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OBJECTIVES: To investigate the trends and racial/ethnic disparities in adequate prenatal care (PNC) use in the USA. METHODS: A repeated cross-sectional study was conducted using May 2016-May 2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A primary outcome was the Kotelchuck index, a measure of the adequacy of PNC use, and the year was a key independent variable. Multinomial and binary logistic regression analyses were performed to examine PNC utilization using multiple imputations with chained equations. RESULTS: Among the 190,262 pregnant individuals, adequate PNC use was largely consistent from 2016 to 2019. However, there was an immediate drop from 77.4-78.3% between 2016 and 2019 to 75.2% in 2020 and 75.8% in 2021. Conversely, both intermediate and inadequate PNC use tended to increase in 2020 and 2021. Adequate PNC use, when compared to inadequate use, showed significantly lower odds in 2020 (adjusted Odds Ratio [aOR] 0.87, 95% CI 0.78-0.96; p = 0.009) and 2021 (aOR 0.87, 95% CI 0.77-0.99; p = 0.033) than in 2016. Notably, Hispanic participants experienced substantial impacts (aOR 0.75, 95% CI 0.64-0.88; p = 0.001 in 2020 and aOR 0.72, 95% CI 0.59-0.89; p = 0.002 in 2021). CONCLUSIONS: While adequate PNC use was a steady, slightly upward trend before 2020, it had a steep decline afterward. It is worth noting that Hispanic individuals were severely affected. Targeted interventions or policies to address barriers to PNC and foster equitable and sustainable care models are required.
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BACKGROUND: Mental health disorders are important prenatal and postpartum health complications. In the rapidly changing healthcare landscape, concerns have been raised about maternal mental well-being in the United States. This study aimed to investigate the relationship between delayed perinatal care and women's mental health during pregnancy and postpartum. METHODS: We conducted a cross-sectional survey from March through April, 2022, of women currently pregnant (n = 590) or one-year postpartum (n = 525). A generalised linear model examined the association of delayed care during pregnancy and postpartum with mental health outcomes, specifically Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD). RESULTS: Individuals who experienced delayed care tended to exhibit higher rates of mental health symptoms compared to those without delays, especially during postpartum (69.4% vs. 30.7% for MDD; 46.6% vs. 24.8% for GAD). The results from multivariable regression analysis were consistent, showing a greater prevalence of MDD (aPR [adjusted Prevalence Ratio] 2.25, 95%CI 1.82-2.79; p < .001) and GAD (aPR 2.00, 95%CI 1.53-2.61; p < .001), respectively, when delays in postpartum care occurred. Reasons for delayed care, such as financial and time issues, lack of transportation, nervousness about seeing a doctor, and rural residency, were associated with increased mental health symptoms. CONCLUSION: The current analysis highlights the significant adverse health impact of delayed care among pregnant and postpartum women. Continued, targeted efforts to reduce practical barriers to accessing prenatal and postpartum care are required to ensure maternal mental health.
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Food and alcohol disturbance (FAD) is an understudied form of disordered eating, in which the consumption of calories is restricted in preparation for drinking alcohol. Guided by previous literature, the present study examined the direct, indirect, and interactive relationships between social media use, anxiety, social support, FAD, and disordered eating among young adults. Recruited from a large southwestern public university, the sample included 679 undergraduate students who completed an online survey in spring of 2022 and who indicated that they consume alcohol and are 18 to 29 years old. Two moderated mediation analyses assessed the indirect effects of anxiety on the relationships between social media use with FAD and disordered eating, and the conditional contribution of social support. Results indicated that social media use was related to disordered eating both directly and indirectly through anxiety, but it was only related to FAD through anxiety. Furthermore, indirect effects connecting social media use to FAD and disordered eating were conditional upon social support. Our findings suggest FAD and disordered eating may be coping mechanisms for anxiety stemming from social media exposure, though these associations appear to be attenuated when social support is high. As such, these findings may be relevant for shaping future intervention and prevention efforts for emerging adults experiencing FAD and disordered eating.
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Ansiedad , Trastornos de Alimentación y de la Ingestión de Alimentos , Medios de Comunicación Sociales , Apoyo Social , Humanos , Femenino , Masculino , Adulto Joven , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Ansiedad/psicología , Adulto , Adolescente , Estudiantes/psicología , Consumo de Bebidas Alcohólicas/psicología , Encuestas y Cuestionarios , Conducta Alimentaria/psicologíaRESUMEN
This cohort study examines trends in suicide rates for veterans with and without traumatic brain injury compared with the US adult population.
