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Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923-934. https://doi.org/10.2105/AJPH.2024.307730).
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Depressão , Saúde Mental , Humanos , Feminino , Adulto , Estudos Transversais , Estudos Prospectivos , Saúde Mental/estatística & dados numéricos , Canadá/epidemiologia , Depressão/epidemiologia , Pessoa de Meia-Idade , Estresse Psicológico/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem , Indústria de Petróleo e Gás , Características de Residência/estatística & dados numéricos , GravidezRESUMO
We examined the association between childhood adversity and fecundability (the per-cycle probability of conception), and the extent to which childhood social support modified this association. We used data from 6,318 female participants aged 21-45 years in Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study (2013-2022). Participants completed a baseline questionnaire, bimonthly follow-up questionnaires (until pregnancy or a censoring event), and a supplemental questionnaire on experiences across the life course including adverse childhood experiences (ACE) and social support (using the modified Berkman-Syme Social Network Index [SNI]). We used proportional probabilities regression models to compute fecundability ratios (FR) and 95% confidence intervals (CI), adjusting for potential confounders and precision variables. Adjusted FRs for ACE scores 1-3 and ≥4 vs. 0 were 0.91 (95% CI: 0.85, 0.97) and 0.84 (95% CI: 0.77, 0.91), respectively. FRs for ACE scores ≥4 vs. 0 were 0.86 (95% CI: 0.78, 0.94) among participants reporting high childhood social support (SNI ≥4) and 0.78 (95% CI: 0.56, 1.07) among participants reporting low childhood social support (SNI <4). Our findings confirm results from two previous studies and indicate that high childhood social support slightly buffered the effects of childhood adversity on fecundability.
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Objective: Non-Hispanic Black women have increased rates of preterm birth and low infant birth weight. However, we do not know if these disparities replicate in women veterans, a population that may be at further risk for poor perinatal outcomes. This study sought to examine ethnoracial differences in preterm birth and low infant birth weight in veterans. Methods: A national sample of randomly chosen women veterans (i.e., oversampled for residency in high crime neighborhoods) reported information about all pregnancies they have had in their life, demographic characteristics, and history of childhood trauma exposures. The analytic sample was limited to individuals who identified as Hispanic/Latinx, Black, or White (n = 972). Mixed-effects regression models were used to examine ethnoracial differences in gestational age at delivery and infant birth weight, controlling for age at pregnancy, childhood trauma exposure, pregnancy during military service, income, and education. Results: Both Black and Hispanic/Latinx veterans were significantly more likely to have an infant born at lower gestational age (B = -1.04 and B = -1.11, respectively) and lower infant birth weight (B = -195.83 and B = -144.27, respectively) as compared with White veterans in covariate-adjusted models. Black (odds ratio = 3.24, confidence interval = 1.16, 9.09) veterans were more likely to meet the clinical definition of preterm birth as compared with White veterans. Conclusions: Results align with what is seen in the general population regarding ethnoracial disparities in gestational age at delivery and infant birth weight. Findings highlight the critical need for more research on mechanisms and prevention efforts for ethnoracial disparities in perinatal outcomes.
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Negro ou Afro-Americano , Hispânico ou Latino , Recém-Nascido de Baixo Peso , Resultado da Gravidez , Nascimento Prematuro , Veteranos , População Branca , Humanos , Feminino , Veteranos/estatística & dados numéricos , Gravidez , Adulto , Nascimento Prematuro/etnologia , Hispânico ou Latino/estatística & dados numéricos , População Branca/estatística & dados numéricos , Resultado da Gravidez/etnologia , Resultado da Gravidez/epidemiologia , Negro ou Afro-Americano/estatística & dados numéricos , Recém-Nascido , Idade Gestacional , Estados Unidos/epidemiologia , Disparidades nos Níveis de Saúde , Peso ao Nascer , Fatores SocioeconômicosRESUMO
OBJECTIVES: Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender. METHODS: A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire. RESULTS: Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women. CONCLUSIONS: Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Depressão/epidemiologia , Discriminação Percebida , Transtornos de Ansiedade/epidemiologia , Ansiedade/epidemiologiaRESUMO
Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.
