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Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.ORCID-id: 0000-0002-2706-1730
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.ORCID-id: 0000-0003-4329-6721
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.ORCID-id: 0000-0003-0180-0280
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.ORCID-id: 0000-0003-4729-9962
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2019 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, nr 4, s. 470-478Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction

Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

Material and methods

Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

Results

After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

Conclusions

Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

Ort, förlag, år, upplaga, sidor
2019. Vol. 98, nr 4, s. 470-478
Nyckelord [en]
antenatal care, health care utilization, neuroticism, personality, pregnancy, prenatal care
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
URN: urn:nbn:se:uu:diva-364260DOI: 10.1111/aogs.13506ISI: 000460954800008PubMedID: 30457176OAI: oai:DiVA.org:uu-364260DiVA, id: diva2:1258489
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, 2007-1955Marianne och Marcus Wallenbergs Stiftelse, MMW2011.0115Sveriges läkarförbund, SLS-250581Vetenskapsrådet, 521-2010-3293Vetenskapsrådet, K2008-54X-20642-01-3Svenska läkaresällskapetStiftelsen Söderström - Königska sjukhemmetTore Nilsons Stiftelse för medicinsk forskningTillgänglig från: 2018-10-24 Skapad: 2018-10-24 Senast uppdaterad: 2019-04-15Bibliografiskt granskad
Ingår i avhandling
1. Anxious personality traits in pregnant women: Associations with postpartum depression, delivery complications and health care use
Öppna denna publikation i ny flik eller fönster >>Anxious personality traits in pregnant women: Associations with postpartum depression, delivery complications and health care use
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Anxious personality traits, including those encompassed by negative emotionality (neuroticism) and the tendency to worry about close relationships (attachment anxiety) during pregnancy were the focus of this thesis. The overall aim was to examine perinatal correlates of these characteris-tics in terms of psychiatric and obstetric health as well as antenatal care (ANC).

Papers I-II were part of a large population-based project on pregnant women in Uppsala in 2009-2012 (n=2160). Papers III-IV adjoined participants from several projects in 2005-2011, on oral contraceptive use, infertility, induced abortion, premenstrual mood disorder, and perina-tal depression (n=2819). The participants reported on the Swedish universities Scales of Per-sonality for neuroticism (papers II-IV) and the Attachment Style Questionnaire (ASQ) for attachment anxiety (papers I-II). The participants also answered the Edinburgh Postnatal De-pression Scale on depressive symptoms (paper II). In paper III, information on obstetric com-plications for primiparous women with singleton pregnancies (n=1969) was extracted from Swedish national health registers. In paper IV, ANC use was derived from medical records of obstetric low-risk women residing in Uppsala (n=1052).

The ASQ had similar psychometric properties in pregnant women (n=1631) as in previous reports (paper I). In non-depressed pregnant women (n=1431), the combination of neuroticism and attachment anxiety was the best risk indicator of postpartum depressive symptoms (paper II). Whereas high neuroticism was not related to obstetric complications (paper III), it was associated with higher use of ANC (paper IV).

Summarized, this thesis illustrates how anxious personality traits may predispose for post-partum depression and higher use of ANC in the absence of obstetric complications. Future development of these findings should be to evaluate individual and societal benefits of a greater emphasis on psychological support in ANC.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 67
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1510
Nyckelord
Personality, neuroticism, adult attachment, perinatal depression, postpartum depression, obstetric complications, health care use
Nationell ämneskategori
Psykiatri
Forskningsämne
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-359600 (URN)978-91-513-0488-5 (ISBN)
Disputation
2018-12-14, Auditorium minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-11-21 Skapad: 2018-10-24 Senast uppdaterad: 2018-11-30

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Axfors, CathrineHellgren, CharlotteVolgsten, HelenaSkoog Svanberg, AgnetaEkselius, LisaWikström, Anna-KarinRamklint, MiaSkalkidou, AlkistisSundström-Poromaa, Inger

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Axfors, CathrineHellgren, CharlotteVolgsten, HelenaSkoog Svanberg, AgnetaEkselius, LisaWikström, Anna-KarinRamklint, MiaSkalkidou, AlkistisSundström-Poromaa, Inger
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Psykiatri, Akademiska sjukhusetReproduktiv hälsaObstetrisk och reproduktiv hälsoforskningKlinisk obstetrik
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Acta Obstetricia et Gynecologica Scandinavica
Reproduktionsmedicin och gynekologi

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