Support interventions to reduce psychological distress in families experiencing stillbirth in high income countries: A systematic review.

BACKGROUND: Previous research indicates disparities in the care of bereaved parents and siblings following a stillbirth in the family. The aim of this systematic review was to assess the effects of interventions aimed at reducing psychological distress among parents or siblings in high-income countries after experiencing a stillbirth. METHODS: The databases CINAHL, Medline, PsycInfo, Cochrane Library, and EMBASE were searched in August 2022. RESULTS: Four intervention studies from the United States (US), the United Kingdom (UK), Finland, and Australia, met the inclusion criteria. The interventions comprised a perinatal grief support team; a perinatal counselling service; a grief support program; and a support package including contacts with peer supporters and health care staff. No studies of interventions for siblings were found. The results could not be synthesised due to disparities in interventions and outcome measures. The risk of bias was assessed as high in all four studies and the certainty for all outcomes was rated as very low. CONCLUSION: More controlled trials with rigorous methods are needed to evaluate the effect of bereavement support interventions in parents and siblings after stillbirth. Future studies should include a core outcome set to make them more comparable. Most of the studies in this review were assessed to have an overall high risk of bias, mainly due to problems with missing outcome data; thus, future studies could specifically target this problem.

Treatments for hyperemesis gravidarum: A systematic review.

INTRODUCTION: Hyperemesis gravidarum affects 0.3%-3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up-to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians. MATERIAL AND METHODS: Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non-randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health-related quality of life, small-for-gestational-age infant; and preterm birth. Abstracts and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta-analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150). RESULTS: Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence. CONCLUSIONS: Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies.

Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy.

INTRODUCTION: Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. MATERIAL AND METHODS: On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). REGISTRATION: PROSPERO CRD42021236333. RESULTS: We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92). CONCLUSIONS: Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

Care and support when a baby is stillborn: A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries.

INTRODUCTION: Approximately 2 million babies are stillborn annually worldwide, most in low- and middle-income countries. Present review studies of the parental and healthcare providers' experiences of stillbirth often include a variety of settings, which may skew the findings as the available resources can vary considerably. In high-income countries, the prevalence of stillbirth is low, and support programs are often initiated immediately when a baby with no signs of life is detected. There is limited knowledge about what matters to parents, siblings, and healthcare providers when a baby is stillborn in high-income countries. OBJECTIVES: This systematic review and interpretive meta-synthesis aim to identify important aspects of care and support for parents, siblings, and healthcare professionals in high-income countries from the diagnosis of stillbirth throughout the birth and postpartum period. METHODS: A systematic review and qualitative meta-synthesis were conducted to gain a deeper and broader understanding of the available knowledge about treatment and support when stillbirth occurred. Relevant papers were identified by systematically searching international electronic databases and citation tracking. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol, including qualitative and quantitative study approaches, was registered on PROSPERO (CRD42022306655). RESULTS: Sixteen studies were identified and included in the qualitative meta-synthesis. Experiences of care and support were interpreted and identified as four fusions. First, Personification is of central importance and stresses the need to acknowledge the baby as a unique person. The parents became parents even though their baby was born dead: The staff should also be recognised as the individuals they are with their personal histories. Second, the personification is reinforced by a respectful attitude where the parents are confirmed in their grief; the baby is treated the same way a live baby would be. Healthcare professionals need enough time to process their experiences before caring for other families giving birth. Third, Existential issues about life and death become intensely tangible for everyone involved, and they often feel lonely and vulnerable. Healthcare professionals also reflect on the thin line between life and death and often question their performance, especially when lacking collegial and organisational support. Finally, the fusion Stigmatisation focused on how parents, siblings, and healthcare professionals experienced stigma expressed as a sense of loneliness, vulnerability, and being deviant and marginalised when a baby died before or during birth. GRADE CERQual ratings for the four fusions ranged from moderate to high confidence. CONCLUSIONS: The profound experiences synthesised in the fusions of this meta-synthesis showed the complex impacts the birth of a baby with no signs of life had on everyone involved. These fusions can be addressed and supported by applying person-centred care to all individuals involved. Hence, grief may be facilitated for parents and siblings, and healthcare professionals may be provided with good conditions in their professional practice. Furthermore, continuing education and support to healthcare professionals may facilitate them to provide compassionate care and support to affected parents and siblings. The fusions should also be considered when implementing national recommendations, guidelines, and clinical practice.

