Cecilia Peñacoba-Puente

Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache

Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension‐Type Headache (CTTH). Twenty‐five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36‐Item Short‐Form (SF‐36) questionnaire. The Beck Depression Inventory (BDI‐II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State‐Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression (β=−0.34, p<0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.

Pregnancy worries: a longitudinal study of Spanish women

Objective. To identify pregnancy worries in women by assessing the intensity of these worries and how they change over the course of pregnancy, as well as their relations with sociodemographic and clinical variables. Design. Longitudinal study using a postal questionnaire. Setting. University hospital in Madrid. Population. 285 pregnant women. Method. Women were asked about their pregnancy‐specific worries in their first trimester (mean gestational age 14.4 weeks) and third trimester (mean gestational age 34.3 weeks). Main Outcome Measures. The women completed a questionnaire that included sociodemographic information and the Cambridge Worry Scale. Results. Pregnancy worries were significantly reduced during the third trimester. The main concern throughout gestation was worry about fetal health. Multiparity and pregnancy planning protected women from pregnancy worries, whereas having had a miscarriage had a negative effect. A younger age and being employed contributed to greater socioeconomic worries. Conclusions. Worries related to the health of the fetus are universal across different nationalities. A first pregnancy, unplanned pregnancy, and previous miscarriage are risk factors that influence the intensity of a womans worries. To improve the health and quality of life of pregnant women, a holistic approach to their care should include evaluation of their worries and appropriate intervention in particular groups considered at risk.

Coping strategies of Spanish pregnant women and their impact on anxiety and depression

The aims of this study were to analyze the coping strategies used by women in the first trimester of low-risk pregnancies, their relationships to sociodemographic and pregnancy variables, and their ability to predict anxiety and depression in the third trimester. Participants in the first trimester were 285 Spanish pregnant women, of whom 122 were followed into the third trimester. The use of problem-focused coping was stable, whereas variations occurred in emotion-focused coping. Age, educational level, employment, planned pregnancy, previous childbirth, and previous miscarriage were associated with adaptive coping. Coping strategies predicting anxiety and depressive symptoms were overt emotional expression and social support seeking. Coping through religion predicted anxiety. Coping is a complex process influenced by sociodemographic and obstetric factors that can contribute to the onset of psychological symptoms.

Factor structure, validity and reliability of the Spanish version of the Cambridge Worry Scale

OBJECTIVE To analyse the factor structure and reliability of the Cambridge Worry Scale (CWS) in the Spanish population. DESIGN Prospective cross-sectional study using a postal questionnaire. SETTING The study was conducted at a university hospital in Madrid between October 2007 and December 2008. PARTICIPANTS 285 Spanish pregnant women. METHODS Factor structure of a Spanish version (original 16 items test and reduced 13 items version) of the scale was analysed through exploratory factor analysis. FINDINGS The Spanish version of the reduced 13 items version replicated the original factor structure. The internal consistency was good for the total scale (0.83) and for the subscales (0.70-0.79). Significant positive correlations between the CWS and its subscales with anxiety, depression and neuroticism were found. Similarly, acceptable to good reliability and convergent validity indexes were obtained for the original 16 items test. DISCUSSION The present study confirmed the validity of the two Spanish versions of the CWS (16 item and reduced 13 item). Considering the performance of two of the three items eliminated from the original version and the universality in the use of the short version we recommend the use of the reduced 13 item scale. Practical implications of the use of the CWS in maternity care are discussed.

Factor structure, validity, and reliability of the Spanish version of the Women's Views of Birth Labour Satisfaction Questionnaire.

OBJECTIVE to analyse the factor structure of the Womens Views of Birth Labour Satisfaction Questionnaire (WOMBLSQ) using confirmatory factor analysis. DESIGN prospective cross-sectional study. Data were collected through a mail questionnaire. SETTING the study was conducted at a University Hospital in Madrid. PARTICIPANTS 298 pregnant Spanish women. METHODS confirmatory factor analysis was used to identify the best-fit model. FINDINGS the best fit for the Spanish version of the scale was an eight-factor model, after removing the control factor from the original scale, and merging all items related to pain into one. Internal consistency was satisfactory for the full scale (.82), although the reliability of two factors was less than .45. CONCLUSION this study has provided preliminary evidence that supports the use of the Spanish version of the WOMBLSQ to assess childbirth satisfaction in Spanish-speaking women. Nevertheless, further studies will be needed to determine the validity of the questionnaire and to compare it to other existing tools.

Has catechol-O-methyltransferase genotype (Val158Met) an influence on endocrine, sympathetic nervous and humoral immune systems in women with fibromyalgia syndrome?

