Prenatal and Childbirth Risk Factors of Postpartum Pain and Depression: A Machine Learning Approach.

OBJECTIVES: About 74.91% of U.S. mothers experience postpartum pain at 6 to 10 weeks postpartum, and one in seven U.S. mothers suffer from postpartum depression. We used machine learning to explore physical, psychological, and social factors during pregnancy and childbirth and identify the most important predictors of postpartum pain and depression. METHODS: Data were from the Listening To Mothers III survey (2012), a national representative sample of postpartum mothers. We randomly split the dataset into a training set (N = 1467) and a test set (N = 723). The final models included 34 risk factors identified from previous literature. Postpartum pain was measured as "to what extent the pain interferes with mothers' daily life". PHQ2 scores measured depression. We used the random forest model, an aggregate of many regression trees, to accommodate potential nonlinear/interaction effects. RESULTS: In the test data set, our models explained 15.8% of the variance in pain and 27.1% of the variance in depression. The model's strongest predictors for postpartum pain were Cesarean delivery, holding back while communicating with providers, non-use of pain relief medications, and perceived discrimination. For depression scores, the model's strongest predictors included needing help for depression during pregnancy, perceived discrimination, holding back, gestational diabetes, and pain. CONCLUSIONS FOR PRACTICE: Mental and physical health are intertwined and should be considered integratively in the perinatal period. Besides, practitioners should also be aware of the importance of patient-provider-relationship, which both independently and interact with other risk factors to predict postpartum health.

The association between pre-conception intuitive eating and gestational weight gain.

PURPOSE: To determine if pre-conception intuitive eating, an adaptive eating behavior, was related to gestational weight gain (GWG) and the likelihood of exceeding GWG recommendations. METHODS: This prospective survey study took place in an outpatient obstetric clinic. Participants completed the pre-conception Intuitive Eating Scale for Pregnancy during a prenatal check-up appointment and total GWG was collected from the medical record. The pre-conception Intuitive Eating Scale for Pregnancy assesses unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety to inform what, when, and how much to eat. Hierarchical linear multiple regression and logistic multiple regression analyses determined associations between pre-conception intuitive eating and GWG on the total sample and stratified by weight status (normal/underweight, overweight, and obese). RESULTS: The majority of the sample (n = 253) was white, married, employed, had annual household income > $50,000, and had a college degree. No aspects of pre-conception intuitive eating predicted the likelihood of excess GWG. However, in the total sample, unconditional permission to eat (subscale) was inversely related to total GWG (B = -0.16, p < 0.05). Among women with obesity (n = 36), eating for physical rather than emotional reasons (subscale) was inversely related to total GWG (B = -0.47, p < 0.05). DISCUSSION: Some aspects of intuitive eating during the pre-conception period were related to total GWG, particularly for women with obesity. However, intuitive eating scores did not increase or decrease the likelihood of excess GWG. More research is needed to understand the mechanisms for this association before clinical recommendations can be made. LEVEL OF EVIDENCE: Level III (Evidence obtained from well-designed cohort or case-control analytic studies).

Depression in the barrio: An analysis of the risk and protective nature of cultural values among Mexican American substance users.

Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.

Validation of the intuitive Eating Scale for pregnant women.

Pre-pregnancy maladaptive eating behaviors have predicted inadequate or excess gestational weight gain and poor dietary intake during pregnancy, but little is known about effects of pre-pregnancy adaptive eating behaviors on pregnancy outcomes. The purpose of this study was to produce a valid and reliable measure of adaptive pre-pregnancy eating behaviors for pregnant women using the Intuitive Eating Scale. Data were collected from 266 pregnant women, aged 18 and older who were attending a private prenatal clinic at Texas Children's Hospital Pavilion for Women in Houston, TX using self-administered questionnaires. Confirmatory factor analysis was performed to validate the factor structure of the Intuitive Easting Scale (IES). Concurrent validity was determined using correlations between the three subscale scores [unconditional permission to eat (UPE), eating for physical not emotional reasons (EPR), and relying on hunger/satiety cues (RIH)], perinatal depression status (Edinburgh Postnatal Depression Scale), and pre-pregnancy body mass index (BMI) calculated from self-reported height and weight. After discarding 6 items, the second order model did not fit the data, however, the first order model with three latent factors had reasonable fit (RMSEA = 0.097, CFI = 0.961, TLI = 0.951 and WRMR = 1.21). The internal consistency of the scale was confirmed by Cronbach's alphas (UPE = 0.781, EPR = 0.878 and RIH = 0.786). All subscale scores were inversely related to perinatal depression status. EPR and RIH subscale scores were inversely related to pre-pregnancy BMI, supporting the measure's validity. Among pregnant women, the revised 15 item pre-pregnancy IES (IES-PreP) should be used to evaluate pre-pregnancy adaptive eating behaviors.

Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project.

Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.

Characteristics and factors associated with the risk of a nicotine exposed pregnancy: expanding the CHOICES preconception counseling model to tobacco.

The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures. Conducted in six settings with women at risk for AEP, the percentage of AEP was 12.5% (333/2,672) among women of childbearing age (18-44). A total of 464 of the 2,672 (17.4%) were at risk for NEP. Among women at-risk of an unplanned pregnancy (n = 1,532), the co-occurrence of AEP and NEP risk was more prevalent (16.3%) than AEP risk alone (5.5%) or NEP risk alone (14.0%). In the multivariable model, statistically significant correlates for NEP risk included lifetime drug use, prior alcohol/drug treatment, drug use in the last 6 months, being married or living with a partner, having multiple sexual partners in the last 6 months, physical abuse in the last year, and lower levels of education. These findings suggest that preconception counseling for NEP could be combined with a program targeting AEP.

Tailoring Perinatal Health Communication: Centering the Voices of Mothers at Risk for Maternal Mortality and Morbidity.

The United States has the highest maternal mortality rate of any industrialized country. According to the Centers for Disease Control, Black women die at 2-3 times the rate of white women, and the infant mortality rate in the U.S. is 2.5 times higher than their White counterparts. Maternal and child health programs, such as Healthy Start, are an important gateway to increasing awareness, education, and referral to perinatal care and mental health services. This paper explored mothers' perceptions of the importance of health and healthcare during pregnancy and postpartum and their preferences for communication from a community-based service program, such as Healthy Start. Data were collected from four focus groups with 29 expectant or current mothers. Most participants (57.7%) identify as Black or African American. They age from 24 to 43 with a mean of 31.7. We analyzed the data using the thematic analysis approach. Themes that emerged supported an overall desire for inclusive, strength-based educational materials. Use of advocacy-based health educational materials, materials that show diverse and realistic images of mothers, peer-based education through testimonials, and health education materials that are easy to understand and apply to one's own experience emerged as the broad theme from the focus groups.

A promising new model of care for postpartum depression: A randomised controlled trial of a brief home visitation program conducted in Houston, Texas, USA.

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 - 15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well-child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non-Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five-session home visitation program using the Problem-Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self-efficacy. Based on these results, a short-term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms.

A longitudinal study of the stress-buffering effect of social support on postpartum depression: a structural equation modeling approach.

PURPOSE: Postpartum depression (PPD) impacts about one out of eight new mothers. Research has demonstrated that social support is a protector of PPD. Nevertheless, there has been disagreement on how social support influences depression. The objective is to test two theories - main-effect theory and stress-buffering theory of social support on PPD with different definitions of stress and two types of social support. METHODS: Secondary longitudinal data from the National Data Archive on Child Abuse and Neglect were used. Parenting stress and difficult life circumstances (DLC) measured at six-month postpartum was used to predict the changes in depression from six- to 12-month postpartum; social support at six-month postpartum was conceptualized as a moderator between stress and PPD. Structural Equation Modeling was adopted for the longitudinal analyses. RESULTS: DLC and parental distress both showed long-lasting impacts on PPD. Social support was not found to have a direct or indirect effect on PPD. Neither the stress-buffering theory nor the main-effect model was endorsed by this study. CONCLUSION: Interventions that are accessible to new mothers and aim to improve self-efficacy are recommended. Measures with higher psychometric quality should be used in moderation research. More longitudinal studies with shorter lags between measurement occasions are warranted.

A Pilot Study of Peer-to-Peer SBIRT Simulation as a Clinical Telehealth Training Tool During COVID-19.

