Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy.

OBJECTIVES: The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS: We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS: Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION: In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.

Termination of pregnancy for fetal malformation: A traumatic event? A qualitative analysis of women's perception.

Objective: To investigate women's experience of termination of pregnancy (TOP) for severe fetal malformation.We focus on women's individual perception of psychological counselling on decision making, experiencing the birth process, seeing and holding the baby as well as emotional processing. Methods: An explorative study was conducted with 42 women (the age range was between 21 and 45 years [mean 36.17; SD±6.66]) on average twelve months after TOP using semi-structured qualitative interviews. All women received psychological counselling before, during and after the time of TOP (mean 5.2; range 2-11), at the initial counselling session all partners were present. Data were analysed by means of qualitative content analysis by Mayring; the main research question focused on women's perception of psychological counselling on experiencing TOP and coping with this incisive life event. Results: After receiving psychological counselling most of the women felt sufficiently prepared to make a decision, to experience the birth process and to bid farewell to their child. Seeing and holding the baby were perceived as helpful for emotional processing. At the time of the interview, despite the emotional distress,most women reported having positivememories and felt they had coped with the loss. Conclusions: Long-term psychological care from the time of diagnosis through TOP and follow up impacts positively on experiencing TOP, saying farewell to the child and integrating the loss into life. Further studies to detect women at risk for prolonged mourning-reactions are needed.

Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis.

BACKGROUND: Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. AIM: The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. METHODS: Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. OUTCOMES: The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. RESULTS: Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. CLINICAL IMPLICATIONS: A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. STRENGTHS AND LIMITATIONS: This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. CONCLUSIONS: Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.

Failure to resolve loss and compromised mentalizing in female inpatients with major depressive disorder.

Attachment and mentalizing are central concepts in research on the etiology, course, and treatment of depression. The goal of this cross-sectional study was to clarify the unique value of these constructs in characterizing the presence, severity, and chronicity of depression. We examined 50 female inpatients suffering from Major Depressive Disorder (MDD) in comparison to 47 matched healthy controls regarding their attachment states of mind, mentalizing capacities, and clinical variables indicating depression severity and chronicity (e.g. illness duration, number of hospitalizations). In the group of depressed patients, unresolved attachment with regard to loss was significantly overrepresented. Dimensionally, patients were more disorganized and more insecure, whereas there was no difference on the dismissing-preoccupied dimension between the two groups. Mentalizing was significantly lower in patients than in healthy controls. Logistic regression analysis revealed attachment insecurity, mentalizing deficits, and unresolved loss to be incrementally relevant to predict MDD. Correlations with clinical parameters in the group of depressed patients showed positive associations between mentalizing deficits, attachment insecurity, and variables indicating illness chronicity. Our findings highlight the relevance of the inability to resolve or reappraise loss experiences in depressive states.

Sexual and Psychosocial Functioning in Women with MRKHS after Neovaginoplasty According to Wharton-Sheares-George: A Case Control Study.

BACKGROUND: Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) has a major impact on a woman's psychological and sexual well-being. In most of the studies that addressed treatment techniques, postoperative sexual function was reported to be satisfactory; however, comparatively few studies have additionally provided an accurate analysis of psychosocial functions in MRKHS patients following different kinds of neovaginal treatment. This study is to evaluate sexual and psychosocial functioning after creation of a neovagina according to Wharton-Sheares-George in women with MRKHS. METHODS: We performed a case-control-study using multiple measures to assess sexual and psychosocial functioning. Ten MRKHS patients and 20 controls of a University hospital and tertiary center for pediatric and adolescent gynecology were assessed. The follow-up assessment comprised 6 standardized questionnaires (Female Sexuality Function Index, FSFI; Patient Health Questionnaire, PHQ; Brief Symptom Inventory, BSI; World Health Organization Quality of Life Assessment, WHOQoL-BREF; Parental Bonding Instrument, PBI; and a German questionnaire on body image). The main outcome measures were sexual function, psychological status, quality of life, body image, and parental bonding styles. FINDINGS: Sexual function, psychological status (including depressive and somatic symptoms), quality of life, and own-body experience were at least as good in operated MRKHS patients as in controls. In some measures (FSFI, PHQ-15, psychological domain of the WHOQoL-BREF, and BSI Positive Symptom Total), patients scored significantly better than controls. The results of the PBI indicated a close and sustainable mother-daughter-relationship in MRKHS patients. CONCLUSIONS: We found no evidence for an impairment of sexual or psychosocial functioning in patients after neovaginoplasty according to Wharton-Sheares-George. MRKHS may not necessarily compromise sexual and psychological well-being, provided that the syndrome is properly managed by a multidisciplinary team of health professionals.

