Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort.

BACKGROUND: We aimed to investigate the index traumatic event associated with post-traumatic stress disorder (PTSD) and evaluate the timing of the onset of symptoms in relation to the recent delivery. METHODS: Questionnaire study regarding prior exposure to traumatic events, PTSD, postpartum depression (PPD) and fear of childbirth among women two to 12 months postpartum, recruited via targeted internet sites. RESULTS: Questionnaires were completed by 143 women, with PPD reported by 22 (15.4%), probable PTSD by 11 (7.7%), and fear of childbirth by 14 (9.8%). Overall, 97 (67.8%) women reported a prior traumatic event: 16 (16.5%) reported the recent delivery to be the worst traumatic event and that symptoms began subsequent to this delivery; 17 (17.5%) reported the worst traumatic event was not the recent delivery but symptoms had started postpartum. Significantly higher symptom levels suggestive of PTSD and PPD were found in women whose trauma event was not delivery, yet symptoms started postpartum. Women whose traumatic event pre-dated the delivery also showed significantly higher symptom levels of PTSD. More than half of those describing PTSD related to the recent delivery presented with clinically relevant levels of fear of childbirth, compared with less than a third of women whose PTSD was related to a different event. CONCLUSION: PTSD identified postpartum may not be linked to the recent delivery and often pre-dates it. Future studies should identify the trigger traumatic event responsible for PTSD symptoms, to enable a more accurate picture of the reasons for PTSD and fear of childbirth.

Survival in commercially insured multiple sclerosis patients and comparator subjects in the U.S.

OBJECTIVE: Compare survival in patients with multiple sclerosis (MS) from a U.S. commercial health insurance database with a matched cohort of non-MS subjects. METHODS: 30,402 MS patients and 89,818 non-MS subjects (comparators) in the OptumInsight Research (OIR) database from 1996 to 2009 were included. An MS diagnosis required at least 3 consecutive months of database reporting, with two or more ICD-9 codes of 340 at least 30 days apart, or the combination of 1 ICD-9-340 code and at least 1 MS disease-modifying treatment (DMT) code. Comparators required the absence of ICD-9-340 and DMT codes throughout database reporting. Up to three comparators were matched to each patient for: age in the year of the first relevant code (index year - at least 3 months of reporting in that year were required); sex; region of residence in the index year. Deaths were ascertained from the National Death Index and the Social Security Administration Death Master File. Subjects not identified as deceased were assumed to be alive through the end of 2009. RESULTS: Annual mortality rates were 899/100,000 among MS patients and 446/100,000 among comparators. Standardized mortality ratios compared to the U.S. population were 1.70 and 0.80, respectively. Kaplan-Meier analysis yielded a median survival from birth that was 6 years lower among MS patients than among comparators. CONCLUSIONS: The results show, for the first time in a U.S. population, a survival disadvantage for contemporary MS patients compared to non-MS subjects from the same healthcare system. The 6-year decrement in lifespan parallels a recent report from British Columbia.

Association between body mass index and suicide, and suicide attempt among British adults: the health improvement network database.

OBJECTIVE: To examine the associations between body mass index (BMI) and incidence rate (IR) of suicide attempt and suicide. DESIGN AND METHODS: 849,434 British adults were identified from The Health Improvement Network (THIN) database between January 2000 and October 2007. BMI was categorized into six levels: <18.5 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30.0-34.9, 35.0-39.9, and ≥40 (obese levels I-III). RESULTS: We identified 3,111 suicide attempts by Read codes and 75 suicides with medical records. The overall IR of suicide attempt was 82.2 cases per 100,000 person-years. The IR decreased with BMI in men with depression (471.3-166.0 cases per 100,000 person-years, P for trend = 0.02) and in men without depression (241.5-58.0 cases per 100,000 person-years, P for trend < 0.0001). In women with depression, an L-shaped relationship was observed, that is, a higher rate in underweight group when compared with reference group (503.2 vs. 282.7 per 100,000 person-years) and no significant differences in others (231.8-195.5 cases per 100,000 person-years). In women without depression, the IR was U-shaped with BMI (125.2 in underweight, 68.6 in reference, and 48.5-79.9 cases in overweight and obese I-III groups per 100,000 person-years, P for trend < 0.0001). The above trends remained after adjustment for the covariates. Regarding suicide, the overall IR was 2.0 cases per 100,000 person-years, which tended to decrease with BMI (P = 0.14). CONCLUSIONS: We concluded an inverse linear association between BMI and suicide attempt among men, an L-shaped association in nondepressive women, and a U-shaped association in depressive women were observed. The study also suggested an inverse linear tendency between BMI and suicide.

Postoperative cataract surgery satisfaction in a rural Kenyan clinic.

PURPOSE: To assess prospectively the factors influencing patient satisfaction following intracapsular cataract extraction (ICCE) surgery in a rural eye unit in Kenya. SETTING: Nakuru Eye Unit, Rift Valley Provincial General Hospital, Nakuru, Kenya, and Johns Hopkins School of Public Health, Department of International Health, Baltimore, Maryland, USA. METHODS: Starting in November 1992, 232 consecutive blind or visually impaired rural patients, over age 40, with simple senile cataract were offered free standard ICCE. Only 70% agreed to surgery. An interviewer-administered questionnaire and a brief interview were performed postoperatively on day 2, completing an extensive preoperative analysis that was part of the Kenya Rural Cataract Project. A satisfaction level indicator composed from the most important factors, applying a logistic regression model, is suggested as a predictive index for a patient to become a motivator in his or her community. RESULTS: Most patients were happy with their decision to have cataract surgery, even though 92% of the operations were done by clinical officers. Patients were overwhelmingly willing to have their fellow eye operated on or to recommend the operation to another "blind" friend (83.4%). The proposed model correctly classified 87.1% of operated patients, with high sensitivity (88.2%) and specificity (81.5%). CONCLUSIONS: Cultural differences are paramount in determining health behavior priorities and satisfaction. The post ICCE satisfaction in developing countries must be better evaluated to achieve higher self-referral of cataract-blind patients for surgery in Africa. Hospital conditions, although appreciated, did not play a major role in patients' satisfaction. The immediate surgical outcome was the key factor.