Qualitative researchers often engage in work addressing challenging, difficult, or sensitive topics and are consequently exposed to the participants’ narratives which may be emotionally charged, ...distressing, or compromising. These narratives occasionally rest heavy on a researcher’s conscience or may linger in the mind. Much literature has assessed how best to keep participants safe, but less attention has been given to how we keep researchers safe. We therefore document the following: (1) Our experiences of the issues presented by undertaking qualitative research involving challenging, difficult, or sensitive topics; and (2) Practical principles devised to overcome these issues, ensuring safety and wellbeing amongst researchers engaging in these types of qualitative research. We provide guidance for qualitative researchers of all levels of experience and expertise on how best to protect and support themselves, their colleagues, and other collaborating research staff, when undertaking qualitative research which might otherwise feel uncomfortable or overwhelming to tackle.
•The heterogeneity of postpartum psychosis poses diagnostic challenges.•Although generally considered a rare entity, more than 16% of women with bipolar disorder have a manic, mixed or psychotic ...episode after childbirth.•There is paucity of data on the identification of women at risk of having postpartum psychosis.•Managing the predisposing, precipitating, perpetuating, and protective factors has the potential to improve the short- and long-term prognosis of postpartum psychosis.
To review the phenomenology, nosology, and treatment of postpartum psychosis.
Using the keywords postpartum, puerperal, psychosis, bipolar, mania, depression, classification, nosology, phenomenology, diagnosis, suicide, infanticide, and treatment, four electronic databases, MEDLINE/PubMed (1966–2020), PsycINFO (1806–2020), EMBASE (1980–2020), and the Cochrane Database of Systematic Reviews were searched. We also searched the reference lists of articles identified to find articles of interest.
There is a lack of consensus about the diagnostic criteria. Although it is usually considered a rare entity, as many as 16% of women with bipolar I disorder have mood or psychotic episodes that meet the contemporary definition of postpartum psychosis. There is a paucity of data on the identification of women at risk of having postpartum psychosis. Atypical antipsychotics and lithium are commonly recommended for acute treatment of postpartum psychosis, however, there are no randomised trials of drugs in the acute treatment of manic/mixed or depressive episodes with psychosis in the postpartum period.
This is not a systematic review but rather a selective appraisal of the literature.
Controversies surrounding its phenomenology and nosology have probably prevented consensus about its management. Accurate diagnosis of postpartum psychosis is crucial for suicide risk assessment and prediction, and treatment planning. As much as possible clinicians should consider applying the DSM-5 nomenclature to characterize disorders subsumed under the umbrella of postpartum psychosis. A nuanced approach that takes into consideration the predisposing, precipitating, perpetuating, and protective factors could potentially improve the short- and long-term prognosis of postpartum psychosis.
Global crises inevitably increase levels of anxiety in postpartum populations. Effective and efficient measurement is therefore essential. This study aimed to create a 12-item research short form of ...the 51-item Postpartum Specific Anxiety Scale PSAS and validate it for use in rapid response research at a time of global crises PSAS-RSF-C. We also present the same 12-items, in five other languages (Italian, French, Chinese, Spanish, Dutch) to increase global accessibility of a psychometric tool to assess maternal mental health.
Twelve items from the PSAS were selected on the basis of a review of their factor loadings. An on-line sample of UK mothers (N = 710) of infants up to 12 weeks old completed the PSAS-RSF-C during COVID-19 'lockdown'.
Principal component analyses on a randomly split sample (n = 344) revealed four factors, identical in nature to the original PSAS, which in combination explained 75% of the total variance. Confirmatory factor analyses (n = 366) demonstrated the four-factor model fit the data well. Reliability of the overall scale and of the underlying factors in both samples proved excellent.
Findings suggest the PSAS-RSF-C may prove useful as a clinical screening tool and is the first postpartum-specific psychometric scale to be validated during the COVID-19 pandemic. This offers psychometrically sound assessment of postpartum anxiety. By increasing the accessibility of the PSAS, we aim to enable researchers the opportunity to measure maternal anxiety, rapidly, at times of global crisis.
