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

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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.

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Notes

  1. 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.

References

  • 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 37:539–542

    Article  PubMed  Google Scholar 

  • 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):760–763

    Article  CAS  PubMed  Google Scholar 

  • 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):551–555

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • 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):1390–1398

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):91–97

    Article  CAS  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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 49:353–358

    Article  PubMed  Google Scholar 

  • 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):423–430

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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):732–740

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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):603–612

    Article  CAS  PubMed  Google Scholar 

  • 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):223–228

    PubMed  Google Scholar 

  • 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 117:1127–1138

    Article  CAS  PubMed  Google Scholar 

  • 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 13:147

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):1–15

    Article  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):197–203

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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):147–157

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  • 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 14:227–238

    Article  PubMed  Google Scholar 

  • 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):173–181

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

  • 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 31:60–69

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):302–307

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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):69–77

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • 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:2193–2202

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  • 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 14:731–747

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  • 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):563–572

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Acknowledgments

Thanks to Dr. Cheryl Beck for her guidance and collaboration with this project, and to DeVora Gilliam and Valerie Williams for distribution of the screening tool. A special thanks to the women and men in The Center for Fetal Diagnosis and Treatment for their willingness to provide our team with further insight into the unique psychological risks of this highly understudied population.

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The authors declare that they have no conflict of interest.

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Correspondence to Joanna C. M. Cole.

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Cole, J.C.M., Moldenhauer, J.S., Berger, K. et al. Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality. Arch Womens Ment Health 19, 443–453 (2016). https://doi.org/10.1007/s00737-015-0580-6

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  • DOI: https://doi.org/10.1007/s00737-015-0580-6

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