Bidirectional relationship between intraindividual changes in behavioral activation and intraindividual changes in postpartum depressive symptoms: A random intercept cross-lagged panel model.

According to Lewisohn's model of depression, decreases in behavioral activation (BA) occurring after facing a vital stressor may increase the risk of depression. Transition to parenthood is a potentially stressful life event that increases the risks of postpartum depression. We aimed to (a) describe the changes in BA and depressive symptomatology between the prepartum period, 1 month, 3 months, and 6 months postpartum and (b) evaluate the bidirectionality of the relationship between intraindividual changes in BA and intraindividual changes in depressive symptoms longitudinally. Chilean pregnant women (N = 503) completed a battery of questionnaires when they were between 32 and 37 weeks of gestation and 1, 3, and 6 months after delivery. A repeated measures analysis of variance showed that BA significantly decreased from prepartum to 1 month postpartum. A random intercept cross-lagged panel model supported the bidirectional inverse relationship between intraindividual changes in BA and intraindividual changes in depressive symptoms. The effect sizes of these associations were large (ßs ranging from -.141 to -.243) according to Orth et al. (2022)'s recommendations for cross-lagged effect benchmarks. This relationship showed robustness when multigroup random intercept cross-lagged panel models were conducted to adjust for several covariates (i.e., marital status, the type of health insurance, type of delivery, primiparous vs. multiparous participants, and pregnancy or delivery complication or newborn health problem). Nonetheless, reporting a previous history of major depression moderated this relationship so that intraindividual decreases in BA more likely led to intraindividual increases in depressive symptoms in people with a history of depression than in people without such a history. We discuss implications for behavioral models of depression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Antecedente de depresión, síntomas de estrés postraumático, apoyo social percibido: prediciendo la depresión posparto / History of depression, post-traumatic stress symptoms, perceived social support: predicting postpartum depression

Objetivo: Describir y analizar si el apoyo social percibido modera la relación entre antecedente de depresión (AD) o síntomas de trastorno de estrés postraumático (TEPT) y desarrollo de síntomas de depresión posparto (SDPP), evaluado prospectivamente. Método: Diseño longitudinal de tres tiempos: antes del parto (n = 458), primer mes posparto (n = 406) y tercer mes posparto (n = 426). Se utilizaron la Escala de Depresión Posparto de Edimburgo (EPDS), la Escala de Síntomas de Estrés Postraumático (PCL-C) y la Escala de Apoyo Social Percibido (MOS). Se realizó un análisis de ocho modelos jerárquicos de regresión lineal múltiple, por cada tiempo de evaluación en el estudio. Resultados: Se encontró una asociación significativa entre síntomas de TEPT y puntaje de SDPP en los tres tiempos. El apoyo social percibido es un factor protector significativo para los SDPP en los tiempos 1 y 2, mientras que el AD es un factor de riesgo significativo en los tiempos 2 y 3. Los resultados no apoyan las hipótesis de interacción. Conclusiones: El apoyo social es un factor protector significativo, que puede disminuir los SDPP; sin embargo, disminuye con el tiempo. El apoyo social no logra revertir la asociación de los síntomas de TEPT con el puntaje en SDPP.

Objective: Describe and analyze if the perceived social support moderates the relationship between depression history or post-traumatic stress disorder symptoms and the development of symptoms of postpartum depression, prospectively evaluated. Method: Longitudinal design of three times: before partum (n = 458), one month (n = 458) and 3 months postpartum (n = 458). The version of the Edinburgh Postnatal Depression Scale (EPDS), the version of the PTSD Checklist-Civilian Version (PCL-C), and the version of the Medical Outcomes Study Social Support Survey (MOS) were used. Analysis of eight hierarchical multiple linear regression models. Results: A significant association was found between symptoms of post-traumatic stress and postpartum depression, in the three times measured. The perceived social support variable was found to be a significant protective factor for perinatal depression in times 1 and 2, and history of depression was significant in times 2 and 3. The results do not support the interaction hypothesis. Conclusions: Social support is a significant protective factor, which can reduce the symptoms of postpartum depression, nevertheless the significance decreases over time. However, social support fails to reverse the association of post-traumatic stress disorder symptoms with symptoms of postpartum depression score.

Pain Intensity Predicts Pain Catastrophizing During the Postpartum Period: A Longitudinal Random Intercept Cross-Lagged Panel Study.

