Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review.

Perimenopause is often called a window of vulnerability for the development or exacerbation of mood and anxiety disorders. Evidence points to social and psychological factors contributing to the onset of mood and anxiety disorders or the symptoms of depression and anxiety during perimenopause. Therefore, the purpose of this narrative review was to synthesize the findings of studies examining associations between social and psychological factors and the development of mood and anxiety disorders and the symptoms of depression and anxiety during perimenopause. PsychINFO, Ovid MEDLINE, and CINAHL were searched for studies (published between January 2014 and November 2023) assessing the social and psychological factors associated with perimenopausal mood and anxiety disorders and the symptoms of depression and anxiety. These factors were categorized as either protective or harmful. Study quality was assessed using STROBE guidelines. The search yielded 17 studies. Social support was identified as a social factor protective against perimenopausal depression and anxiety. Resiliency characteristics were reported to be protective psychological factors associated with fewer depressive symptoms. Mental health history, family history of major depressive disorder, trait anxiety and neuroticism, stressful life events, adverse childhood events, and chronic stress were categorized as harmful psychological factors associated with depression during perimenopause. Limited research has been conducted to understand factors associated with perimenopausal anxiety. The identification of these social and psychological factors associated with mood and anxiety disorders during perimenopause will help lead to earlier detection of women at risk and the development of multifaceted interventions.

Development of an Acute Stroke Care Seeking Framework.

ABSTRACT: BACKGROUND: A multitude of variables influence an individual's decision to seek care in emergency situations. By recognizing these variables and their impact on the timeline of an individual seeking care for a stroke, nurses have an opportunity to positively affect the outcomes of stroke within the community. The purpose of this narrative review was to develop a research framework describing the variables involved in care seeking during an acute stroke. METHODS: Using a theory synthesis methodology that included variable identification and the establishment of relationships between variables based on existing literature, a framework describing variables relevant to acute stroke care seeking behavior was developed. RESULTS: Fourteen recently published studies reported significant variables related to seeking emergency medical care during the hyperacute phase of a stroke. Eight variables were identified and characterized as either promoters or distractors. Promoters led an individual to seek acute stroke care earlier, such as perceived symptom severity, stroke knowledge, and the presence of others. Distractors led an individual to delay seeking acute stroke care and resulted in later hospital arrival times, such as a lack of social network or resources, comorbid conditions, and incongruity with the local health system. CONCLUSION: Although individual decision making is exceedingly complex and varies by individual and situation, the developed acute stroke care seeking framework may provide a basis on which to develop stroke awareness programs and interventions targeted at individuals at risk for delayed acute stroke care.

Social connection and self-neglect: A case for broader exploration.

OBJECTIVE: Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework provides evidence-based characteristics across structure, function, and quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health. METHODS: A narrative case study is presented using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN. RESULTS: The findings highlight the complexity of social connection that may be observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case are presented. CONCLUSION: The results from this case give rise to considerations that may be generalizable to other SN cases. Recommendations for future research on social connection in this population are provided.

A Cross-sectional Survey of Comprehension and Satisfaction of Spanish-Reading Adults Regarding RÁPIDO as a Stroke Awareness Acronym.

ABSTRACT: BACKGROUND: Delay time to hospital arrival may be influenced by lack of recognition of stroke signs and the necessity to seek emergency medical, which in turn is influenced by language barriers to, a modifiable risk factor, stroke awareness education. The objective was to determine the comprehension and satisfaction of a Spanish stroke awareness acronym, RÁPIDO, among community-living, Hispanic and Latino, Spanish-reading adults. METHODS: A 33-item survey was completed by 166 adults. Data on sociodemographics, language preferences, stroke education, and comprehension and satisfaction with RÁPIDO were collected. Descriptive characteristics were calculated. Fisher exact tests were performed to determine whether reading language (group 1, only or predominantly reads in Spanish; group 2, reads in Spanish and English equally or reads predominately in English) influenced survey responses. Responses to open-ended questions were categorized. RESULTS: Sixty-nine percent of the participants were born outside of the United States, 82% currently resided in the United States, 34% read only or predominately in Spanish, and 7% had a stroke. Most participants thought RÁPIDO was informative, eye-catching, and easily remembered. Significant differences were found between reading language preference groups for correctly identifying RÁPIDO images for facial drooping (group 1, 80%; group 2, 95%; P ≤ .001) and dizziness/loss of balance (group 1, 54%; group 2, 73%; P = .027). Eighty percent or more of all participants were able to correctly interpret RÁPIDO images for facial drooping, blurry vision, impaired speech, and call emergency services. Adding "911" to the RÁPIDO image of the clock was a common suggestion. CONCLUSIONS: RÁPIDO was well received among the participants. Modifications to RÁPIDO images representing dizziness/loss of balance and arm weakness, and the addition of "911" may improve its usefulness. Obtaining more extensive feedback across the United States and testing the effect of RÁPIDO on increasing knowledge of stroke signs and retention of that knowledge are necessary next steps.