Personality organization in borderline patients with a history of suicide attempts.

Suicide attempts (SA) are common in patients with Borderline Personality Disorder (BPD). Recent studies focus on aspects of personality associated with risk for SA such as deficits in affect regulation including impulse control and aggression. The current study examines associations of dysfunctional personality organization, psychiatric comorbidities as well as non-suicidal self-injury (NSSI) with SA in a sample of 68 BPD outpatients. Patients with a history of SA yielded higher scores in personality domains of aggression, especially self-directed aggression. Further, a history of SA was associated with a worse general level of personality organization and a higher prevalence rate of NSSI and substance abuse disorder. The results demonstrate that SA in BPD patients might be regarded as a manifestation of impaired personality functioning rather than mere state variables and symptoms. Moreover, these findings might have implications for indication, treatment, and prognosis of Borderline Personality Disorder.

Mentalizing in female inpatients with major depressive disorder.

Depression is associated with profound impairments in social and interpersonal functioning. However, little research has addressed deficits in mentalizing capacity that may underlie these impairments. The aim of this study was, therefore, to investigate the capacity for mentalization in female inpatients with depression in comparison with healthy controls. We assessed 46 inpatients with major depressive disorder with regard to psychiatric diagnoses, severity of depression, cognitive impairment, and verbal intelligence. In addition, 20 healthy controls matched for sex, age, and education were included. Mentalization was scored on the Adult Attachment Interview using the Reflective Functioning Scale. The female inpatients with depression showed a significantly lower capacity for mentalization compared with the healthy controls. Mentalization deficits were not restricted to depression-specific topics. Moreover, deficits in mentalizing capacity were related to illness duration, number of admissions, and cognitive impairment. The results indicate severe impairment in the ability of the female inpatients with depression to identify and interpret mental states of the self and others. Correlations with illness duration and number of admissions suggest that a chronic course of depression results in further mentalizing impairments. The investigation of mentalization may be of particular importance for the development of targeted psychotherapeutic interventions for depression.

A qualitative approach to examine women's experience of planned cesarean.

OBJECTIVE: To investigate women's expectations regarding cesarean and to assess the subjective experience of birth of these women. Because the birth experience is a multidimensional phenomenon, qualitative as well as quantitative approaches were used to investigate women's expectations and experiences with cesarean. DESIGN: Descriptive cohort study. SETTING: The Division of Obstetrics and Feto-Maternal Medicine of the Department of Obstetrics and Gynecology of an Austrian medical university. PARTICIPANTS: Forty-eight women with a planned cesarean birth. METHODS: Semistructured interviews were conducted with the 48 women before (36(th) week of gestation) the planned cesarean and shortly thereafter. Data were analyzed by means of a qualitative content analysis. Anxiety, depression, and psychological distress were assessed using standardized questionnaires. RESULTS: More than three fourths (81.3%) of the women were satisfied with the cesarean. Nevertheless, 83.3% of the women expressed anxiety about cesarean, including fears about the health of the infant, the epidural anesthesia, and possible complications. Before the cesarean, only one half of the women (54.2%) felt that they had been sufficiently informed about the planned cesarean, and only 25% had detailed knowledge about the specific course of events of the cesarean. Quantitative assessment showed low depression levels and overall psychological distress before and after the cesarean. State anxiety levels were high before the cesarean and moderate afterwards. CONCLUSION: Although the overall satisfaction and psychological tolerability of a planned cesarean is high, improvement is possible by providing more detailed information to the prospective mothers and by specifically addressing prevalent anxieties.