Objective:Stress can play an important role in etiology of fibromyalgia syndrome (FMS) by activating the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system (SNS), and altering the immune system. The current study examined the influence of catechol-O-methyltransferase (COMT) Val158Met genotypes on salivary markers of HPA axis (cortisol), SNS (&agr;-amylase), and immune (IgA) systems in women with FMS. Methods:Seventy-six women with FMS diagnosed according to the American College of Rheumatology criteria participated in the study. Salivary cortisol, &agr;-amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva. A numerical pain rate scale (0 to 10) was used to assess the intensity of pain, whereas functional ability was determined using the Fibromyalgia Impact Questionnaire (FIQ). After amplifying Val158Met polymorphisms by polymerase chain reaction, 3 COMT genotypes were considered: Val/Val, Val/Met, and Met/Met. Results:Women with FMS with the Met/Met genotype reported higher &agr;-amylase activity, lower salivary flow rate, and lower IgA concentration than those women with FMS carrying the Val/Met (P<0.05) or Val/Val (P<0.01) genotypes. No difference in cortisol concentration (P>0.70) was found. These results were not associated with the intensity of pain, disability, and medication intake. Conclusions:The results suggest that women with FMS with the Met/Met genotype exhibit greater disturbed activity of the SNS and humoral immune system. These results provide initial evidence of a link between Val158Met polymorphism and dysfunctions in the SNS and humoral immune system in women with FMS.

Post-Partum Depression, Personality, and Cognitive-Emotional Factors: A Longitudinal Study on Spanish Pregnant Women.

In this study, our purpose was to examine whether personality and cognitive factors could be related to post-partum depression (PPD), mediated by anxiety, in Spanish women. Women were evaluated for personality and cognitive factors after the first trimester, for anxiety in the third trimester, and for PPD 4 months after childbirth. A structural equation model revealed that personality and cognitive factors were associated with anxiety and PPD as predictors. Neuroticism and extroversion proved to be the most relevant factors. Conscientiousness was associated with pregnancy anxiety. Pregnancy anxiety appeared as an independent predictor of PPD. The model presented here includes personality and cognitive and emotional factors as predictors of PPD. Comprehensive care for pregnant women should contemplate assessment and intervention on all these aspects. Special focus should be on cognitive factors and emotional regulation strategies, so as to minimize the risk of later development of emotional disorders during puerperal phases.

Influence of coping strategies on somatic symptoms in pregnant Spanish women: differences between women with and without a previous miscarriage

The aim of this research was to analyze the relation between coping strategies and somatic symptomatology in pregnant Spanish women and the influence of a previous miscarriage on these variables. We used a correlational retrospective design, which included 207 expectant mothers (44 with a previous miscarriage). The instruments included a questionnaire on coping with stress and questions about first-trimester symptoms. Regression analysis showed a significant positive relationship between sleep disturbances and overt emotional expression coping, between tiredness/fatigue and avoidance coping, and between nausea and religious coping. The influence of coping strategies on somatic symptomatology did not differ significantly between women who had had or had not had a previous miscarriage, although women with a previous miscarriage scored higher on the use of religious coping and positive reappraisal and reported more nausea.

Autoeficacia y automanejo de los hábitos saludables en fibromialgia

UNLABELLED Fibromyalgia is a disorder characterized by general chronic pain, together with other symptoms such as fatigue, sleep disorders, anxiety and depression. AIM To analyze, in FM patients, the effects of a multi-component intervention program (nursing+cognitive-behavioural therapy, focused on improving resting habits, physical exercise, and family relationships, working simultaneously on empowerment and patient self-efficacy. METHOD A quasi-experimental design was used following-up 5 women diagnosed with fibromyalgia. An analysis was performed on their daily habits, self-efficacy for chronic pain, pain perception, functional limitation, and affect. The intervention was composed by 8 group sessions: Six of them aimed at health education and self-management of healthy habits (nursing), and two sessions dedicated to increasing self-efficacy (cognitive-behavioural therapy). Follow-up consisted of five individual sessions (nursing) so as to consolidate the newly acquired habits, maintain self-management and self-efficacy based on observing compliance. RESULTS Statistically significant improvements were observed (pre-, pos-) in habit modification and in self-efficacy, as well as for positive and negative affect. Also, statistically significant differences were found pre-follow up for functional limitation. CONCLUSIONS The role of nursing has to be considered within multi-component programs, in particular during follow-up, for changing habits and for self-efficacy, in response to some of the current limitations of interventions with these patients.

Relationship Between Postpartum Depression and Psychological and Biological Variables in the Initial Postpartum Period

Objectives The aims of this study were to evaluate the predictive relationship between psychological symptomatology 24 h postpartum and depression 4 months postpartum, and analyze the relationship between estradiol and postpartum mood. Methods Two hundred women participated in an assessment 24 h postpartum and gave a blood sample for estradiol analysis. One hundred eleven of these women completed the second assessment 4 months postpartum. The Beck Depression Inventory II and the Scale of State-Trait Anxiety were used to assess psychological symptoms. Results At 24 h postpartum, symptoms of depression, trait anxiety, and state anxiety were all significantly correlated with each other. Depression at 24 h postpartum was the only significant independent predictor of depression at 4 months postpartum, explaining 28.7% of the variance. No statistically significant relationship was found between levels of estradiol and mood. Symptoms of depression immediately postpartum thus appear to be a predictor of postpartum depression. Conclusions for Practice These results suggest that early postpartum psychological evaluation of the mother, and intervention as warranted, might prevent or lessen postpartum depression.