8464785
Depression and Anxiety Symptoms in Mothers of Newborns Hospitalized on the Neonatal Intensive Care Unit
BackgroundMothers of infants hospitalized in the neonatal intensive care unit (NICU) are at risk for clinically significant levels of depression and anxiety symptoms; however, the maternal/infant characteristics that predict risk have been difficult to determine. Previous studies have conceptualized depression and anxiety symptoms separately, ignoring their comorbidity. Moreover, risk factors for these symptoms have not been assessed together in one study sample. ObjectivesThe primary aim of this study was to determine whether a diagnostic classification approach or a common factor model better explained the pattern of symptoms reported by NICU mothers, including depression, generalized anxiety, panic, and trauma. A secondary aim was to assess risk factors of aversive emotional states in NICU mothers based on the supported conceptual model. MethodIn this cross-sectional study, a nonprobability convenience sample of 200 NICU mothers completed questionnaires assessing maternal demographic and infant health characteristics, as well as maternal depression and anxiety symptoms. Structural equation modeling was used to test a diagnostic classification model and a common factor model of aversive emotional states and the risk factors of aversive emotional states in mothers in the NICU. ResultsMaximum likelihood estimates indicated that examining symptoms of depression and anxiety disorders as separate diagnostic classifications did not fit the data well, whereas examining the common factor of negative emotionality rendered an adequate fit to the data and identified a history of depression, infant illness, and infant prematurity as significant risk factors. DiscussionThis study supports a multidimensional view of depression and should guide both clinical practice and future research with NICU mothers.
25834779
Births: preliminary data for 2000.
OBJECTIVES
This report presents preliminary data for 2000 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented.


METHODS
Data in this report are based on more than 96 percent of births for 2000. The records are weighted to independent control counts of births received in State vital statistics offices in 2000. Comparisons are made with 1999 final data.


RESULTS
The number of births rose 3 percent between 1999 and 2000. The crude birth rate increased to 14.8 per 1,000 population in 2000, 2 percent higher than the 1999 rate. The fertility rate rose 3 percent to 67.6 per 1,000 women aged 15-44 years between 1999 and 2000. The birth rate for teenagers, which has been falling since 1991, declined 2 percent in 2000 to 48.7 births per 1,000 females aged 15-19 years, another historic low. The rate for teenagers 15-17 years fell 4 percent, and the rate for 18-19 year olds was down 1 percent. Since 1991, rates have fallen 29 percent for teenagers 15-17 years and 16 percent for teenagers 18-19 years. Birth rates for all of the older age groups increased for 1999-2000: 1 percent among women aged 20-24 years, 3 percent for women aged 25-29 years, and 5 percent for women in their thirties. Rates for women aged 40-54 years were also up for 2000. The birth rate for unmarried women increased 2 percent to 45.2 births per 1,000 unmarried women aged 15-44 years in 2000, but was still lower than the peak reached in 1994. The number of births to unmarried women was up 3 percent, the highest number ever reported in the United States. However, the number of births to unmarried teenagers declined. The proportion of women who began prenatal care in the first trimester of pregnancy (83.2 percent) did not improve for 2000, nor did the rate of low birthweight (7.6 percent). The total cesarean rate rose for the fourth consecutive year to 22.9 percent, the result of both a rise in the rate of primary cesarean deliveries and a decline in the rate of vaginal births after previous cesarean delivery.
24675346
Symptoms of Acute Stress Disorder in Mothers of Premature Infants
PURPOSE:To determine whether significant symptoms of acute stress disorder (ASD) are present in mothers of premature infants in the neonatal intensive care unit (NICU). SUBJECTS:Forty mothers of premature infants born less than 33 weeks and admitted into NICU. DESIGN:Prospective, cohort, within-subjects. METHODS:Mothers completed the Stanford Acute Stress Reaction Questionnaire, Edinburgh Postnatal Depression Scale, and the Acute Stress Disorder Interview to explore the number and severity of stress-related symptoms at 2 separate time periods, 7 to 10 days after birth, and 1 month after birth. RESULTS:Twenty-eight percent of the mothers met diagnostic criteria of ASD at 7 to 10 days after birth, and at 1 month after birth ASD symptoms persisted. The majority of the mothers described premature birth as a traumatic stressor. The most commonly met criteria were dissociation and anxiety. Significant symptoms of depression were found in 43% of mothers and persisted 1 month after birth. Rates of depression and moderate to severe symptoms of ASD were significantly related in mothers at 1 week and at 1 month after birth. CONCLUSIONS:The premature birth experience is traumatic for mothers and may lead to various emotional responses including stress-related symptoms such as depression and/or ASD. Mothers with significant symptoms of depression and those with symptoms of stress seem to be more at risk for developing symptoms of ASD.
21082077
Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children.
BACKGROUND
Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the offspring.