[Mentalization and bonding in chronic pelvic pain patients: a pilot study]. / Mentalisierungsfähigkeit und Bindung bei Patientinnen mit chronischen Unterbauchschmerzen: eine Pilotstudie.

OBJECTIVES: The study assesses mentalization (reflective functioning, RF), parental bonding, psychiatric comorbidity, and experiences of violence in chronic pelvic pain patients (CPP). METHODS: Twenty-two CPP patients were investigated using SCID I and II as well as the German version of the parental bonding instrument (FEB). Experiences of violence were assessed by semistructured interviews. Adult attachment interviews (AAI) were rated according to the Reflective Functioning Scale (RF Scale). RESULTS: CPP patients showed a lower capacity of mentalization (RF=2.3) compared to that of healthy individuals (RF approximately 5). Maternal bonding was rated as affectionless control (36.4 %) and as neglectful parenting (31.8 %). 54 % of the women reported experiences of violence. Axis I comorbidity was prevalent in 54.5 %, and axis II comorbidity was prevalent in 36.4 %. CONCLUSIONS: Further psychoanalytic-psychosomatic research should focus on the low capacity of mentalization, adverse parenting, and experiences of violence in chronic pelvic pain patients.

[The psychic structure of chronic pain patients]. / Psychische Struktur bei chronischen Schmerzpatienten.

OBJECTIVES: The study investigates the psychic structure and psychiatric comorbidity of chronic pain patients according to Kernberg's concept of personality organization. METHODS: We assessed 48 chronic pain patients attending the Behavioural Medicine Pain Clinic in the Department of Psychiatry. Patients were diagnosed using the SCID (DSM-IV). Psychic structure was assessed using the Structured Interview of Personality Organization (STIPO). RESULTS: At least one psychiatric diagnosis was found in 94 % of the patients, and 63 % of the patients met the criteria of at least one diagnosis of a personality disorder. In 58 % of the patients, we diagnosed a borderline personality organization, with high deficits in the dimensions of coping, defence mechanisms and identity. CONCLUSIONS: The high prevalence of borderline personality organization confirms the importance of a diagnostic investigation of the psychic structure and the necessity for psychotherapeutic treatment in chronic pain patients.

Physical, sexual, and psychological violence in a gynaecological-psychosomatic outpatient sample: prevalence and implications for mental health.

OBJECTIVE: The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence. STUDY DESIGN: We performed a cohort study of women (n=424) who attended a psychosomatic-gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV. RESULTS: Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) (p<.002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) (p<.001). CONCLUSIONS: We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.

[The capacity for mentalization in depressive patients: a pilot study]. / Mentalisierungsfähigkeit bei depressiven Patientinnen: Eine Pilotstudie.

OBJECTIVES: Mentalization has been primarily investigated in Borderline Personality Disorders. This pilot study takes the first step toward investigating mentalization in depressive patients. METHODS: First, we present the theoretical background of the concept of mentalization and previous studies. Secondly, we report the results of this pilot study. 20 female inpatients suffering from Major Depressive Disorder were investigated with SKIDI+II, depression-scales (HAM-D, BDI), cognitive tests (TMT, MCVCT), and the Adult Attachment Interview (AAI), rated according to the Reflective Functioning Scale (RF Scale). RESULTS: Depressed patients showed less capacity for mentalization (RF = 2.3) than did borderline patients (RF approximately 3) and healthy individuals (RF approximately 5). Comorbidity with dependent personality disorder correlated with higher RF scores, while comorbidity with schizoid personality disorder correlated with lower RF scores. CONCLUSIONS: Moderate to severe depression goes along with a breakdown of mental capacity. Further research should focus on investigating changes in the capacity for mentalization in remission and changes in the course of psychotherapeutic treatments.