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Koppling av influensapandemi och könsmogna stadiet i samband med depressiva och belastade ångestsymptom senare i livet hos den kvinnliga grekiska befolkningen: Finns det möjlighet att förebygga?
University of Skövde, School of Health Sciences.
2020 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesisAlternative title
Association of influenza pandemics and reproductive stage with later life depressive and anxiety symptoms in greek woman : Is there opportunity for prevention? (English)
Abstract [sv]

Bakgrund: Influensa är ett stort folkhälsoproblem på grund av att den är det vanligaste globala smittsamma sjukdomsutbrott som leder till grava mentala och fysiska hälsobelastningar.

Syfte: Vi undersökte kliniskt relevanta depressiva och belastade ångestsymptom i kvinnor i samband med förlossningen under två av 1900-talets influensapandemier, N2N2 och/eller H2N3 samt det könsmogna stadiet (mellan ålder vid menarke and ådler vid menopaus) där andra reproduktiva faktorer i den kvinnliga grekiska befolkningen beaktades.

Metoder: Tvärsnitts- och historiska data uppkom från 1039 kvinnliga deltagare som deltog i studien Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) där sociodemografiska variabler inkluderade ålder. Resultatet av de depressiva symtomen mättes med hjälp av den Geriatriska depressionsskalan bestående av 15-artiklar (GDS-15). En kliniskt relevant depressiv symptom börda definierades som GDS>5. Ångestsymptom mättes med de 7 ångest artiklarna från sjukhusets ångest och depressionsskala (HADS-A). En kliniskt relevant belastad ångestsymptom definierades som >8 för HADS. H2N2-pandemi perioden inträffades 1956-1958 och H2N3-pandemin, 1967-1969. Självrapporterade reproduktiva steg variabler inkluderade ålder vid menarke, ålder vid menopaus, antal graviditeter, antal barn, barnens födelseår och antal aborter.

Resultat: Kliniskt relevanta depressiva och belastade ångestsymptom observerades bland 24,5% respektive 15,8% av HELIAD-deltagarna. Ingen koppling observerades mellan varken GDS >5 (Chi-square, 0,39, p = 0,56) eller HADS >8 (Chi-square, 0,06, p = 0,82) och födelse under H2N2- och / eller H2N3-pandemier. Univariat samband mellan ålder vid menarke, antal graviditeter, det könsmogna stadiet, och antal aborter var dock associerat med GDS >5 (alla p <0,10). Därför, en stegvis logistisk regressionsmodell som utvärderade reproduktiva variabler visade att det fanns högre odds för en kliniskt relevant depressiv symtombörda i samband med en äldre ålder vid menarke (OR 1.09, 95% KI 1.00, 1.18) och högre antal graviditeter (OR 1.07, 95% KI 1,01, 1,14). Inga förbindelser observerades gällande ångest.

Slutsats: Vår hypotes att födelse under en influensapandemi skulle påverka förekomsten av kliniskt relevanta senare depressiva och ångestsymptom avvisades i denna analys. Vår sekundära hypotes att reproduktions variabler skulle associeras med psykisk ohälsa senare i livet avvisades dock inte för depressiva symtom. Även om sambandet mellan en kliniskt relevant belastad depressiv symtom och ålder vid menarche och antalet graviditeter inte var övertygande, framhävs den viktiga rollen kvinnors reproduktiva hälsa har under hela livet. Mer forskning behövs för att förstå det tidsmässiga och konsekventa sambandet.

Abstract [en]

Background: Influenza is a major public health concern due to increasingly frequent global infectious disease outbreaks that result in great mental and physical health burdens.

Aim: We investigated clinically relevant later life depressive and anxiety symptom burdens in women in association with giving birth during two 20th century influenza pandemics, H2N2 and/or H2N3, and reproductive stage, the total reproductive years of a woman defined mathematically as the age at menopause minus the age at menarche. We also considered other reproductive factors.

Methods: Cross-sectional and historical data originated from 1039 female participants age 54 and older, enrolled in the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) in Greece. Sociodemographic variables included age. The depressive symptoms outcome was measured using the 15-item Geriatric Depression Scale (GDS-15). A clinically relevant depressive symptom burden was defined as GDS >5, Anxiety symptoms were measured using the 7 anxiety items from the Hospital Anxiety and Depression Scale (HADS-A). A clinically relevant anxiety symptom burden was defined as >8 for HADS. The H2N2 pandemic period occurred from 1956-1958 and the H2N3 pandemic, from 1967-1969. Selfreported reproductive stage variables included age at menarche, age at menopause, number of pregnancies, number of offspring, offspring’ birth year, and number of abortions.

Results: Clinically relevant depressive and anxiety symptom burdens were observed among 24.5% and 15.8% of HELIAD participants, respectively. No association was observed between either GDS >5 (2, 0.39, p=0.56) or HADS >8 (2, 0.06, p=0.82) and giving birth during the H2N2 and/or H2N3 pandemics. However, univariate association between age at menarche, number of pregnancies, reproductive stage, and number of abortions were associated with GDS >5 (all p <0.10). Therefore, a stepwise logistic regression model evaluating these reproductive variables showed that higher odds of a clinically relevant depressive symptom burden in association with an older age at menarche (OR 1.09, 95%CI 1.00, 1.18) and higher number of pregnancies (OR 1.07, 95% CI 1.01, 1.14). No associations were observed for anxiety.

Conclusion: Our hypothesis that giving birth during an influenza pandemic would influence the occurrence of clinically relevant later life depressive and anxiety symptoms was rejected in this analysis. However, our secondary hypothesis that reproductive variables would be associated with later life mental health was not rejected for depressive symptoms. While the associations between a clinically relevant depressive symptom burden and age at menarche and number of pregnancies were not strong, they point to the important role of women’s reproductive health over the life course. More research is needed to understand the temporality and consistencies of these associations.

Place, publisher, year, edition, pages
2020. , p. 22
Keywords [en]
H3N2, H1N1, pregnancy, depression, anxiety
Keywords [sv]
H3N2, H1N1, graviditet, depression, ångest
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:his:diva-19490OAI: oai:DiVA.org:his-19490DiVA, id: diva2:1530531
Subject / course
Public Health Science
Educational program
Public Health Science: Infection Prevention and Control - Master’s Programme 60 ECTS
Supervisors
Examiners
Available from: 2021-02-23 Created: 2021-02-23 Last updated: 2021-02-23Bibliographically approved

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