AIMS
To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years.


METHOD
Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448).


RESULTS
Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14, 95% CI 1.48-3.10) and girls (OR=1.88, 95% CI 1.3-2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56, 95% CI 1.02-2.41) and girls (OR=1.51, 95% CI 1.22-2.81).


CONCLUSIONS
There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.
29890568
Postpartum depression: current status and future directions.
Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring. The first six months after delivery may represent a high-risk time for depression. Estimates of prevalence range from 13% to 19%. Risk factors mirror those typically found with major depression, with the exception of postpartum-specific factors such as sensitivity to hormone changes. Controlled trials of psychological interventions have validated a variety of individual and group interventions. Medication often leads to depression improvement, but in controlled trials there are often no significant differences in outcomes between patients in the medication condition and those in placebo or active control conditions. Reviews converge on recommendations for particular antidepressant medications for use while breastfeeding. Prevention of PPD appears to be feasible and effective. Finally, there is a growing movement to integrate mental health screening into routine primary care for pregnant and postpartum women and to follow up this screening with treatment or referral and with follow-up care. Research and clinical recommendations are made throughout this review.
14546782
Comorbidity of anxiety and unipolar mood disorders.
Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and major depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disorders. This work has focused on both the cognitive content of anxiety and depression and on the effects that anxiety and depression have on information processing for mood-congruent material.
1616729
Perinatal Depression: A Systematic Review of Prevalence and Incidence
OBJECTIVE: We systematically review evidence on the prevalence and incidence of perinatal depression and compare these rates with those of depression in women at nonchildbearing times. DATA SOURCES: We searched MEDLINE, CINAHL, PsycINFO, and Sociofile for English-language articles published from 1980 through March 2004, conducted hand searches of bibliographies, and consulted with experts. METHODS OF STUDY SELECTION: We included cross-sectional, cohort, and case-control studies from developed countries that assessed women for depression during pregnancy or the first year postpartum with a structured clinical interview. TABULATION, INTEGRATION, AND RESULTS: Of the 109 articles reviewed, 28 met our inclusion criteria. For major and minor depression (major depression alone), the combined point prevalence estimates from meta-analyses ranged from 6.5% to 12.9% (1.0-5.6%) at different trimesters of pregnancy and months in the first postpartum year. The combined period prevalence shows that as many as 19.2% (7.1%) of women have a depressive episode (major depressive episode) during the first 3 months postpartum; most of these episodes have onset following delivery. All estimates have wide 95% confidence intervals, showing significant uncertainty in their true levels. No conclusions could be made regarding the relative incidence of depression among pregnant and postpartum women compared with women at nonchildbearing times. CONCLUSION: To better delineate periods of peak prevalence and incidence for perinatal depression and identify high risk subpopulations, we need studies with larger and more representative samples.
22465001
The impact of very premature birth on the psychological health of mothers.
BACKGROUND
The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants.


STUDY DESIGN
A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital.


SUBJECTS AND METHODS
Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care.


RESULTS
Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms.


