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01-06-2016 | Original Article

Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality

Authors: Joanna C. M. Cole, Julie S. Moldenhauer, Kelsey Berger, Mark S. Cary, Haley Smith, Victoria Martino, Norma Rendon, Lori J. Howell

Published in: Archives of Women's Mental Health | Issue 3/2016

Abstract

The aim of the study was to determine the incidence of psychological distress among expectant women carrying fetuses with prenatal diagnosed abnormalities and their partners. A 2-year retrospective medical chart review was completed of 1032 expectant mothers carrying fetuses with a confirmed anomaly, and 788 expectant fathers, who completed the CFDT Mental Health Screening Tool. Furthermore, 19.3 % of women and 13.1 % of men reported significant post-traumatic stress symptoms, and 14 % of men and 23 % of women scored positive for a major depressive disorder. Higher risk was noted among expectant parents of younger age and minority racial/ethnic status, and women with post-college level education and current or prior use of antidepressant medications. Heightened distress was noted within fetal diagnostic subgroups including neck masses, sacrococcygeal teratomas, neurological defects, and miscellaneous diagnoses. Incorporating screening tools into prenatal practice can help clinicians better identify the potential risk for psychological distress among expectant parents within high-risk fetal settings.

Authorization to utilize the scale was obtained from Dr. Cheryl Beck, author of the original PDSS, and the staff at the “UnNamed” Center bought its copyright from the Western Psychological Services.

Aite L, Zaccara A, Trucchi A, Brizzi C, Nahom A, Iacobelli B, Bagolan P (2009) When uncertainty generates more anxiety than severity: the prenatal experience with cystic adenomatoid malformation of the lung. J Perinat Med 37:539–542CrossRefPubMed

Aite L, Zaccara A, Mirante N, Nahom A, Trucchi A, Capolupo I, Bagolan P (2011) Antenatal diagnosis of congenital anomaly: a really traumatic experience? J Perinatol 31(12):760–763CrossRefPubMed

Asnaani A, Richey JA, Dimaite R, Hinton DE, Hofmann SG (2010) A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis 198(8):551–555CrossRefPubMedPubMedCentral

Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285CrossRefPubMed

Beck CT, Gable RK (2001) Further validation of the postpartum depression screening scale. Nurs Res 50(3):155–164CrossRefPubMed

Blom EA, Jansen PW, Verhulst FC, Hofman A, Raat H, Jaddoe VW, Tiemeier H (2010) Perinatal complication increase the risk of postpartum depression: The Generation R study. BJOG 117(11):1390–1398CrossRefPubMed

Brandon AR, Trivedi MH, Hynan LS (2008) Prenatal depression in women hospitalized for obstetric risk. J Clin Psychiatry 69(4):635–643CrossRefPubMedPubMedCentral

Brisch KH, Munz D, Bemmerer-Mayer K, Terinde R, Kreienberg R, Kächele H (2003) Coping styles of pregnant women after prenatal ultrasound screening for fetal malformation. J Psychosom Res 55(2):91–97CrossRefPubMed

Byatt N, Hicks-Courant K, Davidson A, Levesque R, Mick E, Allison J, Moore Simas TA (2008) Depression and anxiety among high-risk obstetric inpatients. Arch Womens Ment Health 11(5–6):644–649

Centers for Disease Control and Prevention (2013) Birth Defects Data & Statistics. Retrieved March 26, 2013, from http://www.cdc.gov/ncbddd/birthdefects/data.html

Eaton WW, Muntaner C, Smith C, Tien A, Ybarra ML (2004) Center for epidemiologic studies depression scale: review and revision (CESD and CESD-R). In: Maruish ME (ed) The Use of Psychological Testing for Treatment Planning and Outcomes Assessment, 3rd edn. Lawrence Erlbaum, Mahwah, NJ, pp 363–377

Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Summary Evidence Report-Technology. Assessment No. 119. Agency for Healthcare Research and Quality, Rockville: MD, USA, Prepared by the RTI-University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016

