maternal psychological health outcomes: A systematic review

ProblemPoor mental health remains a significant cause of morbidity for childbearing women globally.BackgroundGroup care has been shown to be effective in reducing select clinical outcomes, e.g., the rate of preterm birth, but less is known about the effect of Group Prenatal Care (GPC) on mental health outcomes of stress, depression and anxiety in pregnant women.AimTo conduct a systematic review of the current evidence of the effect of group pregnancy care on mental health and wellbeing outcomes (i.e., stress, depression and/or anxiety) in childbearing women.MethodsA comprehensive search of published studies in Medline, PsychInfo, CINAHL, ProQuest databases, ClinicalTrials.gov and Google Scholar. Databases were systematically searched without publication period restriction until Feb 2020. Inclusion criteria were randomized controlled trials (including quasi-experimental) and observational studies comparing group care with standard pregnancy care. Included were studies published in English, whose primary outcome measures were stress, depression and/or anxiety.ResultsNine studies met the inclusion criteria, five randomized controlled trials and four observational studies, involving 1585 women (39%) in GPC and 2456 women (61%) in standard (individual) pregnancy care. Although evidence is limited, where targeted education was integrated into the group pregnancy care model, significant reductions in depressive symptoms were observed. In addition, secondary analysis across several studies identified a subset of GPC women, i.e., higher risk for psychological symptoms, who reported a decrease in their depression, stress and anxiety symptoms, postpartum. Due to the diversity of group care structure and content and the lack of outcomes measures universally reported, a comprehensive meta-analysis could not be performed.ConclusionThe evidence suggests improvements in some markers of psychological health outcomes with group pregnancy care. Future research should involve larger well-designed studies encompassing cross-population data using a validated scale that is comparable across diverse childbearing populations and clinical settings to better understand the impact of group pregnancy care.     

Qualitative insights into women's personal experiences of perinatal depression and anxiety

Background and aimSymptoms of perinatal depression and anxiety are usually described and understood from a nosological perspective. This research sought to gain insight into women's lived experience of postnatal depression and anxiety, the factors that contribute to these symptoms and the context in which they develop.MethodFace to face and telephone interviews were conducted with 28 women from metropolitan and rural areas across Australia, who had experienced postnatal depression and/or anxiety within the last five years. Analysis was conducted from a grounded theory perspective.FindingsParticular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience.ConclusionsThe findings provide useful insights into women's experiences of mental health symptoms during the perinatal period, how these symptoms present and the factors involved in their development and maintenance. The need to consider women's perspectives to develop resources and health promotions strategies, as well as within the context of relationships with health professionals is highlighted. The study emphasizes the need for greater, more accurate information surrounding perinatal depression and the need to increase the profile and awareness of anxiety disorders.     

Translation and factor analysis of structural models of Edinburgh Postnatal Depression Scale in Serbian pregnant and postpartum women – Web-based study

BackgroundThe Edinburgh Postnatal Depression Scale (EPDS) is well accepted for detecting symptoms of postnatal depression. The aim of this study was to examine psychometric properties and to evaluate structural models of the Serbian translation of EPDS in pregnant and postpartum women.MethodsThe original English version of the EPDS was translated into Serbian, and checked by means of back-translation. Data were collected via an anonymous online questionnaire posted on a Serbian website devoted to pregnancy topics. The study sample included 201 women (76 pregnant, 125 postpartum). The internal consistency of the scale was measured by Cronbach's α coefficient. Principal component analysis was used to determine scale dimensions while confirmatory factor analysis was used to evaluate model fit.FindingsCronbach α coefficient was 0.84 and 0.83 in pregnant and postpartum women, respectively, which indicated good internal consistency of the Serbian EPDS. Three dimensions of the scale were revealed in both groups of women. Goodness of fit indices described good and excellent model in pregnant and postpartum women, respectively. High level of depression symptoms (score ≥13) was recorded in 27.6% and 24.8% (p > 0.05) of pregnant and postpartum women, respectively. Moderate level of depression symptoms (score 10–12) was recorded in 21.1% and 16.8% (p > 0.05) of pregnant and postpartum women, respectively.ConclusionThe Serbian translation of the EPDS showed good consistency and good model characteristics in pregnant and postpartum women. However, cut-off values, sensitivity and specificity of the scale should be determined in the further studies with more representative samples of women.     