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This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum (n = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care.
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Cobertura del Seguro , Periodo Posparto , Embarazo , Humanos , Femenino , Estados Unidos , Encuestas y CuestionariosRESUMEN
BACKGROUND: This study examined changes in reported alcohol use among women during the early stages of the COVID-19 pandemic and the relations to adverse changes in employment (e.g. job loss, furlough, reduced pay). Further, this study assessed how the relation between changes in alcohol use and experiencing an adverse change in employment was moderated by four theoretically relevant dimensions of conformity to masculine norms (CMNI, i.e. risk-taking, winning, self-reliance, and primacy of work). METHODS: The sample for the present study is a subset of a survey that was conducted in the spring of 2020 among U.S. adults and includes 509 participants who met the inclusion criteria. We assessed pandemic-related employment change status, changes in reported frequency and quantity of alcohol consumed, and four CMNI dimensions. Relations between these variables were assessed with a multinomial logistic regression path model. RESULTS: Experiencing an adverse change in employment early in the pandemic was related to increased alcohol use when moderated by the CMNI dimension primacy of work. For people higher on primacy of work, an adverse change in employment was associated with a higher likelihood of reporting an increase in frequency, but not quantity, of drinking (rather than a decrease or no change). Not experiencing an adverse change in employment early in the pandemic was associated with an increased likelihood of reporting an increase for quantity but not frequency. CONCLUSION: The results highlight the importance of considering how work-oriented women may be at risk for increasing alcohol use when confronted with changes in work status.
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COVID-19 , Pandemias , Adulto , Humanos , Femenino , Conducta Social , Empleo , Consumo de Bebidas Alcohólicas/epidemiologíaRESUMEN
This cross-sectional study examines all-cause and cause-specific mortality rates among pregnant and recently pregnant US women from 2019 to 2020 and compares mortality rates by race and ethnicity.
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Etnicidad , Mujeres Embarazadas , Humanos , Femenino , Embarazo , Causas de Muerte , Factores de RiesgoRESUMEN
Rates of mood disorders and substance use increased during the COVID-19 pandemic for postpartum women. The present study's aims were to: (1) examine the prevalence of major depressive disorder (MDD) in postpartum women during the COVID-19 pandemic, and (2) evaluate whether social support can buffer the associations between MDD, psychosocial factors (perceived stress, generalized anxiety, and intimate partner violence) and substance use (alcohol and drug use). A nationwide survey included 593 postpartum mothers (within 12 months from birth). Participants were assessed for a provisional diagnosis of MDD, and provided responses on validated instruments measuring stress, intimate partner violence, suicidal ideation, generalized anxiety, social support, and substance use. A hierarchical logistic regression model assessed the association of psychosocial factors and substance use with MDD. The final model shows that social support attenuates the association of MDD with perceived stress, alcohol use, and drug use, but does not buffer the relationship of MDD with anxiety or intimate partner violence. Social support was shown to significantly attenuate the effects of stress, alcohol use, and drug use on MDD, suggesting that the presence of a strong, supportive social network should be an area of increased focus for public health and healthcare professionals when caring for postpartum women.
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COVID-19 , Trastorno Depresivo Mayor , Violencia de Pareja , Trastornos Relacionados con Sustancias , Femenino , Humanos , Trastorno Depresivo Mayor/epidemiología , COVID-19/epidemiología , Pandemias , Apoyo Social , Trastornos Relacionados con Sustancias/epidemiología , Violencia de Pareja/psicologíaRESUMEN
Previous research has found that major depressive disorder (MDD) commonly occurs in hypothyroid populations. The purpose of this study was to use the biopsychosocial model to investigate factors associated with MDD and hypothyroidism by comparing hypothyroid patients with MDD and without MDD. A sample of 386 participants with hypothyroidism completed both cognitive and psychosocial self-reported assessments along with a questionnaire rating the severity of common hypothyroid symptoms. Participants were divided into two groups (MDD and no MDD) using the diagnostic criteria of the Patient Health Questionnaire. Univariate comparisons were used to assess differences in the severity of physical, psychological, and social correlates in participants with and without MDD. Participants with MDD reported significantly worse symptom severity, increased stress, and disruptions of cognitive functioning. Compared to individuals without MDD, they also indicated poorer quality of life, doctor-patient relationships, and treatment adherence. Individuals with comorbid depression and hypothyroidism reported worse outcomes across physical symptoms, social factors, and psychological and cognitive states than individuals without MDD. Integrating depression screeners and independent treatment for MDD, in addition to the patient's hypothyroid treatment plan, may result in hypothyroid symptom relief and greater quality of life.
