Health Problems Mediate the Effects of Adverse Childhood Experiences on the Frequency of Cannabis Use in a Sample of Pregnant and Breastfeeding Women.

Many health organizations recommend that mothers avoid cannabis during pregnancy and breastfeeding because they are concerned about exposing infants to Δ-9-tetrahydrocannabinol (THC), the psychoactive substance in cannabis. Yet, data collected by the U.S. Centers for Disease Control demonstrate that a small percentage of mothers continue to use cannabis despite warnings. The frequency of cannabis use is an important variable because frequent use increases THC exposure. The present study examined two variables related to the frequency of cannabis use during pregnancy and breastfeeding: health problems and adverse childhood experiences (ACEs). We examined a possible mediation effect of health problems on the relationship between ACEs and the frequency of cannabis use during pregnancy and breastfeeding. Our sample was entirely comprised of 1,343 women who used cannabis during pregnancy and breastfeeding. We collected data online. The women were recruited from a Facebook group that supports pregnant and breastfeeding mothers who use cannabis. To be included, participants needed to be at least 18 years old and to have used cannabis while pregnant or breastfeeding. The sample was 79% White, 8% Hispanic, and 14% Black, and 1,199 currently resided in the United States, 76 in Canada, 11 in the United Kingdom, and the rest resided in 13 other countries. Ninety-three percent of the sample reported at least one ACE, and 59% reported 4 or more. Ninety-six percent reported that they were using cannabis to treat a health problem, and the number of health problems ranged from 0 to 8. Two mediation analyses found that the total number of ACEs increased the risk of health problems, which increased the frequency of cannabis use. ACE total was not significantly related to the frequency of use once health problems were accounted for. ACEs are related to the frequency of cannabis use in pregnant and breastfeeding women, but indirectly through trauma's impact on health problems. These findings suggest that practitioners might be able to lower the frequency of cannabis if they directly address health problems.

Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study.

BACKGROUND: Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. OBJECTIVES: This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. DESIGN: Anonymous, online cross-sectional survey. METHODS: Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. RESULTS: The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. CONCLUSION: Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.

The prevalence of posttraumatic stress disorder and its associated factors among frontline health workers during the COVID-19 pandemic working at case management center in Ethiopia, 2020.

OBJECTIVES: COVID-19, because of its rapid transmission and the uncertainty about how it is transmitted, evoked fear and anxiety among frontline health professionals. This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) and its association with impairments in functioning and comorbid mental health symptoms in Ethiopia in 2020. METHOD: An English-language, online, cross-sectional survey study was administered to 207 different health professionals working at a COVID-19 center using a random sampling technique. The 17-item Symptom Scale for Posttraumatic Stress Disorder-Self-Reporting Version was used to determine the presence of PTSD. Bivariate and multivariable logistic regression analyses were conducted to determine psychosocial factors associated with PTSD. RESULTS: The overall prevalence of PTSD in this study was 55 (26.5%). Those at the highest risk included women, those working at a high-risk site, current substance users, and professionals with poor quality of sleep. CONCLUSION: The prevalence of PTSD among frontline health care providers was higher than in the general population. Some environmental and psychological variables were associated with increased risk. We recommend that health care providers who provide frontline care be regularly screened for PTSD and provided with mental health services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Recent research on secondary trauma.

This is an introduction to the special issue "Secondary Trauma." The first few sections focus on different professional groups affected by secondary trauma. Articles also describe the impact of COVID on healthcare providers and other professionals. Another section describes secondary trauma's effects on family members, including intergenerational transmission. The last section includes articles on assessing and treating secondary trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Secondary Traumatic Stress and Moral Injury in Maternity Care Providers: A Narrative and Exploratory Review.

Introduction: A significant percentage of maternity providers have experienced secondary traumatic stress following a traumatic birth. Previous studies identified it as an issue, but this literature review is 5-9 years old. In addition, the construct of moral injury has significantly increased our understanding of secondary trauma for military veterans. In the wake of COVID-19, this construct also applies to healthcare providers. Objectives: The present article updates these reviews and compares findings for three groups: labor and delivery nurses, midwives, and obstetricians. The second portion of this review re-examines previously published qualitative research to determine whether moral injury might more accurately describe the experiences of maternity personnel. Methods: A comprehensive review of PubMed, Scopus, Web of Science, PsychINFO, and CINAHL was conducted in June 2021 using search terms such as compassion fatigue, secondary trauma, moral injury, labor and delivery, nurses, midwives, and obstetricians. Forty articles were identified, but only 16 focused on secondary trauma or moral injury. Results: Secondary trauma is a significant concern affecting at least 25% of maternity staff. However, some countries have very low rates, which correspond to low rates in childbirth-related trauma in mothers. Secondary trauma can lead to several symptoms, including re-experiencing, avoidance, negative changes in mood and cognitions, and hyperarousal, which can cause significant impairment. As a result, many providers decide to leave the field in the wake of a traumatic birth. The incidence of moral injury is unknown, but a re-examination of previously published qualitative data suggests that this construct, generally used to describe combat veterans, does describe some of what providers have reported. Acts of omission, i.e., failure to stop the harmful acts of others had long-term negative effects on labor and delivery nurses, consistent with data from military samples. Two possible mediators were proposed: hierarchical and gendered relationships in hospitals and agency of care. Conclusion: The effects of traumatic birth on providers can be severe, including possible psychological sequelae, impaired job performance, and leaving the field. Moral injury expands upon the construct of secondary traumatic stress. This construct better describes the experiences of maternity staff in non-primary roles who witness traumatic births and are often haunted by events that they could not prevent, but often question whether they should have.

