Reproductive health in women with serious mental illnesses
TL;DR: It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population.
Abstract: Aims and objectives To determine what problems female psychiatric patients have in terms of reproductive health. Background The reproductive health problems faced by female psychiatric patients are matters that have been neglected in the areas of both psychiatry and women's health. This study aims to make a contribution from Turkey to the literature in this neglected field. Design The study is descriptive and was conducted with 292 female patients treated in an acute inpatient psychiatric ward. Methods Data were collected through face-to-face interviews and a questionnaire based on the literature and prepared by the researchers which was designed to determine the kinds of reproductive health issues the patients were experiencing. Results It was found that compared with healthy women, the distinctive features of the participants in terms of sexuality were more negative; in particular, patients diagnosed with bipolar disorder were more likely to have been forced by their partners to have sex, they had suffered from rape or sexually transmitted diseases, the majority of those who had previous sexual experience had tried to use contraceptives but had been unable to continue using them, they were most likely to choose the method of withdrawal for contraception, their rates of pregnancy and abortion were high, they received less antenatal care, and they were more likely to have smoked during pregnancy. Conclusions It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population. Relevance to clinical practice The results of this study may be useful for nurses in the clinical field for calling an attention and raising an awareness of the reproductive health problems of women with psychiatric disorders, taking the necessary preventive measures, and developing damage-reducing strategies.
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TL;DR: Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with bipolar disorder, and have an increased risk of mood disorders in the postnatal period.
Abstract: Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015 Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum All stages of inclusion, quality assessment and data extraction were done by two people All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared The search identified 2809 papers After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis It is evident that adverse outcomes are more common in women with BD and their babies Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction
80 citations
Cites background from "Reproductive health in women with s..."
...Female patients with psychiatric disorders seem to have more negative attributes with regard to sexuality and reproduction [11]....
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TL;DR: Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms and there is a lack of uniformity in the definition of bipolar disorder across studies.
54 citations
TL;DR: Research pertinent to the clinical care of women with bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities, and pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents.
Abstract: This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
31 citations
TL;DR: A need for greater communication and assistance in the areas of intimacy and sexuality for persons with psychotic disorders is highlighted, and a need for better access to resources such as dating skills and couples therapy programs as well as more consumer-oriented research is needed.
Abstract: For individuals with a psychotic disorder, dating can present several challenges and lead many to be excluded from intimate relationships. These difficulties may stem from a number of factors, including impairments in social and sexual functioning. Although scientific interest in this topic is mounting, the last quantitative review of the literature dates back to 2003. Objectives The aim of this systematic review was to collect, evaluate, and synthesize quantitative data from studies published in the last 15 years on romantic relationships and sexuality in the context of a psychotic disorder. Methods Articles were retrieved from PsycINFO, PubMed, Web of Science, and ProQuest databases and were retained if they met the following inclusion criteria: (a) original research or meta-analysis, (b) complete or partial sample with a psychotic disorder diagnosis, (c) provision of quantitative data specific to the population of interest, and (d) studies focusing on romantic relationship and/or sexuality variables as correlates, predictors, mediators, or outcomes. Study quality was evaluated using PRISMA criteria. Results 43 studies were identified, 24 of which were categorized as obstacle-related (e.g., focusing on negative aspects of intimacy, such as risky behaviors) and 19 of which were deemed neutral or recovery-oriented (e.g., focusing on positive aspects of intimacy, such as marital functioning). Conclusions and implications for practice Results highlight a need for greater communication and assistance in the areas of intimacy and sexuality for persons with psychotic disorders. Better access to resources such as dating skills and couples therapy programs as well as more consumer-oriented research is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
14 citations
TL;DR: This article discusses critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and shows how these can be translated into a practice framework for improving nurses' response.