Giuliani R, Tripani A, Pellizzoni S, Clarici A, Lonciari I, D’Ottavio G, Schleef J (2014) Pregnancy and postpartum following a prenatal diagnosis of fetal thoracoabdominal malformation: The parental perspective. J Pediatr Surg 49:353–358CrossRefPubMed

Gupton A, Heaman M, Ashcroft T (1997) Bed rest from the perspective of the high-risk pregnant woman. J Obstet Gynecol Neonatal Nurs 26(4):423–430CrossRefPubMed

Gurevich M, Devins GM, Rodin GM (2002) Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics 43(4):259–281CrossRefPubMed

Hedrick J (2005) The lived experience of pregnancy while carrying a child with a known, nonlethal congenital abnormality. J Obstet Gynecol Neonatal Nurs 34(6):732–740CrossRefPubMed

Hoehn KS, Wernovsky G, Rychik J, Tian ZY, Donaghue D, Alderfer MA, Gaynor JW (2004) Parental decision-making in congenital heart disease. Cardiol Young 14:309–314CrossRefPubMed

Hunfeld JA, Wladimiroff JW, Passchier J, Venema-Van Uden MU, Frets PG, Verhage F (1993) Emotional reactions in women in late pregnancy (24 weeks or longer) following the ultrasound diagnosis of a severe or lethal fetal malformation. Prenat Diagn 13(7):603–612CrossRefPubMed

Hynan MT, Mounts KO, Vanderbilt DL (2013) Screening parents of high-risk infants for emotional distress; rationale and recommendations. J Perinatol 33(10):748-753

Josefsson A, Angelsioo L, Berg G, Ekstrom CM, Gunnervik C, Nordin C, Sydsjö (2002) Obstetric, somatic, and demographic risk factors for postpartum depression symptoms. Obstet Gynecol 99(2):223–228PubMed

Kaasen A, Helbig A, Malt UF, Næs T, Skari H, Haugen GN (2010) Acute maternal social dysfunction, health perception and psychological distress after ultrasonographic detection of a fetal structural anomaly. BJOG 117:1127–1138CrossRefPubMed

Kaasen A, Helbig A, Malt UF, Næs T, Skari H, Haugen GN (2013) Paternal psychological response after ultrasonographic detection of structural fetal anomalies with a comparison to maternal response: a cohort study. BMC Pregnancy Childbirth 13:147CrossRefPubMedPubMedCentral

Kingston D, James-Kelley S, Tyrrell J, Clark L, Hamza D, Holmes P, Austin MP (2015) An integrated web-based mental health intervention of assessment-referral-care to reduce stress, anxiety, and depression in hospitalized pregnant women with medically high-risk pregnancies: a feasibility study protocol of hospital-based implementation. JMIR Res Protocol 4(1):1–15CrossRef

Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 8:24CrossRefPubMedPubMedCentral

Maloni JA, Chance B, Zhang C, Cohen AW, Betts D, Gange SJ (1993) Physical and psychosocial side effects of antepartum hospital bed rest. Nurs Res 42(4):197–203CrossRefPubMed

Maloni JA, Park S, Anthony MK, Musil CM (2005) Measurement of antepartum depressive symptoms during high-risk pregnancy. Res Nurs Health 28(1):16–26CrossRefPubMed

Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157CrossRefPubMed

Modarres M, Afrasiabi S, Rahnama P, Montazeri A (2012) Prevalence and risk factors of childbirth-related post-traumatic stress symptoms. BMC Pregnancy Childbirth 12:88CrossRefPubMedPubMedCentral

National Research Council and Institute of Medicine (2009) Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. The National Academies Press, Washington, DC

Nazareth I (2011) Should men be screened and treated for postnatal depression? Expert Rev Neurother 11(1):1–3CrossRefPubMed

Ozer EJ, Best SR, Lipsey TL, Weiss DS (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129:52–73CrossRefPubMed