Traumatic events, psychological symptoms, and aggression in male and female prisoners.

Objective: Establish the relationship between the types of traumatic experiences, number of traumas, age at the time of traumatic events with psychopathological symptoms and aggression in an Ecuadorian prison. Method: A cross-sectional study with 101 offenders from Ambato's Detention Center in Ecuador. Results: Of the prisoners in this sample, 27 have PTSD. Incarcerated individuals who have suffered intentional trauma, multiple traumas, and trauma before the age of 18 show higher levels of psychopathological symptoms and aggression. Conclusions: This study highlights the importance of mental health care in prisons. Research outcomes are relevant for future investigation in Latin American prisons for the design and implementation of trauma-related interventions. Trauma-focused interventions can prevent violence and mitigate its consequences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mode of Cannabis Use and Factors Related to Frequency of Cannabis Use Among Breastfeeding Mothers: Results from an Online Survey.

Background: In the United States, 5% of breastfeeding mothers report using cannabis. Frequent cannabis use results in higher delta-9-tetrahydrocannabinol (THC) in breast milk, and mode of cannabis use may also impact risk to the infant. The aim of this study was to understand how breastfeeding mothers use cannabis and factors related to frequency of its use. Methods: An anonymous online survey was conducted among mothers who used cannabis while breastfeeding. Frequency of cannabis use was ascertained along with modes of and reasons for cannabis use. Respondents were grouped by frequency of use: less-than-daily (n = 686), low-daily (1-3 times/day; n = 423), and high-daily (≥4 times/day; n = 218). Chi-square and analysis of variance tested between-group differences, and ordinal logistic regression examined factors associated with cannabis use frequency. Results: Smoking (88%) was the most common mode of cannabis consumption, followed by vaping (48%) and oral/edibles (36%). Smoking and vaping differed by cannabis use frequency. Only 54% used cannabis to get high, but was reported more among frequent users. In contrast, 89% of mothers used cannabis for mental or physical health symptoms, including anxiety, depression, gastrointestinal symptoms, chronic pain, and posttraumatic stress disorder. These symptoms differed by cannabis use frequency. Reporting more symptoms was associated with higher frequency of use. The odds of increasing cannabis use frequency was 2.7 for those reporting 1-2 health reasons, 5.6 for those reporting 3-4 health reasons, and 13.1 for reporting ≥5 health reasons. Conclusions: Strategies are needed to address maternal mental and physical health, which may be key to reducing cannabis use among breastfeeding mothers.

Neuroticism and PTSD symptoms: Gender moderates the mediating effect of peritraumatic emotions and dissociation.

OBJECTIVE: Gender differences in posttraumatic stress disorder (PTSD) prevalence and severity are well established; there is also growing evidence that men and women develop PTSD symptoms differently. This article aims to examine gender differences in the relationship between PTSD symptoms and personality traits according to the Five Factor model (FFM), based on the data from different studies conducted in Poland. METHOD: The meta-analysis method and path analyses were conducted on the data from seven studies, including 1,182 women and 1,150 men. Five studies were carried out among motor vehicle accident survivors, one from fire and flood victims. All of the studies had a cross-sectional design. RESULTS: All FFM traits were significantly related to PTSD symptoms. Neuroticism showed the strongest relationship. Further analyses revealed a moderated mediation of this relationship: It was stronger for men and mediated by peritraumatic emotions and dissociation for women. CONCLUSIONS: The results indicate that PTSD development is mediated by peritraumatic factors, but this mediation is moderated by gender. Men with higher Neuroticism are at particular risk of developing PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic growth and depreciation in people with chronic pain: A profile analysis.