CONCLUSIONS
The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.
38560
Prevalence and Correlates of Posttraumatic Stress and Postpartum Depression in Parents of Infants in the Neonatal Intensive Care Unit (NICU)
The purpose of this study was to assess the prevalence and correlates of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in mothers and fathers, and postpartum depression (PPD) in mothers, of infants in the Neonatal Intensive Care Unit (NICU). 86 mothers and 41 fathers completed measures of ASD and of parent perception of infant medical severity 3–5 days after the infant’s NICU admission (T1), and measures of PTSD and PPD 30 days later (T2). 35% of mothers and 24% of fathers met ASD diagnostic criteria at T1, and 15% of mothers and 8% of fathers met PTSD diagnostic criteria at T2. PTSD symptom severity was correlated with concurrent stressors and family history of anxiety and depression. Rates of ASD/PTSD in parents of hospitalized infants are consistent with rates in other acute illness and injury populations, suggesting relevance of traumatic stress in characterizing parent experience during and after the NICU.
22708692
Depressive Symptoms in Mothers of Prematurely Born Infants
Objective: This longitudinal, descriptive study described the level of depressive symptoms in mothers of preterm infants from birth through 27 months corrected age and examined factors associated with depressive symptoms. The framework for the study was guided by an ecological developmental systems perspective and an adaptation of the Preterm Parental Distress Model. Methods: In this model, we hypothesize that a mother's emotional distress to the birth and parenting of a prematurely born child is influenced by personal and family factors, severity of the infant's health status, and illness-related stress and worry. Participants were 102 mothers of preterm infants who were off the ventilator and not otherwise dependent on major technology at enrollment. Results: Mean depressive symptoms scores on the Center for Epidemiologic Studies Depression Scale (CES-D) during hospitalization were high and more than half the mothers (63%) had scores of ≥16 indicating risk of depression. Depressive scores declined over time until 6 months and then were fairly stable. Unmarried mothers, mothers of infants who were rehospitalized, and mothers who reported more maternal role alteration stress during hospitalization and worry about the child's health had more depressive symptoms through the first year. Mothers who reported more parental role alteration stress during hospitalization (odds ratio [OR] = 1.570, 95% confidence interval [CI]: 1.171–2.104) and more worry about the child's health (OR = 2.350, 95% CI: 1.842–2.998) were more likely to experience elevated CES-D scores that put them at risk of depression. Also, mothers of rehospitalized infants had decreasing odds of elevated CES-D scores over time (OR = 0.982 per week, 95% CI: 0.968–0.996). Conclusions: Findings have implications for the support of mothers during hospitalization and in the early years of parenting a preterm infant.
18493847
Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant.
CONTEXT
Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; <1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants.


OBJECTIVE
To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and developmental risk.


DESIGN
Longitudinal prospective follow-up study of a cohort of mothers of high- and low-risk VLBW and term infants from birth to 3 years.


SETTING
All level III neonatal intensive care units from a large midwestern metropolitan region.


PARTICIPANTS
Mothers and infants prospectively and consecutively enrolled in a longitudinal study between 1989 and 1991. High-risk VLBW infants were diagnosed as having bronchopulmonary dysplasia, and comparison groups were low-risk VLBW infants without bronchopulmonary dysplasia and term infants (>36 weeks, >2500 g).


MAIN OUTCOME MEASURES
Standardized, normative self-report measures of maternal psychological distress, parenting stress, family impact, and life stressors.


RESULTS
Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n=123) at 1 month (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms, while parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups.


CONCLUSIONS
The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.
27281047
Prevalence of suicidality during pregnancy and the postpartum
SummaryThis review examined the available prevalence estimates of suicidality (suicide deaths, attempts, and ideation including thoughts of self harm) in pregnancy and the postpartum. Studies that used defined community or clinic samples were identified through multiple electronic databases and contacts with primary authors. Definitions of and measurement of suicide deaths, intentional self-harming behavior, suicide attempts, and thoughts of death and self-harm were varied and are described with each study. While suicide deaths and attempts are lower during pregnancy and the postpartum than in the general population of women, when deaths do occur, suicides account for up to 20% of postpartum deaths. Self-harm ideation is more common than attempts or deaths, with thoughts of self-harm during pregnancy and the postpartum ranging from 5 to 14%. The risk for suicidality is significantly elevated among depressed women during the perinatal period, and suicide has been found to be the second or leading cause of death in this depressed population.
21470195
Anxiety disorders during pregnancy and the postpartum period: A systematic review.
OBJECTIVE
The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period.


DATA SOURCES
MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder.


STUDY SELECTION
All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included.


DATA EXTRACTION
Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period.


DATA SYNTHESIS
Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management.