Screening, Brief Intervention and Referral to Treatment (SBIRT), is an evidence-based approach to screening and early intervention for those at risk of substance use disorders. With the ongoing health concerns related to COVID-19, there is an increased need for social workers who can competently deliver evidence-based interventions, such as SBIRT, via telehealth. Due to the COVID-19 pandemic, traditional SBIRT training approaches using face-to-face (FTF) instruction and FTF simulated practice may not be a safe or feasible way to develop students' SBIRT- related skills. This study explores 35 social work graduate students' experiences of learning SBIRT skills in a remote learning format and subsequently delivering a SBIRT intervention to a live "client" via a peer-to-peer simulated telehealth session. Overall, students reported that the shift from FTF to remote learning made learning SBIRT skills difficult, and that providing brief intervention and referral was the most difficult step of the simulated SBIRT telehealth intervention. Qualitative feedback indicates that overall, students found the simulated telehealth sessions a valuable learning experience, but also reported that richer educational experiences would have resulted from additional practice opportunities and real time feedback. Implications for future research, simulation-based education and clinical practice are discussed.

'You withhold what you are feeling so you can have a family': Latinas' perceptions on community values and postpartum depression.

OBJECTIVE: The purpose of this study was to explore the postpartum depression (PPD) beliefs and experiences of mothers who access local community faith-based organisations providing family services to low-income, predominantly immigrant Latino populations. DESIGN: Using a qualitative research design, we conducted 18 focus groups with Latina mothers to inquire about their community values and beliefs of PPD. All groups were conducted in Spanish. SETTING: An academic research team located in Houston, Texas, USA, partnered with six faith-based organisations in five cities to recruit and host focus groups at the site of the organisation. PARTICIPANTS: One hundred and thirty-three women participated in the focus groups across all sites. Thirty-seven of them (27.8%) had given birth to a child in less than 1 year. Inclusion criteria included mothers 18 years and older and Latino ethnicity. RESULTS: A six-step process was used to apply thematic analysis to sort data into the themes. All mothers had heard of depression after childbirth, some had experienced it and most remarked that the personal experience and community acceptance of it vary by family. The main findings suggest that mothers take pride in parenting by instilling values to support family and the value of relying on family for emotional support. Findings reveal that many mothers suffer and sacrifice for their children, they feel judged and feel they must hide their emotions. Factors such as birth and postpartum customs from a native country, gender roles and beliefs of what a good mother shape their beliefs and messages about PPD. CONCLUSION: Our findings indicate that programme developers should consider family and community focused education and intervention efforts to help decrease stigma and increase understanding of PPD.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study.

The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18-35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

Closing the Gap between Policy and Practice in Screening for Perinatal Depression: A Policy Analysis and Call for Action.

Although perinatal depression (PND) is one of the most common maternal morbidities, it is frequently undetected. Screening for early detection and intervention has the potential to prevent depressive symptoms from worsening. In the United States, five states have enacted legislation in relation to screening for PND, but a gap remains between policy and practice in providing continuum of care for mothers who may be suffering from depressive symptoms. From the perspective of policy formation, the reasons for this gap include a discrepancy between policy and practice goals, lack of regulations on capability building among perinatal care providers, and few pathways for establishing collaborations between medical providers and mental health professionals. The authors recommend involving social workers in the process to promote a better continuum of care after screening through comprehensive policy that explicitly states goals to effectively screen women in the perinatal period.

Racial and ethnic variation in the predictors of maternal parenting stress.

Little is known about the causes of maternal parenting stress in the Mexican American population. We examine determinants of parenting stress among Mexican American mothers in comparison to non-Hispanic white and non-Hispanic black mothers. We base our analysis on Belsky's conceptual model (1984), which specifies predictors of parenting stress in three domains: maternal characteristics, child characteristics, and social context. Using data from the Fragile Families and Child Wellbeing Study, a national survey of new mothers conducted in large cities beginning in 1998, we draw a sample of 2,898 mothers from diverse racial and ethnic backgrounds. Our findings suggest differences in the determinants of parenting stress by racial or ethnic group. Overall, the patterns of parenting stress for non-Hispanic white and non-Hispanic black mothers are fairly consistent with Belsky's parenting model. However, for Mexican American mothers social support, but not partner support, ameliorate parenting stress and depression is not associated with parenting stress. Importantly as well, despite significant social disadvantage, the levels of parenting stress in Mexican American mothers does not significantly differ from those of non-Hispanic whites. Specific recommendations are made to practitioners for culturally competent responses to parenting stress in the provision of social services to Mexican American families. Implications for future research are twofold: our study calls for the incorporation of diverse samples when examining the determinants of parenting stress and for the development of theoretical frameworks that reflect the unique aspects of psychosocial well-being among Mexican Americans.

Comfort and confidence levels of health care professionals providing pediatric palliative care in the intensive care unit.

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.