Publications by authors named "Lianne Tomfohr-Madsen"

49 Publications

Prenatal Care Disruptions and Associations With Maternal Mental Health During the COVID-19 Pandemic.

Front Glob Womens Health 2021 23;2:648428. Epub 2021 Apr 23.

Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed restrictions. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The stress caused by these changes may negatively affect the well-being of pregnant individuals with impacts on the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4,604 participants was collected from English- and French-speaking Canadians between April 5 and June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results highlight the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.
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http://dx.doi.org/10.3389/fgwh.2021.648428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593981PMC
April 2021

Social adjustment in survivors of acute lymphoblastic leukemia without cranial radiation therapy.

Pediatr Blood Cancer 2021 Oct 19:e29407. Epub 2021 Oct 19.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Objective: To evaluate group differences in social adjustment in survivors of pediatric acute lymphoblastic leukemia (ALL) compared to survivor siblings and controls; identify disease-related predictors of social adjustment in survivors; and explore whether executive functioning explained differences in social adjustment across groups and between disease-related predictors.

Methods: Survivors of pediatric ALL (n = 38, average age at diagnosis = 4.27 years [SD = 1.97]; average time off treatment = 4.83 years [SD = 1.52]), one sibling (if available, n = 20), and one parent from each family were recruited from a long-term survivor clinic. Healthy age- and sex-matched controls (n = 38) and one parent from each family were recruited from the community. Parents completed the Behavioral Assessment System for Children, Parent Rating Scale (BASC-3) Social Withdrawal subscale as a measure of social adjustment, and the Behavior Rating Inventory of Executive Functions (BRIEF-2) as a measure of executive function for each of their children. Multilevel modeling and mediation analysis were used to achieve the study aims.

Results: Parents reported that survivors had significantly worse social adjustment compared to controls (b = 6.34, p = .004), but not survivor siblings. Among survivors, greater time off treatment (b = 2.06, p = .058) and poorer executive functioning (b = 0.42, p = .006) were associated with worse social adjustment. Executive function did not mediate differences in social withdrawal between survivors and controls or the relationship between time off treatment and social withdrawal among survivors.

Conclusions: Survivors of pediatric ALL presenting to follow-up programs should be screened for difficulties with social adjustment. Future research should examine treatment- and nontreatment-related factors contributing to poorer social outcomes.
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http://dx.doi.org/10.1002/pbc.29407DOI Listing
October 2021

Associations Between the Gut Microbiota and Internalizing Behaviors in Preschool Children.

Psychosom Med 2021 Oct 12. Epub 2021 Oct 12.

Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada Department of Psychology, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada UCVM Bioinformatics, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Alberta, Canada.

Objective: Emerging evidence points toward a connection between mental health and the gut microbiota and its metabolites (e.g., short-chain fatty acids - SCFAs). It is unknown whether gut microbiota levels are associated with the development of mental health problems (e.g., internalizing or externalizing behaviors) in preschool children. The objective of this study was to evaluate associations between the gut microbiota and internalizing and externalizing behaviors in preschool-aged children.

Methods: A community sample of 248 typically developing children (3-5 years) provided a stool sample for gut microbiota and SCFA analysis. Parents reported child internalizing and externalizing behaviors using the Child Behavior Checklist. Associations between child behaviors and gut microbiota measures were analyzed using Spearman correlations followed by an adjustment for multiple testing, with subanalysis conducted in children clinically "at risk" for behavioral problems compared to those who were not using Mann-Whitney U tests.

Results: There was a correlation between Shannon alpha diversity with internalizing behaviors (rs = -0.134, p = 0.035), and its subscale somatic complaints (rs = -0.144, p = 0.023), while children clinically "at risk" for internalizing problems had decreased alpha diversity (U = 551, p = 0.017). Internalizing behaviors correlated with valerate and isobutyrate (rs = -0.147, p = 0.021; rs = -0.140, p = 0.028, respectively), while the somatic complaints subscale additionally correlated with acetate and butyrate (rs = -0.219, p = 0.001; rs = -0.241, p < 0.001, respectively). These findings were also present in children "at risk" for internalizing problems (U = 569, p = 0.026; U = 571, p = 0.028), and somatic complaints (U = 164, p = 0.004; U = 145, p = 0.001).

Conclusions: These analyses reveal novel associations between internalizing behaviors and the gut microbiota in preschool children. Furthermore, a relationship between somatic complaints and acetate and butyrate was identified, indicating that interventions that increase SCFA production warrant future investigation.
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http://dx.doi.org/10.1097/PSY.0000000000001026DOI Listing
October 2021

eHealth Interventions to Treat Substance Use in Pregnancy: A Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2021 09 22;18(19). Epub 2021 Sep 22.

Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada.

Substance use during pregnancy is associated with adverse pregnancy and neonatal outcomes; eHealth interventions offer a potential accessible treatment option. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of eHealth interventions for the treatment of substance use during pregnancy. A comprehensive search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from May 2020 to April 2021. The protocol for this study was registered with Prospero (CRD42020205186) through the University of York Centre for Reviews and Dissemination. Two independent reviewers completed screening, data extraction, and quality assessment. RCTs were included if they reported: (a) administration of an eHealth intervention for (b) substance use outcomes, among (c) pregnant individuals. Comprehensive Meta-Analysis Software (CMA) was used to calculate pooled effect sizes (Odds Ratio) to determine the effect of eHealth interventions on substance use outcomes. Six studies were identified with substance use outcomes that included: smoking ( = 3), alcohol ( = 2), and other ( = 1). eHealth interventions were delivered through the internet ( = 1), computer ( = 3), telephone ( = 1), and text ( = 1). Results suggested that eHealth interventions significantly reduced substance use in pregnant individuals compared to controls (OR = 1.33, CI = 1.06 to 1.65, = 0.013). eHealth interventions offer a promising and accessible treatment option to reduce substance use during pregnancy. This work was supported by the generous donors of the Alberta Children's Hospital Foundation, the Canadian Child Health Clinician Scientist Program (CCHCSP), the Canadian Institute of Health Research and the Fonds de Recherche du Québec-Santé.
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http://dx.doi.org/10.3390/ijerph18199952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507611PMC
September 2021

Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women.

Trials 2021 Aug 12;22(1):532. Epub 2021 Aug 12.

University of Calgary, Calgary, Canada.

Background: Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes).

Methods: A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12-28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3).

Discussion: CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children.

Trial Registration: ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.
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http://dx.doi.org/10.1186/s13063-021-05498-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358257PMC
August 2021

Daily mindfulness training reduces negative impact of COVID-19 news exposure on affective well-being.

Psychol Res 2021 Jun 24. Epub 2021 Jun 24.

Department of Psychology, University of New Hampshire, 105 Main St, Durham, NH, USA.

COVID-19 has led to mental health adversities worldwide. The current study examined whether daily practice of brief mindfulness training has a beneficial impact on affective well-being, and mitigates the negative impact of exposure to COVID-19 news during the pandemic. Participants were randomly assigned into a mindfulness training (MT) group or a waitlist control (WC) group. Participants in the MT group practiced guided mindfulness meditation for a minimum of 10 min each day for 10 days. Both groups completed questionnaires assessing well-being at baseline and after the 10-day period. We also included four ecological momentary assessments (EMA) interspersed throughout the day to measure fine-grained affective states and recent exposure to COVID-19-related news, which has been linked to negative affect. We observed an increase in positive affect in the MT group compared to the WC group in the post-training assessment. However, no group differences emerged in the other three post-training affective measures of negative affect, anxiety and depression. EMA revealed that the MT group also showed more positive affective valence than the WC group across the 10 days. Notably, the WC group reported more negative affective valence following COVID-19 news exposure, whereas the MT group was not impacted. Taken together, our study indicates brief sessions of guided mindfulness meditation during COVID-19 may boost positive affect and serve as a protective buffer against the negative impact of exposure to COVID-19-related news on affective well-being. These findings highlight the utility of mindfulness meditation as an accessible and cost-effective technique to elevate positive affect amidst the COVID-19 pandemic.
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http://dx.doi.org/10.1007/s00426-021-01550-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222951PMC
June 2021

Alcohol and substance use in pregnancy during the COVID-19 pandemic.

Drug Alcohol Depend 2021 08 21;225:108760. Epub 2021 May 21.

Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada. Electronic address:

Background: The impact of the COVID-19 pandemic on alcohol and substance use has been a topic of concern. Pregnant women are currently experiencing elevated anxiety and depression symptoms, which may increase risk of substance use, and potentially result in poor perinatal and neurodevelopmental outcomes for children.

Methods: Survey results were analyzed from an ongoing study of 7470 pregnant individuals in Canada: Pregnancy during the COVID-19 Pandemic. Participants were asked about current use of alcohol and substances, symptoms of depression and anxiety, and COVID-19 concerns: how much they worry about COVID-19 threatening their baby's life, threatening their own life, care for themselves or the baby, feelings of social isolation, and financial difficulties.