CONCLUSIONS
Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.
21264007
Infants in a neonatal intensive care unit: parental response
Objective: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU. Design: Random sample of NICU parents and term non-NICU parents were assessed across a variety of psychiatric and psychosocial measures shortly after the birth of their infant. Setting: Christchurch Women’s Hospital, New Zealand. Labour ward and level III NICU. Participants: A total of 447 parents (242 mothers; 205 fathers) with an infant admitted to a regional NICU during a 12 month period; 189 parents (100 mothers; 89 fathers) with infants born at term and not requiring NICU admission. Main outcome measures: Depression and anxiety symptoms, psychosocial functioning. Results: Overall, levels of anxiety and depression were low in both parent groups. Compared with control parents, a higher percentage of NICU parents had clinically relevant anxiety and were more likely to have had a previous NICU admission and be in a lower family income bracket. Infant prematurity was associated with higher levels of symptomatology in both NICU mothers and fathers. Conclusions: Specific interventions are not needed for most parents who have an infant admitted to the NICU as they appear to adapt relatively successfully. Infant prematurity impacts negatively on the father as well as the mother. Consequently these parents may benefit from increased clinical attention.
9867505
Identifying Mothers of Very Preterm Infants At-risk for Postpartum Depression and Anxiety Prior to Discharge
Objective:We investigated whether particular demographics, maternal psychosocial and infant factors identified mothers of very preterm infants at risk for postpartum depression or anxiety at the time of discharge from a level III urban Neonatal Intensive Care Unit (NICU).Study Design:A racially diverse cohort of mothers (N=73) of preterm infants (gestational age <30 weeks) completed a comprehensive questionnaire at discharge from the NICU assessing postpartum depression, anxiety and psychosocial and demographic factors. Additionally, infants underwent brain magnetic resonance imaging before discharge.Result:Twenty percent of mothers had clinically significant levels of depression whereas 43% had moderate to severe anxiety. Being married (P<0.01), parental role alteration (P<0.01) and prolonged ventilation (P<0.05) were associated with increased depressive symptoms. No psychosocial, demographics or infant factors, including severity of brain injury, were associated with state anxiety levels.Conclusion:Maternal factors, such as marital status, stress from parental role alteration and infant factors, such as prolonged ventilation, are associated with increased depression. However, clinically significant levels of anxiety are common in mothers of very preterm infants with few identifiable risk factors. These findings support the need for universal screening within the NICU.
23966099
Acute Posttraumatic Stress Symptoms Among Urban Mothers With Newborns in the Neonatal Intensive Care Unit: A Preliminary Study
Objectives: Traumatic stress symptoms from multiple causes are endemic among impoverished women who are also at high risk for delivering infants requiring neonatal intensive care unit (NICU) care, but whether this event itself constitutes a distinct traumatic stress trigger is unknown. Previous research does suggest having an infant in the NICU generates traumatic stress among white middle-class mothers, stress that can impact their infant’s behavior and development. This study evaluated the prevalence of acute posttraumatic stress symptoms among low-income mothers of infants admitted to the NICU compared with similar mothers with infants in the well baby nursery (WBN). Methods: A total of 59 NICU and 60 WBN mothers were recruited from the Boston Medical Center. Within the first week after birth, all participants were assessed for postpartum acute posttraumatic stress and depression symptoms and asked about lifetime traumatic events before the birth of their baby. The acute posttraumatic stress symptoms were analyzed as a continuous variable and whether they reached the categorical severity criteria for acute stress disorder. Results: NICU mothers show increased symptoms of acute posttraumatic stress and depression. Twenty-three percent of NICU and 3% of WBN reached severity criteria for acute stress disorder. When controlling for relevant covariates, having a newborn in the NICU had a significant association with the number of mothers’ acute posttraumatic stress symptoms not fully explained by their symptoms of depression or prior lifetime history of traumatic events. Conclusions: Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.
