Risk factors associated with postpartum depression and PTSD after birth in a sample of Slovak women.

Background: Pregnancy, childbirth and the postpartum period represent a unique experience in a woman's life that significantly changes their life. Methods: The aim of the study is to analyse risk factors of postpartum depression and posttraumatic stress disorder symptoms after birth in a sample of women in Slovakia. Data from the INTERSECT project were collected, including 437 postpartum women (mean age 30.5 ± 4.8). Posttraumatic stress disorder was (PTSD) measured through the City BiTS questionnaire, postpartum depression (PPD) symptoms were detected using the Edinburgh Postnatal Depression Scale (EPDS) and birth satisfaction was measured by the Birth Satisfaction Scale- Revised (BSS-R). Results: An increased risk for the development of PPD (the EPDS score >12.5) was found in 11.4 % of respondents, PTSD after birth was identified among 2.8 % of respondents. In the linear regression models, birth satisfaction (95%CI: 0,56; -0,19), subjective perception of birth (95%CI: 0,82; 1,63), previous trauma (95%CI: 0,27; 3,74), respect during birth (95%CI: 5,08; -0,45), and health complications of both mother (95%CI: 0,12; 2,81) and child (95%CI: 1,53; 1,84) were found significantly associated with the posttraumatic stress symptoms after birth (total explained variance 37 %). Subjective perception of birth as traumatic (95%CI: 0,82; 1,63), previous trauma in the anamnesis (95%CI: 0,27; 3,74) and respect during birth (95%CI: 5,08; -0,45) were significantly associated with the depression symptoms (total explained variance 15 %). Conclusion: Subjective perception of birth, birth satisfaction, previous trauma in anamnesis as well as lack of respect during birth were found as crucial risk factors for both PPD and postpartum PTSD.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

Selected Factors of Experiencing Pregnancy and Birth in Association with Postpartum Depression.

BACKGROUND: The aim of the study is to analyse the risk of postpartum depression using dimensions of perceived support (information, emotional, and physical), antenatal education (satisfaction and attitude), and attitude toward pregnancy (wanted or unwanted). METHODS: A cross-sectional study was carried out among 584 postpartum women in two university birth centres in Slovakia. The Edinburgh Postnatal Depression Scale (EPDS) score was used. Descriptive statistics and analysis of variance, as well as logistic regression, were employed in the study. Found associations were adjusted for education level, type of birth, psychiatric history, and age. RESULTS: As many as 95.1% of women reported their pregnancy as being wanted. Antenatal education, particularly satisfaction with it, showed a negative association with the EPDS score level. No significant differences in depression levels were found considering attitude toward pregnancy and perceived support. CONCLUSIONS: The study pointed out the significance of antenatal education to lower the risk of the postpartum depression. One of the important criteria of effective education is a woman's subjective satisfaction with it.

Virtual patients: an option for future distance midwifery education?

BACKGROUND: The objective is to introduce the creating a set of virtual patients (VPs) to support distance midwifery education as well as the impact of distance education by means of VPs on knowledge, skills, motivation, clinical practice, and student satisfaction. METHODS: VPs were created using OpenLabyrinth (OL). The impact of the distance education was assessed using a feedback questionnaire. RESULTS: When creating our own VPs, the design and development phase can be considered the most difficult. On a scale of 1 (agree) to 4 (disagree), the student feedback rates were mostly positive (1.04-2.13). A high degree of agreement was associated with the acquisition of theoretical knowledge (1.15-1.28) and skills (1.43). CONCLUSIONS: The creation of our own VPs is challenging for teachers due to its unconventional character. The students expressed great satisfaction with distance learning, but lacked face-to-face contact with the patient.

Infant sleep and temperament characteristics in association with maternal postpartum depression.

OBJECTIVE: Aim of this study was to examine the association between infant temperament and sleep characteristics and postpartum depressive symptoms among mothers. STUDY DESIGN: Research data were collected at the baseline (2nd -4th days postpartum) and the follow-up (6-8 weeks postpartum), Slovak version of the (EPDS) was used, along with questions focused on perceived sleeping problems of an infant, and temperament Linear regression models were employed. SETTING: Two public hospital sites in Slovakia. PARTICIPANTS: 204 women participated in both time points (mean age 30.9 ± 4.8, age range: 20-44; 78.9% vaginal births; 56.9% primiparas). RESULTS: Significant differences in the EPDS scores were found according to infant sleeping problems (p ≤ 0.05) and duration of infant night sleep (p ≤ 0.01). Both night sleep and day sleep duration were significant predictors for the level of postpartum depression symptoms at the 6-8 weeks follow-up in the linear regression model after adjusting for confounding variables (ß= -0.13; 95%CI: -3.04;-0.01; ß= -0.15; 95%CI: -3.02;-0.28, total explained variance 39.0%). Infant temperament characteristics have not been found significant predictors of postpartum depression symptoms in this study. KEY CONCLUSIONS: Significant differences in depression levels were found among postpartum women according to perceived sleeping problems of infant, and the duration of infant night sleep. It is important to focus more attention on the role of infant sleeping problems as a possible risk factor for the increased occurrence of postpartum depressive symptoms.

