Anksioznost v peripartalnem obdobju Rus Prelog, Polona; Rus Makovec, Maja
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
10/2023, Letnik:
92, Številka:
9-10
Journal Article
Recenzirano
Odprti dostop
Nosečnost je za ženske občutljivo obdobje, ki ga spremljajo pomembne fiziološke in psihološke spremembe, tako na čustveni kot biološki, hormonski ravni. Anksioznost je v obdobju tako velikih sprememb ...do neke mere normalen in prilagoditven odgovor na situacijo, vendar pa nekatere nosečnice izkusijo visoko raven anksioznosti, ki doseže stopnjo klinično pomembne motnje. Anksiozne motnje, ki se v peripartalnem obdobju najpogosteje pojavljajo, so generalizirana anksiozna motnja, panična motnja, fobije, obsesivno kompulzivna motnja in posttravmatska stresna motnja. Pretekla anamneza razpoloženjskih in/ali anksioznih motenj je med najmočnejšimi napovedovalci razvoja peripartalne anksioznosti. Kljub temu, da raziskovalno zanimanje za anksiozne motnje v peripartalnem obdobju narašča in vemo več o značilnostih in diagnostiki, pa so dokazi o klinični obravnavi – tako farmakološki kot nefarmakološki - še vedno omejeni. Tveganje in korist uvedbe farmakološkega zdravljenja vedno individualno pretehtamo. Prepoznava in obravnava anksioznosti med nosečnostjo sta bistvenega pomena in delujeta kot preventiva psihiatričnim motnjam po porodu. Poporodna anksioznost matere lahko tudi pomembno ovira proces navezovanja matere in otroka, kar ima posredno tudi vpliv na razvoj otroka. Pri nosečnicah, ki pa so v psihiatrično obravnavo že vključene zaradi obravnavane duševne motnje, pa je sledenje, podpora in dobro interdisciplinarno sodelovanje lečečega psihiatra in ginekološke službe nujno potrebno.
The present study explored whether specific single-nucleotide polymorphisms in alcohol metabolic pathway are associated with alcohol dependence or alcohol-related psychopathological symptoms.
Three ...groups of male unrelated subjects were included: 101 currently alcohol-dependent patients, 100 formerly alcohol-dependent subjects and 97 healthy controls. The following questionnaires were implemented: AUDIT, Zung Depression and Anxiety scale, Brief Social Phobia Scale, Yale-Brown Obsessive Compulsive Scale, Obsessive Compulsive Drinking Scale and Buss-Durkee Hostility Inventory. All the subjects were genotyped for CYP2E1 c.-1053C>T and CAT c.-262C>T.
Statistically significant differences in the distribution of genotypes and alleles for CAT c.-262C>T polymorphism were observed among the three investigated groups. We observed a higher frequency of CAT -262T allele in alcohol-dependent subjects (OR = 1.74, 95% CI = 1.164-2.610). Among currently dependent patients CAT -262T allele carriers had higher AUDIT scores (P = 0.023), while CYP2E1-1053T allele carriers had significantly higher YBOCS-obsession subscale scores (P = 0.005) and Zung Anxiety Scale scores (P = 0.011).
Our findings suggest that the CAT c.-262C>T genetic polymorphism influences the susceptibility to alcohol dependence and severity of alcohol dependence, while CYP2E1 c.-1053C>T polymorphism influences the expression of obsessive-compulsive and anxiety symptoms.
BACKGROUNDA high rate of concurrent depression and anxiety has been identified among the patients of pain clinics. Evaluation of own pain can appear as a perception of being negatively impacted by ...pain-related suffering in social relations. SUBJECTS AND METHODSA questionnaire with 228 variables was applied to 109 randomly chosen patients at outpatient pain clinic of the Ljubljana University Clinical Centre. Following summative scores were treated as a set of dependent variables in MANOVA, as a set of predictors in discriminant analysis: level of depression (Zung), level of anxiety (Zung), evaluation of the nature of pain and perceptions of negatively impacted social relations. Actual pain has been self-evaluated on a visual-analogue pain scale from 0 to 10 and recorded in subgroups with a low, middle and high intensity of actual pain (criterion variable). RESULTSThe average age of the participants was M=52.7 years (SD 13.9), 70.9 % of them female. Participants with a high intensity of pain were found to have the highest level of depression, the highest level of anxiety and were negatively impacted in their social relations to the greatest extent. Only the first discriminant function was found to be significant (p<0.05). The structure matrix showed a high correlation between anxiety level (0.88) and depression level (0.86), and a low correlation with the perception of negatively impacted social relations (0.57). CONCLUSIONSThe results emphasize the connection between pain intensity, anxiety, depression and interpersonal relational issues in the context of patients with chronic pain at an outpatient pain clinic. Anxiety and mood were found to be the best predictors for the perception of pain intensity. The results are preliminary, but significantly support the multidisciplinary collaboration of treatment at a pain clinic with mental health professionals.
Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for ...depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment.
A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning.
Highly educated nulliparas and those with a higher level of co-workers' emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers' support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth).
The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.
For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships ...is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics.
The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable.
28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas.
Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas' mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.
BACKGROUNDThe purpose of this study was to examine the relationship between the important indicators that define mental health functioning during the first pregnancy: the level of depression, anxiety ...and fear of childbirth in the context of nulliparas' intimate partner attachment style type and older generation's emotional support. SUBJECTS AND METHODSA group of 325 nulliparas in the third trimester of pregnancy were enrolled at the Childbirth preparation program of the University Medical Centre Ljubljana's Division of Gynaecology and Obstetrics. The following instruments were applied: Experiences in Close Relationships-Revised, The Edinburgh Depression Scale, two aspects of anxiety - Zung Anxiety Scale and a questionnaire regarding fear of childbirth. Attachment anxiety and avoidance scales were recoded into four categories of a prototypical attachment style: secure, fearful, preoccupied and dismissive. Two-way ANOVA and the chi-square test were used for the statistical analysis. RESULTSAll indicators of mental health functioning of our sample of nulliparas differed significantly regarding their partner attachment style. Nulliparas with a fearful, but also with a preoccupied type of attachment, showed less optimal mental health indicators compared to those with a secure/dismissive type of attachment. A significant interactive effect of partner attachment and emotional support from the older generation was found on the level of depression. Partner attachment styles and emotional support from the older generation were found to be statistically dependent. CONCLUSIONSIn our sample a secure attachment seems to represent a protective buffer for the level of depression, even when a lower emotional support of the older generation was included. Screening and intervening on intimate attachment style as a protective factor for antenatal depression and different forms of anxiety is proposed.
Abstract Introduction Using the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an ...18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI). Methods The sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time. Results At the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level. Conclusions Studied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.
Depression, anxiety and chronic pain are frequent co-occurrent disorders. Patients with these mental disorders experience more intense pain that lasts for a longer time.
Questionnaire with 228 ...variables was applied to 109 randomly chosen patients that were treated at an outpatient clinic for treatment of chronic pain of the University Clinical Centre Ljubljana from March to June 2013. 87 patients responded to the questionnaire (79.8%). Location of pain considering diagnosis was the criterion in the discriminant analysis (soft tissue disorders; headache; symptoms not elsewhere classified; back pain) and following summative scores as predictors: level of depression and anxiety (The Zung Self-Rating Depression/Anxiety Scale), evaluation of pain and perceptions of being threatened in social relations.
Average age of participants was M = 52.7 years (SD 13.9), with 70.9% female, 29.1% male participants. 63% of respondents achieved clinically important level of depression and 54% clinically important level of anxiety. On univariate level, the highest level of depression and anxiety was found for back pain and the lowest for headache. No significant difference was found in evaluation of pain and perceptions of being threatened in social relations regarding location of pain. Self-evaluation of depression has, in the framework of discriminant analysis, the largest weight for prediction of differentiation between different locations of pain.
Different locations of pain have different connections with mood levels. The results of research on a preliminary level indicate the need to consider mental experience in the treatment of chronic pain.
Background. Depression, anxiety and chronic pain are frequent co-occurrent disorders. Patients with these mental disorders experience more intense pain that lasts for a longer time.
Method. ...Questionnaire with 228 variables was applied to 109 randomly chosen patients that were treated at an outpatient clinic for treatment of chronic pain of the University Clinical Centre Ljubljana from March to June 2013. 87 patients responded to the questionnaire (79.8%). Location of pain considering diagnosis was the criterion in the discriminant analysis (soft tissue disorders; headache; symptoms not elsewhere classified; back pain) and following summative scores as predictors: level of depression and anxiety (The Zung Self-Rating Depression/Anxiety Scale), evaluation of pain and perceptions of being threatened in social relations.
Results. Average age of participants was M = 52.7 years (SD 13.9), with 70.9% female, 29.1% male participants. 63% of respondents achieved clinically important level of depression and 54% clinically important level of anxiety. On univariate level, the highest level of depression and anxiety was found for back pain and the lowest for headache. No significant difference was found in evaluation of pain and perceptions of being threatened in social relations regarding location of pain. Self-evaluation of depression has, in the framework of discriminant analysis, the largest weight for prediction of differentiation between different locations of pain.