OBJECTIVE: Pain catastrophizing is an important psychological predictor of pain. Recent evidence suggests the relationship between catastrophizing and pain intensity could be bidirectional, but most studies have been conducted on chronic pain patients and using criticized statistical methods. The present study aimed to examine if the relationship between pain intensity and catastrophizing was bidirectional in the context of childbirth. METHODS: A total of 504 women without chronic pain were recruited on their 32-37 gestational week. They completed measures of catastrophizing and pain intensity on the first encounter and then again at 1, 3, and 6 months postpartum. The temporal relationship between the variables was assessed using a random intercept cross-lagged panel model. RESULTS: The hypothesis of reciprocal association did not receive support, as pain intensity predicted catastrophizing during the postpartum period, but catastrophizing did not show an effect over pain intensity at any moment. CONCLUSIONS: Pain intensity predicting catastrophizing is consistent with previous literature, while the lack of effect of catastrophizing over pain intensity is an unexpected result, which may suggest that catastrophizing plays a different role in the postpartum period. These results highlight the importance of timely efforts for pain management during the postpartum period and contribute to the theoretical conceptualization of catastrophizing.

Psychometric Properties of the Fibromyalgia Survey Questionnaire in Chilean Women With Fibromyalgia.

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Chilean version of the Fibromyalgia Survey Questionnaire (FSQ). METHODS: Women with fibromyalgia (FM; n = 214), women with rheumatoid arthritis (RA; n = 97), and women without chronic pain (being followed by Gynecology, G; n = 117) from the Red de Salud UC CHRISTUS (Santiago, Chile) participated. Women with FM completed the FSQ, Fibromyalgia Impact Questionnaire (Revised Version), Numerical Pain Rating Scale, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Patient Health Questionnaire 15, and Short-Form Health Survey. Two weeks later, they completed the FSQ again by phone (n = 120). RESULTS: The FSQ total scale showed excellent to good internal consistency at T1 (α = 0.91, ω = 0.91) and T2 (α = 0.78, ω = 0.78), and good test-retest reliability (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.72-0.85). It showed medium to large correlations with the other measures. Discriminant analysis between the FM group and the control group (RA and G) revealed that the FSQ total scale reached a classification accuracy of 81.3%. Receiver operating characteristic curve (adjusted area under the curve, 0.88; 95% CI, 0.85-0.92) showed that the best FSQ cutoff was 17, resulting in sensitivity of 89% (95% CI, 0.84-0.93) and specificity of 75% (95% CI, 0.69-0.80). Considering the FM diagnosis performed by a rheumatologist as the criterion standard, sensitivity and specificity of the modified 2010 American College of Rheumatology preliminary criteria for FM were 92.8% (95% CI, 0.88-0.96) and 63.4% (95% CI, 0.57-0.70), respectively. CONCLUSIONS: The Chilean version of the FSQ presents good psychometric properties and is a useful tool in clinical settings to assist in FM diagnosis and symptom assessment. A cutoff score of 17 or higher seems to be the most appropriate for Chilean population.

Humor Improves Women's but Impairs Men's Iowa Gambling Task Performance.

The Iowa Gambling Task (IGT) is a popular method for examining real-life decision-making. Research has shown gender related differences in performance, in that men consistently outperform women. It has been suggested that these performance differences are related to decreased emotional control in women compared to men. Given the likely role of emotion in these gender differences, in the present study, we examine the effect of a humor induction on IGT performance and whether the effect of humor is moderated by gender. IGT performance and parameters from the Expectancy Valence Model (EVM) were measured in 68 university students (34 men; mean age 22.02, SD = 4.3 and 34 women; mean age 22.3, SD = 4.1) during a 100 trial-IGT task. Participants were exposed to a brief video before each of the IGT decisions available; one half of the samples (17 men and 17 women) was exposed to 100 humor videos, while the other half was exposed to 100 non-humor videos during the task. We observed a significant interaction between gender and humor, such that under humor, women's performance during the last block (trials 80-100) improved (compared to women under non-humor), whereas men's performance during the last block was worse (compared to men under non-humor). Consistent with previous work, under non-humor, men outperformed women in the last block. Lastly, our EVM results show that humor impacts the learning mechanisms of decision-making differently in men and women. Humor impaired men's ability to acquire knowledge about the payoff structure of the decks, and as a consequence, they were stuck in suboptimal performance. On the other hand, humor facilitated women's ability to explore and to learn from experience, improving performance. These findings deepen our understanding of the mechanisms underlying IGT decision-making and differential effects of humor in men and women.