The Association between Birth Satisfaction and the Risk of Postpartum Depression.

Negative experiences with childbirth might have a negative impact on a woman's overall health, including a higher risk of postpartum depression. The aim of the study was to examine the association between birth satisfaction and the risk of postpartum depression (PPD). A 30-item version of the Birth Satisfaction Scale (BSS) and the Edinburgh Postnatal Depression Scale (EPDS) were used, as well as the Perceived Stress Scale (PSS). The study included 584 women (mean age 30.6 ± 4.9), 2 to 4 days postpartum. In the regression model, the negative effect of birth satisfaction on the risk of postpartum depression was shown: a lower level of satisfaction with childbirth was a significant predictor of a higher risk of PPD (ß = -0.18, 95% CI = -0.08; -0.03). The regression model was controlled for the effect of the sociodemographic factors (such as education or marital status) and clinical variables (such as parity, type of delivery, psychiatric history, levels of prenatal stress). Levels of prenatal stress (ß = 0.43, 95% CI = 0.27; 0.39), psychiatric history (ß = 0.08, 95% CI = 0.01; 3.09), parity (ß = -0.12, 95% CI = -1.82; -0.32) and type of delivery (ß = 0.11, 95% CI = 0.20; 1.94) were also significantly associated with the levels of postnatal depression. The current study confirmed the association between the level of birth satisfaction and the risk of developing PPD, i.e., a lower satisfaction with childbirth may increase the risk of developing PPD.

Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women.

BACKGROUND: Postpartum depression has a negative impact on quality of life. The aim of this study was to examine the factor structure and psychometric properties of the Slovak version of the Edinburgh Postnatal Depression Scale (EPDS). METHODS: A paper and pencil version of the 10-item EPDS questionnaire was administered personally to 577 women at baseline during their stay in hospital on the second to fourth day postpartum (age, 30.6 ± 4.9 years; 73.5% vaginal births vs. 26.5% operative births; 59.4% primiparas). A total of 198 women participated in the online follow-up 6-8 weeks postpartum (questionnaire sent via e-mail). RESULTS: The Slovak version of the EPDS had Cronbach's coefficients of 0.84 and 0.88 at baseline (T1) and follow-up, respectively. The three-dimensional model of the scale offered good fit for both the baseline (χ2(df = 28) = 1339.38, p < 0.001; CFI = 0.99, RMSEA = 0.02, and TLI = 0.99) and follow-up (χ2(df = 45) = 908.06, p < 0.001, CFI = 0.93, RMSEA = 0.09, and TL = 0.90). A risk of major depression (EPDS score ≥ 13) was identified in 6.1% in T1 and 11.6% in the follow-up. Elevated levels of depression symptoms (EPDS score ≥ 10) were identified in 16.7% and 22.7% of the respondents at baseline and follow-up, respectively. CONCLUSIONS: The Slovak translation of the EPDS showed good consistency, convergent validity, and model characteristics. The routine use of EPDS can contribute to improving the quality of postnatal health care.

Psychometric properties of the Slovak version of the Birth Satisfaction Scale (BSS) and Birth Satisfaction Scale-Revised (BSS-R).

OBJECTIVE: This study is focused on assessing psychometric properties of the Slovak version of the 30-item Birth Satisfaction Scale (BSS) and revised 10-item BSS-R. STUDY DESIGN: Quantitative cross-sectional study design was used, with the primary goal of examining factor structure, internal consistency, and both divergent and known-groups validity of the Slovak version of BSS and BSS-R. SETTING: Four public hospital sites in central Slovakia PARTICIPANTS: A 30-item BSS questionnaire was administered to 506 women 2-4 days after birth (mean age 29.9 years, SD = 5.1). RESULTS: The mean BSS score was 112 (SD 13.6, score range 30-150), and BSS-R 27.3 (SD 5.4, score range 0-40). Significantly higher birth satisfaction was found among women after physiological birth, multiparas, women with supporting person at birth, with pain relief, and with university education. Both Slovak version of BSS and BSS-R have been shown to have good reliability, as well as good divergent and known-group validity. The results of confirmatory factor revealed that three-factor model of the BSS-R offers a good fit to the Slovak data (χ2, df32) = 79.40, p < 0.001, CFI = 0.96 and RMSEA = 0.05). KEY CONCLUSIONS: The Slovak version of the 10-item BSS-R has been found to have excellent psychometric properties and can be used as a valid outcome measure of birth satisfaction in Slovak hospital settings.

