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A Study Protocol of a Three-Group Randomized Feasibility Trial of an Online Yoga Intervention for Mothers After Stillbirth (The Mindful Health Study)

Description

Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress

Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12–18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

Methods: The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

Discussion: This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

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Created

Date Created
2017-07-06

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From Grief, Guilt, Pain, and Stigma to Hope and Pride – A Systematic Review and Meta-Analysis of Mixed-Method Research of the Psychosocial Impact of Stillbirth

Description

Background: Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been

Background: Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide.

Methods: Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included.

Results: Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7). In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent.

Conclusion: Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.

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Created

Date Created
2016-01-19

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Best Practice in Bereavement Photography After Perinatal Death: Qualitative Analysis With 104 Parents

Description

Background: Postmortem memento photography has emerged in Western hospitals as part of compassionate bereavement care for parents facing perinatal death. Many parents endorse this psychosocial intervention, yet implementation varies greatly and little research on parents’ specific needs guides health care professionals.

Background: Postmortem memento photography has emerged in Western hospitals as part of compassionate bereavement care for parents facing perinatal death. Many parents endorse this psychosocial intervention, yet implementation varies greatly and little research on parents’ specific needs guides health care professionals. Parents are in crisis and vulnerable after the death of their child, thus best practice is crucial. This study contributes 104 parents’ experiences and opinions toward the understanding of best practice in perinatal bereavement photography.

Methods: Parents who experienced the perinatal death of their child were recruited from U.S.-based bereavement organizations and social media sites. Volunteers completed an anonymous internet survey with open- and closed-ended questions. Direct recommendations and pertinent statements regarding the process of postmortem photography were analyzed for thematic content in keeping with conventional content analysis. Recurrent themes and sub-themes were counted to identify response patterns.

Results: Of 93 parents with pictures, 92 endorsed them. Of 11 without pictures, nine wanted them. Parents made a variety of recommendations regarding appropriate psychosocial support, the consent process, obstacles to photography, logistics of photography, and material aspects of photographs themselves. Overall, parents wanted many pictures and much variety. Some wanted professional photography while others wanted support for taking their own pictures. Parents wanted guidance from staff who respected their particular needs. Many said decisions were difficult during their crisis. Parents who were initially resistant expressed current appreciation for pictures or expressed regret that they had not participated. Parents recommended that professionals strongly encourage parents to create memento photos despite parents’ initial reservations. Persistent cultural reasons against photography emerged in one case. Quotes by parents illuminate themes and enable respondents to speak directly to health care professionals.

Conclusions: Parents overwhelmingly support postmortem bereavement photography when conducted sensitively, even if imperfectly executed. Providers significantly influence parents during their crises; mindful, patient-centered care with appropriate respect for difference is necessary. Providers must understand the importance of postmortem photographs to parents who have limited opportunity to capture memories of their child. Hospitals should provide education and support for this important psychosocial intervention.

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Created

Date Created
2014-06-23

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Physical Activity and Depressive Symptoms After Stillbirth: Informing Future Interventions

Description

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study.

Methods: Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics.

Results: One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001).

Conclusions: Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population.

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Created

Date Created
2014-11-29

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Differential Responses of Dinitrogen Fixation, Diazotrophic Cyanobacteria, and Ammonia Oxidation Reveal a Potential Warming-Induced Imbalance of the N-Cycle in Biological Soil Crusts

Description

N2 fixation and ammonia oxidation (AO) are the two most important processes in the nitrogen (N) cycle of biological soil crusts (BSCs). We studied the short-term response of acetylene reduction assay (ARA) rates, an indicator of potential N2 fixation, and

N2 fixation and ammonia oxidation (AO) are the two most important processes in the nitrogen (N) cycle of biological soil crusts (BSCs). We studied the short-term response of acetylene reduction assay (ARA) rates, an indicator of potential N2 fixation, and AO rates to temperature (T, -5°C to 35°C) in BSC of different successional stages along the BSC ecological succession and geographic origin (hot Chihuahuan and cooler Great Basin deserts). ARA in all BSCs increased with T until saturation occurred between 15 and 20°C, and declined at 30–35°C. Culture studies using cyanobacteria isolated from these crusts indicated that the saturating effect was traceable to their inability to grow well diazotrophically within the high temperature range. Below saturation, temperature response was exponential, with Q10 significantly different in the two areas (~ 5 for Great Basin BSCs; 2–3 for Chihuahuan BSCs), but similar between the two successional stages. However, in contrast to ARA, AO showed a steady increase to 30–35°C in Great Basin, and Chihuhuan BSCs showed no inhibition at any tested temperature. The T response of AO also differed significantly between Great Basin (Q10 of 4.5–4.8) and Chihuahuan (Q10 of 2.4–2.6) BSCs, but not between successional stages. Response of ARA rates to T did not differ from that of AO in either desert. Thus, while both processes scaled to T in unison until 20°C, they separated to an increasing degree at higher temperature. As future warming is likely to occur in the regions where BSCs are often the dominant living cover, this predicted decoupling is expected to result in higher proportion of nitrates in soil relative to ammonium. As nitrate is more easily lost as leachate or to be reduced to gaseous forms, this could mean a depletion of soil N over large landscapes globally.

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Created

Date Created
2016-10-24

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Adverse Outcomes in Bereaved Mothers: The Importance of Household Income and Education

Description

Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet

Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet this variable has not yet been sufficiently evaluated in outcomes specifically for bereaved parents. This study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources. Practice and policy implications are discussed.

