255 research outputs found
Supplemental Material, sj-docx-1-ptd-10.1177_08968608221086734 - Symptom dimensions of anxiety and depression in patients receiving peritoneal dialysis compared to haemodialysis
No full textSupplemental Material, sj-docx-1-ptd-10.1177_08968608221086734 for Symptom dimensions of anxiety and depression in patients receiving peritoneal dialysis compared to haemodialysis by Els Nadort, Robbert W Schouten, Xander Luijkx, Prataap K Chandie Shaw, Frans J van Ittersum, Yves FC Smets, Louis-Jean Vleming, Friedo W Dekker, Birit FPH Broekman and Carl EH Siegert in Peritoneal Dialysis International</p
Exploring unintended pregnancy journeys among women with psychiatric vulnerability using interpretative phenomenological analysis
No full textBackground: It is known that women with unintended pregnancies (UPs) experience many challenges. Women with psychiatric vulnerability may face specific concerns regarding the transmission of psychiatric vulnerability, parenting skills and bonding capacities with their offspring. This study aimed to explore how women with psychiatric vulnerability experience UPs.
Methods: This is a prospective qualitative study using semi-structured interviews during pregnancy and after delivery regarding the experiences of women with UPs and psychiatric vulnerability and involved partners. Follow-up interviews were conducted three to six months after delivery. Interpretative phenomenological analysis was employed to analyze the data.
Results: Women with psychiatric vulnerabilities described unintended pregnancies as complex events, often marked by ambivalent pregnancy intentions, concerns about generational trauma, and fears about parental adequacy. The pregnancies triggered heightened psychiatric symptoms, resurfacing childhood memories, and concerns about stigma, yet also motivated participants to seek support from mental health professionals and trusted others. Women adopted coping strategies such as focusing on the future, seeking distraction, and accepting support to manage emotional challenges. Across pregnancy and postpartum, many participants reported developing strong prenatal and postnatal bonding with the newborn, creating safety nets, and making intentional behavioral changes to support their babies. For several women, the unintended pregnancy ultimately fostered personal growth and contributed to an improvement in mental well-being.
Conclusions: This study elucidates the experiences of unintended pregnancies in women with psychiatric vulnerability. Our findings show that for women with psychiatric vulnerability, UPs may also become a window of opportunity for treatment, personal growth and create a safety net for the baby and oneself. This work may help mental healthcare providers to support comprehensively expectant parents who decide to continue UPs
The role of ethnicity and socioeconomic status in Southeast Asian mothers’ parenting sensitivity
No full textPast research indicates that socioeconomic status (SES) accounts for differences in sensitivity across ethnic groups. However, comparatively little work has been conducted in Asia, with none examining whether ethnicity moderates the relation between SES and sensitivity. We assessed parenting behavior in 293 Singaporean citizen mothers of 6-month olds (153 Chinese, 108 Malay, 32 Indian) via the Maternal Behavioral Q-Sort for video interactions. When entered into the same model, SES (F(1,288) = 17.777, p <.001), but not ethnicity, predicted maternal sensitivity (F(2,288) =.542, p =.582). However, this positive relation between SES and sensitivity was marginally moderated by ethnicity. SES significantly positively predicted sensitivity in Chinese, but not Malay dyads. Within Indian dyads, SES marginally positively predicted sensitivity only when permanent residents were included in analyses. We discuss the importance of culture on perceived SES-associated stress. However, because few university-educated Malays participated, we also consider whether university education, specifically, positively influences sensitivity.</p
Stress, vulnerability and resilience, a developmental approach
No full textBACKGROUND: The origins of mental disorders arise often in childhood. Early life is a period of unique sensitivity with long lasting effects on mental health. However, the mechanisms for these effects remain unclear. OBJECTIVE: This thesis describes a variety of studies using a developmental framework to promote greater understanding of the influence of nature (genotypes) and nurture (e.g., environmental risk and protective factors) on outcomes later in childhood. METHOD: The aim of this thesis is to investigate gene and environmental influences on behavioural, emotional, and cognitive outcomes in different samples from the Netherlands and Singapore, most derived from the general population. We assessed early life influences from a neurobiological, social, and a psychological perspective by using a biopsychosocial framework. RESULTS: Our studies support the hypothesis that all experiences during life, including early experiences in utero, will influence the expression of genes and in the end the mental health of individuals. However, genotypes influencing stress responses are found to be "plastic," which implies that they can be modulated by environmental experiences during life. In line with this, patterns of resilience are found to be context-dependent too. CONCLUSIONS: The model of "epigenetic programming" suggests the predictive power of the environment in utero and early childhood on mental health later in life. This association is probably determined by a neurodevelopmental pathway with individual differences in neural and endocrine responses to stress
Affective dysregulation in pregnancy