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COVID-19 , Transtornos de Estresse Pós-Traumáticos , Veteranos , Masculino , Humanos , Feminino , COVID-19/epidemiologia , Saúde Mental , Pandemias , Transtornos de Estresse Pós-Traumáticos/psicologia , Depressão/psicologiaRESUMO
OBJECTIVE: Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories. METHODS: We conducted a qualitative study using clinical case consultation field notes (N = 47 meetings) which were gathered during a hybrid effectiveness-implementation pilot study of Written Exposure Therapy (WET) for PTSD among pregnant women seen in an obstetrics-SUD clinic [2019-2021]. Patient baseline survey data (N = 25) were used to characterize the sample and contextualize engagement. RESULTS: Participants were exposed to a high number of trauma/adversity event types. There was no association between number of trauma/adversity event types and treatment response or dropout. Qualitative findings revealed clinical features relevant to PTSD treatment, including multi-system involvement; parental trauma and substance use; relevance of substance use to trauma context and posttraumatic cognitions, emotions, and behaviors; impact of trauma on experiences of pregnancy, attachment, and child rearing; limited social networks placing women at risk of ongoing violence; and experiences of substance use discrimination. CONCLUSION: PTSD treatment among pregnant women with substance use histories is highly important to maternal-child health.
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Transtornos de Estresse Pós-Traumáticos , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Gravidez , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Gestantes , Projetos Piloto , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Encaminhamento e ConsultaRESUMO
Sexual assault and harassment in the U.S. military are very common. Military sexual trauma (MST) is defined as sexual assault or harassment experienced during military service; yet, the relative impact of sexual assault, harassment, and their combination is not well understood. Given the extent and potential severity of the long-term outcomes of MST, it is critical to evaluate the relative impacts of these types of MST on long-term mental health outcomes. Veterans (n = 2499; 54% female) completed self-report measures of experiences of sexual assault and harassment perpetrated by coworkers during military service, posttraumatic stress disorder (PTSD), depression, and suicidality. Controlling for combat exposure, all types of MST experiences (Harassment Only, Assault Only, or Both) compared to No MST predicted greater severity of PTSD, depression, and suicidality after military service. Compared to Veterans with No MST, those who experienced Both Assault and Harassment reported significantly more severe PTSD, depression, and suicidality followed by Harassment Only, and then Assault Only. Data suggest that different types of MST experiences have an impact on long-term mental health outcomes, and the combination of Both sexual Assault and Harassment is particularly deleterious.
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Militares , Delitos Sexuais , Assédio Sexual , Transtornos de Estresse Pós-Traumáticos , Suicídio , Veteranos , Humanos , Feminino , Masculino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Assédio Sexual/psicologia , Depressão/epidemiologia , Depressão/psicologia , Trauma Sexual Militar , Veteranos/psicologia , Militares/psicologia , Delitos Sexuais/psicologiaRESUMO
OBJECTIVE: This pilot open trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET), a 5-session evidence-based intervention for posttraumatic stress disorder (PTSD) during pregnancy. Participants were pregnant women with comorbid PTSD and substance use disorder (SUD) receiving prenatal care in a high risk obstetrics-addictions clinic. METHODS: A total of 18 participants with probable PTSD engaged in the intervention, and 10 completed the intervention and were included in outcome analyses. Wilcoxon's Signed-Rank analyses were used to evaluate PTSD and depression symptoms and craving at pre-intervention to post-intervention and pre-intervention to the 6-month postpartum follow-up. Engagement and retention in WET and therapist fidelity to the intervention manual were used to assess feasibility. Quantitative and qualitative measures of patient satisfaction were used to assess acceptability. RESULTS: PTSD symptoms significantly decreased from pre-intervention to post-intervention (S = 26.6, p = 0.006), which sustained at the 6-month postpartum follow-up (S = 10.5, p = 0.031). Participant satisfaction at post-intervention was high. Therapists demonstrated high adherence to the intervention and excellent competence. CONCLUSIONS: WET was a feasible and acceptable treatment for PTSD in this sample. Randomized clinical trial studies with a general group of pregnant women are needed to expand upon these findings and perform a full-scale test of effectiveness of this intervention.