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Trastorno Depresivo Mayor , Hipotiroidismo , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Humanos , Hipotiroidismo/complicaciones , Calidad de Vida/psicología , Autoinforme , Índice de Severidad de la EnfermedadAsunto(s)
Mortalidad Materna/tendencias , Complicaciones del Embarazo/mortalidad , Mujeres Embarazadas , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Distribución por Edad , Causas de Muerte , Niño , Femenino , Homicidio/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Vigilancia de la Población , Embarazo , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this paper is to analyze the impact of major depressive disorder, both preoperatively and one year postoperatively, on the functional and psychosocial outcomes of total knee arthroplasty (TKA). METHODS: Two hundred sixty patients undergoing a total knee arthroplasty completed both the baseline and 12-month follow-up assessments. Short-Form Health Inventory (SF36), Western Ontario and McMaster University Arthritis Index (WOMAC), and Knee Society Score (KSS) were measured both preoperatively and postoperatively. The Patient Health Questionnaire (PHQ) was used to diagnose major depressive disorder (MDD) at baseline and follow-up; patients were then classified into one of four groups: No MDD, Lost MDD, Gained MDD, and Continuous MDD. Univariate analysis compared the four groups at baseline, one-year follow-up, and change scores using a Kruskal-Wallis test for continuous data or a chi-square test of independence for categorical data. RESULTS: Two hundred seven (79.60%) patients were in the No MDD group, 22 (8.50%) patients were in the Lost MDD group, 19 (7.30%) patients were in the Gained MDD group, and 12 (4.60%) patients were in the Continuous MDD group. There were significant between-group differences present in baseline measures of WOMAC and SF36 mental health summary. In addition, there were significant group differences in the follow-up WOMAC, KSS, and SF36 scores. CONCLUSIONS: Depression was associated with poorer preoperative and postoperative TKA scores. Patients who were depressed 12 months after surgery demonstrated poorer recovery than patients who did not show depressive symptoms before TKA or within the year after.
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Artroplastia de Reemplazo de Rodilla/psicología , Trastorno Depresivo Mayor/complicaciones , Calidad de Vida/psicología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Prospectivos , Recuperación de la Función , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to identify demographic and psychosocial variables associated with successful completion of a functional restoration program and return-to-function within 3 months of treatment completion. METHODS: Three hundred seven patients admitted to the functional restoration program were evaluated for completion status and 200 patients with valid data were assessed for 3-month return-to-function status following completion. Psychosocial and functional status was assessed at baseline. RESULTS: Key factors associated with program completion included lower perceived disability, lower pain, lower functional impairment, and lower fear avoidance. Factors associated with 3-month return-to-function included lower perceived disability, lower depression, greater belief that pain is not associated with impairment, and higher quality of life. CONCLUSIONS: Psychosocial and functional factors contribute to both functional restoration completion and 3-month return-to-function outcomes.
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Dolor Crónico/psicología , Dolor Crónico/rehabilitación , Enfermedades Musculoesqueléticas/psicología , Enfermedades Musculoesqueléticas/rehabilitación , Enfermedades Profesionales/psicología , Enfermedades Profesionales/rehabilitación , Adulto , Reacción de Prevención , Dolor Crónico/etiología , Depresión/psicología , Autoevaluación Diagnóstica , Miedo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Escalas de Valoración Psiquiátrica , Calidad de Vida , Recuperación de la Función , Reinserción al Trabajo , Evaluación de Capacidad de TrabajoRESUMEN
OBJECTIVE: To compare patients with chronic low back pain (LBP) with those with chronic lower extremity (LE) disorders. METHODS: Participants were 2164 consecutive patients with either LE or LBP disorders, admitted to a functional restoration program (FRP). Analyses compared demographic, psychosocial, and work-related factors and 1-year post-FRP socioeconomic outcomes. RESULTS: Patients with LE disorders initially reported lower symptom levels of depression, pain, and disability and were also less likely to have a substance use or opioid dependence disorder, relative to LBP patients. Both groups improved on measures of pain, disability, and depression after the FRP. Patients in both groups also displayed similarly high return-to-work and work-retention rates 1-year post-FRP. CONCLUSIONS: This FRP seems to be effective equally for patients with chronic LE disorders and those with LBP disorders.