Age differences in brain systems supporting transient and sustained processes involved in prospective memory and working memory.

In prospective memory (PM), an intention to act in response to an external event is formed, retained, and at a later stage, when the event occurs, the relevant action is performed. PM typically shows a decline in late adulthood, which might affect functions of daily living. The neural correlates of this decline are not well understood. Here, 15 young (6 female; age range=23-30years) and 16 older adults (5 female; age range=64-74years) were scanned with fMRI to examine age-related differences in brain activation associated with event-based PM using a task that facilitated the separation of transient and sustained components of PM. We show that older adults had reduced performance in conditions with high demands on prospective and working memory, while no age-difference was observed in low-demanding tasks. Across age groups, PM task performance activated separate sets of brain regions for transient and sustained responses. Age-differences in transient activation were found in fronto-striatal and MTL regions, with young adults showing more activation than older adults. Increased activation in young, compared to older adults, was also found for sustained PM activation in the IFG. These results provide new evidence that PM relies on dissociable transient and sustained cognitive processes, and that age-related deficits in PM can be explained by an inability to recruit PM-related brain networks in old age.

Brain systems underlying attentional control and emotional distraction during working memory encoding.

Goal-directed behavior requires that cognitive operations can be protected from emotional distraction induced by task-irrelevant emotional stimuli. The brain processes involved in attending to relevant information while filtering out irrelevant information are still largely unknown. To investigate the neural and behavioral underpinnings of attending to task-relevant emotional stimuli while ignoring irrelevant stimuli, we used fMRI to assess brain responses during attentional instructed encoding within an emotional working memory (WM) paradigm. We showed that instructed attention to emotion during WM encoding resulted in enhanced performance, by means of increased memory performance and reduced reaction time, compared to passive viewing. A similar performance benefit was also demonstrated for recognition memory performance, although for positive pictures only. Functional MRI data revealed a network of regions involved in directed attention to emotional information for both positive and negative pictures that included medial and lateral prefrontal cortices, fusiform gyrus, insula, the parahippocampal gyrus, and the amygdala. Moreover, we demonstrate that regions in the striatum, and regions associated with the default-mode network were differentially activated for emotional distraction compared to neutral distraction. Activation in a sub-set of these regions was related to individual differences in WM and recognition memory performance, thus likely contributing to performing the task at an optimal level. The present results provide initial insights into the behavioral and neural consequences of instructed attention and emotional distraction during WM encoding.

Controlling the emotional heart: heart rate biofeedback improves cardiac control during emotional reactions.

When regulating negative emotional reactions, one goal is to reduce physiological reactions. However, not all regulation strategies succeed in doing that. We tested whether heart rate biofeedback helped participants reduce physiological reactions in response to negative and neutral pictures. When viewing neutral pictures, participants could regulate their heart rate whether the heart rate feedback was real or not. In contrast, when viewing negative pictures, participants could regulate heart rate only when feedback was real. Ratings of task success paralleled heart rate. Participants' general level of anxiety, emotion awareness, or cognitive emotion regulation strategies did not influence the results. Our findings show that accurate online heart rate biofeedback provides an efficient way to down-regulate autonomic physiological reactions when encountering negative stimuli.

Learned cardiac control with heart rate biofeedback transfers to emotional reactions.

Emotions involve subjective feelings, action tendencies and physiological reactions. Earlier findings suggest that biofeedback might provide a way to regulate the physiological components of emotions. The present study investigates if learned heart rate regulation with biofeedback transfers to emotional situations without biofeedback. First, participants learned to decrease heart rate using biofeedback. Then, inter-individual differences in the acquired skill predicted how well they could decrease heart rate reactivity when later exposed to negative arousing pictures without biofeedback. These findings suggest that (i) short lasting biofeedback training improves heart rate regulation and (ii) the learned ability transfers to emotion challenging situations without biofeedback. Thus, heart rate biofeedback training may enable regulation of bodily aspects of emotion also when feedback is not available.

