Maternal Psychological Stress after Prenatal Diagnosis of Congenital Heart Disease
ABSTRACT OBJECTIVE: To determine whether prenatal diagnosis of congenital heart disease (CHD) increases maternal stress. STUDY DESIGN: Self-report instruments were administered to mothers carrying a fetus with CHD. Domains included: (1) traumatic stress (Impact of Events Scale-Revised); (2) depression (Beck Depression Index II); and (3) anxiety (State-Trait Anxiety Index). Modifiers included: (1) coping skills (COPE Inventory); (2) partner satisfaction (Dyadic Adjustment Scale); and (3) demographics. Multivariate linear regression models were used to assess relationships between stress measures and modifiers. RESULTS: Fifty-nine mothers (gestational age 27 ± 3 weeks) completed all measures. Clinically important traumatic distress was seen in 39%, depression in 22%, and state anxiety in 31%. Lower partner satisfaction was associated with higher depression (P < .01) and higher anxiety (P < .01). After controlling for partner satisfaction and income, "denial" was most associated with increased traumatic stress, anxiety, and depression (P < .01). CONCLUSIONS: Posttraumatic stress, depression, and anxiety are common after prenatal diagnosis of CHD. Healthy partner relationships and positive coping mechanisms can act as buffers.
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- "Factorial invariance across gender has been reported (South et al., 2009), although not in the Spanish population. Within the past year, the DAS has been used to measure dyadic satisfaction in many different medical disciplines such as cardiology (Rychik et al., 2013), neurology (Norup & Elklit, 2013), obstetrics and gynaecology (Galhardo, Cunha, Pinto-Gouveia, & Matos, 2013; Van den Broeck et al., 2013), oncology (Fife, Weaver, Cook, & Stump, 2013; Robbins, Mehl, Smith, & Weihs, 2013), otorhinolaryngology (Smith, Pukall, & Chamberlain, 2013), urology (Walker, Hampton, Wassersug, Thomas, & Robinson, 2013), or psychology (Daspe, Sabourin, Péloquin, Lussier, & Wright, 2013; Varghese et al., 2013). The DAS has been adapted for use in many countries. "
ABSTRACT: La Escala de Ajuste Diádico (EAD) es una escala de autoinforme de satisfacción conyugal que ha sido ampliamente utilizada en distintas culturas. En España no existen en la actualidad estudios que analicen las propiedades psicométricas de la escala en parejas con y sin malestar ni que realicen análisis factoriales independientes de los datos de hombres y mujeres. El objetivo de este estudio es determinar algunas propiedades psicométricas de una versión española de la EAD en una muestra de 915 participantes: 403 que buscaban terapia de pareja y 512 que no requerían terapia. Los resultados respaldan la fiabilidad del instrumento para ambas submuestras. El análisis factorial confirmatorio mostró una estructura interna de cuatro factores que se corresponde con la propuesta por el autor de la escala original. Además, la versión española de la EAD ofrece una alta capacidad discriminante entre ambos subgrupos, constituyendo un instrumento válido y fiable para medir la satisfacción conyugal en parejas españolas que buscan terapia y en aquellas que no la requieren.International Journal of Clinical and Health Psychology 05/2014; 14(2):137–144. DOI:10.1016/S1697-2600(14)70047-X · 2.79 Impact Factor
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ABSTRACT: Abstract Objective: Decision-making during prenatal diagnosis has not been extensively studied. We aimed to determine psychological correlates and level of decisional conflict following prenatal diagnosis. Method: A total of 159 pregnant women were consecutively enrolled. All participants completed three questionnaires (the Hospital Anxiety and Depression scale, the Berlin Social Support scales and the Decisional Conflict scale) at three time points (T1 - waiting period between prenatal testing and disclosure of the results; T2 - decision phase within 3 days from test result disclosure; T3 - digestion period within 3 weeks from disclosure). Results: Women with fetal anomaly who terminate pregnancy were significantly more anxious and depressed than controls at each time point. Additionally, women with a normal fetus who terminate pregnancy presented higher level of anxiety and depression compared with controls at T2. Women who terminated pregnancy showed increased uncertainty scores at T2 and T3. Anxious and depressed individuals at T2 (decision period) were more uncertain about their choice at T3 compared to women with normal levels of anxiety and depression. Conclusion: The decision to terminate pregnancy, irrespective of test results, may determine emotional distress and psychiatric morbidity. Women who were anxious and depressed at decision appeared to be more uncertain about their choices as time passed by. A careful assessment of women during prenatal diagnosis should be useful to identify women who may benefit from psychological support.Journal of Psychosomatic Obstetrics & Gynecology 05/2013; 34(2). DOI:10.3109/0167482X.2013.797404 · 1.23 Impact Factor
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ABSTRACT: There is a growing population of adults with congenital heart disease (CHD) due to improved survival beyond childhood. It has been suggested that adults with CHD may be at increased risk for mental health problems, particularly depression. The reported incidence of depression in CHD varies from 9% to 30%. This review examines the evidence for a higher depression rate in CHD vs general population. Possible explanations are offered from a variety of disease models, ranging from brain injury to the psychoanalytical approach. Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy, separation from the parents during hospitalizations and brain organic syndromes. Later in life, patients often have to cope with physical limitations. Recent improvements in care may be protective. Current patients may benefit from an earlier age at first surgical intervention, fewer reoperations and inclusion to the mainstream schooling, among other factors. At this point, there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD. Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.World Journal of Cardiology (WJC) 06/2013; 5(6):186-195. DOI:10.4330/wjc.v5.i6.186 · 2.06 Impact Factor