71544007
Postpartum depression in mothers of infants cared for in a Neonatal Intensive Care Unit – Incidence and associated factors
This longitudinal cohort study investigated the incidence of postpartum depression (PPD) among mothers of infants cared for in two Neonatal Intensive Care Units (NICU) and factors related to PPD onset. 123 mothers were posted the Edinburgh Post-Natal Depression Scale (EPDS) and a questionnaire to record infant and maternal data at 1 month, and a repeat EPDS scale at 4 months post-discharge. PPD incidence was 15% at 1 month, 14% at 4 months, and varied by NICU (23% vs. 8%). Pre-pregnancy and/or antenatal depression was significantly associated with the incidence of PPD. Mothers who experienced PPD at 1 month had an almost eight fold risk of experiencing PPD at 4 months. Women who were not offered counselling during their infant’s stay on the NICU had a 60% increased risk for PPD onset. The findings highlight the need for routine pre-natal screening and targeted support for mothers with infants admitted to NICU.
41114642
Correlates of Depressive Symptoms in Mothers of Preterm Infants
Purpose: To identify factors related to depressive symptoms in mothers of preterm infants and to changes in depressive symptoms between hospitalization and when the infant was six months corrected age and to determine whether these factors differentiate mothers at high risk for depression from mothers at low risk for depression. Design: Correlational. Sample: During hospitalization, 39 mothers of preterm infants and, at six months corrected infant age, 34 mothers of preterm infants. Main Outcome Variable: Depressive symptoms as measured on the Center for Epidemiological Studies Depression scale. Results: At enrollment, 19 mothers (48.7 percent) had elevated depressive symptom scores. When the infants were six months corrected age, mean scores had decreased by 36 percent, and only 20 percent of the mothers had elevated scores. During hospitalization, the correlates of depressive symptoms were similar to the factors that differentiated between mothers at high risk and those at low risk for depression. However, the correlates of depressive symptoms during hospitalization were different from correlates of changes in depressive symptoms between hospitalization and six months corrected infant age. Identifying correlates of maternal depressive symptoms may lead to earlier identification and treatment of women at risk for depression, thereby decreasing the negative effects on infant development.
32629048
The Course of Postpartum Psychiatric Disorders in Women and Their Partners
This study examined the course of postpartum psychiatric disorders in a community sample of mothers and their partners to determine whether sociodemographic variables, life stress, and psychiatric history were related to persistence of mental health problems. At 6 months postpartum, 48 index couples where the wife had a psychiatric disorder at 2 months postpartum and 50 control couples with no such diagnosis underwent diagnostic interviews and completed questionnaires on psychological symptoms, life stress, and treatment history. The results indicate that at follow-up, 54% of the index mothers still had a psychiatric diagnosis, as did 60% of their partners who had had a psychiatric diagnosis at 2 months postpartum. Socioeconomic status, country of origin, and life stress were related to persistence, as were diagnosis and timing of onset of the disorder. About a third of the parents were referred for treatment. It is concluded that for many families, postpartum psychiatric disorders are not a transient phenomenon.
26431059
Distinguishing symptom dimensions of depression and anxiety: an integrative approach.
BACKGROUND
Clark and Watson developed the tripartite model in which a symptom dimension of 'negative affect' covers common psychological distress that is typically seen in anxious and depressed patients. The 'positive affect' and 'somatic arousal' dimensions cover more specific symptoms. Although the model has met much support, it does not cover all relevant anxiety symptoms and its negative affect dimension is rather unspecific. Therefore, we aimed to extend the tripartite model in order to describe more specific symptom patterns with unidimensional measurement scales.