Abstract: AIMS AND OBJECTIVES: The aim of this article is to discuss critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and to show how these can be translated into a practice framework for improving nurses' response. BACKGROUND: Intimate partner violence is a universal problem and is considered a significant public health issue. Nurses are in an ideal position to recognise and respond to intimate partner violence, but many lack confidence in this area of practice. In our previous empirical work, we identified three concepts through which nurses' responses to intimate partner violence can be understood: awareness, recognition and empowerment. In this article, we advance nursing knowledge by showing how these concepts can form a practice framework to improve nurses' responses to intimate partner violence. DESIGN: A discussion paper and development of a practice framework to improve nurses' responses to intimate partner violence. DISCUSSION: The framework comprises three principal needs of women and three related key requirements for nurses to meet these needs. Arising from these are a range of practice outcomes: enhanced understanding of intimate partner violence, increased confidence in recognising intimate partner violence, establishment of trusting relationships, increased likelihood of disclosure and optimised safety. CONCLUSIONS: Nurses sometimes lack confidence in recognising and responding to intimate partner violence. Awareness, recognition and empowerment are important concepts that can form the basis of a framework to support them. When nurses feel empowered to respond to intimate partner violence, they can work together with women to optimise their safety. RELEVANCE TO CLINICAL PRACTICE: Access to adequate and timely intimate partner violence education and training is important in improving nurses' responses to intimate partner violence. Getting this right can lead to enhanced safety planning and better health outcomes for women who experience intimate partner violence. Although difficult to measure as an outcome, nurses' improved responses can contribute to higher rates of referral for help and reduction in intimate partner violence rates.© 2016 John Wiley & Sons Ltd. Language: en
13 citations
Cites background from "Reproductive health in women with s..."
...2015) and reproductive and mental health (Ozcan et al. 2014)....
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...It is important that education and training meets the needs of nurses from different clinical environments, such as emergency contexts (Rahmqvist Linnarsson et al. 2015) and reproductive and mental health (Ozcan et al. 2014)....
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TL;DR: Smoking during pregnancy is in many countries recognized as the most important preventable risk factor for an unsuccessful pregnancy outcome.
Abstract: The prevalence of smoking during pregnancy varies markedly across countries. In many industrialized countries, prevalence rates appear to have peaked and begun to decline, whereas in other countries smoking is becoming increasingly common among young women. Randomized controlled trials have shown that smoking interventions during pregnancy have had limited success. Smoking during pregnancy is in many countries recognized as the most important preventable risk factor for an unsuccessful pregnancy outcome. Smoking is causally associated with fetal growth restriction, and increasing evidence also suggests that smoking may cause stillbirth, preterm birth, placental abruption, and possibly also sudden infant death syndrome. Smoking during pregnancy also is generally associated with increased risks of spontaneous abortions, ectopic pregnancies, and placenta previa and may increase risks of behavioral disorders in childhood. Smoking during pregnancy will continue to be an important risk factor for maternal and fetal outcomes during pregnancy.
1,048 citations
"Reproductive health in women with s..." refers background in this paper
...Observational work has indicated that 20–40% of women who smoke take a break from their smoking during their pregnancy (Cnattingius 2004)....
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01 Jul 2010
TL;DR: A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders and associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape.
Abstract: OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I 2 statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
827 citations
"Reproductive health in women with s..." refers background in this paper
...…et al. 2007, Campos et al. 2008, Guimaraes et al. 2009, Hariri et al. 2011, Mamabolo et al. 2012); increased rates of abuse and rape (Miller 1997, Chen et al. 2010, Hariri et al. 2011); reduced fertility (Miller 1997, Dickerson et al. 2004); increased rates of unwanted pregnancy (Miller 1997,…...
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...Abuse and rape of psychiatric patients are frequently reported in the literature (Miller 1997, Weinhardt et al. 1999, Pehlivan 2004, Chen et al. 2010, Davison & Huntington 2010, Hariri et al. 2011, Mamabolo et al. 2012)....
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TL;DR: While genetic liability and gene-environment interactions may account for some outcomes, maternal risk factors and biological and behavioral concomitants of severe mental illness appear to be major determinants of increases in reproductive pathology in this cohort.
Abstract: OBJECTIVE: This study ascertained the incidence of complications during pregnancy, labor, and delivery and the neonatal characteristics of infants born to women with schizophrenia, bipolar disorder, or major depression in a population-based cohort. METHOD: Based on records linkage across a psychiatric case register and prospectively recorded obstetric data, the study comprised women with schizophrenia or major affective disorders who had given birth to 3,174 children during 1980–1992 in Western Australia. A comparison sample of 3,129 births to women without a psychiatric diagnosis was randomly selected from women giving birth during 1980–1992. Complications were scored with the McNeil-Sjostrom Scale. Odds ratios were calculated for specific reproductive events. RESULTS: Both schizophrenic and affective disorder patients had increased risks of pregnancy, birth, and neonatal complications, including placental abnormalities, antepartum hemorrhages, and fetal distress. Women with schizophrenia were significan...
