Psychometric testing of the Chinese version of the Perceived Maternal Parenting Self-Efficacy Scale among postpartum women.

BACKGROUND: Maternal parenting self-efficacy plays a critical role in facilitating positive parenting practices and successful adaption to motherhood. The Perceived Maternal Parenting Self-Efficacy Scale (PMPS-E), as a task-specific measure, confirms its psychometric properties in cultural contexts. Compared with other tools, the advantages of the PMPS-E are as follows: (i) specific context or time period during the lifespan of a child, (ii) explicitly assess parenting self-efficacy across a diverse enough range of parenting tasks or activities during the perinatal/postnatal period and (iii) having robust psychometric properties. The aim of this study was to translate and determine the psychometric properties of the PMPS-E among Chinese postpartum women (C-PMPS-E). METHOD: The cross-cultural adaptation process followed Beaton et al.'s intercultural debugging guidelines. A total of 471 women were included to establish the psychometric properties of the C-PMPS-E. Mothers were asked to complete the C-PMPS-E, Edinburgh Postnatal Depression Scale (EPDS), the Generalized Anxiety Disorder-7 (GAD-7) and several demographic questions. The psychometric testing of the C-PMPS-E was established through item analysis, construct validity and internal consistency reliability. RESULTS: Item analysis showed that the critical ratios of all items were greater than 3 between the low-score group and high-score group, and all item-total correlation coefficients were greater than 0.4. The fit indices showed that the original correlated four-factor model of C-PMPS-E was observed to be an excellent fit to the data. The PMPS-E was negatively correlated with the EPDS and GAD-7 demonstrating its discriminant validity. As expected, no significant correlation was found between PMPS-E total or subscale scores and mothers' age. In addition, statistically significant differences for parity were detected for C-PMPS-E total and subscale scores with multipara having higher scores. This was taken as further evidence of the scale known-groups discriminant validity. In terms of internal consistency, the Cronbach's alpha of the C-PMPS-E total scale was 0.950, and subscales ranged from 0.76 to 0.89. Furthermore, a ROC curve analysis was conducted to establish the ability of the C-PMPS-E to distinguish between symptoms of depression and symptoms of anxiety. A cut-off value of 55 was identified that resulted in good specificity and fair sensitivity. CONCLUSION: The C-PMPS-E is a reliable and valid tool to assess maternal parenting self-efficacy in a Chinese context.

A longitudinal study of symptom cluster latent profiles in ovarian cancer patients undergoing chemotherapy.

BACKGROUND: This study aimed to identify distinct patterns within the symptom cluster of fatigue, pain, and sleep disturbance among ovarian cancer patients receiving chemotherapy, to determine the factors predicting these patterns and their impact on quality of life. METHODS: The longitudinal study collected data from 151 ovarian cancer patients at three time points: before chemotherapy (T0), after the first chemotherapy cycle (T1), and following the completion of four cycles of chemotherapy (T2). Latent profile analysis and latent transition analysis were used to identify symptom patterns and evaluate changes in symptom patterns. A bias-adjusted three-step approach was utilized to examine predictor variables and distal outcomes associated with latent class membership. RESULTS: Three symptom patterns emerged: "All Low," "Moderate" (T0)/"Low pain and high sleep disturbance" (T1 and T2), and "All High." Patients with lower educational attainment and higher levels of anxiety and depression were found to be at an elevated risk of belonging to the "All High" class. All quality-of-life domains showed significant differences among the three subgroups, following an "All Low" > "All High" pattern (p < 0.05). Membership in three classes remained relatively stable over time, with probabilities of 0.749 staying within their groups from T0 to T2. CONCLUSIONS: This study underscores the existence of a diverse and heterogeneous experience within the symptom cluster of fatigue, pain, and sleep disturbance among ovarian cancer patients. Importantly, these patterns were stable throughout chemotherapy. Recognizing and understanding these patterns can inform the development of targeted interventions to alleviate the burden of symptom clusters in this population.

Relationship among post-traumatic growth, spiritual well-being, and perceived social support in Chinese women with gynecological cancer.