The efficacy of adding group behavioral activation to usual care in patients with fibromyalgia and major depression: design and protocol for a randomized clinical trial.

BACKGROUND: Fibromyalgia and major depression frequently co-occur. Patients with both conditions have a worse prognosis and higher disability, and their treatment options are scarce. Behavioral activation (BA) may be an especially useful intervention for these patients, as it targets mechanisms of action that seem to be common to both disorders. Nevertheless, its efficacy has not been examined in people with both conditions. We describe the design and rationale of a randomized clinical trial aimed to evaluate the efficacy of adding BA (applied in groups) to usual care in order to reduce the severity of depressive symptoms (primary outcome) among Chilean women with fibromyalgia and major depression (N = 90). Pain intensity, fibromyalgia impact, pain catastrophizing and hypervigilance, physical health symptoms, environmental reward, and BA will be evaluated as secondary outcomes. METHODS: Women will be randomized to an experimental arm (n = 45) which will receive usual care (UC) for fibromyalgia with comorbid depression plus BA; and a comparison arm, which will receive only UC for fibromyalgia with comorbid depression (n = 45). Outcome assessment will take place at four time points: (1) at baseline, (2) when the experimental arm is under treatment (between sessions 6 and 7), (3) immediately after the experimental arm complete the treatment, and (4) at a 3-month follow-up. The following instruments will be used: Chilean version of the Patient Health Questionnaire-9 (PHQ-9), Composed Pain Intensity Index, Fibromyalgia Impact Questionnaire Revised (FIQ-R), Pain Catastrophizing Scale (PCS), Pain Vigilance and Awareness Questionnaire (PVAQ), Patient Health Questionnaire (PHQ-15), Reward Probability Index (RPI), and the Activation subscale of the Behavioral Activation for Depression Scale (BADS). DISCUSSION: We expect that, after treatment, the group receiving BA should experience greater reductions in the primary and secondary outcomes than the group receiving only UC. These reductions should be both statistically and clinically significant and will be maintained at follow-up. This study will contribute to facilitate the integrated treatment of fibromyalgia and depression. TRIAL REGISTRATION: ClinicalTrials.gov under the name "Testing Interventions for Patients with Fibromyalgia and Depression," Identifier: NCT03207828 . Registered on 5 July 2017 (last update posted 21 September 2017).

Improving maternity care in the Dominican Republic: a pilot study of a community-based participatory research action plan by an international healthcare team.

This article is a report of the process and results of a feasibility pilot study to improve the quality of maternity care in a sample of 31 women and their newborns delivering in a public, tertiary hospital in the Dominican Republic. The pilot study was the first "action step" taken as a result of a formative, community-based participatory research (CBPR) study conducted between 2008 and 2010 by an interdisciplinary, international partnership of U.S. academic researchers, Dominican medical/nursing personnel, and Dominican community health workers. Health personnel and community health workers separately identified indicators most important to measure quality of antepartum maternity care: laboratory and diagnostic studies and respectful, interpersonal communication. At the midpoint and the completion of data collection, the CBPR team evaluated the change in quality indicators to assess improvement in care. The pilot study supports the idea that joint engagement of community health workers, health personnel, and academic researchers with data creation and patient monitoring is motivating for all to continue to improve services in the cultural context of the Dominican Republic.

A community-based participatory research approach to explore community perceptions of the quality of maternal-newborn health services in the Dominican Republic.

OBJECTIVE: to understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality. DESIGN: qualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change. SETTING: four urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital. PARTICIPANTS: adolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team. MEASUREMENTS AND FINDINGS: following informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services. KEY CONCLUSIONS AND IMPLICATIONS: this study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.

Repercusión de un programa de mejora continúa en los registros de enfermería / Impact of the continuous improvement program in the clinical nursing records

Los registros presentes en las hojas de enfermería; son el soporte de los cuidados que la enfermera brinda a cada uno de los pacientes que le son asignados en su jornada laboral, además de ser un elemento importante en la continuidad y toma de decisiones para la gestión del cuidado; por lo tanto deben cubrir ciertos requisitos que favorezcan la permanencia y seguridad del cuidado.