OBJECTIVE: Chronic pain can disrupt everyday life and shatter beliefs about the world. Shattered beliefs may be rebuilt, either positively or negatively, leading to posttraumatic growth (PTG) or posttraumatic depreciation (PTD). According to a transdiagnostic emotion regulation perspective, these phenomena are associated with coping strategies and emotions related to the body, self, others, and the world. Because PTG and PTD can coexist, this study aims to compare different profiles of rebuilt beliefs based on emotions, emotion regulation, and psychopathology. METHOD: People with chronic pain (N = 1,577) completed online self-report questionnaires evaluating PTG and PTD, trauma-related emotions, and reactions regarding pain (guilt, shame, mental defeat, injustice, feeling discounted, sensitivity to pain traumatization, sense of body-self unity), difficulties in emotion regulation, coping strategies, and psychopathological symptoms. RESULTS: Profiles illustrate four ways to experience potentially traumatic and life-challenging circumstances: no disruption, ambivalence, growth, and distress. Differences were found regarding trauma-related emotions and reactions, levels of comorbid psychopathologies, and emotion regulation. CONCLUSIONS: Considering trauma as a genuine dimension of chronic pain experience could provide an important framework to better address the resources and trajectories of people with chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trauma psychology in an era of interesting times.

Younger readers tend to prefer digital versions of journals. Many members of all ages have expressed concern regarding the expense and environmental impact of printing and shipping hard copies. Could we eventually see Psychological Trauma moving to an all-digital format? And would that make it easier to integrate materials that would make the journal more interactive? It will be interesting to see how these trends can impact our journal. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Oxytocin is a principal hormone that exerts part of its effects by active fragments.

Oxytocin is a nonapeptide consisting of a cyclic six amino-acid structure and a tail of three amino acids. It was originally known for its ability to induce milk ejection and to stimulate uterine contractions. More recently, oxytocin has been shown to stimulate social behaviors, and exert pain-relieving, anti-stress/anti-inflammatory and restorative effects. We hypothesize that oxytocin is a principal hormone that, in part, exerts its effects after degradation to active fragments with more specific effect profiles. Experimental findings on rats show that administered oxytocin exerts biphasic effects. For example, after an initial increase in pain threshold, a second more long-lasting increase follows. Blood pressure and cortisol levels initially increase and then reverse into a long-lasting decrease in blood pressure and cortisol. Whereas the initial effects are, the second-phase effects are not blocked by an oxytocin antagonist, but by an opioid mu-antagonist and by an alpha 2-adrenoreceptor antagonist, respectively, suggesting that other receptors are involved. Repeated administration of oxytocin induces multiple anti-stress effects, which are mediated by alpha 2-adrenoreceptors. Repeated administration of linear oxytocin and linear oxytocin fragments with a retained C-terminal reduce spontaneous motor activity, a sedative or anti-stress effect, suggesting that alpha 2-adrenoreceptors have been activated. In contrast, linear mid-fragments stimulate motor activity. Low-intensity stimulation of cutaneous nerves in rats, as well as breastfeeding and skin-to-skin contact between mothers and babies, trigger immediate anti-stress effects. Some of these effects are likely caused by open ring/linear C-terminal fragments activating alpha 2-adrenoreceptors. Oxytocin fragments may be pre-formed and released in the brain or created by metabolic conversion of the principal hormone oxytocin in the central nervous system. Oxytocin and its fragments may also be released from peripheral sites, such as peripheral nerves, the gastrointestinal tract, and blood vessels in response to decreased sympathetic or increased parasympathetic nervous tone. Smaller fragments of oxytocin produced in the periphery may easily pass the blood-brain barrier to induce effects in the brain. In conclusion, oxytocin is linked to many different, sometimes opposite effects. The intact cyclic molecule may act to initiate social interaction and associated psychophysiological effects, whereas linear oxytocin and C-terminal fragments may induce relaxation and anti-stress effects following social interaction. In this way, the principal hormone oxytocin and its fragments may take part in a behavioral sequence, ranging from approach and interaction to calm and relaxation. Linear fragments, with an exposed cysteine-residue, may exert anti-inflammatory and antioxidant effects and thereby contribute to the health-promoting effects of oxytocin.

Emerging findings on trauma in the military.

Trauma among military personnel is an ongoing concern. Some estimate that up to 23% of post-9/11 service members have posttraumatic stress disorder (Meyer et al., 2019). Even when service personnel do not meet full criteria for posttraumatic stress disorder (PTSD), they often have trauma symptoms and comorbid depression, anxiety, or substance abuse. In response to the needs of military personnel, we are pleased to present a special issue with recent research on trauma in the military. The articles in this special issue represent four areas of emerging research on this population: beliefs, cognitions, and moral injury; relationships and coping; symptoms and comorbidity; and recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

New research on military and mass trauma: An introduction to the special issue.

