Jennifer L. Barkin

Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression

OBJECTIVE Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric disorder (PMDD). No study has yet examined their association with mood in women with major depressive disorder (MDD). The purpose of this study was to determine whether estrogen-progestin combination or progestin-only contraceptives are associated with depression severity, function and quality of life, or general medical or psychiatric comorbidity in women with MDD. METHODS This analysis focused on a large population of female outpatients less than 40 years of age with non-psychotic MDD who were treated in 18 primary and 23 psychiatric care settings across the US, using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Baseline demographic and clinical information was gathered and compared between three groups based on hormonal use: combination (estrogen-progestin)(N=232), progestin-only (N=58), and no hormone treatment (N=948). RESULTS Caucasians were significantly more likely to use combined hormone contraception. Women on progestin-only had significantly more general medical comorbidities; greater hypersomnia, weight gain and gastrointestinal symptoms; and worse physical functioning than women in either of the other groups. Those on combined hormone contraception were significantly less depressed than those with no hormone treatment by the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated. The combined hormone group also demonstrated better physical functioning and less obsessive-compulsive disorder (COCD) comorbidity than either of the other groups. CONCLUSIONS Synthetic estrogen and progestins may influence depressive and physical symptoms in depressed women.

The influence of menopause status and postmenopausal use of hormone therapy on presentation of major depression in women.

Objective:The purpose of this study was to determine whether there are differences in depression characteristics among premenopausal, perimenopausal, and postmenopausal women with major depressive disorder. This study also evaluated these differences between postmenopausal women with major depressive disorder who are taking and not taking hormone therapy. Methods:Analyses conducted with data from the Sequenced Treatment Alternatives to Relieve Depression study focused on female outpatients with nonpsychotic major depressive disorder seeking treatment in 41 primary or psychiatric care settings across the United States. Baseline demographic and clinical characteristics were compared among women not taking hormone therapy who were premenopausal (n = 950), perimenopausal (n = 380), or postmenopausal (n = 562). These comparisons were also made between postmenopausal women (n = 768) taking (n = 171) or not taking (n = 562) hormone therapy. Results:After adjusting for sociodemographic and clinical baseline differences, premenopausal women were more likely to present with irritability than were either perimenopausal or postmenopausal women and were more likely to have decreased appetite and less likely to have early-morning insomnia than were perimenopausal women. Postmenopausal women were more likely to have suicidal ideation and poorer physical functioning than were either of the other groups and were more likely to have sympathetic arousal and gastrointestinal symptoms than were premenopausal women. After adjusting for baseline differences, postmenopausal women taking hormone therapy had better physical functioning, fewer melancholic features, less sympathetic arousal, and more lack of involvement in activities than did women not taking hormone therapy. Conclusions:Menopause status and postmenopausal use of hormone therapy may influence the clinical presentation of major depressive episodes in women.

Development of the Barkin Index of Maternal Functioning

BACKGROUND Maternal functional status is important to capture in the 12 months after childbirth, as this period marks a critical window for both mother and child. In most cases, mothers are the primary caregivers and are, therefore, responsible for the majority of the work related to infant care tasks, such as feeding, diaper changes, and doctors appointments. Additionally, the quality of mother-child interaction in the year after childbirth affects child development. To date, postpartum functioning has exacted scarce coverage, with only one instrument claiming to measure the concept explicitly. This necessitated the development of the Barkin Index of Maternal Functioning (BIMF), which was designed to measure functioning in the year after childbirth. METHODS Three focus groups comprised of 31 new mothers were held to elicit womens concept of functioning in the first postpartum year. Women were asked to discuss the responsibilities associated with new motherhood as well as the circumstances surrounding high and low functioning periods. RESULTS The qualitative data produced by the focus groups were coded by emotive tone and content and translated into item construction for the BIMF, a 20-item self-report measure of functioning intended for use in the year after childbirth. Before implementation into the screening study, the BIMF was critiqued by a panel of experts and cross-checked with the literature to ensure that no major contextual domains were absent. Psychometric testing revealed adequate internal reliability and construct validity, and the BIMF has been implemented successfully in clinical settings. CONCLUSIONS The high level of patient engagement and psychometric properties associated with the BIMF are indicative of its potential to become a valuable tool for assessing maternal wellness.

Assessment of Functioning in New Mothers

BACKGROUND Assessment of mothers in the year after childbirth is important for a number of reasons, including the well-being of the mother and healthy development of the child. There exists a body of instruments that measure a range of maternal characteristics, such as maternal confidence and self-efficacy. It remains unclear if any of these assessments can be used to measure maternal functioning, which may be a direct indication of potential hazards to the offspring. Accurate assessment of functioning would also aid in identifying women who are struggling in the maternal role. In order to assess whether commonly used maternal assessments extend into the realm of functioning, it is necessary to have an appropriate definition. Therefore, the aims of this analysis are to (1) present a new, patient-centered definition of maternal functional status and (2) evaluate select maternal assessments against this definition. METHODS Three new mother focus groups were held in order to understand womens experiences in the year after childbirth. These experiences informed the definition of maternal functional status, which was used to evaluate select instruments for their capacity to assess maternal functioning. RESULTS None of the instruments covered all seven domains, and all of the instruments covered at least one domain. CONCLUSIONS Although there are means of assessing depression status in the postpartum, there is no comprehensive way of capturing a womans quality of life. A new measure is required in order to capture this multifaceted, patient-defined construct of maternal functioning.

