Browsing by Author "McDonald, Sheila"

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    An Examination of Mode of Birth, Maternal Postpartum Mental Health, and Childhood Behavioural Problems
    (2024-01-26) Grisbrook, Marie-Andrée; Letourneau, Nicole; Dewey, Deborah; Cuthbert, Colleen; McDonald, Sheila
    Cesarean section (C-section) deliveries account for 21% of all deliveries worldwide (Betran, Ye, Moller, Souza, & Zhang, 2021). They are frequently considered a medical necessity in labour dystocia, placenta previa, and malpresentation (Caughey, Cahill, Guise, & Rouse, 2014). However, delivery via C-section has been associated with an increased risk of internalizing (anxiousness, depressiveness, withdrawal) and externalizing (aggression, hyperactivity) behavioural problems among children (Rutayisire et al., 2018; Sirvinskiene, Zemaitiene, Jusiene, & Markuniene, 2016). Research evaluating the link between C-section and child behaviour is inconclusive and limited. Delivery via an emergency C-section is the strongest factor linked to a negative perception of the birth experience (Waldenstrom & Schytt, 2009). A negative perception of the birth experience is strongly associated with postpartum post-traumatic stress disorder (PTSD) (Dekel, Ein-Dor, et al., 2019; Soderquist, Wijma, & Wijma, 2002; Verreault et al., 2012), which may be comorbid with postpartum depression (PPD) (Soderquist, Wijma, & Wijma, 2006). Therefore, it is hypothesized that the relationship between C-section and child behaviour depends on the type of C-section, and postpartum PTSD and PPD mediate this association. This manuscript-based dissertation is comprised of five papers. The first and second manuscripts include a review protocol and systematic review outlining the procedures and current evidence regarding the association between C-section delivery and child externalizing and internalizing behavioural problems. The third manuscript presents results regarding the association between C-section delivery and maternal PPD and the role of maternal PTSD in mediating this association. The fourth manuscript presents the study findings on the association between C-section delivery and child behavioural problems and the role of maternal postpartum PTSD and PPD as mediating factors. The final manuscript reviews the current landscape of maternal postpartum mental health screening in Canada and suggests improvements for screening. The dissertation concludes with implications for nursing practice, policy, education, and research.
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    Child Development for Children Born Too Soon: Identifying Mechanisms and Points for Early Intervention
    (2022-06-27) Stephenson, Nikki L; Metcalfe, Amy L; Tough, Suzanne C; McDonald, Sheila; McMorris, Carly, Williamson, Tyler
    Background: The distribution of gestational age at birth has shifted in the last 40 years, such that the incidence of late preterm (?34 but <37 weeks) and early term (?37 and <39 weeks) births have increased, accounting for 30% of all births. Infants born late preterm or early term have an increased risk of adverse health outcomes, developmental delays, social-emotional and behavioural problems; yet, gestational age at birth alone does not include these infants in routine developmental screening programs. The intersection between the increased incidence and increased risk of developmental challenges for children born late preterm and early term accentuates the importance of understanding their specific early childhood developmental outcomes for future intervention. Methods: Using data from the All Our Families cohort, these studies examined the association between gestational age at birth and trajectories of developmental delay throughout early childhood with social-emotional and behavioural problems at age 5. Patterns of developmental delay were explored using group-based trajectory modelling. Multivariable logistic regression was used to analyze social-emotional and behavioural problems at 5 years of age and the modifying effect of childcare.Results: Late preterm and early term birth increase the probability developmental delays, as does poor maternal mental health in pregnancy, identifying as an ethnic minority, advanced maternal age, or being a male child. However, the effects of decreasing gestational age on the risk of developmental delay differ between individual domains of development. Though decreasing gestational age was not independently associated with social-emotional or behavioural problems at age 5 years, there was a significant interaction between type of childcare and gestational age. Instability of childcare at 3 years of age was independently associated with increased behavioural problems at 5 years of age.Conclusion: This study found that late preterm and early term born children have an increased independent risk of developmental delay throughout early childhood, but not social-emotional or behavioural problems. Additional developmental monitoring may be warranted for children who are born <39 weeks gestation. Providing equitable access to high-quality, stable childcare, where routine developmental screening is often standard practice, may better support these children and their families.