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Dolor de la Región Lumbar/rehabilitación , Extremidad Inferior/lesiones , Traumatismos Ocupacionales/rehabilitación , Recuperación de la Función , Adulto , Enfermedad Crónica , Depresión/etiología , Evaluación de la Discapacidad , Femenino , Humanos , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Traumatismos Ocupacionales/psicología , Dimensión del Dolor , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , Reinserción al Trabajo/estadística & datos numéricosRESUMEN
OBJECTIVE: To systematically evaluate if an interdisciplinary functional restoration program (FRP), shown to be a viable treatment option for patients with chronic disabling occupational lumbar disorders, is as effective in treating chronic disabling occupational upper extremity disorders. METHODS: Participants were 2484 consecutive patients with either arm or lumbar disorders admitted to an FRP. Analyses compared demographic, psychosocial, and work-related factors, and 1-year post-rehabilitation socioeconomic outcomes. RESULTS: Socioeconomic outcomes showed that work-return and work-retention rates after successful completion of the FRP did not differ between the two groups, or among the upper extremity subgroups. CONCLUSIONS: FRP is equally effective for patients with chronic upper extremity or lumbar spine disorders, regardless of the injury type, site in the upper extremity, or the disparity in injury-specific and psychosocial factors identified before treatment.
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Dolor de Espalda/rehabilitación , Personas con Discapacidad/rehabilitación , Enfermedades Profesionales/rehabilitación , Enfermedades de la Columna Vertebral/rehabilitación , Adulto , Enfermedad Crónica , Estudios de Cohortes , Femenino , Humanos , Región Lumbosacra/lesiones , Masculino , Persona de Mediana Edad , Reinserción al Trabajo , Factores Sexuales , Factores Socioeconómicos , Resultado del Tratamiento , Extremidad Superior/lesionesRESUMEN
BACKGROUND: Factors other than surgical technique and implants impact patient outcomes following a total knee arthroplasty. The purpose of this study was to analyze the effects of psychopathology on the rate of improvement following total knee arthroplasty in an indigent population. METHODS: One hundred and fifty-four consecutive indigent patients undergoing a primary total knee arthroplasty for arthritis were enrolled and available for follow-up. Patients were classified as having psychopathology on the basis of the presence of somatization, depression, and/or a panic or anxiety disorder as assessed with the Patient Health Questionnaire. Outcome measures were completed preoperatively and one year postoperatively. Univariate analyses, controlled for sex and age, were used to compare the rates of improvement in patients who exhibited psychopathology with the rates in those without psychopathology. RESULTS: Fifty-four patients (35%) were diagnosed with at least one Axis-I psychological disorder. The psychopathology group showed significantly lower Short Form-36 mental component summary scores both at baseline and one year postoperatively (p < 0.001 for both). The psychopathology group also reported significantly higher levels of perceived disability at baseline on the Pain Disability Questionnaire (p < 0.001) and worse scores on the Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.004); however, the improvement on both of these scales did not differ significantly between the two groups (p > 0.05). The Knee Society Score differed significantly between the two groups at both baseline and the one-year follow-up evaluation (p = 0.003 and p = 0.001, respectively), but there was no significant difference in the total rate of improvement between the two comparison groups (p > 0.05). CONCLUSIONS: Not only is there a high prevalence of psychopathology in the indigent population, but psychopathology may result in lower patient-perceived outcome scores at one year after a total knee arthroplasty. Even though outcome scores may be worse for patients with psychopathology, our study showed that these patients still benefit, with the same degree of improvement in function.