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Created

Date Created
2016-12

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Discerning Bias in Forensic Psychological Reports in Insanity Cases

Description

This project began as an attempt to develop systematic, measurable indicators of bias in written forensic mental health evaluations focused on the issue of insanity. Although forensic clinicians observed in this study did vary systematically in their report-writing behaviors on

This project began as an attempt to develop systematic, measurable indicators of bias in written forensic mental health evaluations focused on the issue of insanity. Although forensic clinicians observed in this study did vary systematically in their report-writing behaviors on several of the indicators of interest, the data are most useful in demonstrating how and why bias is hard to ferret out. Naturalistic data was used in this project (i.e., 122 real forensic insanity reports), which in some ways is a strength. However, given the nature of bias and the problem of inferring whether a particular judgment is biased, naturalistic data also made arriving at conclusions about bias difficult. This paper describes the nature of bias – including why it is a special problem in insanity evaluations – and why it is hard to study and document. It details the efforts made in an attempt to find systematic indicators of potential bias, and how this effort was successful in part but also how and why it failed. The lessons these efforts yield for future research are described. We close with a discussion of the limitations of this study and future directions for work in this area.

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Created

Date Created
2018-04-19

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Validity, Inter-Rater Reliability, and Measures of Adaptive Behavior: Concerns Regarding the Probative Versus Prejudicial Value

Description

The question as to whether the assessment of adaptive behavior (AB) for evaluations of intellectual disability (ID) in the community meet the level of rigor necessary for admissibility in legal cases is addressed. Adaptive behavior measures have made their way

The question as to whether the assessment of adaptive behavior (AB) for evaluations of intellectual disability (ID) in the community meet the level of rigor necessary for admissibility in legal cases is addressed. Adaptive behavior measures have made their way into the forensic domain where scientific evidence is put under great scrutiny. Assessment of ID in capital murder proceedings has garnished a lot of attention, but assessments of ID in adult populations also occur with some frequency in the context of other criminal proceedings (e.g., competence to stand trial; competence to waive Miranda rights), as well as eligibility for social security disability, social security insurance, Medicaid/Medicare, government housing, and post-secondary transition services. As will be demonstrated, markedly disparate findings between raters can occur on measures of AB even when the assessment is conducted in accordance with standard procedures (i.e., the person was assessed in a community setting, in real time, with multiple appropriate raters, when the person was younger than 18 years of age) and similar disparities can be found in the context of the unorthodox and untested retrospective assessment used in capital proceedings. With full recognition that some level of disparity is to be expected, the level of disparity that can arise when these measures are administered retrospectively calls into question the validity of the results and consequently, their probative value.

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Agent

Created

Date Created
2018-02-01

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Moral Disengagement in Legal Judgments

Description

We investigated the role of moral disengagement in a legally‐relevant judgment in this theoretically‐driven empirical analysis. Moral disengagement is a social‐cognitive phenomenon through which people reason their way toward harming others, presenting a useful framework for investigating legal judgments that

We investigated the role of moral disengagement in a legally‐relevant judgment in this theoretically‐driven empirical analysis. Moral disengagement is a social‐cognitive phenomenon through which people reason their way toward harming others, presenting a useful framework for investigating legal judgments that often result in harming individuals for the good of society. We tested the role of moral disengagement in forensic psychologists’ willingness to conduct the most ethically questionable clinical task in the criminal justice system: competence for execution evaluations. Our hypothesis that moral disengagement would function as mediator of participants’ existing attitudes and their judgments—a theoretical “bridge” between attitudes and judgments—was robustly supported. Moral disengagement was key to understanding how psychologists decide to engage in competence for execution evaluations. We describe in detail the moral disengagement measure we used, including exploratory and confirmatory factor analyses across two separate samples. The four‐factor measure accounted for a total of 52.18 percent of the variance in the sample of forensic psychologists, and the model adequately fit the data in the entirely different sample of jurors in a confirmatory factor analysis. Despite the psychometric strengths of this moral disengagement measure, we describe the pros and cons of existing measures of moral disengagement. We outline future directions for moral disengagement research, especially in legal contexts.

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Created

Date Created
2017-11-07

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The “Dark Side” of Institutional Trust

Description

The majority of trust research has focused on the benefits trust can have for individual actors, institutions, and organizations. This “optimistic bias” is particularly evident in work focused on institutional trust, where concepts such as procedural justice, shared values, and

The majority of trust research has focused on the benefits trust can have for individual actors, institutions, and organizations. This “optimistic bias” is particularly evident in work focused on institutional trust, where concepts such as procedural justice, shared values, and moral responsibility have gained prominence. But trust in institutions may not be exclusively good. We reveal implications for the “dark side” of institutional trust by reviewing relevant theories and empirical research that can contribute to a more holistic understanding. We frame our discussion by suggesting there may be a “Goldilocks principle” of institutional trust, where trust that is too low (typically the focus) or too high (not usually considered by trust researchers) may be problematic. The chapter focuses on the issue of too-high trust and processes through which such too-high trust might emerge. Specifically, excessive trust might result from external, internal, and intersecting external-internal processes. External processes refer to the actions institutions take that affect public trust, while internal processes refer to intrapersonal factors affecting a trustor’s level of trust. We describe how the beneficial psychological and behavioral outcomes of trust can be mitigated or circumvented through these processes and highlight the implications of a “darkest” side of trust when they intersect. We draw upon research on organizations and legal, governmental, and political systems to demonstrate the dark side of trust in different contexts. The conclusion outlines directions for future research and encourages researchers to consider the ethical nuances of studying how to increase institutional trust.

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Created

Date Created
2016