Understanding and Reducing Stress and Psychological Distress in Older Women with Heart Disease

ABSTRACT

Stress and psychological distress were assessed in 457 older women who were subsequently randomized to a six-week heart disease management program (“Women take PRIDE”) or to a “usual care” control group. Baseline distress was significantly associated with age, symptoms, physical functioning, social support, optimism, and self-esteem (p < .05). Only 20% of women reported their physician had recommended reducing stress. At four months follow-up, intervention women compared to controls were significantly more likely to report reductions in stress levels (p = 0.02) and also showed improvement in emotional behavior (p = 0.09).     

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.     

Partner relationship,social support and perinatal distress among pregnant Icelandic women

Background

It is inferred that perinatal distress has adverse effects on the prospective mother and the health of the foetus/infant. More knowledge is needed to identify which symptoms of perinatal distress should be assessed during pregnancy and to shed light on the impact of women’s satisfaction with their partner relationship on perinatal distress.

Perceived Stress and Sexual Orientation Among Breast Cancer Survivors

Little is known about the cancer survivorship experiences of sexual minority women (SMW). SMW breast cancer survivors are hypothesized to experience more stress compared to heterosexual breast cancer survivors. A convenience sample of 211 breast cancer survivors (68 SMW, 143 heterosexual women) participated in this cross-sectional online investigation of perceived stress. Regression analyses indicated significant differences in reported stress between heterosexual and SMW breast cancer survivors (β= -.15, p = .03). Our findings may reflect unique experiences had by sexual minority breast cancer survivors. Future research should explore the factors that contribute to elevated perceived stress in this group.     

Socio-demographic Differences in Self-reported Psychological Distress Among 25- to 64-Year-Old Finns

Background Mental health problems are a major public health issue worldwide. The aim of this study was to assess the relative importance of socio-demographic characteristics associated with different domains of psychological distress in Finland. Methods Data source was a nationwide survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from years 2002 to 2003 (N = 5425; response rate 66%). Psychological distress was measured by self-reported questions of general mental health (MHI-5), depression, insomnia and stress. Socio-demographic factors included education, employment status, partnership and children living in the household. Main analyses were conducted by multivariate logistic regression. Results Education, employment and partnership were associated with most of the psychological distress outcomes. Respondents with a lower educational level had poor mental health in both genders but less insomnia and stress in men. Those with an intermediate education had the least stress in women. The unemployed and retired were at a higher risk for poor mental health and depression. Moreover, employment status was associated with insomnia and stress in men. Respondents not having a partner showed a higher risk of psychological distress according to all measures. Not having children living in the household was associated with insomnia in women and with less stress in men. Conclusions Socio-demographic factors, such as having a partner and employment status, are associated with several measures of psychological distress indicating the importance of social and economic factors to psychological well-being. The association of education and of having children living at home varies by the domain of psychological distress measure.     

Mental health issues: a comparison of lesbian, bisexual and heterosexual women

This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed.     

Menopause Symptoms' Predictors: The Influence of Lifestyle,Health- and Menopause-Related,and Sociodemographic Characteristics

This research explores a causal model of menopausal symptoms in peri- and postmenopausal women. A community sample of 710 women was assessed regarding menopausal symptoms, and sociodemographic, health- and menopause-related, and lifestyle characteristics. Structural equation modelling was used. Menopausal status predicted skin/facial hair changes (β = .156; p <.001), vasomotor (β = .122; p <.001) and sexual symptoms (β = .158; p <.001). Age was significantly associated with cognitive impairment (β = .087; p = .003), aches/pain (β = .072; p = .006), urinary (β = .115; p = .004) and also sexual symptoms (β = .107; p = .021). Several menopausal symptoms are predicted, not only by menopausal status, but also by age progression, among other variables; this should be considered in the context of a well-adapted menopausal transition.     

Importance of fatalism in understanding mammography screening in rural elderly women

This study examined the relationship between demographic factors and other correlates of fatalism, and assessed the impact of fatalistic beliefs on the participation in breast cancer screening in rural women. The subjects were 220 women aged 50 and over recruited from 6 large rural counties in South Carolina. Data were collected using a demographic questionnaire and the revised Powe Fatalism Inventory. Results show significant associations between fatalism and increased age (p = 0.005), race (p = 0.0001), doctor recommendation (p = .0034) and decreased educational level (p = 0.001). Fatalism was associated with noncompliance with mammography screening in univariate analysis among African-American women (OR = .362; 95% CI: 1.11, 11.8). After adjusting for possible confounders (age, education, and doctor recommendation), fatalism was not significantly associated with noncompliance with screening. These results illustrate age, race, and education may be important predictors of fatalism and that fatalism may be one barrier that has previously gone unmeasured and unchallenged in understanding screening behavior in older women.     