This study aimed to examine the correlation between post-traumatic growth (PTG), spiritual well-being (SWB), perceived social support (PSS), and demographic and clinical factors in Chinese gynecological cancer patients. Through convenience sampling, we conducted a cross-sectional study of 771 adult patients with gynecological cancer. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Spiritual Well-being 32 (EORTC QLQ-SWB32), Post-traumatic Growth Inventory (PTGI), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to measure SWB, PTG, and PSS. A Multiple Linear Regression Model was used to determine the possible factors contributing to PTG. The subscale with the highest centesimal score in the PTGI was the Appreciation of Life Scale, and the lowest was New Possibility. Gynecologic cancer patients with younger ages (B = - 0.313, P = 0.002), perceived more family support (B = 1.289, P < 0.001), had more existential (B = 0.865, P = 0.010), and had religious belief (B = 5.760, P = 0.034) may have more PTG. Spiritual well-being, perceived social support, younger age, and religious beliefs are associated with post-traumatic growth in gynecological cancer patients. Healthcare staff could provide more professional support to younger patients with religious beliefs. Promoting social support and spiritual well-being could potentially serve as effective interventions for boosting PTG among gynecological cancer.

Pathway analysis of the impact of health literacy, social support and self-efficacy on self-management behaviors in pregnant women with gestational diabetes mellitus.

Objective: The purpose of this study was to investigate the pathways by which health literacy (HL), social support, and self-efficacy influence self-management behaviors of pregnant women with Gestational diabetes mellitus (GDM) and the interrelationships between the variables. Methods: A total of 565 pregnant women with GDM was recruited. The Demographic Characteristics Form, Health Literacy Scale, Perceived Social Support Scale, General Self-efficacy Scale and GDM Self-management Behavior Scale were used for data collection. Descriptive statistics, zero-ordered correlation analysis, and multiple linear regression analysis were performed on the variables; Structural Equation Model (SEM) were constructed for pathway analysis. Results: A positive correlation was found between health literacy, social support, self-efficacy, and self-management behaviors among pregnant women with GDM after adjusting for age, education level, income level, work status, parity, and family history of diabetes (r ranging from 0.203 to 0.533). A further multiple linear regression analysis showed that functional HL, communicative HL, critical HL, social support, and self-efficacy were all independent influences on self-management behaviors and accounted for 36.3% of the variance. Communicative HL and critical HL explained the strongest self-management behaviors (ß = 0.316 and 0.255, respectively, p < 0.001). The SEM model was suitable for χ2/DF = 2.860, RMSEA = 0.060, IFI = 0.953, TLI = 0.943, and CFI = 0.952. The results showed direct positive effects of health literacy on self-management behaviors and self-efficacy, direct positive effects of social support on health literacy and self-efficacy. Social support and self-efficacy have had no significant direct impact on self-management behaviors, but social support may indirectly influence self-management behaviors through the health literacy mediation role. Conclusion: Healthcare providers should pay attention to the positive impacts of health literacy and social support on self-management behaviors of pregnant women with GDM. Improving the health literacy level of pregnant women with GDM should be the key point of intervention in practice, and the social support system should be fully mobilized to enhance emotional support and life support to promote the improvement of self-management behaviors.

Marital adjustment and depressive symptoms among Chinese perinatal women: a prospective, longitudinal cross-lagged study.

OBJECTIVES: The objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women. DESIGN: This was a prospective, longitudinal cross-lagged study. SETTING: The study was conducted at the outpatient department of the largest women's and children's hospital in China, which is located in Chengdu, Sichuan Province. PARTICIPANTS: Four hundred and sixty-three mothers were conveniently sampled. MAIN OUTCOME MEASURES: The Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms. RESULTS: The prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (ß=-0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (ß=-0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant. CONCLUSION: The prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Person-Centered Maternity Care Scale.