Comparing Stroke Risk Factors Among Sexual Minority Groups in Texas.

BACKGROUND: Knowledge gaps remain on stroke risk and disparities between sexual minority (SM) subgroups. In this study, stroke risk between SM subgroups, specifically gay/bisexual men and lesbian/bisexual women (G/BM and L/BW), was assessed. METHOD: Data were collected in June 2022 using a bilingual (English and Spanish) cross-sectional paper-and-pen survey distributed among 183 SM individuals attending the 2022 Houston Pride Parade and Festival, as well as across Texas via phone call or online format. Relevant sociodemographic and stroke risk factors were compared between G/BM and L/BW using chi-square (or Fisher's exact, when appropriate) and two-sample t-tests. Sexual orientation was used to predict stroke risk using multiple binomial logistic regression, adjusting for other sociodemographic determinants. RESULTS: While comparing the stroke risk factors between G/BW and L/BW, statistically significant differences were found in hypertension (p = 0.047), age (p < 0.001), smoking status (p = 0.043), cholesterol level (p < 0.001), and HIV (p = 0.038). G/BM were 2.79 times more likely to have a higher stroke risk compared to L/BW (aOR = 2.79; CI, 1.11-6.05, p = 0.032), after adjusting for other sociodemographic factors. CONCLUSION: This pilot study, conducted in Texas, adds to the existing scientific literature on stroke risk among the SM population and revealed that G/BM might have a higher stroke risk compared to L/BW. These findings can inform future research and intervention designs tailored to G/BM and L/BW communities and improve their overall health.

Perspectives on elder mistreatment screening and responding in emergency departments: A qualitative study with survivors.

OBJECTIVE: Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, posttraumatic stress disorder, and early mortality. Low screening and older adult self-reporting, especially within emergency departments, represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors' perspectives on EM screening and response practices in emergency departments. METHODS: Semi-structured interviews with 19 EM survivors of those with Adult Protective Services validated EM were completed in older adults' homes. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses. RESULTS: The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response. CONCLUSIONS: Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized.

Feasibility and user-experience of a virtual environment for social connection and education after stroke: A pilot study.

OBJECTIVES: To evaluate the feasibility and usability of stroke survivor participation in an 8-week virtual environment intervention that provides opportunities for social support exchanges, social network interactions, and recovery education. MATERIALS AND METHODS: A single-group, pre- and post-test measure design was used. Descriptive statistics were used to examine enrollment and retention rates, proportion of questionnaires completed, and virtual environment process data (e.g., number of log-ins) and usability scores. Changes in pre- and post-intervention questionnaire (e.g., usability, social support, depression, anxiety, loneliness, and self-efficacy) scores were explored using Wilcoxon signed-rank tests and paired t-test. RESULTS: Fifteen (65 %) of the eligible stroke survivors enrolled (60 % white, 27 % black), 12 (80 %) had an ischemic stroke, ages ranged from 33 to 74 years (mean 44 years), and mean months since stroke was 33 ± 23. Retention and questionnaire completion rates were both 93 % (n = 14). Survivors logged into the virtual environment a total of 122 times, logged an average of 49 min/log-in, and 12 (80 %) attended support groups and social activities. Median usability score indicated lower than average usability. Improvement trends in social support, loneliness, and depressive symptoms were found, but significant changes in mean questionnaire scores were not found. CONCLUSIONS: Overall, the results suggest that using a virtual environment to foster social support exchanges, social network interactions, and recovery education after stroke is feasible. Similar to other chronic disease populations, stroke survivor adoption of a virtual environment likely requires ongoing technical assistance, repetition of instructions, and opportunities for practice to reinforce engagement. TRIAL REGISTRATION: NCT05487144.

A retrospective examination of pain in acute stroke at hospital discharge.