Results: The percentage of participants who reported use during pregnancy was 6.7 % for alcohol, 4.3 % for cannabis, 4.9 % for tobacco, and 0.3 % for illicit drugs; 2.6 % were using multiple substances. Higher depression symptoms and financial difficulties were associated with more cannabis and/or tobacco use as well as the co-use of substances. There were no associations between alcohol use and mental health or COVID-19 concerns.

Conclusions: Self-reported rates of use and co-use were lower or comparable to previous research, perhaps reflecting pandemic-related circumstances or the demographics of this sample. Depression symptoms and pandemic-related financial difficulties were associated with more tobacco use, cannabis use, and substance co-use. It remains important to maintain access to perinatal, mental health, and financial supports during the pandemic to mitigate prenatal alcohol and substance use and prevent poor perinatal and long-term neurodevelopmental outcomes for children.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108760DOI Listing
August 2021

Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children.

JMIR Res Protoc 2021 Apr 28;10(4):e25407. Epub 2021 Apr 28.

Department of Pediatrics, University of Calgary, Calgary, AB, Canada.

Background: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments.

Objective: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring.

Methods: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development.

Results: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing.

Conclusions: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets.

International Registered Report Identifier (irrid): DERR1-10.2196/25407.
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http://dx.doi.org/10.2196/25407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080963PMC
April 2021

Depression and anxiety in pregnancy during COVID-19: A rapid review and meta-analysis.

Psychiatry Res 2021 06 1;300:113912. Epub 2021 Apr 1.

Department of Psychology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada.

The study rapidly reviewed and meta-analyzed the worldwide prevalence of depression and anxiety among pregnant women during the COVID-19 pandemic. A systematic search of the literature and meta-analyses were conducted from December 2019 - February 2021 with a total of 46 studies meeting inclusion criteria. Depression was assessed in 37 studies (N = 47,677), with a pooled prevalence of 25.6%. Anxiety was assessed in 34 studies (N = 42,773), with a pooled prevalence of 30.5%; moderation by time showed that prevalence of anxiety was higher in studies conducted later in the pandemic.
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http://dx.doi.org/10.1016/j.psychres.2021.113912DOI Listing
June 2021

Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis.

PLoS One 2021 11;16(2):e0246670. Epub 2021 Feb 11.

Department of Obstetrics & Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: In June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health.

Methods: Linked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood.

Results: Participants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses.

Conclusion: The Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246670PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877569PMC
July 2021

Insomnia symptoms during pregnancy: A meta-analysis.

J Sleep Res 2021 02 2;30(1):e13207. Epub 2020 Nov 2.

Department of Psychology, University of Calgary, Calgary, AB, Canada.

Reports of sleep disturbances are common during pregnancy, yet estimates of prevalence of insomnia symptoms during pregnancy vary widely. The goals of the current review were to summarize the existing data on prevalence of insomnia symptoms during pregnancy and to explore potential moderators, including trimester, gestational age, maternal age, symptoms of anxiety and symptoms of depression. A systematic search of PubMed, PsycInfo and Web of Science was conducted for articles published from inception up to June 2020. In total, 24 studies with a total of 15,564 participants were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 38.2%. Trimester was a significant moderator, such that prevalence of insomnia symptoms was higher in the third trimester (39.7%) compared to first (25.3%) and second (27.2%) trimesters. No other variables significantly moderated the prevalence of insomnia symptoms. The results of the current meta-analysis suggest that the prevalence of insomnia symptoms is higher during pregnancy, particularly in the third trimester. Future research should examine the efficacy and safety of insomnia treatments with this population.
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http://dx.doi.org/10.1111/jsr.13207DOI Listing
February 2021

Corrigendum to elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic journal of affective disorders 277 (2020) 5-13.

J Affect Disord 2021 Jan 18;279:377-379. Epub 2020 Nov 18.

Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada; Department of Psychology, University of Calgary, Canada; Department of Pediatrics, University of Calgary, Canada.

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http://dx.doi.org/10.1016/j.jad.2020.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445275PMC
January 2021

Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis.

Psychol Med 2020 10 11;50(13):2128-2140. Epub 2020 Sep 11.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Background: Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.

Methods: A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.

Results: In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54].

Conclusions: When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
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http://dx.doi.org/10.1017/S0033291720003062DOI Listing
October 2020

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic.

J Affect Disord 2020 12 1;277:5-13. Epub 2020 Aug 1.

Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada; Department of Psychology, University of Calgary, Canada; Department of Pediatrics, University of Calgary, Canada.

Background: Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond.

Methods: We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support.

Results: We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms.

Conclusion: This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.
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http://dx.doi.org/10.1016/j.jad.2020.07.126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395614PMC
December 2020

Neighborhood Socio-Economic Factors and Associations with Infant Sleep Health.