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Terapia Implosiva , Complicações na Gravidez , Transtornos de Estresse Pós-Traumáticos , Transtornos Relacionados ao Uso de Substâncias , Transtornos de Estresse Pós-Traumáticos/terapia , Projetos Piloto , Estudos de Viabilidade , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , Feminino , Gravidez , Adulto , Depressão/terapia , FissuraRESUMO
Little is known about the impact of perceived neighborhood danger on military veterans' mental health, a population potentially at higher risk for this experience, or whether interpersonal social support and neighborhood cohesion can help buffer against poor mental health. This study examined: (1) the impact of perceived neighborhood danger on depression and posttraumatic stress disorder (PTSD) among veterans; (2) whether interpersonal social support and neighborhood cohesion can mitigate these effects; and (3) how prior trauma history may interact with these factors. Six moderation models were examined using data from 3049 veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma study, a mail-based survey that oversampled for veterans in high crime neighborhoods. Most notably, results indicated that perceived neighborhood danger was associated with increased depression and PTSD (all p < .001). Interpersonal social support or neighborhood cohesion mitigated the effect of perceived neighborhood danger on veterans' depression, but, only for those without prior trauma (all p < .011). For trauma-exposed veterans, interpersonal social support was more effective in mitigating the effect of perceived neighborhood danger on depression than neighborhood cohesion (p = .006). Findings help inform interventions to improve the mental health of veterans living in high crime neighborhoods.
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Depressão/epidemiologia , Depressão/psicologia , Apoio Social , Inquéritos e QuestionáriosRESUMO
[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Nov 07 2022 (see record 2023-15574-001). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected.] Objective: Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD: Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS: For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS: Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Masculino , Feminino , Estados Unidos , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Estudos Longitudinais , Psicoterapia , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
Reports an error in "The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use" by Kelly L. Harper, Dawne Vogt, Annie Fox, Yael I. Nillni and Tara Galovski (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Sep 29, 2022, np). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2023-05302-001). OBJECTIVE: Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD: Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS: For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS: Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Masculino , Feminino , Estados Unidos , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Estudos Longitudinais , Psicoterapia , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
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Psychological distress may impact women's risk for future intimate partner violence (IPV). Yet, limited research has utilized longitudinal research designs and there is a scarcity of research looking at the three most commonly implicated mental health factors-posttraumatic stress disorder (PTSD), depression, and alcohol use-within the same study. Research is especially scarce for women veterans, who experience substantial risk for these mental health concerns and experiencing IPV. This study examined the role of PTSD symptoms, depression symptoms, and alcohol use in increasing risk for experiencing future IPV while simultaneously accounting for the impact of recent IPV experience on subsequent mental health. This study included a sample of 1921 women veterans (Mage = 36.5), who were asked to complete three mail surveys over the course of 8 months as part of a larger longitudinal survey study of US veterans' health and well-being. The survey assessed experiences of IPV, PTSD symptoms (PCL-5), depression symptoms (PHQ-9), and alcohol use (AUDIT-C) at each of the three time points. Results from separate path analysis models provided support for the role of PTSD symptoms and depression symptoms (but not alcohol use) in increasing risk for IPV experience over time. However, the path analysis models provided little support, with the exception of PTSD, for the impact of IPV experience on subsequent mental health symptoms. Findings point to the importance of better understanding the mechanisms by which PTSD and depression symptoms can increase risk for IPV to inform theory and prevention and treatment efforts. Detection and treatment of PTSD and depression symptoms among women may help reduce risk for future violence in intimate relationships.