OBJECTIVES: Pain is an overlooked sequela of stroke. Persistent pain after stroke is an underrecognized experience and significantly impacts survivors' function, ability to participate in rehabilitation, and quality of life. The aim of this retrospective, observational study is to examine the incidence of pain at the acute hospitalization period immediately after stroke, to identify the characteristics of those reporting pain at discharge, and to compare pain reporting between stroke and non-stroke hospital controls. MATERIALS AND METHODS: Using discharge diagnosis, this retrospective review examined self- reports of pain during acute hospitalization for stroke compared to those with COPD (control group) admitted during the same time in the same facilities. Variables of interest included age, gender, body mass index (BMI), length of stay, pain assessment score (numeric rating scale [NRS], behavior pain scale [BPS], and medication administration record pain score total [MAR]), smoking history, prevalence of hypertension and race. 821 subjects were included from a total of three campuses from one large hospital system. 772 subjects were included in the comparative analysis with COPD patients from the same facilities during the same time. RESULTS: 43% of patients diagnosed with stroke reported pain at discharge. For stroke survivors reporting pain at discharge, the average BMI was higher (p=0.009), average arrival NIHSS was higher (p=0.044), and mean hospital length of stay was longer (p<0.001). CONCLUSIONS: The evidence demonstrated in this study highlights the critical need for the implementation of targeted objective pain assessment and effective pain interventions for stroke survivors beginning at initial hospitalization.

Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review.

WHAT IS KNOWN ON THE SUBJECT: Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet-delivered or online talk therapy interventions are associated with lower costs and improved accessibility. Current reviews do not address the effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) on quality of life (QoL). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self-guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial. WHAT ARE THE IMPLICATIONS FOR PRACTICE: There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings. Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated. ABSTRACT: INTRODUCTION: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet-delivered CBT (iCBT) is associated with lower costs and improved accessibility. AIM: We aimed to examine the effectiveness of iCBT on QoL in adults with depression. METHOD: PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self-report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis. RESULTS: Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging. DISCUSSION: Internet-delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements. IMPLICATIONS FOR PRACTICE: The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders.

Feasibility of a meditation intervention for stroke survivors and informal caregivers: a randomized controlled trial.

BACKGROUND: Depressive symptoms are a significant psychological complication of stroke, impacting both survivors and informal caregivers of survivors. Randomized controlled trials are needed to determine optimal non-pharmacological strategies to prevent or ameliorate depressive symptoms in stroke survivors and their informal caregivers. METHODS: A prospective, randomized, parallel-group, single-center, feasibility study. Participants were assigned to a 4-week meditation intervention or expressive writing control group. The intervention comprised four facilitator-led group meditation sessions, one session per week and building upon prior session(s). Descriptive statistics were used to examine the proportion of eligible individuals who enrolled, retention and adherence rates, and the proportion of questionnaires completed. Data were collected at baseline, immediately after the 4-week intervention period, and 4 and 8 weeks after the intervention period. Secondary analysis tested for changes in symptoms of depression (Center for Epidemiologic Studies-Depression [CES-D]), anxiety [State-Trait Anxiety Inventory for Adults (STAI)], and pain (Brief Pain Inventory-Short Form) in the intervention group via paired t tests. Linear mixed models were used to compare longitudinal changes in the measures between the groups. Intervention and trial design acceptability were preliminary explored. RESULTS: Seventy-one (77%) individuals enrolled and 26 (37%) completed the study (baseline and 8-week post-intervention visits completed). Forty-two (66%) participants completed baseline and immediate post-intervention visits. Mean questionnaire completion rate was 95%. The median meditation group session attendance rate for the intervention group was 75.0%, and the mean attendance rate was 55%. Non-significant reductions in CES-D scores were found. Paired t tests for stroke survivors indicated a significant reduction from baseline through week 8 in BPI-sf severity scores (p = 0.0270). Repeated measures analysis with linear mixed models for informal caregivers indicated a significant reduction in in STAI-Trait scores (F [3,16.2] = 3.28, p = 0.0479) and paired t test showed a significant reduction from baseline to week 4 in STAI-Trait scores (mean = - 9.1250, 95% CI [- 16.8060 to 1.4440], p = 0.0262). No between-group differences were found. CONCLUSIONS: Future trials will require strategies to optimize retention and adherence before definitive efficacy testing of the meditation intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03239132. Registration date: 03/08/2017.

An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study.

BACKGROUND: Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. OBJECTIVE: We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. METHODS: The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. RESULTS: A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. CONCLUSIONS: An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1371/journal.pone.0171952.

A Person-Centered Approach Understanding Stroke Survivor and Family Caregiver Emotional Health.