Behav Sleep Med 2021 Jul-Aug;19(4):458-470. Epub 2020 Jun 22.

Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

: Sleep health is important for development and improves overall health. There are large socioeconomic gradients in sleep health, from childhood through adulthood. Recent findings suggest that children from neighborhoods with poorer socioeconomic conditions have more sleep problems. The current study aimed to investigate the associations between neighborhood factors and infant sleep health.

Participants And Methods: Secondary data analysis using Multilevel Modeling (MLM) was conducted for a subsample of 2445 women from the All our Families longitudinal cohort study, for whom early pregnancy neighborhood data could be geocoded. The Vancouver Area Neighborhood Deprivation Index (VANDIX) was calculated using census data to assess neighborhood SES. Neighborhood disorder was measured using community crime reports from police services. Mothers rated the perceived safety of their neighborhood and reported on their infants' nighttime sleep consolidation, awakenings, and onset latency at 12 months postpartum.

Results: MLM indicated that neighborhood disorder and maternal perceptions of unsafety predicted less consolidated sleep after accounting for individual and family-level factors including maternal ethnicity, household income, breastfeeding duration, and co-sleeping. Neighborhood deprivation was indirectly related to less consolidated sleep among 12-month-old infants through more reports of disorder and maternal perceptions of less safety.

Conclusions: Consistent with the socio-ecological model of sleep, neighborhood-level, family, and individual factors influence infant sleep health. Policy efforts to increase neighborhood safety and public health initiatives to increase awareness of the importance of sleep could help improve infant sleep health.
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http://dx.doi.org/10.1080/15402002.2020.1778478DOI Listing
September 2021

Sleep Disturbances in Survivors of Pediatric Acute Lymphoblastic Leukemia and Their Siblings.

J Pediatr Psychol 2020 08;45(7):707-716

Department of Psychology, University of Calgary.

Objective: Sleep disturbances have been identified by patients with cancer as common and distressing; however, conflicting evidence about the prevalence of these outcomes exists for survivors of childhood cancers. Additionally, little is known about how the experience of cancer might impact survivor siblings' sleep. The current study compared the sleep of survivors of acute lymphoblastic leukemia who were 2-7 years off therapy and their siblings to healthy control/sibling dyads.

Methods: Participants (survivors, n = 45; survivor siblings, n = 27; controls, n = 45; control siblings, n = 41; 58% male) aged 8-18 (m = 11.64) completed a 7-day sleep diary and seven consecutive days of actigraphy. Parents (n = 90) completed the Children's Sleep Habits Questionnaire for each of their children.

Results: No between-group differences were found on measures of sleep diaries or actigraphy. Parents reported that survivor siblings had significantly poorer sleep habits than survivors or controls. For survivors, greater time off treatment and younger age at diagnosis were associated with less total sleep time, more wake after sleep onset, and decreased sleep efficiency via actigraphy.

Conclusion: Sleep across all groups was consistent and below national guidelines. Although the survivor group did not have poorer sleep compared to their siblings or matched controls, within the survivor group, those who were diagnosed at an earlier age and those who were further off treatment had more disrupted sleep. Parent reports suggested that survivor siblings may be at risk for sleep problems.
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http://dx.doi.org/10.1093/jpepsy/jsaa043DOI Listing
August 2020

Trajectories of Insomnia Symptoms and Associations with Mood and Anxiety from Early Pregnancy to the Postpartum.

Behav Sleep Med 2021 May-Jun;19(3):395-406. Epub 2020 Jun 4.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

: The current study identified heterogeneous trajectories of insomnia symptoms from early pregnancy to early postpartum. The relationship between demographic and psychological predictors of trajectories and associations between trajectory group membership and symptoms of postpartum depression and anxiety were also explored.: 142 pregnant women were enrolled in a prospective online survey.: Women were recruited from a maternity clinic in Calgary, AB and completed measures of insomnia symptoms, depression, generalized anxiety, and interpersonal support at four time-points. Women were recruited and completed the first survey before 20 weeks gestation and were reassessed every 10 weeks. Women were on average 15 weeks gestation, 25 weeks gestation, 35 weeks gestation, and 6 weeks postpartum at the respective time-points. Group-based trajectory analysis was used to determine trajectories of pregnancy insomnia symptoms.: Three trajectory groups were identified. A group (42.3%) in which women reported consistently low insomnia symptoms. A group (44.3%) in which women reported subclinical symptoms which briefly elevated to clinical levels in late-pregnancy, and a group (13.4%) in which women reported consistently elevated insomnia symptoms. Baseline predictors of membership group included anxiety, depression, and ethnicity such that members of the group were more likely to also endorse anxiety and depression. Membership in the group was associated with higher postpartum generalized anxiety and depressive symptoms. Additionally, the group were more likely to experience symptoms indicative of clinically significant depression.: A small group of pregnant women experienced consistently high and elevated insomnia symptoms throughout pregnancy and another larger group endorsed consistently elevated but subthreshold symptoms. Future studies should explore long-term consequences of experiencing high insomnia symptomatology during pregnancy and early postpartum, as well as safe and efficacious interventions.
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http://dx.doi.org/10.1080/15402002.2020.1771339DOI Listing
September 2021