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Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Veteranos , Adulto , Depressão/psicologia , Feminino , Humanos , Violência por Parceiro Íntimo/psicologia , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologiaRESUMO
PURPOSE: To prospectively examine the association between time-to-pregnancy (TTP) and postpartum depression (PPD) and determine whether perceived stress during early pregnancy mediated this association. METHODS: In Pregnancy Study Online, an internet-based preconception cohort study of pregnancy planners, participants completed questionnaires every 8 weeks for up to 12 months or conception, during pregnancy, and at postpartum. A total of 2643 women provided information on sociodemographic factors, reproductive history, and stress (i.e., Perceived Stress Scale [PSS]) during preconception and early pregnancy (completed at â¼4-12 weeks' gestation) and on postpartum depressive symptoms (i.e., Edinburgh Postnatal Depression Scale [EPDS]) at â¼6 months postpartum. We used multivariable modified Poisson regression models to estimate risk ratios and 95% confidence intervals (CIs) for the association between TTP (<3, 3-5, 6-11, ≥12 menstrual cycles) and PPD (EPDS score ≥13). Causal mediation analyses assessed the mediating role of early pregnancy PSS scores. RESULTS: 10.6% of women had EPDS scores indicating possible PPD (≥13). Compared with women who took less than 3 cycles to conceive, risk ratios for those who took 3-5, 6-11, and greater than or equal to 12 were 1.06 (95% CI: 0.77, 1.45), 1.24 (95% CI: 0.90, 1.70), and 1.31 (95% CI: 0.87, 1.99), respectively. Approximately 30% of the association between infertility (TTP ≥ 12) and PPD was mediated by early pregnancy PSS. CONCLUSIONS: There was a modest positive dose-response association between delayed conception and PPD. Perceived stress in early pregnancy explained a small proportion of this association. However, given the width of the CIs, chance cannot be ruled out as an explanation for the observed association.
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Depressão Pós-Parto , Estudos de Coortes , Depressão , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , América do Norte , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Risco , Tempo para EngravidarRESUMO
We examined the associations of male depression and psychotropic medication use with fecundability in a North American preconception cohort study (2013-2020). Men aged ≥21 years completed a baseline questionnaire with questions on history of diagnosed depression, the Major Depression Inventory (MDI), and psychotropic medication use. Pregnancy status was updated via bimonthly female follow-up questionnaires until pregnancy or 12 menstrual cycles, whichever occurred first. Analyses were restricted to 2,398 couples attempting conception for ≤6 menstrual cycles at entry. We fit proportional probabilities models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for age (male and female), education, (male and female), race/ethnicity, physical activity, alcohol intake, body mass index, smoking, and having previously impregnated a partner. Nearly 12% of participants reported a depression diagnosis; 90.6% had low depressive symptoms (MDI <20), 3.5% had mild symptoms (MDI: 20-24), 2.7% had moderate symptoms (MDI: 25-29), and 3.3% had severe symptoms (MDI: ≥30). A total of 8.8% of participants reported current use of psychotropic medications. History of depression was associated with slightly reduced fecundability, although this result was also reasonably compatible with chance (FR = 0.89; 95% CI: [0.76, 1.04]). FRs for mild, moderate, and severe compared with low depressive symptoms were 0.89 (95% CI: [0.66, 1.21]), 0.90 (95% CI: [0.62, 1.31]), and 0.88 (95% CI: [0.65, 1.20]), respectively. This indicates little evidence of a dose-response relationship for depressive symptoms with fecundability, although estimates were imprecise. Current psychotropic medication use mediated 44% of the association between depressive symptoms and fecundability.