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    Cross-sectionally Exploring Proxy Usage for Historical Data Analysis: A Proof of Concept
    (2024-11-01) Adeboye, Promise Anjolaoluwa; McDonald, Sheila; Suzanne, Tough; Patten, Scott; Holodinsky, Jessalyn
    Introduction: Longitudinal cohorts routinely collect information that encompass many different aspects of the life course, but their analysis is often restricted to validated scales. Such validated scales are often routinely shifting to reflect contemporary understandings of important concepts. Such routine changes often mean that a present-day scale measuring a concept may be incomparable to a different scale measuring the same concept in previous time-points. This restriction greatly hampers the strength of longitudinal cohorts in being able to make comparisons across time points. In this problem lies an opportunity to create a method of proxy development such that the proxy would be impervious to scale evolution over time. Flourishing is a common, well-studied concept that is a good candidate for this proof of concept. This thesis explores the use of proxy measurements as an optimization procedure for longitudinal cohorts going forward. Methods: As a proof of concept, two methods were explored for proxy creation using the test concept of flourishing. Using a bootstrapped linear regression approach, the proxy models were evaluated on performance metrics. Discussion: Although the proxy models performed similarly, the interpretation of results differed per model. Through the development of a flourishing proxy based on available data, it is possible to quantify historical flourishing, such that associations can be made between that and other concepts. Due to the context of the model derivation, the coefficients of either models cannot be extrapolated to other cohorts, but the coefficients of the knowledge-driven model can be furthur validated temporally within the derivation cohort. The included variables from both proxies contribute to the conceptual understanding of flourishing, but only in this specific cohort. Conclusion: Proxy derivation methods have the capacity to increase the value-add of historically collected data. However, more evaluations and validations of both the coefficients and the derivation method are needed before this can be used as a finalized procedure.
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    Developing non-response weights to account for attrition-related bias in a longitudinal pregnancy cohort
    (2023-12-14) Pitt, Tona M.; Hetherington, Erin; Adhikari, Kamala; Premji, Shainur; Racine, Nicole; Tough, Suzanne C.; McDonald, Sheila
    Abstract Background Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the “All Our Families” longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models to predict study continuation versus drop-out from baseline to the three-year data collection wave. Methods Two methods of variable selection took place. One method was a knowledge-based a priori variable selection approach, while the second used Least Absolute Shrinkage and Selection Operator (LASSO). The ability of each model to predict continuing participation through discrimination and calibration for both approaches were evaluated by examining area under the receiver operating curve (AUROC) and calibration plots, respectively. Stabilized inverse probability weights were generated using predicted probabilities. Weight performance was assessed using standardized differences of baseline characteristics for those who continue in study and those that do not, with and without weights (unadjusted estimates). Results The a priori and LASSO variable selection method prediction models had good and fair discrimination with AUROC of 0.69 (95% Confidence Interval [CI]: 0.67–0.71) and 0.73 (95% CI: 0.71–0.75), respectively. Calibration plots and non-significant Hosmer-Lemeshow Goodness of Fit Tests indicated that both the a priori (p = 0.329) and LASSO model (p = 0.242) were well-calibrated. Unweighted results indicated large (> 10%) standardized differences in 15 demographic variables (range: 11 − 29%), when comparing those who continued in the study with those that did not. Weights derived from the a priori and LASSO models reduced standardized differences relative to unadjusted estimates, with the largest differences of 13% and 5%, respectively. Additionally, when applying the same LASSO variable selection method to develop weights in future data collection waves, standardized differences remained below 10% for each demographic variable. Conclusion The LASSO variable selection approach produced robust weights that addressed non-response bias more than the knowledge-driven approach. These weights can be applied to analyses across multiple longitudinal waves of data collection to reduce bias.
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    Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
    (2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
    This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
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    Factors Affecting Parental Help seeking for Children with Mental Health Problems
    (2017) Harvalik, Paula; Kingston, Dawn; Arnold, Paul; McDonald, Sheila; Goldsworthy, Sandra
    Background. Childhood mental health problems have an early onset, are highly prevalent, and persistent into adolescents’ and adulthood, and left untreated, mental health problems are exacerbated by comorbid disorders. Early screening and intervention for childhood mental health is key to improved outcomes. Very young children that experience emotional or behavioural problems rely primarily on their parents for help-seeking on their behalf. Parents often do not recognize problematic behaviour that requires further evaluation and treatment. Without parental help-seeking, these children’s mental health problems remain undetected and untreated throughout the lifespan. Understanding what perceived barriers and facilitators exist for parents that have children with problematic behaviours, can inform the development of early intervention programs aimed at very young children (i.e., 5 years old and under). The aim of this thesis by publication was to examine the barriers and facilitators to help-seeking for parents with children that have emotional and behavioural problems. Methods. Two published studies of perceived barriers and facilitators to help-seeking for parents of young children were identified through searches using PubMed, PsycINFO, Embase, and CINAHL databases. Data was extracted and summarized in tables. Results. Parents reported perceived barriers to be: (a) child’s problems being identified as transient and part of a stage that will go way on their own, (b) not knowing what services were available, and (c) not knowing what sources were available for help. Conclusions. Increased research and development of early screening and intervention programs that target parents of very young children will improve mental health outcomes for children, their families, and communities.