Neighborhood socioeconomic status and child sleep duration: A systematic review and meta-analysis.

Sleep Health 2020 10 22;6(5):550-562. Epub 2020 Apr 22.

Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, Alberta, Canada; Faculty of Nursing, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Background: The objective of this systematic review and meta-analysis was to investigate the associations between neighborhood socioeconomic status (nSES) and sleep duration in children aged 0-18 years.

Methods: Three electronic databases were searched for relevant articles that assessed nSES and sleep duration (either subjectively or objectively). Inclusion criteria included peer-reviewed scholarly articles on the topic area that reported an association between nSES and sleep in children and adolescents.

Results: The database searched identified 6080 potentially eligible studies, of which 1210 were selected for full-text review, and 8 met the inclusion criteria. Data included 67,677 unique participants. Studies were conducted in either the United States of America or Australia. Pooled estimates suggested that poorer nSES was associated with shorter child sleep duration (odds ratio: 1.262; 95% confidence interval: 1.086-1.467). This relationship between nSES and sleep was moderated by sleep assessment type (self-report versus actigraphy), child sex/gender, and child race/ethnicity.

Conclusions: Across studies, there is an association between nSES and child sleep duration. This study adds child sleep to the growing number of child health disparities associated with nSES.
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http://dx.doi.org/10.1016/j.sleh.2020.02.012DOI Listing
October 2020

Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort.

Can J Public Health 2020 08 25;111(4):543-554. Epub 2020 Mar 25.

Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

Objective: Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship.

Methods: Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization's child growth guidelines.

Results: In this sample of 1582 mother-child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = - 5.40, p = 0.001) and depression (B = - 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03-0.21) and depression (B(SE) = 0.11(0.07), CI 0.01-0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight.

Conclusions: The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.
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http://dx.doi.org/10.17269/s41997-020-00312-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438469PMC
August 2020

Parental Use of "Cry Out" in a Community Sample During the First Year of Infant Life.

J Dev Behav Pediatr 2020 Jun/Jul;41(5):379-387

Alberta Children's Hospital Research Institute, Calgary, AB, Canada.

Objective: The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment.

Method: This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months.

Results: Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment.

Conclusion: When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.
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http://dx.doi.org/10.1097/DBP.0000000000000791DOI Listing
August 2021

Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: a longitudinal examination.

Pain 2020 04;161(4):821-830

Departments of Psychology and.

Epidemiological and cross-sectional studies have shown that post-traumatic stress disorder symptoms (PTSS) are common and impairing in youth with chronic pain. Yet, the co-occurrence of PTSS and pediatric chronic pain has not been examined longitudinally, which has limited understanding of theoretically proposed mechanisms (eg, sleep disturbance) underlying the PTSS-pain relationship over time. This longitudinal study aimed to fill this gap. Participants included 138 youth (Mage = 14.29, 75% girls) referred to a tertiary-level outpatient chronic pain program and one of their parents. At baseline, youth reported their pain intensity and interference, PTSS, and subjective sleep disturbances (ie, sleep quality and insomnia). Youth and parents completed semistructured diagnostic interviews to determine the child's post-traumatic stress disorder diagnostic status, and youth completed an objective assessment of sleep patterns for 7 days using actigraphy. At 3-month follow-up, youth once again completed the diagnostic interview and reported their pain intensity, pain interference, and PTSS. Partially latent cross-lagged structural equation panel models revealed that, controlling for pain intensity, pain interference and PTSS co-occurred at baseline, but not at follow-up (while controlling for baseline levels). Higher levels of baseline PTSS were predictive of increases in pain interference at follow-up. Furthermore, subjective sleep disturbances mediated the relationship between baseline PTSS and follow-up pain interference. These findings lend support to conceptual models of PTSS-pain co-occurrence and highlight a critical need to assess and address trauma and sleep disturbances in youth with chronic pain.
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http://dx.doi.org/10.1097/j.pain.0000000000001769DOI Listing
April 2020

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood.