BACKGROUND: Increasing evidence show that women across the world face unacceptable mistreatment during childbirth. Person-centered maternity care is fundamental and essential to quality of healthcare services. The aim of this study was to translate and determine the psychometric properties of the Person-Centered Maternity Care (PCMC) Scale among Chinese postpartum women. METHODS: A cross-sectional study was conducted among 1235 post-partum women in China. The cross-cultural adaptation process followed the Beaton intercultural debugging guidelines. A total of 1235 women were included to establish the psychometric properties of the PCMC. A demographic characteristics form and the PCMC were used for data collection. The psychometric properties of the PCMC were evaluated by examining item analysis, exploratory factor analysis, known-groups discriminant validity, and internal consistency. RESULTS: The number of extracted common factors was limited to three (dignity & respect, communication & autonomy, supportive care), explaining a total variance of 40.8%. Regarding internal consistency, the Cronbach's alpha coefficient and split-half reliability of the full PCMC score were 0.989 and 0.852, respectively. CONCLUSIONS: The Chinese version of the PCMC is a reliable and valid tool to assess person-centered care during childbirth in China.

The Chinese version of the Health Professional Communication Skills Scale: Psychometric evaluation.

Objective: This study aims to translate the Health Professional Communication Skills Scale (HP-CSS) into Chinese and assess its psychometric properties. Methods: A total of 836 healthcare professionals were recruited. The demographic characteristics form and HP-CSS were used for data collection. The psychometric properties of HP-CSS were evaluated by examining item analysis, construct validity, known-group discriminant validity, internal consistency, and split-half reliability. Results: In terms of item analysis, the critical ratio (CR) of 18 items was both >3 (CR ranging from 9.937 to 28.816), and the score of each item was positively correlated with the total score (r ranging from 0.357 to 0.778, P < 0.001). The fit indices showed that the original correlated four-factor model of HP-CSS was adequate: χ2 =722.801; df = 126; χ2/df = 5.737; RMSEA = 0.075; CFI = 0.923; NNFI = 0.908; TLI = 0.906; IFI = 0.923. In terms of known-group discriminant validity, the HP-CSS total score was related to gender, occupation, work years, and communication skill training. Cronbach's α coefficient was 0.922, and the split-half reliability was 0.865 for the total scale. Conclusion: The Chinese version of the HP-CSS is a reliable and valid instrument to evaluate communication skills among healthcare professionals in China.

Prevalence and factors associated with trajectories of antenatal depression: a prospective multi-center cohort study in Chengdu, China.

BACKGROUND: Antenatal depression (AD) is a major depressive disorder during pregnancy, which may lead to devastating sequelae for the expectant mothers and infants. This study aimed to investigate the prevalence, to analyze trajectory model based on EPDS score, and to explore the influence factors of AD among pregnant women in Chengdu, China. METHODS: Participants from four maternity hospitals in Chengdu, China were recruited when they had their first pregnancy medical check-up during March 2019 to May 2020. All participants were required to fill in Edinburgh Postnatal Depression Scale Chinese version (EPDS) once during three trimesters and provided information about their health status, social-demographic etc. The trajectory model, chi-square test and multivariate binary logistic regression were used to analyze all collected data. RESULTS: A total of 4560 pregnant women were recruited, while 1051 women completed the study. The prevalence of depression symptoms during the first, second and third trimesters were 32.92% (346/1051), 19.79% (208/1051) and 20.46% (215/1051) respectively. According to the results of the latent growth mixture modeling, the trajectory model of three categories based on EPDS score were identified in this study: low-risk group (38.2%, 401/1051), medium-risk group (54.8%, 576/1051) and high-risk group (7%, 74/1051). Good marital relationship (P = 0.007, OR = 0.33, 95% CI 0.147 ~ 0.74), good relationship with parents-in-law (P = 0.011, OR = 0.561, 95% CI 0.36 ~ 0.874), planned pregnancy (P = 0.018, OR = 0.681, 95% CI 0.496 ~ 0.936) were the protective factors while lower education level (P = 0.036, OR = 1.355, 95% CI 1.02 ~ 1.799), fear about dystocia (P = 0.0, OR = 1.729, 95% CI 1.31 ~ 2.283), recent major negative life events (P = 0.033, OR = 2.147, 95% CI 1.065 ~ 4.329) were the risk factors of medium-risk group. Good marital relationship (P = 0.005, OR = 0.2, 95% CI 0.065 ~ 0.615), good relationship with parents-in-law (P = 0.003, OR = 0.319, 95% CI 0.15 ~ 0.679) were also protective factors of high-risk group, but the risk factors for high-risk group were medical history (P = 0.046, OR = 1.836, 95% CI 1.011 ~ 3.334), pregnancy complications (P = 0.022, OR = 2.015, 95% CI 1.109 ~ 3.662), worry about dystocia (P = 0.003, OR = 2.365, 95% CI 1.347 ~ 4.153), recent major negative life events (P = 0.011, OR = 3.661, 95% CI 1.341 ~ 9.993). No protective or risk factors were identified for low-risk group. CONCLUSION: Even the incidence and levels of depression in the first trimester of pregnancy were the highest, the probability of pregnancy women get depression during gestation period were higher than other population. Therefore, it's important to monitor the psychological status of pregnant women during the whole pregnancy, especially in the first trimester. The study suggested a good partner relationship and good relations with parents-in-law both protected pregnant women from depression and promoted the well-being of mothers and children.