Hope Therapy in a Community Sample: A Pilot Investigation

We report findings from an initial empirical test of a hope-based, group therapy protocol. In this context, hope is defined as a cognitive process through which individuals pursue their goals [Snyder, C. R.: 1994, Free Press, New York]. As such, the eight-session group treatment emphasized building goal-pursuit skills. Findings from a randomized, wait-list control trial using a community sample (n=32 completers) are reported. Participants underwent structured diagnostic interviews (SCID-I) and completed assessment packets. Post-participation assessment results indicate the intervention was associated with statistically significant (p<0.05) improvements in the agency component of hope, life meaning, and self-esteem as well as reductions in symptoms of depression and anxiety. These results suggest that a brief hope intervention can increase some psychological strengths and reduce some symptoms of psychopathology.     

Psychological distress in pregnancy and postpartum

PurposeDepression, stress, and anxiety, termed ‘psychological distress,’ are common in pregnancy and postpartum periods. However, it is unclear whether prenatal psychological distress predicts postpartum psychological distress. We studied the prevalence, comorbidity and associations of maternal depression, stress, and anxiety in the prenatal period in relation to the occurrence of these same measures in the postpartum period.MethodsData originated from the MotherToBaby study of pregnant women residing in the U.S or Canada (2016–2018). Risk ratios and 95% Confidence Intervals using modified-Poisson regression models were used to investigate associations between prenatal psychological distress and postpartum psychological distress.ResultsOf the 288 women in the analysis, 21.2% and 26.7% of women had evidence of prenatal and postnatal psychological distress, respectively. Among those with prenatal psychological distress, 43 (70.5%) also had postpartum psychological distress. Twenty-five (41%) of those with prenatal and 46 (60%) of those with postpartum psychological distress had comorbidity of at least two of the measures. Prenatal measures independently predicted the same postnatal measures; prenatal anxiety also independently predicted postpartum stress. Participants who experienced more types of prenatal psychological distress were at higher risk for postpartum depression, stress, and anxiety.ConclusionDepression, stress, and anxiety are common in pregnant women and often occur together. Prenatal psychological distress measures are associated with postnatal psychological distress measures, with stronger associations among women with more than one type of psychological distress in pregnancy. Interventions during pregnancy may reduce the risk of postpartum psychological distress.     

The effects of maternal depression,anxiety, and perceived stress during pregnancy on preterm birth: A systematic review

BackgroundExperiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices.AimThe aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress.MethodsFour electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013.FindingsOf 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth.ConclusionComplex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants.     

Sleep Time: Media Hype vs. Diary Data

Sleep duration has figured into claims of two trends promoted recently as dysfunctional in the mass media. One is the observation that the population at large is sleeping less than before. The second is that the annual change from Standard Time to Daylight Savings (or summer) Time causes adverse effects, largely through the loss of an hour’s sleep. This paper relies on recent Canadian and U.S. time-use data to empirically test both of these value-laden allegations. Analysis of Statistics Canada’s general social surveys containing time-use information in 1986, 1992, 1998, and 2005 shows that the mean duration of sleep was unchanged between 1986 and 1998 and actually declined by about 15 min a night in 2005, reflecting an earlier bedtime and unchanged arising time. Sleep duration is not constant in the population, though, and the media view might reflect the habits of population sectors such as the intelligence with great access to the media. The American Time Use Study sample of 20,720 respondents in 2003 enabled the analysis of time-use before, on, and after the dates of semi-annual time changes that year. These data showed that any sleep time “lost” in the spring-forward time change was insignificant and short-lived due to the fact that it occurred on the night between Saturday and Sunday, when people typically sleep much longer than on weekdays. While there are other time trade-offs observed after time changes, their explanation lies in other directions.     