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Depressão , Fertilidade , Adulto , Estudos de Coortes , Depressão/tratamento farmacológico , Depressão/epidemiologia , Feminino , Fertilização , Humanos , Masculino , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: In the general population, history of trauma is associated with a range of adverse perinatal outcomes, which have long-term negative consequences for both mother and child. Research examining the impact of trauma, particularly trauma occurring during military service, on perinatal outcomes among women veterans is still in its nascence. The current study examined if warfare exposure and military sexual trauma (MST) contributed unique variance to the prediction of a broad range of adverse perinatal outcomes (i.e., preterm birth, full-term birth, infant birth weight, postpartum depression and/or anxiety). METHOD: Women veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey, and reported information about all pregnancies that occurred since enlistment in the military. They also reported on warfare exposure and MST using the Deployment Risk and Resilience Inventory. RESULTS: A total of 911 women reported on 1,752 unique pregnancies. Results revealed that MST, but not warfare exposure, was associated with having a lower infant birth weight (B = -17.30, SE = 5.41), a slight decrease in the likelihood of having a full-term birth (OR = .97, 95% CI [.93, 1.00]), and an increased likelihood of experiencing postpartum depression and/or anxiety (OR = 1.09, 95% CI [1.10, 1.14]) above and beyond age at pregnancy, racial/ethnic minority status, childhood violence exposure, and warfare exposure. CONCLUSIONS: Findings highlight the importance of screening for MST during pregnancy and trauma-informed obstetric care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Depressão Pós-Parto , Militares , Nascimento Prematuro , Delitos Sexuais , Veteranos , Peso ao Nascer , Etnicidade , Feminino , Humanos , Recém-Nascido , Grupos Minoritários , Trauma SexualRESUMO
OBJECTIVE: Caregivers with a history of trauma exposure may struggle to parent effectively, particularly when symptoms of PTSD are prominent. Consequently, identifying factors that buffer associations between PTSD and poor parental functioning is critical to help trauma-exposed families thrive. One important source of resilience may spring from being part of a socially cohesive neighborhood that offers positive social connections and resources. The purpose of this study was to examine whether greater neighborhood cohesion buffers associations between PTSD and perceived parental functioning. METHOD: A diverse national sample of 563 Black and White veterans raising children in single or dual parent households completed questionnaires assessing PTSD symptoms and neighborhood cohesion at baseline, as well as parental functioning four months later. RESULTS: Multigroup moderation analyses that controlled for crime index, income, and sex revealed that among single Black veterans, but not other groups, the relationship between higher PTSD and poorer parental functioning was weakened for veterans who reported higher neighborhood cohesion. CONCLUSIONS: Findings suggest that PTSD symptoms and neighborhood cohesion affect parenting differently across racial and family makeup configurations, and that higher neighborhood cohesion might be particularly useful in buffering the association between PTSD and parenting among single Black veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Criança , Humanos , Poder Familiar , Pais , Características de ResidênciaRESUMO
OBJECTIVE: To evaluate the associations of a history of diagnosed depression, current depressive symptoms, and recent use of psychotropic medications with semen quality and to consider mediation of the association between depression and semen quality by medication use. DESIGN: Prospective cohort study. SETTING: United States. PATIENT(S): The patients were 329 men aged ≥21 years (566 semen samples) who participated in a semen-testing substudy of Pregnancy Study Online. Pregnancy Study Online is an ongoing, web-based preconception cohort study of couples attempting to conceive. At baseline, participants reported information about depression diagnosis, depressive symptoms using the Major Depression Inventory, medication use in the last 4 weeks, and selected covariates. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The men used an at-home semen-testing kit (Trak; Sandstone Diagnostics, Inc., Pleasanton, California) to measure semen volume, sperm concentration, and motile sperm concentration. We calculated percent motility, total sperm count in the ejaculate, and total motile sperm count. RESULT(S): Forty-nine men (15%) reported a history of depression diagnosis, and 41 (12%) reported recent use of psychotropic medications. A history of depression diagnosis was associated with a 4.3-fold increase in the risk of low semen volume (<1.5 mL) (95% CI 1.16, 16). A 5-unit increase in Major Depression Inventory score was associated with a 1.38-fold increase in the risk of low semen volume (95% CI 0.92, 2.1). The results for other semen parameters were inconsistent. Recent use of psychotropic medications was associated with worse semen quality, and this association was confounded by a history of depression diagnosis. The observed association between depression and semen volume showed little mediation by psychotropic medication use. CONCLUSION: A history of diagnosed depression and severe depressive symptoms at enrollment were associated with low semen volume.