The safety and feasibility of no-placement of urinary catheter after single-port laparoscopic surgery in patients with benign ovarian tumor: A retrospective cohort study.

OBJECTIVE: The aim of this study was to investigate the feasibility and safety of no placement of urinary catheter after single-port laparoscopic surgery in patients with benign ovarian tumor. MATERIALS AND METHODS: Patients with benign ovarian tumor who received ovarian cystectomy or oophorectomy via single-port laparoscopic surgery in our department were screened between July 2019 and March 2021. Patients were divided into placement of urinary catheter group or no-placement of urinary catheter group according to whether an indwelling catheter was used after single-port laparoscopic surgery, and length of hospital stay, occurrence of postoperative urinary retention, incidence of urinary tract infection and re-insertion rate of urinary catheters were compared. RESULTS: There was no significant difference in the rate of urinary catheter re-insertion between the two groups (P = 0.431), but a higher incidence of urinary catheter re-insertion was found in the group of dwelling urinary catheter placement. Simultaneously, there were no significant differences in the rates of urinary tract infection and postoperative urinary retention (1.6% vs 0.6%; P = 0.391 and 4.3% vs 6.9%; P = 0.295, respectively) between the two groups, whereas a significant shorter length of hospital stay was observed in the non-urinary catheter group when compared to the urinary catheter group (4.61 ± 1.40 vs 5.23 ± 1.72; p < 0.001). CONCLUSIONS: Our retrospective study provided evidence to the hypothesis that no placement of urinary catheter in patients with benign ovarian tumor was safe and feasible after single-port laparoscopic surgery. Meanwhile, avoiding urinary catheter could contributed to decrease in the length of hospital stay and is conducive to the enhanced recovery of patients.

The Chinese version of the Caregiver Difficulties Scale: Psychometric evaluation.

BACKGROUND: Evaluating caregiver burden and its health impact is an essential component of long-term care plan for children with disabilities; the Caregiver Difficulties Scale (CDS) has high conceptual sensitivity. The aim of this study was to adapt the CDS to Chinese and investigates the psychometric properties of this tool. METHODS: The study was carried out among caregivers of children with cerebral palsy (n = 194). The CDS, Caregivers Burden Inventory (CBI) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) were used for data collection. Twenty experts were consulted to evaluate the content validity of the scale. The confirmatory factor analysis was conducted to measure the construct validity of CDS. The Spearman correlation coefficients were calculated among CDS, CBI and WHOQOL-BREF to examine the convergent validity and discriminant validity. The reliability was evaluated by examining internal consistency and test-retest reliability. RESULTS: The result of expert consultation showed that the S-CVI was 0.894 and the I-CVI ranged from 0.70 to 1.00. The fit indices showed that the original correlated four-factor model of CDS was adequate: χ2 = 268.397; df = 243; χ2 /df = 1.105; RMSEA = 0.023; CFI = 0.985; NNFI = 0.869; TLI = 0.982; IFI = 0.986. The score of CDS was positively strong associated with the scores of CBI (r = +0.764); negatively correlating with the scores of WHOQOL-BREF (r = -0.627). The Cronbach's alpha was 0.840; intraclass correlation coefficient (ICC) value was 0.843. CONCLUSIONS: The Chinese version of the CDS is a valid and reliable tool to evaluate burden for caregivers of children with CP in China.