METHOD
1333 outpatients provided self report data. To develop an extended factor model, exploratory factor analysis (EFA) was conducted in one part of the data (n=578). Confirmatory factor analysis (CFA) was conducted in the second part (n=755), to assess model-fit and comparison with other models. Rasch analyses were done to investigate the unidimensionality of the factors.


RESULTS
EFA resulted in a 6-factor model: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. CFA in the second sample showed that a 6-factor model with a hierarchical common severity factor fits the data better than alternative 1- and 3-factor models. Rasch analyses showed that each of the factors and the total of factors can be regarded as unidimensional measurement scales.


LIMITATIONS
The model is based on a restricted symptom-pool: more dimensions are likely to exist.


CONCLUSION
The extended tripartite model describes the clinical state of patients more specifically. This is relevant for both clinical practice and research.
26475543
The Lived Experience of Postpartum Depression: A Phenomenological Study
The purpose of this phenomenological study was to describe the essential structure of the lived experience of postpartum depression. Seven mothers who had suffered from postpartum depression were interviewed regarding their subjective experiences. Data were analyzed using Colaizzi's (1978) method of phenomenology. Forty-five significant statements were extracted and clustered into 11 themes. These results were integrated into the essential structure of postpartum depression. Postpartum depression was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing.
43446725
Negative affectivity: the disposition to experience aversive emotional states.
A number of apparently diverse personality scales—variously called trait anxiety, neuroticism, ego strength, general maladjustment, repression-sensitization, and social desirability—are reviewed and are shown to be in fact measures of the same stable and pervasive trait. An integrative interpretation of the construct as Negative Affectivity (NA) is presented. Extensive data indicate that high-NA individuals are more likely to experience discomfort at all times and across situations, even in the absence of overt stress. They are relatively more introspective and tend differentially to dwell on the negative side of themselves and the world. Further research is needed to explain the origins of NA and to elucidate the characteristics of low-NA individuals. Rorer and Widiger (1983) recently bemoaned that in the field of personality "literature reviews appear to be disparate conglomerations rather than cumulative or conclusive integrations" (p. 432). We intend this review to be an exception to this discouraging statement. Distinct and segregated literatures have developed around a number of specific personality measures that, despite dissimilar names, nevertheless intercorrelate so highly that they must be considered measures of the same construct. Following Tellegen (1982), we call this construct Negative Affectivity (NA) and present a comprehensive view of the trait that integrates data from a wide variety of relevant research. We are not the first to note this broad and pervasive personality trait. The Eysencks, for example, (e.g. Eysenck & Eysenck, 1968) have done extensive research in the area, traditionally calling the dimension "Neuroticism," although in their most recent revision (Eysenck & Eysenck, 1975) they suggest a label, "emotionality," that is similar to our own. Nonetheless, in discussing the relation between our interpretation and previous views of the domain, we argue for the preferability of our term, Negative Affectivity. We also present
40726184
Toward a consensual structure of mood.
Reanalyses of a number of studies of self-reported mood indicate that Positive and Negative Affect consistently emerge as the first two Varimax rotated dimensions in orthogonal factor analyses or as the first two second-order factors derived from oblique solutions. The two factors emerged with varyi
45910105
Abnormal personality and the mood and anxiety disorders: implications for structural models of anxiety and depression.
Substantial overlap exists between the mood and anxiety disorders. Previous research has suggested that their comorbidity can be explained by a shared factor (negative emotionality), but that they may also be distinguished by other unique components. The current study explicated these relations using an abnormal personality framework. Current diagnoses of major depression and several anxiety disorders were assessed in 563 Gulf War veterans. Participants also completed the schedule for nonadaptive and adaptive personality (SNAP) to determine how these disorders relate to abnormal personality traits. Analyses of individual diagnoses indicated that depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) were more strongly related to personality than were other anxiety disorders. The Self-Harm Scale distinguished major depression from all other disorders, highlighting its significance for future structural models. Our results add to a growing body of evidence suggesting that GAD and PTSD have more in common with major depression than with their anxiety disorder counterparts.
146270799
Basic dimensions of temperament and their relation to anxiety and depression: A symptom-based perspective
We examine relations among neuroticism/negative emotionality (N/NE), extraversion/positive emotionality (E/PE), and the mood and anxiety disorders. We present data showing that E/PE correlates most strongly with anhedonia/depressed affect and social anxiety. Similarly, although N/NE is a general predictor of psychopathology, it correlates more substantially with subjective distress and dysphoria than with other types of dysfunction. Thus, it is most strongly related to disorders characterized by pervasive distress, moderately related to syndromes involving more limited forms of distress, and weakly related to disorders characterized primarily by behavioral avoidance. We demonstrate a similar pattern at the symptom level, examining the basic dimensions comprising PTSD, OCD, specific phobia, and depression. These systematic associations suggest a fundamental continuity between normal and abnormal psychological processes.
22415240