Assuntos
Transtorno Depressivo Maior/complicações , Psicotrópicos/uso terapêutico , Motilidade dos Espermatozoides/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Adulto , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/patologia , Humanos , Masculino , Estudos Prospectivos , Psicotrópicos/efeitos adversos , Contagem de Espermatozoides , Espermatozoides/patologia , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Mental health symptoms, stress, and low psychosocial resources are associated with preterm delivery. It is unknown if there are groups of women who experience similar patterns of these adverse psychosocial factors during pregnancy and if the risk of preterm delivery differs among these groups. OBJECTIVE: To identify groups of women with similar patterns of adverse psychosocial factors during pregnancy and determine whether the risk of preterm delivery differs among these groups. METHODS: Spontaneous Prematurity and Epigenetics of the Cervix (SPEC) is a prospective cohort study of pregnant women, aged 18 and older. In this analysis, we included women who enrolled after 24 August 2014 and delivered by 20 January 2019. As women could enrol more than once, our cohort included 774 women with 787 pregnancies. We conducted a latent class analysis to identify groups of women with similar patterns of adverse psychosocial factors during pregnancy based on their responses to measures assessing depression, perceived stress, anxiety (pregnancy-related and generalised), stressful life events, resilience, and social support (partner and friend/family). After identifying the latent classes, we used log-binomial regression to compare the incidence of preterm delivery among the classes. RESULTS: The median age among participants was 33.2 years (interquartile range 30.3-36.3), and the majority were non-Hispanic white (56.9%). We identified three classes of adverse psychosocial factors (few, some, and many factors). In total, 63 (8.0%) pregnancies resulted in a preterm delivery. Compared to participants with few factors, the risk of preterm delivery was no different among participants with some (RR 1.23, 95% CI 0.68, 2.25) and many adverse factors (RR 1.62, 95% CI 0.73, 3.62). CONCLUSIONS: We identified three groups of pregnant women with similar patterns of adverse psychosocial factors. We did not observe a difference in the risk of preterm delivery among the classes.
Assuntos
Nascimento Prematuro , Adulto , Colo do Útero , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Gestantes , Nascimento Prematuro/epidemiologia , Estudos ProspectivosRESUMO
OBJECTIVE: This study aimed to (1) examine whether the latent class structure of individuals engaging in self-directed violence and indirect self-harm behaviors (eg, substance use, disordered eating) varied by gender in a sample of US veterans, and (2) test the associations of posttraumatic stress disorder (PTSD) and depressive symptoms with the resulting classes. STUDY DESIGN: Cross-sectional data from 3581 veterans, ages 18-50 (51.9% identified as women) were analyzed. Veterans self-reported histories of self-directed violence, substance use, and disordered eating. Latent class analysis and latent class regression were used to explore class structure by gender and examine association of class membership with PTSD and depressive symptoms. RESULTS: A 4-class model was supported in the sample. Class 1 (20.0%) was characterized by substance use and self-directed violent thoughts and behaviors. Class 2 (8.3%) was characterized by substance use, disordered eating, and self-directed violent thoughts and behaviors. Class 3 (12.6%) was distinguished by indirect self-harm behaviors (substance use and disordered eating). Class 4 (59.6%) reflected low likelihood of behavioral dysregulation. Classes were partially invariant across gender; endorsement of substance use behaviors was generally higher for men in each class. Comorbid clinically significant depressive and PTSD symptoms were associated with the class characterized by highest behavioral dysregulation. CONCLUSIONS: Self-directed violent thoughts and behaviors present comorbidly with indirect self-harm in men and women veterans, although patterns of indirect self-harm behaviors differ slightly by gender. Such comorbidity may be associated with more severe presentations of psychiatric concerns.