No full textAffective symptoms (symptoms of depression and anxiety) are frequently seen during pregnancy. Pregnant women experience depression at a rate of 7-25 % of and anxiety disorders at a rate of 15 -22%. When pregnant women present with affective symptoms, it can have negative effects on their health and that of their (unborn) child. For the mother these effects manifest as complications during pregnancy and delivery, and up to a fourfold increase in the risk of postpartum depression. For the child, there is increased risk of pre-term birth, low birth weight, developmental delay, behavioural problems and psychopathology later in life. For many women depression and anxiety disorders are discovered late during pregnancy or not at all, for the following reasons. At first, symptoms are often confused with physiological changes of pregnancy, such as fatigue or lack of energy. Secondly, pregnant women often are ashamed of their feelings and therefore could find it hard to talk about them. Affective symptoms during pregnancy occur frequently in the immigrant population. Studies show that these women tend to delay their check-ups and have a higher risk of complications during their pregnancy, which means that these complications as well as anxiety and depression are diagnosed at a relatively late stage. Recognizing the symptoms is more difficult within certain cultures where mental problems are often translated into somatic symptoms. Screening might provide a solution for no or late recognition of these symptoms. However, symptoms may fluctuate during pregnancy and opinions differ about the sensitivity and specificity of existing screening tests. The treatment of affective symptoms during pregnancy is equally challenging. The use of medication is sometimes seen as controversial. Some studies on antidepressants, show negative outcomes for mother and child. In these studies, it is often not clear what the clinical relevance of these negative outcomes is and to what extent these are caused by the medication or by the underlying disease. Psychotherapy also has some obstacles, such as long waiting times, lack of time, physical problems, unavailability of childcare and once again, shame. Online psychotherapy could be a solution, but this has not been studied extensively. The focus of my dissertation is on the diagnosis and the treatment of affective symptoms during pregnancy. For recognition it is important that affective symptoms in pregnancy will be destigmatized, allowing women to be more forthcoming in mentioning their feelings. Furthermore, screening might be helpful. Given that symptoms during pregnancy fluctuate, there is a need for multiple screenings. In addition to screening, there need for better schooling for care providers of the pregnant women, enabling them to recognize the symptoms. This is particularly necessary for care providers of women with an immigrant background where affective symptoms might present in a different form. Questionnaires need to be updated and validated continuously, paying extra attention to women with an immigrant background. Concerning medication, further study must be focused on outcomes among women using antidepressants during pregnancy. Are negative outcomes clinically relevant, are they caused by the medication or by an underlying condition? What are the consequences when the medication is not used? In conclusion, the main component of my research was the development and testing of an internet-based intervention which could help pregnant women at home at a time of their own choosing to decrease their affective symptoms. Unfortunately, this intervention did not have the intended effect, in part because of high dropout rates. However, I believe it is possible to adapt the intervention with improved information and guidance and a more appealing design which would result in more women participating and benefiting, and thus giving birth to a successful treatment module
Severity of nausea and vomiting in pregnancy and early childhood neurobehavioral outcomes: the Growing Up in Singapore Towards Healthy Outcomes study
No full textBackground: nausea and vomiting of pregnancy (NVP) affects 50 to 80 percent of women. The existing literature has examined NVP from the perspective of the mother, and relatively less is known about offspring outcomes.Objectives: to study the relationships of NVP with social-emotional, behavioral, and cognitive outcomes of the offspring in a multi-ethnic Asian cohort.Methods: in the Growing Up in Singapore Towards Healthy Outcomes prospective mother-offspring cohort study, mothers responded to a structured NVP questionnaire at 26-28 weeks’ gestation (n=1172) and participants with severe NVP were confirmed using medical records. Children underwent multiple neurodevelopmental assessments throughout childhood. We conducted multivariable regressions with post-estimation predictive margins to understand the associations of NVP with offspring neurobehavioral outcomes, which included 1-year Infant-Toddler Social and Emotional Assessment, 1.5-year Quantitative Checklist for Autism in Toddlers, 2-year Bayley Scales of Infant and Toddler Development, 2- and 4-year Child Behavior Checklist, and 4.5-year Kaufman Brief Intelligence Test. Analyses were adjusted for household income, birth variables, maternal mental health, and other relevant medical variables. Cohen’s d effect sizes were calculated using standardized mean differences (μd).Results: mothers were categorized into no (n=296, 25.3%), mild-moderate (n=686, 58.5%), and severe NVP (n=190, 16.2%), of whom 67 (5.7%) required admission. Compared to children of mothers who had no or mild-moderate NVP, children with exposure to severe NVP exhibited more externalizing behaviors (μd 2.0, 95% CI 0.3, 3.6; Cohen’s d=0.33) and social communication difficulties before 2 years (μd 4.1, 95% Cl 0.1, 8.0; d=0.38), both externalizing (μd 1.5, 95% CI 0.4, 2.6; d=0.43) and internalizing behaviors at 2 years (μd 1.2, Page 5 of 39Paediatric and Perinatal Epidemiology6 95% CI 0.1, 2.2; d=0.35), and only internalizing behaviors after 2 years (μd 1.1, 95% CI 0.4, 2.0; d=0.37).Conclusions: severe NVP is highly prevalent in this Asian cohort and may be adversely associated with multiple offspring neurobehavioral outcomes
De invloed van de Zuiderzee op de stormvloedstanden langs de Friesche kust
No full textCivil Engineering and Geoscience
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