Bilirubin toxicity to the central nervous system (CNS) is responsible for severe and permanent neurologic damage, resulting in hearing loss, cognitive, and movement impairment. Timely and effective ...management of severe neonatal hyperbilirubinemia by phototherapy or exchange transfusion is crucial for avoiding permanent neurological consequences, but these therapies are not always possible, particularly in low-income countries. To explore alternative options, we investigated a pharmaceutical approach focused on protecting the CNS from pigment toxicity, independently from serum bilirubin level. To this goal, we tested the ability of curcumin, a nutraceutical already used with relevant results in animal models as well as in clinics in other diseases, in the Gunn rat, the spontaneous model of neonatal hyperbilirubinemia. Curcumin treatment fully abolished the landmark cerebellar hypoplasia of Gunn rat, restoring the histological features, and reverting the behavioral abnormalities present in the hyperbilirubinemic rat. The protection was mediated by a multi-target action on the main bilirubin-induced pathological mechanism ongoing CNS damage (inflammation, redox imbalance, and glutamate neurotoxicity). If confirmed by independent studies, the result suggests the potential of curcumin as an alternative/complementary approach to bilirubin-induced brain damage in the clinical scenario.
...the COVID-19 pandemic represents a particularly challenging circumstance for PPW with potential adverse outcomes on maternal mental health. ...meta-analysis evidence makes it clear that the ...“objective and subjective social isolation” influences physical and mental health similar to that of well-known biomedical risk factors (e.g., tobacco consumption, lack of physical activity) (Holt-Lunstad et al., 2015). ...the unpredictable situation of being unemployer with a reduced household income can be considered a very stressful event that can lead to psychologicaistress (Sareen et al., 2011). ...a study carrieut in north-eastern Italy found higher levels of depressive symptomatology in the immediate postpartum period among women who gave birth during an active periof COVID-19 quarantine than in women whose delivery occurred in the same perione year earlier (Zanardo et al., 2020). ...this issue constitutes another critical gap te addressed, specifically on how preventive measures involving confinement and sociaistancing may affect PPW and their newborns in terms of their mental well-being and their access to the adequate prenatal and postnatal care they need aneserve.
Introduction
While often positive, the lifecourse transition to motherhood is susceptible to the risk for developing mood disorders. Postpartum anxiety has often been overshadowed by other ...perinatal-specific mental health disorders, such as postpartum depression, and therefore has not been at the forefront or center of as much empirical study. This has meant there is a lack of effective and reliable tools with which to measure it, despite growing evidence suggesting its detrimental impact on mothers, their babies, wider family and social contacts, and on healthcare systems. This current study aimed to translate and validate the Postpartum Specific Anxiety Scale PSAS into the Italian language, and to validate the tool for its use in detecting anxiety specific to motherhood.
Methods
The study (
N
= 457) comprised 4 stages: English-Italian translation and back-translation to obtain the Italian version PSAS-IT; a preliminary pilot study to adapt the PSAS to the characteristics of the Italian population; measurement invariance; and internal reliability of subscales.
Results
The PSAS-IT demonstrates similar psychometric properties as the original English-language PSAS, with acceptable acceptability, construct and convergent validity, and internal consistency. Confirmatory factor analysis for multiple groups (Italy and United Kingdom) showed that the factor structure of the PSAS was valid for both groups
χ
2
(2436) = 4679.481,
p
< 0.001, TLI = 0.969, CFI =0.972, RMSEA = 0.045, SRMR =0.064.
Discussion
The resulting findings offer a reliable measure of postpartum anxiety in Italian language up to six months after birth.