Penticuff JH (1982) Psychologic implications in high-risk pregnancy. Nurs Clin North Am 17:69–78PubMed

Pereira AT, Bos SC, Marques M, Maia B, Soares MJ, Valente J, de Azevedo MH (2011) The Portuguese version of the postpartum depression screening scale: is it valid to screen for antenatal depression? Arch Womens Ment Health 14:227–238CrossRefPubMed

Pinto-Meza A, Moneta MV, Alonso J, Angermeyer MC, Bruffaerts R, Caldas de Almeida JM, de Girolamo G, de Graaf R, Florescu S, Kovess Masfety V, O’Neill S, Vassilev S, Haro JM (2013) Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol 48(2):173–181CrossRefPubMed

Price SK, Corder-Mabe J, Austin K (2012) Perinatal depression screening and intervention: enhancing health provider involvement. J Womens Health (Larchmt) 21(4):447–455CrossRef

Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRef

Rosenberg KB, Monk C, Glickstein JS, Levasseur SM, Simpson LL, Kleinman CS, Williams IA (2010) Referral for fetal echocardiography is associated with increased maternal anxiety. J Psychosom Obstet Gynaecol 31:60–69CrossRefPubMedPubMedCentral

Rychik J, Donaghue DD, Levy S, Fajardo C, Combs J, Zhang X, Szwast A, Diamond GS (2013) Maternal psychological stress after prenatal diagnosis of congenital heart disease. J Pediatr 162(2):302–307CrossRefPubMed

Rychnovsky J, Beck CT (2006) Screening for postpartum depression in military women with the Postpartum Depression Scale. Mil Med 171:1100–1104CrossRefPubMed

Schnoll RA, Harlow LL, Stolbach LL, Brandt UA (1998) A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer. Psychooncology 7(2):69–77CrossRefPubMed

Seyfried LS, Marcus SM (2003) Postpartum mood disorders. Int Rev Psychiatry 15(3):231–242CrossRefPubMed

Skreden M, Skari H, Malt UF, Haugen G, Pripp AH, Faugli A, Emblem R (2010) Long-term parental psychological distress among parents of children with a malformation—a prospective longitudinal study. Am J Med Genet Part A 152A:2193–2202CrossRefPubMed

Söderquist J, Wijma B, Thorbert G, Wijma K (2009) Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG 116(5):672–680CrossRefPubMed

Stainton MC, McNeil D, Harvey S (1992) Maternal tasks of uncertain motherhood. Matern Child Nurs J 20(3–4):113–123PubMed

StataCorp (2013) Stata Statistical Software [Release 13]. StataCorp LP, College Station, TX

Statham H, Solomou W, Chitty L (2000) Prenatal diagnosis of fetal abnormality: psychological effects on women in low-risk pregnancies. Baillieres Best Practice Res Clin Obstet Gynaecol 14:731–747CrossRef

The American College of Obstetricians and Gynecologists (2010) Screening for depression during and after pregnancy. Obstet Gynecol 115(2):394–395CrossRef

Vin-Raviv N, Hillyer GS, Hershman DL, Galea S, Leoce N, Bovbjerg DH, Neugut AI (2013) Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: The BQUAL study. J Natl Cancer Inst 105(8):563–572CrossRefPubMedPubMedCentral

Wool C (2011) Systematic review of the literature: parental outcomes after diagnosis of fetal anomaly. Adv Neonatal Care 11(3):182–192CrossRefPubMed

Title: Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality
Authors: Joanna C. M. Cole
Julie S. Moldenhauer
Kelsey Berger
Mark S. Cary
Haley Smith
Victoria Martino
Norma Rendon
Lori J. Howell
Publication date: 01-06-2016
Publisher: Springer Vienna
Published in: Archives of Women's Mental Health / Issue 3/2016
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-015-0580-6

At a glance: The STEP trials

Springer Medicine

Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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