Type D Personality as a Predictor of Resilience Among Nursing Students.

BACKGROUND: Understanding the factors that influence resilience is especially important in the context of emotionally demanding work environments in health care. The aim of this study is to examine the associations between Type D personality and resilience among nursing students. METHOD: A correlational study design was used, and 150 baccalaureate nursing students participated. The Type D personality subscale, sense of coherence questionnaire, and Baruth protective factors inventory were used. Linear regression analysis and Student's t tests were used. RESULTS: The negative affectivity subscale of the Type D scale was a significant predictor for resilience and sense of coherence. Students with high levels of Type D characteristics had significantly lower levels of resilience and sense of coherence. CONCLUSION: It would be beneficial to include specific interventions for decreasing negative affectivity and promoting stress coping skills training in the training programs in nursing school curricula. [J Nurs Educ. 2018;57(5):296-299.].

Burnout Syndrome Among Health Care Students: The Role of Type D Personality.

The aim of this study was to examine the effect of Type D personality, along with other personality traits (resilience and sense of coherence), on burnout syndrome and its counterpart, engagement, among students of nursing, midwifery, and psychology. A cross-sectional study was conducted on 97 university students (91.9% females; M age = 20.2 ± 1.49 years). A Type D personality subscale, School Burnout Inventory, Utrecht Work Engagement Scale, Sense of Coherence Questionnaire, and Baruth Protective Factor Inventory were used. Linear regression models, Student's t test, and Pearson's correlation analysis were employed. Negative affectivity, a dimension of Type D personality, was a significant personality predictor for burnout syndrome (ß = .54; 95% CI = [0.33, 1.01]). The only significant personality predictor of engagement was a sense of coherence. Students who were identified as having Type D personality characteristics scored significantly higher on the burnout syndrome questionnaire ( t = -2.58, p < .01). In health care professions, personality predictors should be addressed to prevent burnout.

The effect of personality traits and psychosocial training on burnout syndrome among healthcare students.

AIMS: The aims of this paper were to explore the influence of personality factors on student burnout syndrome and to explore the effect of psychosocial training on burnout and personality predictors among university students in health care professions. DESIGN AND METHOD: A quasi-experimental pre-test/post-test design was used to evaluate the effect of psychosocial training. A sample of 111 university students were divided into experimental and control groups (average age 20.7 years, SD=2.8 years; 86.1% females). The School Burnout Inventory (SBI), Sense of Coherence (SOC) questionnaire, and Rosenberg's Self-esteem scale were employed. Linear regression and analysis of variance were applied for statistical analysis. RESULTS: The results show that socio-psychological training had a positive impact on the level of burnout and on personality factors that are related to burnout. After completing the training, the level of burnout in the experimental group significantly decreased (95% confidence interval: 0.93, 9.25), and no significant change was observed in the control group. Furthermore, respondents' sense of coherence increased in the experimental group (95% confidence interval: -9.11, 2.64), but there were no significant changes in respondents' self-esteem levels in either group. CONCLUSIONS: Psychosocial training positively influenced burnout among students in health care professions. Because the coping strategies that were used during the study are similar to effective work coping strategies, psychosocial training can be considered to be an effective tool to prevent burnout in the helping professions.

Effectiveness of hand hygiene education in a basic nursing school curricula.

OBJECTIVES: Although hand hygiene (HH) is the cheapest and simplest tool for the prevention of hospital-acquired infections, poor HH compliance has been reported among health care professionals. A variety of factors influence the compliance with HH guidelines, the most important being the quality of the basic nursing education. The aims of this study were to analyze the effectiveness of the basic nursing education in relation to HH, and to explore the skills and attitudes toward HH among nursing students in praxis. DESIGN AND SAMPLE: A mixed-method approach using a cross-sectional survey combined with observation and curricular analysis was used. A total of 188 nursing students participated in the study. RESULTS: Content analysis revealed significant deficits in the quality of HH-related information in basic nursing educational programs. Our results correlate directly with the reported insufficient levels of HH knowledge and the associated poor HH compliance by students during their training in clinical settings; as shown in observation and questionnaire-based surveys. CONCLUSIONS: The lack of compliance with HH standards among students lead to poor compliance among health care professionals in praxis. Consequently, the role of educational institutions in the prevention of hospital-acquired infections is significant, if the effectiveness of HH education is to be improved.