Int J Environ Res Public Health 2020 01 25;17(3). Epub 2020 Jan 25.

Department of Psychology, University of Miami, Miami, FL 33124, USA.

The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting-problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-hr) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.
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http://dx.doi.org/10.3390/ijerph17030766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038182PMC
January 2020

Recruitment and retention of fathers with young children in early childhood health intervention research: a systematic review and meta-analysis protocol.

Syst Rev 2019 12 1;8(1):300. Epub 2019 Dec 1.

Faculty of Nursing, University of Calgary, PF2278, 2500 University Drive NW, Calgary, Alberta, T2N 1 N4, Canada.

Background: Fathers are under-represented in research and programs addressing early childhood health and development. Recruiting fathers into these interventions can be hampered for multiple reasons, including recruitment and retention strategies that are not tailored for fathers. The primary aim of this systematic review and meta-analysis is to determine the effectiveness of recruitment and retention strategies used to include fathers of children (from conception to age 36 months) in intervention studies. The secondary aim is to investigate study-level factors that may influence recruitment and retention.

Methods: We will conduct searches for scholarly peer-reviewed randomized controlled trials, quasi-experimental studies, and pre-post studies that recruited fathers using the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), and CINAHL. English-language articles will be eligible if they recruited self-identified fathers of children from conception to age 36 months for health-promoting interventions that target healthy parents and children. Two reviewers will independently screen titles/abstracts and full texts for inclusion, as well as grading methodological quality. Recruitment and retention proportions will be calculated for each study. Where possible, we will calculate pooled proportional effects with 95% confidence intervals using random-effects models and conduct a meta-regression to examine the impact of potential modifiers of recruitment and retention.

Discussion: Findings from this review will help inform future intervention research with fathers to optimally recruit and retain participants. Identifying key factors should enable health researchers and program managers design and adapt interventions to increase the likelihood of increasing father engagement in early childhood health interventions. Researchers will be able to use this review to inform future research that addresses current evidence gaps for the recruitment and retention of fathers. This review will make recommendations for addressing key target areas to improve recruitment and retention of fathers in early childhood health research, ultimately leading to a body of evidence that captures the full potential of fathers for maximizing the health and wellbeing of their children.

Systematic Review Registration: PROSPERO CRD42018081332.
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http://dx.doi.org/10.1186/s13643-019-1215-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886200PMC
December 2019

Pregnancy anxiety and preterm birth: The moderating role of sleep.

Health Psychol 2019 Nov 5;38(11):1025-1035. Epub 2019 Aug 5.

Department of Psychology.

Objective: Preterm birth (PTB) is a prevalent public health concern. Pregnancy anxiety, poor sleep quality, and short sleep duration have been associated with an increased risk of PTB. Theoretically, sleep variables could moderate the strength of the relationship between pregnancy anxiety and PTB; investigating this question was the primary aim of this study.

Method: The sample consisted of 290 pregnant women who were assessed at 2 time points in pregnancy: Time 1 (< 22 weeks gestational age [GA]; = 15.04, = 3.55) and Time 2 (32 weeks GA; = 32.44, = 0.99). Pregnancy anxiety was assessed with the Pregnancy-Related Anxiety Scale, sleep quality was assessed by the Pittsburgh Sleep Quality Index, and sleep duration was assessed via actigraphy. Data on gestational age at birth were obtained from the electronic medical record.

Results: After adjustment for relevant covariates, higher levels of pregnancy anxiety were associated with shorter gestational length and an increased risk of PTB. There were no direct associations between sleep quality or sleep duration and gestational length or PTB. Pregnancy anxiety interacted with sleep duration such that pregnancy anxiety was significantly associated with shorter gestational length and PTB only when women had relatively shorter sleep duration (approximately < 8.3 hr).

Conclusions: This study reveals new evidence of an interaction between pregnancy anxiety and sleep duration in the prediction of the timing of delivery. The findings point to avenues to better understand and potentially ameliorate risk for PTB. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000792DOI Listing
November 2019

A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Insomnia in Adolescents With Persistent Postconcussion Symptoms.

J Head Trauma Rehabil 2020 Mar/Apr;35(2):E103-E112

Departments of Psychology (Drs Tomfohr-Madsen, Madsen, Yeates, & Brooks) Psychiatry (Ms Bonneville), and Faculty of Kinesiology (Mr Virani), University of Calgary, Calgary, Alberta, Canada; Faculté St Jean, University of Alberta, Edmonton, Alberta, Canada (Dr Plourde); Neuropsychology Service, Alberta Children's Hospital, Calgary, Alberta, Canada (Mr Virani and Dr Brooks); Faculty of Medicine, University of Queensland, Brisbane, New South Wales, Australia (Dr Barlow); Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, Brooks, and Barlow); Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, and Brooks and Mr Virani); Hotchkiss Brain Institute, Calgary, Alberta, Canada (Drs Yeates and Brooks); and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Yeates and Brooks).