Who are you looking at? The influence of face gender on visual attention and memory for own- and other-race faces.

Previous research suggests that the own-race bias (ORB) in memory for faces is a result of other-race faces receiving less visual attention at encoding. As women typically display an own-gender bias in memory for faces and men do not, we investigated whether face gender and sex of viewer influenced visual attention and memory for own- and other-race faces, and if preferential viewing of own-race faces contributed to the ORB in memory. Participants viewed pairs of female or male own- and other-race faces while their viewing time was recorded. Afterwards, they completed a surprise memory test. We found that (1) other-race males received the initial focus of attention, (2) own-race faces were viewed longer than other-race faces over time, although the difference was larger for female faces, and (3) even though longer viewing time increased the probability of remembering a face, it did not explain the magnified ORB in memory for female faces. Importantly, these findings highlight that face gender moderates attentional responses to and memory for own- and other-race faces.

Emotional responses in spider fear are closely related to picture awareness.

Theories of emotion propose that responses to emotional pictures can occur independently of whether or not people are aware of the picture content. Because evidence from dissociation paradigms is inconclusive, we manipulated picture awareness gradually and studied whether emotional responses varied with degree of awareness. Spider fearful and non-fearful participants viewed pictures of spiders and flowers at four levels of backward masking while electrodermal activity and heart rate were measured continuously. Recognition ratings confirmed that participants' picture awareness decreased with masking. Critically, effects of spider fear on emotion ratings and heart rate also decreased with masking. These findings suggest that effects of spider fear on emotion ratings and heart rate are closely related to picture awareness.

Never mind the spider: late positive potentials to phobic threat at fixation are unaffected by perceptual load.

Research suggests that processing of emotional stimuli may be eliminated if a concurrent task places sufficient demands on attentional resources. To test whether this holds for stimuli with strong emotional significance, pictures of spiders as well as mushrooms were presented at fixation to spider-fearful and non-fearful participants. Concurrently, perceptual load was manipulated in two levels with a peripheral letter discrimination task. Results of event-related potentials showed that, compared with non-fearful participants, spider-fearful participants showed greater late positive potentials (LPP) to spiders than mushrooms, which provides a manipulation check that spiders were emotionally meaningful to spider-fearful participants. Critically, this effect was not affected by level of perceptual load. These findings suggest that strong emotional stimuli at fixation may resist manipulations of perceptual load.

What you fear will appear: detection of schematic spiders in spider fear.

Various experimental tasks suggest that fear guides attention. However, because these tasks often lack ecological validity, it is unclear to what extent results from these tasks can be generalized to real-life situations. In change detection tasks, a brief interruption of the visual input (i.e., a blank interval or a scene cut) often results in undetected changes in the scene. This setup resembles real-life viewing behavior and is used here to increase ecological validity of the attentional task without compromising control over the stimuli presented. Spider-fearful and nonfearful women detected schematic spiders and flowers that were added to one of two identical background pictures that alternated with a brief blank in between them (i.e., flicker paradigm). Results showed that spider-fearful women detected spiders (but not flowers) faster than did nonfearful women. Because spiders and flowers had similar low-level features, these findings suggest that fear guides attention on the basis of object features rather than simple low-level features.

Recognizing masked threat: fear betrays, but disgust you can trust.

If emotions guide consciousness, people may recognize degraded objects in center view more accurately if they either fear the objects or are disgusted by them. Therefore, we studied whether recognition of spiders and snakes correlates with individual differences in spider fear, snake fear, and disgust sensitivity. Female students performed a recognition task with pictures of spiders, snakes, flowers, and mushrooms as well as blanks. Pictures were backward masked to reduce picture visibility. Signal detection analyses showed that recognition of spiders and snakes was correlated with disgust sensitivity but not with fear of spiders or snakes. Further, spider fear correlated with the tendency to misinterpret blanks as threatening (response bias). These findings suggest that effects on recognition and response biases to emotional pictures vary for different emotions and emotional traits. Whereas fear may induce response biases, disgust may facilitate recognition.