Abstract
BackgroundPregnancy-induced hypertension (PIH) is associated with high levels of morbidity and mortality in mothers, fetuses, and newborns. New technologies, such as remote monitoring (RM), were introduced in 2015 into the care of patients at risk of PIH in Ziekenhuis Oost-Limburg (Genk, Belgium) to improve both maternal and neonatal outcomes. In developing new strategies for obstetric care in pregnant women, including RM, it is important to understand the psychosocial characteristics associated with adherence to RM to optimize care.ObjectiveThe aim of this study was to explore the role of patients’ psychosocial characteristics (severity of depression or anxiety, cognitive factors, attachment styles, and personality traits) in their adherence to RM.MethodsQuestionnaires were sent by email to 108 mothers the day after they entered an RM program for pregnant women at risk of PIH. The Generalized Anxiety Disorder Assessment-7 and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and the severity of depression, respectively; an adaptation of the Pain Catastrophizing Scale was used to assess cognitive factors; and attachment and personality were measured with the Experiences in Close Relationships-Revised Scale (ECR-R), the Depressive Experiences Questionnaire, and the Multidimensional Perfectionism Scale, respectively.ResultsThe moderate adherence group showed significantly higher levels of anxiety and depression, negative cognitions, and insecure attachment styles, especially compared with the over adherence group. The low adherence group scored significantly higher than the other groups on other-oriented perfectionism. There were no significant differences between the good and over adherence groups. Single linear regression showed that the answers on the PHQ-9 and ECR-R questionnaires were significantly related to the adherence rate.ConclusionsThis study demonstrates the relationships between adherence to RM and patient characteristics in women at risk of PIH. Alertness toward the group of women who show less than optimal adherence is essential. These findings call for further research on the management of PIH and the importance of individual tailoring of RM in this patient group.Trial RegistrationClinicalTrials.gov NCT03509272; https://clinicaltrials.gov/ct2/show/NCT03509272
Highlights
There is a wide variety of FSDs affecting the different body systems, and almost every medical specialty has defined syndromes referring to patients presenting with a particular set of symptoms (Fischhoff & Wessely, 2003; Wessely & White, 2004)
We provide a clinical example of the systematic treatment approach, and end with a discussion of future areas for research and clinical practice
Many patients will ask their treating physician or psychologist to provide them with a definitive explanation of the role of biological and psychological factors in their disorder, in our treatment approach, we have learned to refrain from trying to provide such answers, which are always based on group research
Summary
Up to 9% of patients present with more than one type of somatic symptom disorder (Bass & May, 2002) This latter term, as defined in DSM-5 (American Psychiatric Association, 2013), emphasizing the persistent nature of somatic symptoms, is much preferred to notions such as “psychosomatic” or “somatoform disorder”, as these terms improperly imply the primacy of psychological factors in the causation of these disorders. These disorders are far from “medically unexplained syndromes”, as they are sometimes referred to. We provide a clinical example of the systematic treatment approach, and end with a discussion of future areas for research and clinical practice
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