Objective: Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery.

Setting: Tertiary pediatric hospital.

Participants: Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms.

Design: A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion.

Main Measures: Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory.

Results: Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms.

Conclusion: In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.
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http://dx.doi.org/10.1097/HTR.0000000000000504DOI Listing
September 2021

Hypertensive Disorders of Pregnancy and Symptoms of Depression and Anxiety as Related to Gestational Age at Birth: Findings From the All Our Families Study.

Psychosom Med 2019 06;81(5):458-463

From the Department of Psychology (Horsley and Ditto), Faculty of Science, McGill University, Montreal, Quebec; Department of Psychology (Tomfohr-Madsen), Faculty of Arts, University of Calgary, Alberta; and Department of Pediatrics and Community Health Sciences (Tough), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Objective: The aim of the study was to investigate whether symptoms of depression or state anxiety changed the strength or nature of the association between hypertensive disorders of pregnancy (HDP) and gestational age at birth.

Methods: We conducted a secondary analysis of data from the All Our Families Cohort, a prospective pregnancy cohort study based in Calgary, Alberta, Canada. Self-reported depressive symptoms and state anxiety were assessed between 3 and 5 months of gestation, and obstetrical information, including diagnosis of HDP, parity, type of delivery, and gestational age at birth, was retrieved from the maternal discharge abstract. All models were adjusted for sociodemographic and obstetric confounders.

Results: Of 2763 women who had a singleton pregnancy and live birth, 247 (9%) were diagnosed with HDP. Women with HDP had significantly shorter gestational length relative to those without the diagnosis (M = 37.87 versus M = 38.99 weeks of gestation), t(2761) = 9.43, p < .001. Moderation analyses showed significant HDP by depressive symptoms and HDP by state anxiety interactions, such that the strength of the association between HDP and gestational age at birth increased alongside greater depressive symptom and state anxiety severity.

Conclusions: Results suggest that depressive symptoms and state anxiety may add to the increased risk for shortened gestation associated with HDP. Women at high risk of cardiovascular complications during pregnancy may benefit from additional resources to manage symptoms of depression or anxiety.
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http://dx.doi.org/10.1097/PSY.0000000000000695DOI Listing
June 2019

Insomnia in Adolescents with Slow Recovery from Concussion.

J Neurotrauma 2019 08 23;36(16):2391-2399. Epub 2019 Apr 23.

2Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.

Sleep disruption can occur after brain injury; however, insomnia prevalence and severity in adolescents with persistent post-concussion symptoms have not been investigated. This study examined: 1) some of the psychometric properties of the Insomnia Severity Index (ISI), 2) the prevalence and severity of insomnia symptoms, and 3) associations between insomnia symptoms and clinical measures of post-concussion symptoms, mental health symptoms, and cognitive tests in adolescents with slow recovery from concussion. Participants ( = 121) were adolescents 13-18 years of age (mean = 16.2; standard deviation [SD] = 1.2) and, on average, of 6.4 months (SD = 3.8) post-concussion. This sample rated insomnia (ISI), post-concussion symptoms, symptoms of depression and anxiety, and cognitive complaints, as well as completed cognitive testing. The ISI demonstrated good internal consistency (alpha = 0.87) and a single factor structure. The majority of the sample endorsed at least some insomnia, with 62% being over the clinical cutoff for experiencing clinically significant symptoms of insomnia. Higher insomnia severity was associated with a greater number of previous concussions, worse post-concussion symptoms, more anxiety, and higher depression. Insomnia was significantly associated with more cognitive complaints and higher rates of failure on performance validity tests, but not with actual objectively measured cognitive abilities. Insomnia is common in adolescents with slow recovery from concussion and is associated with worse post-concussion symptoms, anxiety, depression, cognitive complaints, and performance validity concerns. Investigating evidence-based treatments for insomnia should be a priority in this population.
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http://dx.doi.org/10.1089/neu.2018.6257DOI Listing
August 2019

Couples' treatment preferences for insomnia experienced during pregnancy.

Fam Syst Health 2019 Mar 27;37(1):46-55. Epub 2018 Dec 27.

Department of Psychology.

