Lianne M. Tomfohr-Madsen

Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis

BACKGROUND Research in paternal prenatal and postpartum depression has nearly doubled since prevalence rates were last meta-estimated in October 2009. An updated meta-analysis allows additional questions to be answered about moderators that influence risk. METHODS Studies reporting paternal depression between the first trimester and one-year postpartum were obtained for the period from January 1980 to November 2015. In total 74 studies with 41,480 participants were included, and data was extracted independently by two authors. Moderator analyses included measurement method, timing of assessment, study location, publication year, age, education, parity, history of depression, and maternal depression. RESULTS The meta-estimate for paternal depression was 8.4% (95% confidence interval [CI], 7.2-9.6%) with significant heterogeneity observed among prevalence rates. Prevalence significantly varied based on publication year, study location, measurement method, and maternal depression. Prevalence was not conditional on paternal age, education, parity, history of paternal depression, and timing of assessment. LIMITATIONS Analyses were limited by variability in assessment measures, countries from which studies were available, extant data for the first trimester and 6- to 9-month postpartum, and method of reporting sociodemographic information. CONCLUSIONS Paternal depression was present in 8% of men in the included studies. Future screening policies and interventions should consider moderating risk factors for depression throughout the transition to parenthood.

Disordered gambling and psychosis: Prevalence and clinical correlates

A paucity of research has examined the relationship between psychosis and disordered gambling. Individuals with both psychosis and disordered gambling may represent a uniquely vulnerable clinical population given important commonalities in underlying brain pathology and clinical symptomatology that occur across both disorders (e.g., Potenza and Chambers, 2001), which may manifest in increased risk of poly-comorbidity and symptom severity among this dual disorder population. To our knowledge, only one study has examined rates of psychosis among disordered gamblers, which were found to be 3.5 times higher than non-gamblers (Cunningham-Williams et al., 1998), and no studies have examined the demographic and clinical correlates in a sample of disordered gamblers with and without psychosis. We addressed this empirical gap by examining the co-occurrence of psychosis and disordered gambling in a sample of treatment-seeking disordered gamblers to identify the rates and demographic and clinical correlates. We hypothesized that rates of psychosis would be higher in the population of disordered gamblers compared to the general population and that the dual diagnosis would be associated with greater severity of gambling-related problems and elevated rates of other psychiatric comorbidities.

Adverse childhood experiences and HPA axis function in pregnant women

HighlightsEvaluated associations between adverse childhood experiences (ACEs) and prenatal hypothalamic‐pituitary‐adrenal (HPA) axisMaternal ACEs were associated with increased cortisol at 30 min post waking and a flattened diurnal slopeMaternal ACEs were associated with a progressive steepening of the daytime cortisol slope with advancing gestationThe findings have implications for the intergenerational transmission of maternal ACEs

A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation.

Abstract Purpose: This study explored patients’ decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes. Method: Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts. Results: Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress. Conclusion: The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation. Implications for Rehabilitation Cardiovascular disease is a leading cause of mortality worldwide. Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll. After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.

Developmental origins of infant emotion regulation: Mediation by temperamental negativity and moderation by maternal sensitivity.

Emotion regulation is essential to cognitive, social, and emotional development and difficulties with emotion regulation portend future socioemotional, academic, and behavioral difficulties. There is growing awareness that many developmental outcomes previously thought to begin their development in the postnatal period have their origins in the prenatal period. Thus, there is a need to integrate evidence of prenatal influences within established postnatal factors, such as infant temperament and maternal sensitivity. In the current study, prenatal depression, pregnancy anxiety, and diurnal cortisol patterns (i.e., the cortisol awakening response (CAR) and diurnal slope) were assessed in 254 relatively low-risk mother-infant pairs (primarily White, middle-class) in early (M = 15 weeks) and late pregnancy (M = 33 weeks). Mothers reported on infant temperamental negativity (Infant Behavior Questionnaire–Revised) at 3 months. At 6 months, maternal sensitivity (Parent Child Interaction Teaching Scale) and infant emotion regulation behavior (Laboratory Temperament Assessment Battery) were assessed. Greater pregnancy anxiety in early pregnancy and a blunted CAR in late pregnancy predicted higher infant temperamental negativity at 3 months, and those infants with higher temperamental negativity used fewer attentional regulation strategies and more avoidance (i.e., escape behavior) at 6 months. Furthermore, this indirect effect was moderated by maternal sensitivity whereby infants with elevated negativity demonstrated maladaptive emotion regulation at below average levels of maternal sensitivity. These findings suggest that the development of infant emotion regulation is influenced by the ways that prenatal exposures shape infant temperament and is further modified by postnatal caregiving.

Advancing Concussion Assessment in Pediatrics (A-CAP): A prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: Protocol study

Introduction Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. Methods and analysis A-CAP is a prospective, longitudinal cohort study of children aged 8.00–16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. Ethics and dissemination The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.

The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension

Reduced cardiac vagal control, indexed by relatively lower high-frequency heart rate variability (HF-HRV), is implicated in depressed mood and hypertensive disorders among non-pregnant adults whereas research in pregnancy is limited. This study examined whether maternal HF-HRV during pregnancy mediates the association between depressed mood and gestational hypertension. Depressive symptoms (Edinburgh Depression Scale) and HF-HRV were measured during early (M=14.9 weeks) and late (M=32.4 weeks) pregnancy in 287 women. Gestational hypertension was determined by chart review. Depressive symptoms were associated with less HF-HRV (b=-0.02, p=.001). There was an indirect effect of depressed mood on gestational hypertension through late pregnancy HF-HRV (b=0.04, 95% CI 0.0038, 0.1028) after accounting for heart rate. These findings suggest cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension, though causal ordering remains uncertain.

Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity

Objective: Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. Method: The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale–11 provided a measure of impulsivity. Results: Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. Conclusion: Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.

A systematic review of sleep in hospitalized pediatric cancer patients

The purpose of this systematic review was to describe the occurrence of sleep disruptions in pediatric cancer patients and to identify and discuss the factors related to the hospital sleep environment that may be associated with disturbed sleep.

Insomnia Treatment Preferences During Pregnancy

Objective: To determine pregnant womens preferences for the treatment of insomnia: cognitive behavioral therapy (CBT‐I), pharmacotherapy, or acupuncture. Design: A cross‐sectional survey of pregnant women. Setting: We recruited participants in person at a low‐risk maternity clinic and a pregnancy and infant trade show and invited them to complete an online questionnaire. Participants: The sample (N = 187) was primarily White (70%), married or common‐law married (96%), and on average 31 years of age; the mean gestational age was 28 weeks. Methods: Participants read expert‐validated descriptions of CBT‐I, pharmacotherapy, and acupuncture and then indicated their preferences and perceptions of each approach. Results: Participants indicated that if they experienced insomnia, they preferred CBT‐I to other approaches, χ2(2) = 38.10, p < .001. They rated CBT‐I as the most credible treatment (&eegr;2partial = .22, p < .001) and had stronger positive reactions to it than to the other two approaches (&eegr;2partial = .37, p < .001). Conclusion: Participants preferred CBT‐I for insomnia during pregnancy. This preference is similar to previously reported preferences for psychotherapy for treatment of depression and anxiety during pregnancy. It is important for clinicians to consider womens preferences when discussing possible treatment for insomnia.