ABSTRACT: BACKGROUND: The purpose of this study was to incorporate a person-centered approach to understand the emotional health needs and perspectives of stroke survivors (SSs) and their caregivers. METHODS: In collaboration with 4 SSs and caregivers as research partners, quantitative data were collected to assess poststroke emotional health needs, and qualitative data were collected to gain insight into SS and caregiver emotional health perspectives after stroke. RESULTS: Forty surveys (n = 26 SSs, n = 14 caregivers) were collected. The predominate emotional health needs were frustration (65%), anxiety (54%), and stress (50%) for SSs and stress (71%), worry (57%), and frustration (57%) for caregivers. Two group interviews (n = 7 SSs, n = 3 caregivers) were completed. Four emerging themes were identified: receiving support from those in similar situations, poststroke emotional responses, situations experienced in healthcare settings, and a hypervigilance for sudden and unexpected events. CONCLUSION: Emotional healthcare services for SSs and their caregivers may consider providing reoccurring mental health education and multifaceted treatment approaches, including provision of peer support, and addressing the unique emotional stressors SSs and caregivers may be experiencing. The small sample size precludes generalizing the results into the broader stroke population. However, by leveraging the lived experience of SSs and their caregivers, the results may help find ways to support SSs' and caregivers' emotional health.

RAPIDO: Promoting stroke awareness among Spanish speakers.

ABSTRACT: The mnemonic BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) has been developed for the public to better remember and identify the warning signs of stroke. However, discrepancies may arise when translating stroke educational materials from English to Spanish. This article discusses the use of a culturally tailored tool, RAPIDO, to raise stroke awareness in Spanish-speaking populations.

Parenting stress mediates the longitudinal effect of maternal depression on child anxiety/depressive symptoms.

BACKGROUND: Evidence is lacking for the longitudinal bidirectional relationship between maternal depression and child anxiety/depressive symptoms through pre-school to adolescence and regarding parenting stress as having a mediating effect on this association. METHODS: We performed a secondary analysis of data from the Fragile Families and Child Well-being Study (n = 1,446 child-mother dyads in 20 main U.S. cities) collected at baseline, Year-5 (T1), Year-9 (T2) and Year-15 (T3) (from 1998 to 2017). Maternal depression, child anxiety/depressive symptoms and parenting stress were assessed at three time points (T1-T3). The associations were evaluated using autoregressive cross-lagged panel models. RESULTS: Cross-lagged models indicated that 1) maternal depression significantly predicted subsequent higher child anxiety/depressive symptoms across all time points, and 2) greater child anxiety/depressive symptoms significantly predicted subsequent maternal depression across all time points. Furthermore, T1 maternal depression was indirectly associated with T3 child anxiety/depressive symptoms via T2 parenting stress [b = 0.010 (SE=0.004), p = 0.017]. However, T2 parenting stress did not significantly mediate the association between T1 child anxiety/depressive symptoms and T3 maternal depression [b = 0.004 (SE=0.004), p = 0.256]. LIMITATIONS: The FFCWS oversampled unmarried parents and had a higher proportion of socio-economically disadvantaged racial and ethnic minority families, limiting the generalizability of findings. CONCLUSIONS: Maternal depression is indirectly linked to child anxiety/depressive symptoms via parenting stress.

Early screening for post-stroke depression, and the effect on functional outcomes, quality of life and mortality: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Post-stroke depression (PSD) is a severe complication of cerebrovascular stroke affecting about one-third of stroke survivors. Moreover, PSD is associated with functional recovery and quality of life (QOL) in stroke survivors. Screening for PSD is recommended. There are, however, differences in the literature on the impact of early screening on functional outcomes. In this systematic review, we synthesise the currently available literature regarding the associations between timing and setting of PSD screening and mortality, QOL and functional outcomes in stroke survivors. METHODS AND ANALYSIS: We will systematically search electronic databases including PubMed, Embase, APA PsycINFO, Web of Science, Scopus and CINAHL from inception to August 2021. Four reviewers will screen the title and abstract and full-text level records identified in the search in a blinded fashion to determine the study eligibility. Any selection disagreements between the reviewers will be resolved by the study investigator. Data extraction of eligible studies will be conducted by two reviewers using a predefined template. We will complete the quality assessment of included articles independently by two reviewers using the Newcastle Ottawa Scale. Eventual discrepancies will be resolved by the principal investigator. ETHICS AND DISSEMINATION: Due to the nature of the study design, ethical approval is not required. The systematic review and meta-analysis findings will be published and disseminated in a peer-reviewed journal. Our results will also be disseminated through posters and presentations at appropriate scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42021235993.

Resilience and associated psychological, social/cultural, behavioural, and biological factors in patients with cardiovascular disease: a systematic review.