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Artritis/psicología , Artritis/cirugía , Artroplastia de Reemplazo de Rodilla , Trastornos Mentales/psicología , Pobreza/psicología , Anciano , Artritis/economía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/economía , Persona de Mediana Edad , Satisfacción del Paciente/economía , Recuperación de la Función , Factores de Tiempo , Resultado del TratamientoRESUMEN
Central sensitization (CS) has been proposed as a common pathophysiological mechanism to explain related syndromes for which no specific organic cause can be found. The term "central sensitivity syndrome (CSS)" has been proposed to describe these poorly understood disorders related to CS. The goal of this investigation was to develop the Central Sensitization Inventory (CSI), which identifies key symptoms associated with CSSs and quantifies the degree of these symptoms. The utility of the CSI, to differentiate among different types of chronic pain patients who presumably have different levels of CS impairment, was then evaluated. Study 1 demonstrated strong psychometric properties (test-retest reliability = 0.817; Cronbach's alpha = 0.879) of the CSI in a cohort of normative subjects. A factor analysis (including both normative and chronic pain subjects) yielded 4 major factors (all related to somatic and emotional symptoms), accounting for 53.4% of the variance in the dataset. In Study 2, the CSI was administered to 4 groups: fibromyalgia (FM); chronic widespread pain without FM; work-related regional chronic low back pain (CLBP); and normative control group. Analyses revealed that the patients with FM reported the highest CSI scores and the normative population the lowest (P < 0.05). Analyses also demonstrated that the prevalence of previously diagnosed CSSs and related disorders was highest in the FM group and lowest in the normative group (P < 0.001). Taken together, these 2 studies demonstrate the psychometric strength, clinical utility, and the initial construct validity of the CSI in evaluating CS-related clinical symptoms in chronic pain populations.
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Sensibilización del Sistema Nervioso Central/fisiología , Dolor Crónico/diagnóstico , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Niño , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Adulto JovenRESUMEN
This study documents the prevalence of Axis I diagnoses (ie, depression, anxiety, and others) and their effects on preoperative pain, disability, function, and quality of life assessments in an indigent population undergoing total joint arthroplasty. Consecutive indigent patients scheduled for total joint arthroplasty were categorized by psychosocial testing as either psychologically distressed (PD) or nonpsychologically distressed. Of the subjects, 38% were found to be psychologically distressed. The PD group had significantly lower measures on 7 of the 8 components of the Short Form-36, the Harris hip score, and Knee Society score (P < .05). The PD group also scored significantly worse on both the Western Ontario MacMaster (P < .001) and the Pain Disability Questionnaire (P < .001). There is a high prevalence of psychopathology in the indigent population undergoing total joint arthroplasty, exhibiting poorer scores on pain, disability, function, and quality of life measures before surgery.
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Trastornos Mentales/etiología , Osteoartritis/complicaciones , Osteoartritis/psicología , Pobreza , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/cirugía , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVE: To identify the prevalence, risk factors, and treatment outcomes of patients with chronic disabling occupational musculoskeletal disorders (CDOMD) who met criteria for fibromyalgia. METHODS: This was a prospective prognostic study of a consecutive cohort of CDOMD patients (n = 449) admitted for treatment. Patients were assessed for chronic widespread pain and fibromyalgia. The measures included demographic, injury-related and occupational information, psychosocial measures, and 1-year work status follow-up. RESULTS: The CDOMD patients with fibromyalgia reported higher-level psychosocial distress. Women with fibromyalgia were 9.6 times less likely to return to work 1-year posttreatment and, of those who did, were 4.3 times less likely to retain work. CONCLUSIONS: Of this cohort, 23.2% patients met criteria for fibromyalgia. Patients with fibromyalgia were found to show greater psychosocial distress and significantly poorer rates of work return and work retention 1-year postrehabilitation.
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Fibromialgia/epidemiología , Fibromialgia/etiología , Enfermedades Profesionales , Evaluación de Resultado en la Atención de Salud , Adulto , Estudios de Cohortes , Femenino , Fibromialgia/diagnóstico , Fibromialgia/psicología , Fibromialgia/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: The present study takes a new approach to understanding how presenteeism relates to chronic pain or disability patient outcomes. METHODS: The sample consisted of 2191 consecutive chronic disabling musculoskeletal disorder patients, classified as either presentees (N = 704), or absentees (N = 1487), who were admitted to a functional restoration program. The measures included medical evaluations, demographic data, psychiatric diagnoses at admission, an 1 year follow-up socioeconomic outcome assessment and validated questionnaires evaluating pain, depression, and function. RESULTS: The findings revealed that patients classified as presentees were significantly more likely to complete the prescribed functional restoration treatment program, to return to work (full-duty or full-time), to retain work 1-year posttreatment, and not to have a decrease in job demand from preinjury to posttreatment. CONCLUSIONS: Both employees and employers will benefit if the ill or injured employee stays at work postinjury in lieu of short- or long-term disability.