Major depression and phobias: the genetic and environmental sources of comorbidity.
In a population based sample of 2163 personally interviewed female twins, substantial comorbidity was observed between DSM-III-R defined major depression (MD) and 4 subtypes of phobia: agoraphobia, social phobia, animal phobia and situational phobia. However, the level of comorbidity of MD with agoraphobia was much greater than that found with the other phobic subtypes. We concluded bivariate twin analyses to decompose the genetic and environmental sources of comorbidity between MD and the phobias. Our results suggest that a modest proportion of the genetic vulnerability to MD also influences the risk for all phobic subtypes, with the possible exception of situational phobias. Furthermore, the magnitude of comorbidity resulting from this shared genetic vulnerability is similar across the phobic subtypes. By contrast, the non-familial environmental experiences which predispose to depression substantially increase the vulnerability to agoraphobia, have a modest impact on the risk for social and situational phobias and no effect on the risk for animal phobias. The increased comorbidity between MD and agoraphobia results, nearly entirely, from individual-specific environmental risk factors for MD which also increase the risk for agoraphobia but not for other phobias.
115394
Measurement Model Quality, Sample Size, and Solution Propriety in Confirmatory Factor Models
Sample size recommendations in confirmatory factor analysis (CFA) have recently shifted away from observations per variable or per parameter toward consideration of model quality. Extending research by Marsh, Hau, Balla, and Grayson (1998), simulations were conducted to determine the extent to which CFA model convergence and parameter estimation are affected by n as well as by construct reliability, which is a measure of measurement model quality derived from the number of indicators per factor (p/f) and factor loading magnitude. Results indicated that model convergence and accuracy of parameter estimation were affected by n and by construct reliability within levels of n. Sample size recommendations for applied researchers using CFA are presented herein as a function of relevant design characteristics.
12771588
The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population
Background. Patterns of co-occurrence among the common mental disorders may provide information about underlying dimensions of psychopathology. The aim of the current study was to determine which of four models best fits the pattern of co-occurrence between 10 common DSM-IV and 11 common ICD-10 mental disorders. Method. Data were from the Australian National Survey of Mental Health and Well-Being (NSMHWB), a large-scale community epidemiological survey of mental disorders. Participants consisted of a random population-based sample of 10641 community volunteers, representing a response rate of 78%. DSM-IV and ICD-10 mental disorder diagnoses were obtained using the Composite International Diagnostic Interview (CIDI), version 2.0. Confirmatory factor analysis (CFA) was used to assess the relative fit of competing models. Results. A hierarchical three-factor variation of a two-factor model demonstrated the best fit to the correlations among the mental disorders. This model included a distress factor with high loadings on major depression, dysthymia, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and neurasthenia (ICD-10 only); a fear factor with high loadings on social phobia, panic disorder, agoraphobia and obsessive–compulsive disorder (OCD); and an externalizing factor with high loadings on alcohol and drug dependence. The distress and fear factors were best conceptualized as subfactors of a higher order internalizing factor. Conclusions. A greater focus on underlying dimensions of distress, fear and externalization is warranted.
13841634
Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
22331322
Counselling of postnatal depression: a controlled study on a population based Swedish sample.
In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale (EPDS) at 8 and 12 weeks postpartum and the Montgomery-Asberg Depression Rating Scale (MADRS) and DSM-III-R at about 13 weeks postpartum, 41 women identified as depressed were randomly allocated to a study and a control group. The women in the study group received 6 weekly, counselling visits by the Child Health Clinic nurse and the control group received routine primary care. Twelve (80%) of 15 women with major depression in the study group were fully recovered after the intervention compared to 4 (25%) of 16 in the control group. Counselling by health nurses is helpful in managing postnatal depression and seems to work well within the Swedish Primary Health Care system.
29734544
Further validation of the IDAS: evidence of convergent, discriminant, criterion, and incremental validity.
The authors explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; D. Watson et al., 2007) in 2 samples (306 college students and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS; the mean convergent correlations were .51 and .62 in the student and patient samples, respectively. With the exception of the Well-Being Scale, the scales also consistently demonstrated significant discriminant validity. Furthermore, the scales displayed substantial criterion validity in relation to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) mood and anxiety disorder diagnoses in the patient sample. The authors identified particularly clear and strong associations between (a) major depression and the IDAS General Depression, Dysphoria and Well-Being scales, (b) panic disorder and IDAS Panic, (c) posttraumatic stress disorder and IDAS Traumatic Intrusions, and (d) social phobia and IDAS Social Anxiety. Finally, in logistic regression analyses, the IDAS scales showed significant incremental validity in predicting several DSM-IV diagnoses when compared against the Beck Depression Inventory-II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996) and the Beck Anxiety Inventory (A. T. Beck & R. A. Steer, 1990).
123504887
Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and G...
120166447
Alternative Ways of Assessing Model Fit