Partner support during the prenatal testing period after assisted conception

Background

Pregnancy after infertility is a challenging experience. The first-trimester screening test may add stress. Partner support reduces psychological distress in pregnant women after spontaneous conception. No data are available for women who conceive via assisted reproductive technology.

Cognitive adaptation and women's adjustment to conjugal bereavement

Conjugal bereavement is experienced by the majority of older women in enduring relationships. Although most experience considerable distress in the immediate aftermath of this loss, the majority adjusts over the course of time. The current study of self-selected participants applies the theory of cognitive adaptation in an attempt to distinguish between women who have successfully adjusted to the death of their husbands versus those who exhibit prolonged distress. Results of this study suggest that positivity biases in personally relevant information processing (i.e., self-deception, marital aggrandizement, dispositional optimism) are significantly associated with life satisfaction and the absence of psychiatric distress. The contribution of cognitive adaptation is maintained over and above that provided by personality variables (i.e., neuroticism, extraversion, openness to experience). Intervention strategies to treat enduring distress among widowed women are considered on the basis of these findings.     

The stories of women who are transferred due to threat of preterm birth

Background

Women at risk of preterm birth before 32 weeks gestation are routinely transferred to facilitate birth at a hospital that has Neonatal Intensive Care. The clinical outcomes of being ‘in-born” improves newborn and neonatal outcomes is well documented. However little is known about the women's experiences when such a complication occurs.

Cognitive Adaptation and Women's Adjustment to Conjugal Bereavement

ABSTRACT

Conjugal bereavement is experienced by the majority of older women in enduring relationships. Although most experience considerable distress in the immediate aftermath of this loss, the majority adjusts over the course of time. The current study of self-selected participants applies the theory of cognitive adaptation in an attempt to distinguish between women who have successfully adjusted to the death of their husbands versus those who exhibit prolonged distress. Results of this study suggest that positivity biases in personally relevant information processing (i.e., self-deception, marital aggrandizement, dispositional optimism) are significantly associated with life satisfaction and the absence of psychiatric distress. The contribution of cognitive adaptation is maintained over and above that provided by personality variables (i.e., neuroticism, extraversion, openness to experience). Intervention strategies to treat enduring distress among widowed women are considered on the basis of these findings.     

Effect of audit and feedback on the availability, utilisation and quality of emergency obstetric care in three districts in Malawi

BACKGROUND: Facility-based maternal death reviews and criterion-based clinical audit, were introduced in three districts in Malawi in 2006. RESEARCH QUESTION: Can audit and feedback improve the availability, utilisation and quality of emergency obstetric care (EmOC)? PARTICIPANTS AND METHODS: Observational study in which emergency obstetric care offered to women who gave birth in 73 health facilities (13 hospitals and 60 health centres) in three districts in Malawi in 2005 (baseline, 41,637 women) was compared to 2006 (43,729 women) and 2007 (51,085 women). RESULTS: The number of comprehensive and basic EmOC facilities did not change over the 3-year period (p for trend=1.000). Although institutional delivery rate decreased in 2006, overall it increased over 3 years (p for trend<0.001) - 31.8% (2005), 31.1% (2006) and 34.7% (2007), and Caesarean section rate was low and did not change (p for trend=0.257) - 1.7% (2005), 1.6% (2006) and 1.5% (2007). There was a significant increase in the met need for EmOC (p for trend<0.001) - 15.2% for 2005, 17.0% for 2006 and 18.8% for 2007. Maternal mortality decreased significantly from 250 per 100,000 women in 2005 to 222 in 2006 and 182 in 2007 (p for trend<0.001). Similarly, the case fatality rate decreased monotonically (p for trend<0.001) - 3.7% (2005), 3.0% (2006) and 1.5% (2007). DISCUSSION: Audit and feedback can improve availability, utilisation and quality of emergency obstetric care in countries with limited resources. CONCLUSION: There is need to increase availability of emergency obstetric care by upgrading some health centres to EmOC level through training of staff and provision of equipment and supplies.     