Conclusion. Different locations of pain have different connections with mood levels. The results of research on a preliminary level indicate the need to consider mental experience in the treatment of chronic pain
Izhodišče. Depresija in anksioznost sta pogosti sočasni duševni motnji s kronično bolečino. Bolniki s tema motnjama doživljajo intenzivnejšo bolečino, ki traja dlje časa. Obstajajo tudi socialno-kontekstualni dejavniki bolečine, kot so spremenjena socialna vloga človeka s kronično bolečino oziroma socialna izločenost.
Metoda. Vprašalnike z 228 spremenljivkami smo aplicirali na 109 naključno izbranih bolnikov, ki so se zdravili v Ambulanti za zdravljenje bolečine Kliničnega centra Ljubljana od marca do junija 2013. 87 bolnikov je izpolnilo vprašalnik (79,8 %). V diskriminantni analizi je bil kriterij lokacija bolečine glede na diagnozo (motnja mehkih tkiv; glavobol in živčni pleteži; nespecifični simptomi; bolezni hrbta), kot prediktorji pa seštevne vrednosti depresivnosti (Zungova samoocenjevalna lestvica depresivnosti), anksioznosti (Zungova samoocenjevalna lestvica anksioznosti), evalvacije bolečine in zaznave lastne ogroženosti v socialnih odnosih zaradi bolečine.
Rezultati. Povprečna starost udeležencev je bila 52,7 leta (SD 13,9), 70,9 % žensk in 29,1 % moških. 63 % jih je doseglo klinično pomembno raven depresivnosti in 54 % klinično pomembno raven anksioznosti. Na univariatni ravni smo ugotavljali najvišjo raven depresivnosti in anksioznosti pri lokaciji bolečine v hrbtu, najnižjo pri glavobolu. Med prediktorji diskriminantne analize ima za napoved razlikovanja med bolečinskimi lokacijami izrazito največjo težo samoocena depresivnosti. Gre za zelo visoko korelacijo (0,93). Raven depresivnosti v naturalističnem vzorcu protibolečinske ambulante najbolje napoveduje lokacijo/diagnozo bolečine. Če so udeleženci ocenjevali raven svoje depresivnosti kot visoko, so sodili v skupino z diagnozo bolečine v hrbtu. Udeleženci z diagnozo bolečine v hrbtu tudi v pomembno večjem številu še vedno prebolevajo resne stresorje iz preteklega leta kot udeleženci z drugimi lokacijami bolečine. Udeleženci z lokacijo bolečine glavobol se glede raziskovanih spremenljivk (depresivnost, anksioznost, evalvacija bolečine, zaznava lastne ogroženosti v socialnih odnosih zaradi bolečine) najbolj razlikujejo od udeležencev z drugimi tremi lokacijami bolečine; najbolj so si podobni udeleženci z lokacijo mehkih tkiv in diagnozo nespecifičnih simptomov. Udeleženci pa se glede na lokacijo bolečine niso razlikovali med seboj glede tega, kako škodljivo doživljajo bolečino in kako prizadete se počutijo zaradi bolečine v svojih socialnih odnosih.
Zaključek. Različne lokacije bolečine se na različen način povezujejo z različno ravnijo razpoloženja. V raziskovanem vzorcu je ocena ravni lastne depresivnosti ekskluzivni napovedovalec lokacije bolečine. Rezultati raziskave na preliminarni ravni kažejo potrebo po upoštevanju duševnega doživljanja pri obravnavi bolnikov s kronično bolečino
Objective: In a representative sample of 4700 Slovene high school students, we examined their eating behavior and its correlations with some psychosocial and psychological characteristics with the ...aim of identifying the main risk factors for disordered eating.
Method: Using a questionnaire which also included Zung’s Self-rating Depression Scale and Rosenberg’s Self-Esteem Scale, we compared girls (
n = 2507) and boys (
n = 2193) with regard to their satisfaction with their body weight, weight-reducing activities, and frequency of binge eating. We assessed their family relationships, abuse of alcohol and other psychoactive drugs, suicidal ideation, and suicidal tendences, as well as their level of depression and self-esteem.
Results: The results showed significant differences between girls and boys, between groups of those who were satisfied and those who were dissatisfied with their body weight, and also between groups which indulged in frequent binge eating and those which did not.
Conclusion: Within a general population of adolescents, there is a substantial number of subjects with disordered eating behavior, some part of whom are at high risk for eating disorders.
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