The role of childhood adversity and prenatal mental health as psychosocial risk factors for adverse delivery and neonatal outcomes.

OBJECTIVE: Exposure to adverse childhood experiences (ACEs) is a significant predictor for physical and mental health problems later in life, especially during the perinatal period. Prenatal common mental disorders (PCMDs) are well-established as a risk for obstetric interventions but knowledge on combined effects of multiple psychosocial risk factors is sparse. We aim to examine a comprehensive model of ACEs and PCMDs as risk factors for poor delivery and neonatal outcomes. METHOD: With structural equation modeling, we examined direct and indirect pathways between psychosocial risk and delivery and neonatal outcomes in a prospective cohort from pregnancy to birth in Iceland. RESULTS: Exposure to ACEs increased risk of PCMDs [ß = 0.538, p < .001, CI: 0.195-1.154] and preterm delivery [ß = 0.768, p < .05, CI: 0.279-1.007)]. An indirect association was found between ACEs and increased risk of non-spontaneous delivery [ß = 0.054, p < .05, CI: 0.004-0.152], mediated by PCMDs. Identical findings were observed for ACEs subcategories. CONCLUSION: ACEs are strong predictors for mental health problems during pregnancy. Both ACEs and PCMDs diagnosis are associated with operative delivery interventions and neonatal outcomes. Findings underscore the importance of identifying high-risk women and interventions aimed at decreasing psychosocial risk during the prenatal period.

Evaluating User Compliance in Mobile Health Apps: Insights from a 90-Day Study Using a Digital Sleep Diary.

Sleep diaries are the gold standard for subjective assessment of sleep variables in clinical practice. Digitization of sleep diaries is needed, as paper versions are prone to human error, memory bias, and difficulties monitoring compliance. METHODS: 45 healthy eligible participants (Mage = 50.3 years, range 23-74, 56% female) were asked to use a sleep diary mobile app for 90 consecutive days. Univariate and bivariate analysis was used for group comparison and linear regression for analyzing reporting trends and compliance over time. RESULTS: Overall compliance was high in the first two study months but tended to decrease over time (p < 0.001). Morning and evening diary entries were highly correlated (r = 0.932, p < 0.001) and participants significantly answered on average 4.1 days (95% CI [1.7, 6.6]) more often in the morning (M = 60.2, sd = 22.1) than evening ((M = 56.1, sd = 22.2), p < 0.001). CONCLUSION: Using a daily diary assessment in a longitudinal sleep study with a sleep diary delivered through a mobile application was feasible, and compliance in this study was satisfactory.

[Economic evaluation of interdisciplinary pain rehabilitation. One IKR for rehabilitation gives eight IKR back to society].

INTRODUCTION: There is limited research on the long-term benefits of an interdisciplinary pain rehabilitation, even though short-term benefits have been well documented. The present study evaluated the effects of an interdisciplinary pain rehabilitation program with a three-year follow-up. A special emphasis was placed on economic evaluation of the treatment from a societal perspective. MATERIAL AND METHODS: The study was conducted at the chronic pain unit of the Reykjalundur rehabilitation center. Every fifth patient referred to the Reykjalundur Rehabiliation Center pain clinic was randomized to participate in this study. Data was collected over the course of 4,5 years with a three years follow-up. Finally, economic evaluation was conducted at the end of the research. RESULTS: After treatment patients experienced less pain, fear and avoidance, anxiety and depression symptoms and improved social functioning. Work ability increased from 36% to 47% at the end of rehabilitation and continued to rise to 57% at three year follow-up. Economic evaluation from a societal perspective showed that cost associated with the rehabilitation had leveled out in three years and continued throughout life. CONCLUSION: The results indicate that interdisciplinary rehabilitation for chronic pain has a positive impact on function and the experience of pain as well as positive psychosocial effect. An economic evaluation of the treatment shows that the rehabilitation is very cost effective and that each Icelandic krona (IKR) spent is returned eightfold back to society.

Cognitive Behavioral Therapy for Depression and Anxiety in an Interdisciplinary Rehabilitation Program for Chronic Pain: a Randomized Controlled Trial with a 3-Year Follow-up.

PURPOSE: Cognitive behavioral therapy (CBT) is known to be effective for treating depression and anxiety in patients with chronic pain, but there is limited research studying the long-term benefits of CBT in this population. The present study evaluated the effects of CBT provided in the context of an interdisciplinary pain management program with a 3-year follow-up. METHODS: One hundred fifteen patients with chronic musculoskeletal pain participated in an interdisciplinary pain management program. Eighty of these patients meeting criteria for CBT treatment were randomized to receive or not receive CBT for depression and anxiety in addition to rehabilitation pain management. The remaining 35 patients constituted a second comparison group. Follow-up data were collected 1 and 3 years post-treatment with 19% of the patients dropping out after 1 year and 34% after 3 years. Attrition analysis did not indicate that there was significant attrition bias in the data. RESULTS: All three groups evidenced improved depression following treatment (p < 0.001). The pre- to post-treatment effect sizes (Cohen's d) for depression in the CBT treatment group was large (ES = 1.36). The CBT treatment group maintained improvements on all measures at a 3-year follow-up, while the comparison groups did not. This was especially evident with respect to depression (pre-treatment to 3 years follow-up ES = 1.35 and between-group ES = 0.57). Before treatment, 36% of all the patients reported that they were able to work. At 3 years post-treatment, 59%, 58%, and 44% of the patients were working who were in the CBT treatment group, the Comparison group, and the Non-CBT group, respectively. CONCLUSION: The results indicate that providing CBT for depression and anxiety as part of a rehabilitation pain management program may enhance the long-term benefits of treatment. This finding, if replicated in additional studies, has important clinical and economic implications.