AIMS: The aim of this systematic review of the literature is to synthesize the evidence regarding the associations between individual-level psychological, social/cultural, behavioral, and biological variables with resilience in patients with CVD. METHODS AND RESULTS: A systematic search of PubMed, PsycINFO and CINAHL was conducted from database inception through March 2020. Studies with a quantitative research design were eligible for inclusion if published in English and focused on resilience among adults with CVD. Of the 788 articles retrieved, 34 studies (35 articles) were included in the review. Twenty-three studies focused on psychological factors, with findings of inverse relationships between resilience and depression, anxiety, and stress. Evidence regarding associations between resilience and social/cultural or behavioral variables was scarce. Four of the 6 studies regarding biological factors found low stress resilience in young adulthood was associated with early diagnoses of stroke, heart failure, and coronary heart disease. CONCLUSION: Enhancing resilience may improve quality of life for CVD patients, but research is needed to further explore the complex relationships between resilience and associated variables. This research should prioritize under-represented groups (i.e. women and minority racial/ethnic groups), with the eventual goal of developing interventions to support resilience in CVD patients.

The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status.

BACKGROUND: Household material hardships could have a negative impact on maternal mental health. Understanding mechanisms by which material hardship trajectories affect maternal depression and anxiety could aid health care professionals and researchers to design better interventions to improve mental health outcomes among mothers. METHODS: The study identified family-level mechanisms by which material hardship trajectories affect maternal depression and anxiety using Fragile Families and Child Wellbeing Study data (n = 1,645). Latent growth mixture modelling was used to identify latent classes of material hardship trajectories at Years-1, -3, and -5. Parenting stress and couple relationship quality was measured at Year-9. The outcome measures included maternal depression and generalized anxiety disorder (GAD) at Year-15 based on the Composite International Diagnostic Interview - Short Form. RESULTS: Parenting stress mediated the association between low-increasing hardship (b = 0.020, 95% confidence interval (CI):0.003, 0.043) and maternal depression. Parenting stress also mediated the association between high-increasing hardship (b = 0.043, 95% CI:0.004, 0.092), high decreasing hardship (b = 0.034, 95% CI=0.001, 0.072), and low-increasing (b = 0.034, 95% CI:0.007, 0.066) and maternal GAD. In all models, current material hardship was directly related to maternal depression (b = 0.188, 95% CI:0.134, 0.242) and GAD (b = 0.174, 95% CI:0.091, 0.239). LIMITATIONS: Study results need to be interpreted with caution as the FFCWS oversampled non-marital births as part of the original study design. CONCLUSIONS: While current material hardship appears to be more related to maternal mental health, prior material hardship experiences contribute to greater parenting stress which places mothers at risk for experiencing depression and GAD later on.

Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study.

BACKGROUND: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. OBJECTIVE: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. METHODS: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. RESULTS: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). CONCLUSIONS: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.

A meta-analysis of the global impact of the COVID-19 pandemic on stroke care & the Houston Experience.

OBJECTIVE: To review the global impact of the COVID-19 pandemic on stroke care-metrics and report data from a health system in Houston. METHODS: We performed a meta-analysis of the published literature reporting stroke admissions, intracerebral hemorrhage (ICH) cases, number of thrombolysis (tPA) and thrombectomy (MT) cases, and time metrics (door to needle, DTN; and door to groin time, DTG) during the pandemic compared to prepandemic period. Within our hospital system, between January-June 2019 and January-June 2020, we compared the proportion of stroke admissions and door to tPA and MT times. RESULTS: A total of 32,640 stroke admissions from 29 studies were assessed. Compared to prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI, 65.02%, 76.54%], ICH cases was 83.10% [95% CI, 71.01%, 95.17%], tPA cases was 81.74% [95% CI, 72.33%, 91.16%], and MT cases was 88.63% [95% CI, 74.12%, 103.13%], whereas DTN time was 104.48% [95% CI, 95.52%, 113.44%] and DTG was 104.30% [95% CI, 81.99%, 126.61%]. In Houston, a total of 4808 cases were assessed. There was an initial drop of ~30% in cases at the pandemic onset. Compared to 2019, there was a significant reduction in mild strokes (NIHSS 1-5) [N (%), 891 (43) vs 635 (40), P = 0.02]. There were similar mean (SD) (mins) DTN [44 (17) vs 42 (17), P = 0.14] but significantly prolonged DTG times [94 (15) vs 85 (20), P = 0.005] in 2020. INTERPRETATION: The COVID-19 pandemic led to a global reduction in stroke admissions and treatment interventions and prolonged treatment time metrics.