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    Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study
    (2024-06-17) MacDonald, Shannon E.; Dhungana, Manisha; Stagg, Victoria; McDonald, Sheila; McNeil, Deborah; Kellner, James D.; Tough, Suzanne; Saini, Vineet
    Abstract Background Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines. Methods In this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates. Results In multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74–1.82), MMR/MMRV (OR 1.03, 95% CI 0.72–1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86–2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77–1.53), MMR/MMRV (OR 1.07, 95% CI 0.82–1.40), or all vaccines combined (OR 1.00, 95% CI 0.80–1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers. Conclusion Health care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.
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    Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination
    (2019-01-10) McNeil, Deborah A; Mueller, Melissa; MacDonald, Shannon; McDonald, Sheila; Saini, Vineet; Kellner, James D; Tough, Suzanne
    Abstract Background Understanding reasons for and against vaccination from the parental perspective is critical for designing vaccination campaigns and informing other interventions to increase vaccination uptake in Canada. The objective of this study was to understand maternal vaccination decision making for children. Methods Mothers participating in a longitudinal community-based pregnancy cohort, the All Our Babies study in Calgary, Alberta, completed open-ended survey questions providing explanations for the vaccination status of their child by 24 months postpartum. Qualitative responses were linked to administrative vaccination records to examine survey responses and recorded child vaccination status. Results There were 1560 open-ended responses available; 89% (n = 1391) provided explanations for vaccinating their children, 5% (n = 79) provided explanations for not vaccinating/delaying, and 6% (n = 90) provided explanations for both. Themes were similar for those vaccinating and not vaccinating/delaying; however, interpretations were different. Two broad themes were identified: Sources of influence and Deliberative Processes. Sources of influence on decision making included personal, family, and external experiences. Deliberative Processes included risk, research, effectiveness, and balancing risks/benefits. Under Deliberative Processes, responsibility was a category for those vaccinating; while choice, instrumental/practical, and health issues were categories for those not vaccinating/delaying. Mothers’ levels of conviction and motivation provided a Context for understanding their decision making perspectives. Conclusions Vaccination decision making is complex and impacted by many factors that are similar but contribute to different decisions depending on mothers’ perspectives. The results of this study indicate the need to examine new intervention approaches to increase uptake that recognize and address feelings of pressure and parental commitment to choice.
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    Mental health outcomes of mothers who conceived using fertility treatment
    (BioMed Central, 2014-02-28) Raguz, Nikolett; McDonald, Sheila; Metcalfe, Amy; O'Quinn, Candace; Tough, Suzanne C
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    The role of feeding practices in the relationship between postpartum depression and child growth: Analysis of the All Our Babies study
    (2017-12-20) Lee, Yoon Shin; Fenton, Tanis; Sauve, Reginald; Rose, Marianne; McDonald, Sheila; Benzies, Karen
    The purpose of this study was to examine the relationships among postpartum depression at 4 months of age, feeding practices and child growth at age 2 years. This study used data from 1881 mothers participating in the All Our Babies Study in Calgary. The mothers participated in five surveys between 24 weeks gestation and 2 years of child age. Multivariable regression analysis was done. Postpartum depression was negatively related to exclusive breastfeeding duration (β = -2.30 weeks, 95% CI: -4.39, -0.22). Postpartum depression and feeding practices were unrelated to child growth at age 2 years. We found mothers with postpartum depression at 4 months terminated exclusive breastfeeding earlier (2.3 weeks) than mothers without postpartum depression whose average exclusive breastfeeding duration was 20.2 weeks. The findings suggest a need for breastfeeding support for mothers with postpartum depression to sustain breastfeeding to the recommended duration.