460 citations
TL;DR: The clinical assessment of C MD in women must include exploration of violence and gender disadvantage, and gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.
Abstract: Background Gender disadvantage and reproductive health are major determinants of women's health in developing countries. Objective To determine the association of factors indicative of gender disadvantage and reproductive health with the risk of common mental disorders (CMDs) in women. Design Cross-sectional survey from November 1, 2001, to June 15, 2003. Participants A total of 3000 women randomly selected from a sampling frame of women aged 18 to 45 years in Goa; 2494 women participated. Main Outcome Measures The primary outcome was the presence of a CMD, as defined by the Revised Clinical Interview Schedule. An interview and blood and vaginal/urine specimens were collected to ascertain risk factors. Results The prevalence of CMD was 6.6% (95% confidence interval [CI], 5.7%-7.6%). Mixed anxiety-depressive disorder was the most common diagnosis (64.8%). Factors independently associated with the risk for CMD were factors indicative of gender disadvantage, particularly sexual violence by the husband (odds ratio [OR], 2.3; 95% CI, 1.1-4.6), being widowed or separated (OR, 5.4; 95% CI, 1.0-30.0), having low autonomy in decision making (OR, 1.98; 95% CI, 1.2-3.2), and having low levels of support from one's family (OR, 2.2; 95% CI, 1.4-3.3); reproductive health factors, particularly gynecological complaints such as vaginal discharge (OR, 3.2; 95% CI, 2.2-4.8) and dyspareunia (OR, 2.5; 95% CI, 1.4-4.6); and factors indicative of severe economic difficulties, such as hunger (OR, 2.7; 95% CI, 1.6-4.6). There was no association between biological indicators (anemia and reproductive tract infections) and CMD. Conclusions The clinical assessment of CMD in women must include exploration of violence and gender disadvantage. Gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.
254 citations
TL;DR: Data is reviewed about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning to reduce unwanted pregnancies and incorporate family planning measures into mental health care delivery systems.
Abstract: This article reviews data about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning. Women with schizophrenia have high rates of coerced sex, sexual risk behavior, and unwanted pregnancies. High rates of obstetric complications and custody loss increase morbidity for women and their offspring. Since untreated psychosis increases these problems, the risks of withholding pharmacotherapy must be weighed against the risks of prescribing medications during pregnancy. The puerperium is a time when women are especially vulnerable to exacerbations of schizophrenia. Mothers with schizophrenia may have a reduced ability to read children's cues, and they often have weak social support networks. Their children may be more difficult to raise than other children. Parenting rehabilitation can address some of these problems. Often, women with schizophrenia who are sexually active and do not wish to become pregnant do not use contraception. Incorporating family planning measures into mental health care delivery systems may reduce unwanted pregnancies.
166 citations
"Reproductive health in women with s..." refers background or methods or result in this paper
...…are: high number of partners (Dickerson et al. 2004, Karadag et al. 2004, Pehlivan 2004, Matevosyan 2009); engaging in risky sexual actions (Miller 1997, Karadag et al. 2004, Pehlivan 2004, Carey et al. 2007, Campos et al. 2008, Guimaraes et al. 2009, Hariri et al. 2011, Mamabolo et al.…...
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...…Hariri et al. 2011, Mamabolo et al. 2012); increased rates of abuse and rape (Miller 1997, Chen et al. 2010, Hariri et al. 2011); reduced fertility (Miller 1997, Dickerson et al. 2004); increased rates of unwanted pregnancy (Miller 1997, Matevosyan 2009); decreased marriage rates (Pehlivan 2006,…...
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...…(Miller 1997, Chen et al. 2010, Hariri et al. 2011); reduced fertility (Miller 1997, Dickerson et al. 2004); increased rates of unwanted pregnancy (Miller 1997, Matevosyan 2009); decreased marriage rates (Pehlivan 2006, MacCabe et al. 2009); low rates of using contraceptive methods (Matevosyan…...
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...…three-fourths of women in Turkey receive prenatal care, and when this is considered, it is seen that women with psychiatric conditions receive less prenatal care than the healthy population; many studies support this finding (Miller 1997, Bennedsen et al. 2001, Howard 2005, Shah & Howard 2006)....
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...In many studies, it has been reported that few people with serious mental illness use contraceptive methods and that the rate of people who have unprotected sex in this group is between 33–73% (Miller 1997, Pehlivanoglu et al. 2007)....
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