Circadian Rhythms,Sleep, and Cognitive Skills: Evidence From an Unsleeping Giant

This study analyzes the effects of sleep duration on cognitive skills and depression symptoms of older workers in urban China. Cognitive skills and mental health have been associated with sleep duration and are known to be strongly related to economic behavior and performance. However, causal evidence is lacking, and little is known about sleep deprivation in developing countries. We exploit the relationship between circadian rhythms and bedtime to identify the effects of sleep using sunset time as an instrument. Using the Chinese Health and Retirement Longitudinal Study, we show that a later sunset time significantly reduces sleep duration and that sleep duration increases cognitive skills and eases depression symptoms of workers aged 45 years and older. The results are driven by employed individuals living in urban areas, who are more likely to be constrained by rigid work schedules. We find no evidence of significant effects on the self-employed, non-employed, or farmers.     

Linking Metatraits of the Big Five to Well-Being and Ill-Being: Do Basic Psychological Needs Matter?

There is considerable evidence that two higher order factors underlie the Big-Five dimensions and that these two factors provide a parsimonious taxonomy. However, not much empirical evidence has been documented as to the extent to which these traits relate to certain psychological constructs. In this study, we tested a structural model to investigate the individual differences in well-being and ill-being by examining the mediating effects of autonomy, relatedness, and competence on the extent to which two higher order factors of personality, namely Stability and Plasticity, are linked to life satisfaction and depression. In testing the model, we controlled for the effects of current affect. A large community sample participated and responded to self-measures of The Big-Five personality, basic psychological needs satisfaction, satisfaction with life, depressive symptoms, and positive and negative affect. The results revealed that satisfaction of basic psychological needs fully mediated the relationship between Plasticity and life satisfaction, as well as depression. It also fully mediated the relationship between Stability and life satisfaction, and partially mediated the relationship between Stability and depression.     

Measuring Dimensions of Perceived Discrimination in Five Stigmatized Groups

The purpose of this investigation was to design and validate a multidimensional scale with the potential to measure perceived discrimination in different stigmatized groups. The study was carried out in Spain with a sample of 1,016 participants belonging to five stigmatized groups: Latin American immigrants, Romanian immigrants, people with HIV, gays and lesbians. Confirmatory factor analysis validated the existence of four dimensions in the scale: blatant group discrimination, subtle group discrimination, blatant individual discrimination, and subtle individual discrimination. In accordance with the literature, the scale presents positive relations with the stigma consciousness scale (Pinel in J Pers Soc Psychol 76:114–128, 1999) and negative relations with two measures of psychological well-being, affect balance and self-acceptance. Likewise, the results indicate that the perception of subtle individual discrimination is more negatively associated with participants’ psychological well-being.     

Predictors of Sexual Minority Youth’s Reported Suicide Attempts and Mental Health

Lesbian, gay, and bisexual youth (LGBY) report higher rates of mental health concerns compared to heterosexual youth due to minority stressors. This study examined the interpersonal and intrapersonal variables that predict psychological distress and self-reported suicide attempts in a sample of 61 LGBY in the Mid-South, which is a highly overlooked regional area for LGBY research. Youth who lost friends when coming out were 29 times more likely to report suicide attempts, and those who experienced psychological maltreatment from caregivers were 9.5 times more likely to report a suicide attempt. Internalized heterosexism, feelings of guilt or shame, and psychological maltreatment from caregivers were significant predictors of depression and anxiety symptoms. This study highlights the importance of creating affirming spaces for LGBY, particularly in areas of the country that experience greater political oppression of sexual minorities, such as the Mid-South.     

Parenthood, Marital Status, and Well-Being in Later Life: Evidence from SHARE

Using pooled cross-sectional data from the first two waves of the Survey of Health, Ageing and Retirement in Europe, we address the question of whether and how parenthood and marital status are associated with various dimensions of elders’ well-being, which we define by elements of the individual’s economic situation, psychological well-being, and social connectedness. The results of our multivariate analysis suggest that childless individuals do not generally fare worse than parents in terms of their economic, psychological, or social well-being. Although there is some indication for a ‘protective effect’ of marriage, having a partner does not per se contribute to greater psychological well-being: only those reporting satisfaction with the extent of reciprocity in their relationship report lower numbers of depression symptoms than their unmarried counterparts. We observe no systematic associations between parenthood (marriage, respectively) and individuals’ propensity to participate in social activities. These findings are fairly stable, that is, they hold for both men and women as well as across various cohorts, and they do not vary systematically between countries.