The role of maternal self-care in new motherhood

OBJECTIVE To examine the following: (1) womens perceptions regarding the role of maternal self-care, (2) specific applications of self-care in new motherhood and (3) barriers to practising effective self-care. DESIGN three focus groups were conducted in order to study womens perspectives regarding the key components of new motherhood. SETTING Recruitment took place in Allegheny County, surrounding Pittsburgh. The focus groups were held at the University of Pittsburghs Medical School. PARTICIPANTS Thirty-one adult women who had given birth in the year prior to enrollment participated in the study. METHODS The focus group conversations were recorded and transcribed for purposes of qualitative analysis. Conversation related to maternal self-care, which was identified as a component of new motherhood, was grouped into one of three categories: (1) womens valuations of self-care, (2) effective applications of self-care and (3) barriers to good self-care practice. FINDINGS Two ideologies regarding the role of self-care emerged. In one conception of effective mothering, self-care was of primary importance. On the contrary, some women associated a sometimes extreme form of self-sacrifice with new motherhood. Effective applications of self-care included taking time to exercise, allowing the infants father to care for the child for a period of time and going out to restaurants. Barriers to good self-care practice were time, other limited resources such as money and social support and difficulty accepting help and setting boundaries. KEY CONCLUSIONS Additional focus groups should be conducted with the purpose of studying maternal self-care exclusively. This work is an important first step in identifying ways to help new mothers better care for themselves.

Semantic Assessment of the Barkin Index of Maternal Functioning in a Medically Underserved Obstetric Population.

PURPOSE This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for postpartum functional assessment in a low-income obstetric population in medically underserved, Central Georgia (USA). DESIGN AND METHODS Cognitive interviewing, a best practices approach to instrument development and validation, was performed on 24 new mothers. FINDINGS The BIMF was comprehensible to this population of disadvantaged women. PRACTICE IMPLICATIONS The BIMF has broad appeal due to its comprehensibility, patient-centered assessment style, and psychometric profile. Method of questionnaire administration and characteristics of the study and/or patient population should routinely be considered when implementing any type of self-reported health screening.

Applications of and Barriers to Holistic Self-Care in a Low-Income, High-Risk Obstetric Population

OBJECTIVE We examined 1) womens perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care. METHODS Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: womens valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied. RESULTS Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money. CONCLUSIONS Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.

Information Management in New Motherhood: Does the Internet Help or Hinder?

BACKGROUND: Women are faced with the task of gathering information and making subsequent decisions for themselves and their families as they are often the primary caregivers. OBJECTIVE: The purpose of this study was to elucidate prominent themes related to information management and Internet usage in new motherhood. While the advantages to online support have been explored, triggered anxiety has not been a focus of the literature. DESIGN: A focus group study of 31 adult, postpartum women was held at a large, urban medical center in the Northeastern United States. Data related to information management were extracted and analyzed thematically. RESULTS: Women reported experiencing (a) a forcible, internal drive for information related to family health and (b) a high level of anxiety surrounding health-related Internet searches. CONCLUSIONS: Health care providers must be aware that women will consult the Internet for information and that at least a portion of those individuals will experience anxiety as a result.

Correlates of Postpartum Maternal Functioning in a Low-Income Obstetric Population:

BACKGROUND: Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. OBJECTIVE: The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. DESIGN: One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. RESULTS: Higher Edinburgh Postnatal Depression Scale scores (p < .0001) and being married (p = .043) were associated with decreased maternal functioning. CONCLUSIONS: Health care providers should be cognizant of the relationship between postnatal depression and maternal functioning and its potential implications for family health.

The Impact of Stressful Life Events on the Incidence of Type 2 Diabetes in U.S. Adults From the Health and Retirement Study

Objectives We evaluated the association between cumulative stressful life events (SLE) and type of stress (lifetime vs. recent) and incident diabetes (T2DM) in middle-aged U.S. adults. Methods Data from the 2006-2014 waves of the Health and Retirement Study (HRS) were analyzed (n = 7956). Stress-related differences in age at T2DM diagnosis were estimated using Cox proportional hazards models. Results The adjusted risk of T2DM significantly increased by six percent per unit increase in cumulative SLE (95% CI = 1.03, 1.11), by five percent per unit increase in lifetime stress (95% CI = 1.00, 1.09), and by 23% per unit increase in recent stress (95% CI = 1.12, 1.36). Each level of cumulative SLE (one, two, three, and > four events) and recent stress (one and > two events) compared to no stress was significantly associated with an increased risk of T2DM. Each level of lifetime stress compared to no stress was significantly associated with an elevated risk of T2DM except for three events. Discussion Cumulative SLE and type of stress were associated with incident T2DM in middle-aged adults. Reducing the direct effect of stress with management interventions may reduce the indirect effect of developing T2DM and warrants further investigation.