Association between maternal smoke exposure and congenital heart defects from a case-control study in China.

There is a gap in knowledge how maternal exposure to environmental tobacco smoke (ETS) is associated with offspring congenital heart defects (CHDs). In this case-control study, we collected data on 749 fetuses with CHDs and 880 fetuses without any congenital anomalies to examine the association of maternal ETS with fetal CHDs and the potentially moderating effect by maternal hazardous and noxious substances (HNS), periconceptional folate intake and paternal smoking. Maternal exposure to ETS in first trimester was associated with increased risk of CHDs in a dose-response gradient, with the AORs (95% CI) were1.38 (1.00-1.92), 1.60 (1.07-2.41), and 4.94 (2.43-10.05) for ETS < 1 h/day, 1-2 h/day, and ≥ 2 h/day, respectively. With the doubly unexposed group as reference categories, AORs for maternal ETS exposure ≥ 2 h/day in the absence of folate intake, in the presence of HNS exposure or paternal smoking, were 7.21, 11.43, and 8.83, respectively. Significant additive interaction between ETS exposure and maternal folate intake on CHDs was detected. Maternal ETS exposure during first trimester may increase the risk of offspring CHDs in a dose-response shape, and such effect may be modified by maternal folate intake or other potential factors.

The mediating role of coping styles in the relationship between perceived social support and antenatal depression among pregnant women: a cross-sectional study.

BACKGROUND: Antenatal depression (AD) is common in pregnant women and is associated with adverse outcomes for the mother, fetus, infant and child. The influencing factors of AD among pregnant women have been studied; however, the mechanisms of these factors remain unclear. This study was designed to examine the direct and serial mediating roles of coping styles in the relationship between perceived social support and AD among pregnant women. METHODS: A cross-sectional study was conducted among 1486 pregnant women who registered to give birth at a tertiary hospital. A self-developed questionnaire was administered to obtain sociodemographic and obstetric data. The Perceived Social Support Scale (PSSS), Simplified Coping Style Questionnaire (SCSQ), and Edinburgh Postnatal Depression Scale (EPDS) were administered to measure the perceived social support, coping styles, and depressive symptoms of pregnant women, respectively. Multiple linear stepwise regression analysis was used, and then, the specific relationships among influencing factors were determined through structural equation modelling (SEM). RESULTS: The prevalence of AD was 24.02%. The average scores of intrafamily support, extrafamily support, positive coping styles, negative coping styles and EPDS reported by pregnant women were 24.16 ± 3.09, 44.52 ± 6.16, 27.34 ± 4.89, 9.79 ± 3.82, and 7.44 ± 3.56, respectively. Multiple regression analysis showed that pregnant women with a higher level of intrafamily support exhibited a positive coping style and a decreased risk of AD. Compared with extrafamily support, the direct effect (-0.16 vs. -0.10, P < 0.05) and indirect effect of intrafamily support through coping styles (-0.028 vs. -0.027, P < 0.05) on AD were stronger. Two indirect pathways explained 17.46% of the variance in the EPDS scores. CONCLUSION: Higher social support decreased the likelihood of AD, not only directly but also through the mediating roles of coping styles. Social support should be strengthened, and positive coping styles should be advocated in every stage of pregnancy. Specifically, intrafamily support should be given more attention for pregnant Chinese women.

Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China.