PTSD in military personnel and survivors of mass trauma are particularly pertinent to our world today. The stories of these trauma survivors are in the news nearly every day. With this in mind, the editors are pleased to present this special issue of Psychological Trauma focusing on military and mass trauma. Psychological Trauma is at the forefront of trauma research, and the editors are proud to present this compilation of articles on these two important topics. (PsycINFO Database Record

The new paradigm for depression in new mothers: current findings on maternal depression, breastfeeding and resiliency across the lifespan.

The results from these recent studies demonstrate that breastfeeding has a much larger role to play in maintaining physical and mental health than we have previously believed. It's not just the milk. Because breastfeeding increases maternal responsivity, it makes the day-to-day experience of mothering more tolerable. It increases the chances that the babies will be securely attached and will not have their stress and inflammatory response systems chronically up-regulated. Breastfeeding is so much more than just a method of feeding. It's a way of caring for a baby that will provide a lifetime's worth of good health because it provides a way for mothers to connect with their babies, even if they did not experience that kind of care themselves. In short, breastfeeding can make the world a happier and healthier place, one mother and baby at a time.

The influence of prior rape on the psychological and physical health functioning of older adults.

OBJECTIVES: Older adults who have experienced traumatic events earlier in life may be especially vulnerable to additional challenges associated with aging. In a cross-sectional study of older females, the present study examines whether a history of rape is associated with current psychological and health problems. METHOD: This study used existing data from the female respondents (N = 1228) in the National Social Life, Health, and Aging Project (NSHAP), a national probability sample of adults between the ages of 57 and 85 interviewed in their homes. It was determined whether or not the participant experienced forced sexual contact since the age of 18. Measures of psychological health (e.g., scales of depression, anxiety, and loneliness), the presence or absence of a number of serious health problems, and a one-item measure of self-esteem were obtained. RESULTS: Adult rape occurred in 7% of the sample. On average, 36 years had elapsed since the rape had occurred. Using structural equation modeling (SEM), rape was associated with lower self-esteem, psychological, and physical health functioning. Self-esteem partially mediated the association between rape and psychological functioning, but not health functioning. These associations were significant even after controlling for participant characteristics and risky health behaviors. CONCLUSIONS: Mechanisms linking prior rape to psychological and health problems in older age are discussed, as well as treatment recommendations for symptomatic older adults.

Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: a comparison of breastfeeding, mixed-feeding, and formula-feeding mothers.

BACKGROUND: Women with a history of sexual assault are at increased risk for sleep difficulties and depression in their first year of motherhood. Breastfeeding improves sleep parameters and lowers risk of depression for women in general. However, it is unknown whether breastfeeding is related to maternal depression, sleep quality, and maternal well-being in sexual assault survivors. We examined the association between sexual assault and several indices of sleep, depression, and maternal well-being in a large sample of sexual assault survivors in the first year postpartum. We also explored whether feeding method was related to our outcome variables for both sexually assaulted and non-assaulted women. SUBJECTS AND METHODS: A sample of 6,410 mothers of infants 0-12 months old participated in the online Survey of Mothers' Sleep and Fatigue; 994 women had a history of sexual assault. RESULTS: As predicted, women with a history of sexual assault had a number of sleep difficulties, increased risk of depression, and overall poorer subjective well-being than their non-assaulted counterparts. However, sexual assault survivors who were breastfeeding were at lower risk on all of the sleep and depression parameters than sexual assault survivors who were mixed or formula feeding. CONCLUSIONS: Sexual assault has a pervasive negative effect on new mothers' sleep quality and risk of depression. However, these negative effects were less severe for the breastfeeding mothers than they were for the mixed- or formula-feeding mothers.

Childhood Abuse and Current Health Problems among Older Adults: The Mediating Role of Self-Efficacy.

OBJECTIVES: Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. METHODS: Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N=1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and employed a multiethnic sample that is representative of the general population in this area. RESULTS: Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. CONCLUSIONS: There are far reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a life-long risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning.

Maternal obesity from all sides.

This column features excerpts from a recent series of articles from the Lamaze International research blog, Science & Sensibility. The eight-part series examined the issue of maternal obesity from various perspectives, incorporating writings from Kimmelin Hull, a physician assistant, a Lamaze Certified Childbirth Educator, and the community manager of Science & Sensibility; Kristen Montgomery, a nursing professor at the University of North Carolina-Charlotte; Pamela Vireday, a childbirth educator and blogger; and Kathleen Kendall-Tackett, a health psychologist, lactation consultant, and writer/speaker. The authors of the blog series, titled "Maternal Obesity from All Sides," reviewed current research about risks associated with maternal obesity as well as the humanistic issues and lived experiences of pregnant women of size.