Introduction: Insomnia during pregnancy is prevalent, yet little is known about preferred treatments for the disorder. The current study investigated both pregnant women's and their partners' preferences for treatment of maternal insomnia, comparing the two most empirically supported therapies: cognitive-behavioral therapy for insomnia (CBT-I) and pharmacotherapy.

Method: We recruited pregnant women and their partners ( = 212) from a low-risk maternity clinic in Calgary, AB, Canada. Participants read expert validated treatment descriptions of pharmacotherapy and CBT-I and indicated their preference for treatment of maternal insomnia. Participants also completed the Insomnia Severity Index and Edinburgh Postnatal Depression Scale.

Results: The majority of pregnant women (72.6%) and their partners (73.6%) selected CBT-I as their preferred choice for treatment of maternal insomnia, with a high concordance between partners. Correlates of maternal treatment choice included previous use of treatment and partner preference.

Discussion: Findings suggest that pregnant women and their partners prefer CBT-I to pharmacotherapy as a treatment for maternal insomnia. Partners' preference may be an important consideration for women selecting treatment for insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/fsh0000391DOI Listing
March 2019

Study Protocol: Determining Research Priorities of Young Albertan Families (The Family Research Agenda Initiative Setting Project-FRAISE)-Participatory Action Research.

Front Public Health 2018 28;6:228. Epub 2018 Aug 28.

Faculty of Nursing, University of Calgary, Calgary, AB, Canada.

Pregnancy and childrearing can be an exciting and stressful time for new parents. The maternal-child health landscape has changed dramatically over the last few decades and research priorities need to address these rapid changes. There have been limited attempts to engage and collaborate with members of the public to develop research priorities for families who are expecting or parenting an infant to age 24 months. The work that has been completed has attempted to identify parental preference for information delivery and barriers to uptake of parenting programs but has not investigated parental research priorities. In collaboration with provincial research units and strategic clinical networks (SCN), we will use principles of participatory action research (PAR) as our theoretical framework/method, and a modified James Lind Alliance priority setting approach to prioritize a list of research questions that parents/knowledge users believe will support the health of their families. This will result in a top 10 list of parent/knowledge user-identified research priorities. This project will consist of three phases. In the first phase, we developed a steering committee of parents/knowledge users, healthcare providers, community agencies, and researchers to design a survey about health priorities for families. In the second phase, we will distribute the survey to diverse groups of parents/knowledge users/providers and hold a series of meetings to identify and prioritize potential questions from new parents about health issues from conception to age 24 months. In the third phase, we will collaboratively disseminate and translate findings. This study will highlight parental health concerns and recommend parent-identified research priorities to inform future research projects needed to support the health of families between conception to age 24 months. Understanding the health research priorities of families in the community will help ensure future research contributes to meaningful changes in the health of young children, parents/knowledge users, and families. This study and protocol have received ethical approved from the Conjoint Health Research Ethics Board at the University of Calgary (REB17-0014). The top 10 research priorities will be published and additional findings from the study will be distributed through pamphlets and newsletters.
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http://dx.doi.org/10.3389/fpubh.2018.00228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121170PMC
August 2018

The evaluation of a brief motivational intervention to promote intention to participate in cardiac rehabilitation: A randomized controlled trial.

Patient Educ Couns 2018 11 26;101(11):1914-1923. Epub 2018 Jun 26.

Department of Psychology, University of Calgary, Calgary, Canada.

Objectives: Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet many referred patients do not participate. Motivational interviewing could be beneficial in this context, but efficacy with prospective CR patients has not been examined. This study investigated the impact of motivational interviewing on intention to participate in CR.

Methods: Individuals recovering from acute coronary syndrome (n = 96) were randomized to motivational interviewing or usual care, following CR referral but before CR enrollment. The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, barriers, self-efficacy, illness perception, social support, intervention acceptability, and CR participation.

Results: Compared to those in usual care, patients who received the motivational intervention reported higher intention to attend CR (p = .001), viewed CR as more necessary (p = .036), had fewer concerns about exercise (p = .011), and attended more exercise sessions (p = .008). There was an indirect effect of the intervention on CR enrollment (b = 0.45, 95% CI 0.04-1.18) and CR adherence (b = 2.59, 95% CI 0.95-5.03) via higher levels of intention. Overall, patients reported high intention to attend CR (M = 6.20/7.00, SD = 1.67), most (85%) enrolled, and they attended an average of 65% of scheduled CR sessions.

Conclusion: A single collaborative conversation about CR can increase both intention to attend CR and actual program adherence.

Practice Implications: The findings will inform future efforts to optimize behavioral interventions to enhance CR participation.
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http://dx.doi.org/10.1016/j.pec.2018.06.015DOI Listing
November 2018
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