ABSTRACT: The physical and psychological condition of patients with gynaecological cancer has received much attention, but there is little research on spirituality in palliative care. This study aimed to investigate spiritual well-being and its association with quality of life, anxiety and depression in patients with gynaecological cancer. A cross-sectional study was conducted in China in 2019 with 705 patients diagnosed with primary gynaecological cancer. European Organisation for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-SWB32 and EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used to measure spiritual well-being, quality of life, anxiety and depression. Univariate and multiple linear regression analyses were performed to examine associations between spiritual well-being, quality of life, anxiety and depression. Functioning scales and global health status were positively correlated with spiritual well-being (P < .05). Anxiety and depression were negatively correlated with spiritual well-being (P < .05). Depression (-0.362, P < .001) was the strongest predictor of Existential score. Anxiety (-0.522, P < .001) was the only predictor of Relationship with self. Depression (-0.350, P < .001) and Global health (0.099, P = .011) were the strongest predictors of Relationship with others. Religion (-0.204, P < .001) and Depression (-0.196, P < .001) were the strongest predictors of Relationship with someone or something greater. Global health (0.337, P < .001) and Depression (-0.144, P < .001) were the strongest predictors of Global-SWB. Well spiritual well-being is associated with lower anxiety and depression, and better quality of life. Health providers should provide more spiritual care for non-religious patients and combine spiritual care with psychological counselling to help patients with gynaecological cancer, especially those who have low quality of life or severe symptoms, or experience anxiety or depression.

Comparisons on perinatal depression between the first-child women and the second-child women in West China under the universal 2-child policy: A STROBE compliant prospective cohort study.

BACKGROUND: Universal 2-child policy was proposed in 2015 in China, but it was still uncertain whether having a second child would have any impacts on maternal health, especially mental health. So, the aim of this study was to compare the incidence of perinatal depression between the first-child women and the second-child women and to describe the patterns of perinatal depression from the first and third trimesters to 6 weeks postpartum. METHODS: A prospective cohort study was conducted in a university hospital, 969 first-child women and 492 second-child women registered in this hospital from Dec 2017 to Mar 2018 were involved in the study. The Mainland Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) was applied to screen perinatal depressive symptoms, while socio-demographic and obstetric data were obtained by self-administered questionnaires. Multiple logistic regression analyses were used to compare the risk of depression between 2 groups, and repeated measures of analysis of variances (ANOVAs) were used to determine the EPDS scores of 2 groups across 3 stages. RESULTS: The incidence of perinatal depression was 21.78% to 24.87% and 18.29% to 22.15% in the first-child group and the second-child group, respectively. The second-child women were less likely to exhibit depressive symptoms than the first-child women in the first trimester (Adjusted OR = 0.630, 95%CI = 0.457-0.868, P = .005), but no significant difference was found between the 2 groups in the third trimester and at postpartum period. During the whole perinatal period, no significant difference was found in EPDS scores of the first-child group among the three stages. However, the EPDS scores of the second-child group were higher in the first trimester than that at the postpartum period. CONCLUSION: The risk of perinatal depression for the second-child women was no higher than for the first-child women, and the EPDS scores of the second-child women were decreasing during the perinatal period. So couples in West China are recommended to consider having a second child without much worry about its negative effects on mental health under the universal 2-child policy.

Association between social and family support and antenatal depression: a hospital-based study in Chengdu, China.