Psychosocial predictors of change in quality of life in patients after coronary interventions.

OBJECTIVE: Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease. METHODS: A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data. RESULTS: A change in physical HRQOL was predicted by baseline psychologic well-being (ß = -.39; 95% confidence interval [CI], -1.00 to -.16) and baseline HRQOL (ß = -.61; 95% CI, -.83 to -.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (ß = -.37; 95% CI, -.99 to -.09), vital exhaustion (ß = -.21; 95% CI, -.69 to -.03), and baseline HRQOL (ß = -.76; 95% CI, -1.03 to -.44). Ejection fraction did not significantly predict HRQOL. CONCLUSION: Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.

Psychosocial factors of coronary heart disease and quality of life among Roma coronary patients: a study matched by socioeconomic position.

OBJECTIVES: The aim of this study was to assess whether psychosocial factors and health-related quality of life (HRQL) differ between Roma and non-Roma coronary patients and to what degree socioeconomic status (SES) explains these differences. METHODS: We included 138 patients out of 437 interviewed: 46 Roma, all with low SES, 46 non-Roma with low SES, and 46 non-Roma with high SES. Groups were matched for age, gender and education. The GHQ-28 was used for measuring psychological well-being, the Maastricht interview for vital exhaustion, the type D questionnaire and the Cook-Medley scale for personality and the SF-36 for HRQL. SES was indicated by income and education, and disease severity by ejection fraction. ANOVA and linear regression were used. RESULTS: Roma scored poorly compared to non-Roma in psychological well-being, vital exhaustion and HRQL (p ≤ 0.001); however, these differences could be to a substantial extent explained by SES. With regard to personality traits, ethnicity and SES played a less significant role. CONCLUSIONS: The adverse quality of life among Roma coronary patients may warrant additional care, which should target their low SES but also other factors related to their ethnic background, such as culture and living conditions.

Socioeconomic inequalities in quality of life and psychological outcomes among cardiac patients.

OBJECTIVES: The aim of this article is to explore socioeconomic inequalities in the psychological characteristics (psychological well-being, perceived mental health status) and perceived quality of life among cardiac patients. METHODS: A structured interview was conducted with 362 patients (32% women, mean age 56 +/- 7.3 years) referred for coronary angiography. The GHQ-28 was used to measure psychological well-being, the SF-36 for perceived mental health status. Income and education indicated socioeconomic position. Logistic regressions were employed, adjusted for age, gender, functional status and severity of disease. RESULTS: Patients with low income or education had a higher probability of having poor psychological well-being compared to participants with high income or education (OR 5.5,CI 2.32-12.80; OR 3.1,CI 1.52-6.37 resp.), and were also more likely to have worse mental health status (OR2.9,CI 1.02-8.51;OR 4.8,CI 1.36-16.99 resp.), and low quality of life (OR 2.9,CI 1.02-8.51; OR 4.8,CI 1.36-16.99 resp.). CONCLUSIONS: Socioeconomic status was found to be negatively associated with the psychological outcomes and quality of life among cardiac patients. Socioeconomic inequalities should be taken into account when designing suitably-adapted interventions focusing on psychosocial factors among cardiac patients.

Socioeconomic differences in psychosocial factors contributing to coronary heart disease: a review.

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.

Vital exhaustion in coronary heart disease: the impact of socioeconomic status.

BACKGROUND: Vital exhaustion has been shown to be a significant risk factor contributing to coronary heart disease, as well as a predictor of a worse prognosis among coronary patients. Socioeconomic differences in vital exhaustion may be part of the causal mechanism in the health and mortality inequalities connected with socioeconomic disadvantage. Our aim was to explore socioeconomic inequalities in vital exhaustion among coronary patients. METHODS: We included 362 patients (32% women, mean age 56+/-7.3 years) who were referred for coronary angiography. The Maastricht interview for vital exhaustion was conducted with each patient. Level of income and education were used as indicators of socioeconomic status. Functional status was assessed with the NYHA (dyspnoe symptoms) and CCS (chest pain) scales. RESULTS: Logistic regression showed significant socioeconomic inequalities in vital exhaustion among patients. Participants with low and middle income and education had a higher probability of being exhausted in comparison with patients with high income and education [odds ratio (95% confidence interval): 13.31 (4.67-37.94) and 2.10 (1.19-3.64), respectively]. Associations remained statistically significant after controlling for the effect of functional status and seriousness of disease. Socioeconomic differences were more salient among men than among women. CONCLUSION: Low education and income seem to be strongly associated with higher vital exhaustion among patients; a significant factor contributing to worse prognosis and lower quality of life among patients with coronary heart disease.