This article is concerned with measures of fit of a model. Two types of error involved in fitting a model are considered. The first is error of approximation which involves the fit of the model, with optimally chosen but unknown parameter values, to the population covariance matrix. The second is overall error which involves the fit of the model, with parameter values estimated from the sample, to the population covariance matrix. Measures of the two types of error are proposed and point and interval estimates of the measures are suggested. These measures take the number of parameters in the model into account in order to avoid penalizing parsimonious models. Practical difficulties associated with the usual tests of exact fit or a model are discussed and a test of “close fit” of a model is suggested.
42246712
Comparative fit indexes in structural models.
Normed and nonnormed fit indexes are frequently used as adjuncts to chi-square statistics for evaluating the fit of a structural model. A drawback of existing indexes is that they estimate no known population parameters. A new coefficient is proposed to summarize the relative reduction in the noncentrality parameters of two nested models. Two estimators of the coefficient yield new normed (CFI) and nonnormed (FI) fit indexes. CFI avoids the underestimation of fit often noted in small samples for Bentler and Bonett's (1980) normed fit index (NFI). FI is a linear function of Bentler and Bonett's non-normed fit index (NNFI) that avoids the extreme underestimation and overestimation often found in NNFI. Asymptotically, CFI, FI, NFI, and a new index developed by Bollen are equivalent measures of comparative fit, whereas NNFI measures relative fit by comparing noncentrality per degree of freedom. All of the indexes are generalized to permit use of Wald and Lagrange multiplier statistics. An example illustrates the behavior of these indexes under conditions of correct specification and misspecification. The new fit indexes perform very well at all sample sizes.
122534821
Bayesian Model Selection in Social Research
It is argued that P-values and the tests based upon them give unsatisfactory results, especially in large samples. It is shown that, in regression, when there are many candidate independent variables, standard variable selection procedures can give very misleading results. Also, by selecting a single model, they ignore model uncertainty and so underestimate the uncertainty about quantities of interest. The Bayesian approach to hypothesis testing, model selection, and accounting for model uncertainty is presented. Implementing this is straightforward through the use of the simple and accurate BIC approximation, and it can be done using the output from standard software. Specific results are presented for most of the types of model commonly used in sociology. It is shown that this approach overcomes the difficulties with P-values and standard model selection procedures based on them. It also allows easy comparison of nonnested models, and permits the quantification of the evidence for a null hypothesis of interest, such as a convergence theory or a hypothesis about societal norms.
25080368
Anxiety, Depression, and Hostility In Mothers of Preterm Infants
Anxiety, depression, and hostility in 47 mothers of high-risk preterm infants were tested at the time of infant discharge and when the infant was 9 months old. Mothers of these high-risk preterms were significantly more anxious and depressed before their infant was discharged than when the infant was 9 months old. Before infant discharge, multiparas were significantly more depressed than primiparas. Additionally, mothers whose infants remained in the hospital longer than the mean of 51 days were significantly less depressed at infant discharge than were mothers whose infants had shorter hospital stays. Maternal anxiety, depression, and hostility did not differ based on marital status, maternal education, socioeconomic status, or maternal age at the time of infant discharge or when the infant was 9 months old.
22832834
Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact.
Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and family support in the NICU. We examine the research and available evidence supporting FCC in the NICU and offer recommendations for increased dissemination and for future study.
7489250
Flexibility and Negative Affect: Examining the Associations of Explanatory Flexibility and Coping Flexibility to Each Other and to Depression and Anxiety
Recent research on vulnerabilities to depression and anxiety has begun to de-emphasize cognitive content in favor of the responsiveness of the individual to variations in situational context in arriving at explanations of events (explanatory flexibility) or attempts to cope with negative events (coping flexibility). The present study integrates these promising avenues of conceptualization by assessing the respective contributions of explanatory and coping flexibility to current levels of depression and anxiety symptoms. Results of structural equation modeling support a model of partial mediation in which both explanatory flexibility and coping flexibility independently contribute to the prediction of latent negative affect, with coping flexibility partially mediating the influence of explanatory flexibility.
143098417
African American Students' Responses to Racial Discrimination: How Race-Based Rejection Sensitivity and Social Constraints are Related to Psychological Reactions
We examined the association between two individual differences (race-based rejection sensitivity and social constraints in talking about racism with family, friends, and/or intimate partners) and psychological reactions to an incident of racial discrimination. Participants were 551 African American undergraduates from either a predominantly white university (PWU) or a historically black university (HBU). Race-based rejection sensitivity (RS-Race) predicted higher negative affect and lower forgiveness for the perpetrator. Social constraints predicted higher negative affect and (marginally) lower forgiveness. There was also an interaction between social constraints and RS-Race: RS-Race was strongly negatively related to positive affect and forgiveness among participants with low social constraints but essentially unrelated among those with high social constraints. Thought intrusions (that might prolong the memory of the prejudicial event) also mediated the effects of RS-Race and social constraints on negati...