BACKGROUND: Antenatal depression (AD) is considered as one of the major health burdens and has adverse effects on the outcome of expectant mothers and newborns. The present study aims to investigate the prevalence of antenatal depression (AD), and to explore the potential risk factors of AD among pregnant women in Chengdu, including personal background, related social factors, family factors and cognitive factors. METHODS: The prospective nested case-control study included pregnant women who were in their second pregnancy and attended prenatal care at three tertiary hospitals and one regional hospital in Chengdu, China, between March 2015 and May 2016. Self-designed questionnaires were given to participants in their second and third trimesters to collect information on clinical and demographic characteristics, and a modified edition of Edinburgh Postnatal Depression Scale (EPDS) were used to measure AD. The logistic regression was applicated in analyses. RESULTS: A total of 996 pregnant women were included in analysis. Ninety-three women suffered from AD symptoms only in their second trimester, 96 only in their third trimester, and 107 displayed persistent depression in both trimesters. In the univariate analyses, age and marital relationships were linked with AD occurrence in both second and third trimester. In addition, increasing age, full-time job, higher education level, and no gender preference of spouse were associated with reduced persistent depression. Multivariate analysis showed that gender preference and marital relationship were the potential risk factors of persistent depression. CONCLUSIONS: Age, marital relationship relationships, with parents-in-law, the negative recognition of this pregnancy and husband's gender preference were found as risk factors of AD occurrence in some specific trimester. Gender preference of husbands and marital relationships were independently associated with persistent depression. These findings suggest that stronger family support can help improve mental health of pregnant women.

Are spiritual interventions beneficial to patients with cancer?: A meta-analysis of randomized controlled trials following PRISMA.

BACKGROUND: In addition to the physical burden, the quality of life and survival in patients with cancer may also be reduced because of psychological distress, such as spiritual crisis, anxiety, and depression. Many studies have verified that spirituality could reduce anxiety and depression and improve quality of life and adjustment to cancer. However, there is uncertainty regarding the effectiveness of spiritual interventions in patients with cancer. The purpose of this meta-analysis is to use randomized controlled trials (RCTs) to evaluate the effects of spiritual interventions on spiritual and psychological outcomes and quality of life in patients with cancer. METHODS: All RCTs using spiritual interventions relevant to the outcomes of patients with cancer were retrieved from the following databases: Embase, PubMed, PsycINFO, Ovid, Springer Online Library, Wiley Online Library, Oxford Journals, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. The reference lists of identified RCTs were also screened. The Cochrane risk of bias tool was used to evaluate the quality of the studies, RevMan (5.3) was used to analyze the data, and GRADE (3.6.1) was used to evaluate the evidence quality of the combined results. RESULTS: Ten RCTs involving 1239 patients were included. Spiritual interventions were compared with a control group receiving usual care or other psychosocial interventions. The weighted average effect size across studies was 0.46 (P = .003, I = 78%) for spiritual well-being, 0.19 (P = .005, I = 46%) for quality of life, -0.33 (P = .01, I = 50%) for depression, -0.58 (P = .03, I = 77%) for anxiety, and -0.38 (P = .008, I = 0%) for hopelessness. In subgroup analysis according to the type of cancer, only the weighted average effect size of spiritual well-being in patients with breast cancer had statistical significance (standardized mean difference 0.78, P = .01, I = 70%). CONCLUSION: Spiritual interventions may improve spiritual well-being and quality of life, and reduce depression, anxiety, and hopelessness for patients with cancer. However, due to the mixed study design and substantial heterogeneity, some evidence remains weak. More rigorously designed research is needed.

[Associations Between Stress Coping Strategies and Perceived Social Support in Young Patients with Gynecologic Cancers].

OBJECTIVE: To determine the associations between stress coping strategies and perceived social support in young patients with gynecologic cancers. METHODS: The study was conducted in young patients with gynecologic cancers who were admitted to the West China Second University Hospital, Sichuan University from January 2014 to January 2015. Data were collected using three questionnaires, tapping into clinical features, multidimensional scales of perceived social support (MSPSS), and coping strategies with stress [including effective coping ways (ECW) and ineffective coping ways (ICW)]. RESULTS: A total of 236 patients completed the questionnaires. Those with a job, fare incomes, or higher levels of education were more likely to get higher total MSPSS scores and lower ICW scores compared with those unemployed, less than expenditures or primary school level (P < 0.05). ECW scores increased with increasing levels of total MSPSS scores (r = 0.247, P < 0.05) and support from family (r = 0.324, P < 0.05), friends (r = 0.172, P < 0.05), and significant others (r = 0.183, P < 0.05). CONCLUSION: Social support from family members is the main source of young women with gynecologic cancers in coping with stress.