Oxidative stress levels are reduced in postmenopausal women with exercise training regardless of hormone replacement therapy status

This study investigated whether postmenopausal women on HRT would experience a greater reduction in oxidative stress after 24 weeks of aerobic exercise training compared to postmenopausal women not on HRT. Plasma thiobarbituric acid reactive substances (TBARS), an indicator of oxidative stress, was measured in 48 previously sedentary postmenopausal women on HRT (n = 21) and not on HRT (n = 27) before and after 24 weeks of aerobic exercise training. Baseline levels of TBARS differed significantly between groups after controlling for age, BMI, and fasting blood glucose (P = 0.03). There was a significant reduction in TBARS after 24 weeks of training in the overall group. When analyzed separately, both postmenopausal women on HRT and those not on HRT had a significant reduction in TBARS; however, there was no significant difference between groups (-0.71 +/- 0.14 nmol/ml in non-HRT users vs. -0.50 +/- 0.16 nmol/ml in HRT users; P = 0.33) even after controlling for age, BMI, and baseline levels of TBARS. Our results showed that aerobic exercise training significantly decreased oxidative stress in postmenopausal women; however, both HRT users and non-HRT users benefited equally.     

“The loss was traumatic… some healthcare providers added to that”: Women’s experiences of miscarriage

Background

Miscarriage is a common event in Australia and is estimated to occur in up to one in four confirmed pregnancies. Prior research has demonstrated that miscarriage is associated with significant distress, grief and loss, and in some cases clinically significant levels of depression, anxiety, and Post Traumatic Stress Disorder. Despite these consequences for women’s emotional and mental health, studies have commonly found that women feel that healthcare providers often lack empathy, support, and acknowledgement of their loss.

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.     

Serious psychological distress,sex, and falls among the elderly

Serious psychological distress and falls are two major public health problems among the elderly. This study aims to test the hypothesis that although serious psychological distress can increase the risks of falls among the elderly, it tends to affect elderly women more than elderly men. Data of this study are from the 2011 California Health Survey Interviews (CHIS). We extracted a sample of 13,153 respondents aged 65 and older for this study, including 8,087 females and 5,066 males. We tested both unadjusted and adjusted interaction effects using bivariate and multivariate logistic regression analysis. Elderly women with serious psychological distress had the greatest likelihood of falls as compared to men with serious psychological distress and men and women without serious psychological distress. With respect to the covariates, limitations of physical activity and poor self-rated health status, Asian race, and older age were more likely to be associated with falls. This study provides further information on sex disparities of falls among the elderly such that serious psychological distress has a greater impact on falls for elderly women than elderly men. Thus, the findings of our studies suggest that mental health services and intervention can be useful to prevent falls for elderly women.     

Sleep quality and stress in women with pregnancy-induced hypertension and gestational diabetes mellitus

BackgroundPregnant women with complications including pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) often experience disrupted sleep patterns because of activation of the sympathetic nervous system. These pathologies are aggravated by sympathetic nervous system activation and may be related to stress. The present study aimed to clarify the characteristics of and changes in sleep quality and stress in pregnant women with PIH and GDM during the second and third trimesters.MethodsWe enrolled 56 women in their second or third trimesters who were diagnosed with PIH or GDM. Participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS). Secretory immunoglobulin A (SlgA) concentrations were measured as a biological indicator of stress.ResultsPSS scores and subjective stress parameters were significantly higher than those reported from previous studies of healthy pregnant women (15.2 points and 15.1 points for the second and third trimesters, respectively).Mean one-day values for SIgA were 168.3 and 205.7 μg/mL for the second and third trimesters, respectively. During the second and third trimesters, SIgA scores were higher than those reported for healthy pregnant women in previous studies. The PSQI component scores sleep disturbance (C5) and sleep duration (C3) in follow up case were significantly higher in the third trimester than in the second trimester.DiscussionThis investigation suggests that pregnant women with PIH and GDM experience higher stress levels than do non-pregnant women and healthy pregnant women. Further, our results indicate that sleep quality worsens during the third trimester compared with the second trimester.     

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.     

Psychometric Evaluation of a Serbian Version of the Subjective Happiness Scale

The main aim of this research was to examine the psychometric properties of the Subjective Happiness Scale (SHS; Lyubomirsky and Lepper in Soc Indic Res 46:137–155, 1999) in a sample of young adults in Serbia (N = 605, mean age = 21.99). The SHS demonstrated adequate internal consistency reliability and homogeneity. Exploratory and Confirmatory factor analyses supported the unidimensional structure of the SHS. The results provided support for the convergent validity of the SHS, by significant correlations with measures of subjective well-being (life satisfaction, positive and negative affect, emotional distress), positive expectations (optimism and self-efficacy), meaning in life and personality traits (extraversion and neuroticism). As compared to the Satisfaction with Life Scale, the SHS showed significantly higher correlations with measures of emotional states and personality traits. Hierarchical regression analyses showed that the SHS had incremental validity over and above subjective well-being and personality traits in predicting emotional distress and meaning in life.