The role of anxiety is unknown in relation to postpartum bonding, unlike the well-known detrimental effect that postpartum depression has on the relationship between a mother and child. This study ...investigates how anxiety affects mother–infant bonding after childbirth, comparing the Italian version of the Postpartum Specific Anxiety Scale (PSAS-IT) with generalized measures of anxiety. Examining 324 non-randomly-selected participants responding to various scales, including the Edinburgh postnatal depression scale (EPDS), generalized anxiety disorder (GAD), postpartum-specific anxiety scale (PSAS-IT), postpartum bonding questionnaire (PBQ), and baby care questionnaire (BCQ-2), initial results suggest a link between certain postpartum anxiety symptoms and attachment problems. Surprisingly, anxiety measured with the PSAS has no direct influence on attachment; however, it is a strong predictor of bonding, even when maternal age, general anxiety, and depression are taken into account, explaining 3% of the variance in scores (β = 0.26, p < 0.001). This emphasizes the importance of early identification and intervention of postpartum anxiety in promoting bonding between mother and child.
This study aims to explore the clinical and socio-demographic characteristics of 30 women who committed filicide and compare them to those of 60 postpartum women who did not commit filicide, ...including 30 with severe postpartum mental illness and 30 without a known history of psychiatric disorders. Clinical assessment included a face-to-face interview with the Structured Clinical Interviews for DSM-IV Axis I and Axis II Disorders. Information on socio-economic, medical, and personal factors was collected using the Clinical Interview for DSM-IV and organized in a clinical vignette and OPCRIT ratings. Consensus best-estimate diagnoses were made according to DSM-V criteria. Inference was conducted using Fisher's exact test for categorical variables and Mann-Whitney U rank test for continuous variables. Family history of violent death, psychotic symptoms (OR 8.3; CI 95% 2.26-36.13), severe insomnia (9.8; 2.28-61.75), and a schizophrenia spectrum or bipolar diathesis (4.8; 1.22-23.86) were associated with history of filicide. Rates of history of sexual abuse in childhood were higher in both the filicide and the severe postpartum mental illness groups compared to healthy controls (6.7; 1.25-70.46 and 7.8; 1.47; 80.47 respectively). Conversely, we did not observe any difference in the rates of history of sexual abuse in adulthood across groups. The lack of adequate postpartum psychiatric care was an important precipitating factor in many cases of infanticide and even late filicide. This study underscores the need for increasing awareness by health care professionals and the wider society of the complex dynamics and psychiatric risks associated with motherhood.
Summary
Suicidal risk in mothers is a public health priority. Risk factors include biological, psychological and psychosocial factors. Among the biological factors, the role of sleep disturbances as ...potential contributors to increased suicidal risk during the peripartum period is becoming apparent. To explore this further, we conducted a systematic review following the PRISMA criteria. Currently, 10 studies have examined the role of insomnia and poor sleep quality in suicidal risk during the peripartum period and have involved 807,760 women. The data showed that disturbed sleep and poor sleep quality increase the risk of suicidal ideation in both pregnant women with and without perinatal depression. The results of the meta‐analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63–4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58–5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83–12.34; p < 0.001). These findings emphasise the importance of assessing and addressing sleep disturbances during the peripartum period to mitigate their adverse effects on peripartum psychopathology and suicidal risk.
Abstract The current study examined whether attachment theory could contribute to identifying risk factors involved in filicide. Participants were 121 women: mothers from the normative population ...(NPM, n = 61), mothers with mental illness (MIM, n = 37), and filicidal mothers, i.e., mothers who had murdered their child (FM, n = 23). Descriptive variables were collected and the Adult Attachment Interview was used to assess mental representations of attachment relationships using the traditional coding system and the Hostile/Helpless (HH) attachment state of mind coding. Unresolved, Insecure, Entangled, and Helpless representations of attachment relationships were overrepresented in the FM group. When a constellation of descriptive and attachment-based risk factors was taken into account, the HH attachment state of mind was found to contribute significantly to distinguishing between MIM and FM groups. As predicted, when the Bayesian Information Criterion was applied to multinomial regression models, descriptive variables were shown to be less able alone than in association with attachment-based classifications to disentangle the increased risk for committing filicide.
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