Validation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in Chengdu mothers.

BACKGROUND: The Mainland Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) has been validated among antenatal women, subsequent validation among postnatal women is necessary. OBJECTIVES: This study investigated the prevalence of postnatal depression and the psychometric characteristics of the Mainland Chinese version of the EPDS among postnatal women. DESIGN: Two studies were used for validating the EPDS with specific aims. Study I established the psychometric properties of the EPDS by examining the convergent, discriminant and construct validity, internal consistency and stability of the scale. Study II established its sensitivity, specificity and the optimal cut-off score of the EPDS according the DSM-IV-TR criteria using the Structured Clinical Interview. SETTING: : Four regional public hospitals in Chengdu. PARTICIPANTS: : A convenience sample was composed of 300 and 342 postnatal women in study I and II, respectively. METHOD: A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. The Beck Depression Inventory (BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-12) were used to investigate the convergent, discriminant and construct validity. An exploratory factor analysis was used to investigate the structural validity of the scale. Confirmatory factor analysis (CFA) was tested the proposed factor module by Linear Structural Relations (LISREL). The Cronbach's alpha reliability coefficient, split-half reliability and test-retest reliability were used to examine the internal consistency and stability of the scale. RESULTS: The prevalence of postnatal depression was 4.7%. Structural validity revealed a three-factor structure for the EPDS and the CFA showed a good overall fit of this three-factor model. Convergent and construct validity was supported and discriminant validity suggested that the EPDS successfully discriminated among the nondepressed, mildly and clinically depressed groups. The area under curve (AUC) was 89.6% and the logistic estimate for the threshold score was 10.5 (sensitivity, 81.25%; specificity, 80.67%) for clinical depression. The split-half reliability of the EPDS was 0.74, Cronbach's alpha was 0.78 and test-retest reliability was 0.90. CONCLUSIONS: Our data confirm the validity of the Mainland Chinese version of EPDS in identifying postnatal depression among postnatal women in Chengdu by using >10 cut-off point. Because of its brevity and acceptability, it is recommended that the EPDS be used in routine postnatal screening.

Psychometric evaluation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) has been validated in many countries, but not in Mainland China. OBJECTIVES: This study investigated the reliability and validity of the Mainland Chinese version of the EPDS. DESIGN: A three-stage design was used for this study. Stage I consisted of a multi-stepped process of forward and backward translation, using a panel of six experts to test content validity. Stage II established the psychometric properties of the EPDS by examining the convergent, discriminant and construct validity, internal consistency and stability of the scale. Stage III established its sensitivity, specificity and the optimal cutoff score of the EPDS according the DSM-IV-TR criteria using the Structured Clinical Interview. SETTING: Three regional public hospitals in Chengdu. PARTICIPANTS: A convenience sample was composed of 312 and 451 pregnant women at 28-36 weeks' gestation. METHOD: Translation and back-translation of the original English instrument and content validation by an expert panel. Receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. The Beck Depression Inventory (BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-12) were used to investigate the convergent, discriminant and construct validity. The Cronbach's alpha reliability coefficient, split-half reliability and test-retest reliability were used to examine the internal consistency and stability of the scale. RESULTS: The translation process was rigorously conducted to ensure that equivalence was established. Content validity was confirmed by a satisfactory level of agreement with a content validity index (CVI) of 0.93. The area under curve (AUC) was 85.6% and the logistic estimate for the threshold score was 9.5 (sensitivity, 80.0%; specificity, 83.03%) for clinical depression. Convergent and construct validity was supported and discriminant validity suggested that the EPDS successfully discriminated among the non-depressed, mildly and clinically depressed groups. The split-half reliability of the EPDS was 0.76, Cronbach's alpha was 0.79 and test-retest reliability was 0.85. CONCLUSIONS: Based on the results of this psychometric testing, the Mainland Chinese version of the EPDS is considered ready for use in the routine screening of pregnant women. It is hoped that with this type of cross-cultural information, the universality of the constructs of the instrument can be reliably demonstrated.