Gotowe bibliografie tematyczne / Postpartum abuse

Gotowa bibliografia na temat „Postpartum abuse”

Autor: Grafiati
Data publikacji: 4 czerwca 2021
Data aktualizacji: 20 lutego 2023

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Artykuły w czasopismach na temat "Postpartum abuse"

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Buist, Anne. "Childhood Abuse, Parenting and Postpartum Depression". Australian & New Zealand Journal of Psychiatry 32, nr 4 (sierpień 1998): 479–87. http://dx.doi.org/10.3109/00048679809068320.

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Objective: While the potential negative effects on children of maternal depression has been documented, the influence of a maternal history of childhood abuse on child development is unclear. This study, the first stage of a 3–year follow-up study, looks at childhood abuse in women with depression in the postpartum period. Method: Fifty-six women admitted with postpartum depressive disorders were assessed with respect to their wellbeing, relationships and infant interaction. Twenty-eight women had a history of sexual abuse before the age of 16, nine physical/ emotional abuse and 19 had no history of abuse. Results: The mother-infant relationship was seen to be impaired in the sexually abused group (p = 0.007). The significance increased when all abused women were compared to controls (p = 0.001). In addition, abuse was associated with more severe depression on the Beck Depression Inventory (p = 0.046), and a trend to higher anxiety and longer lengths of stay (p = 0.05 for physical abuse). Partners rated themselves as being more skilled and confident parents. Conclusions: The effect of childhood abuse was indistinguishable between emotional and physical abuse in postpartum depressed women. The most significant effect was a deleterious one on the mother-infant relationship in those women with a history of abuse.
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Kennedy, Stephanie C., i Stephen J. Tripodi. "Childhood Abuse and Postpartum Psychosis". Affilia 30, nr 1 (24.07.2014): 96–105. http://dx.doi.org/10.1177/0886109914544719.

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Abdelmounaim, Loutfi Guennoun, Mohammed Khouchoua, Nouha Nhiri, Naouale Biougnache, Mohamed Adnane Rhaidouni, Ouassila Laouji, Fatima El Hadraoui i in. "Oxytocin Abuse and Postpartum Hemorrhage". Open Journal of Obstetrics and Gynecology 12, nr 12 (2022): 1320–27. http://dx.doi.org/10.4236/ojog.2022.1212116.

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Buist, Anne. "Childhood Abuse, Postpartum Depression and Parenting Difficulties: A Literature Review of Associations". Australian & New Zealand Journal of Psychiatry 32, nr 3 (czerwiec 1998): 370–78. http://dx.doi.org/10.3109/00048679809065529.

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Objective: The aim of this paper is to obtain an understanding of the links between maternal postpartum depression, poor parenting and childhood abuse, and the subsequent development of adult psychopathology in children from these families. Method: A literature review was undertaken of studies on postpartum depression looking at parental childhood abuse, parenting and child outcomes, as well as childhood abuse and its association with adult depression and parenting difficulties. Results: Considerable overlap is noted in predisposing factors for major depression, postpartum depression, inadequate parenting and childhood abuse. Links appear to begin in early infancy, suggesting postpartum depression as a possible mechanism for intergenerational transmission of psychopathology. Conclusions: Further research is required to look at the outcome of children of women who are at high risk of chronic or recurrent depression and of difficulties parenting; the postpartum period is the optimum time for identification and intervention.
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WACHTER, KERRI. "Drug Abuse Linked to Postpartum Suicidal Ideation". Internal Medicine News 41, nr 16 (sierpień 2008): 18. http://dx.doi.org/10.1016/s1097-8690(08)70904-1.

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WACHTER, KERRI. "Depression, Drug Abuse Predict Postpartum Suicidal Ideation". Clinical Psychiatry News 36, nr 9 (wrzesień 2008): 23. http://dx.doi.org/10.1016/s0270-6644(08)70627-1.

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Mendelson, Maria A., i Janet Chandler. "Postpartum cardiomyopathy associated with maternal cocaine abuse". American Journal of Cardiology 70, nr 11 (październik 1992): 1092–94. http://dx.doi.org/10.1016/0002-9149(92)90369-a.

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Bauleni, Esther M., Leesa Hooker, Hassan P. Vally i Angela Taft. "Intimate-partner violence and reproductive decision-making by women attending Victorian Maternal- and Child-Health services: a cross-sectional study". Australian Journal of Primary Health 24, nr 5 (2018): 422. http://dx.doi.org/10.1071/py17183.

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The reproductive years are a critical period where women experience greater risk of intimate-partner violence (IPV). Most studies investigating the association between IPV and reproductive health have been completed in low- and middle-income countries. This study aimed to examine the relationship between IPV and women’s reproductive decision-making in Victoria, Australia. We analysed secondary data from a cluster-randomised trial of IPV screening that surveyed new mothers attending Maternal- and Child-Health centres in Melbourne. Survey measures included the experience of partner abuse in the past 12 months using the Composite Abuse Scale and four reproductive decision-making indicators. Results showed that IPV affects reproductive decision-making among postpartum women. Women who reported abuse were less likely to plan for a baby (adjusted Odds Ratio 0.48, 95% CI: 0.31–0.75) than were non-abused women, significantly more likely to have partners make decisions for them about contraception (Risk ratio (RR) 4.09, 95% CI: 1.31–12.75), and whether and when to have a baby (RR 12.35, 95% CI: 4.46–34.16), than they were to make decisions jointly. Pregnant and postpartum women need to be screened for partner violence that compromises women’s decision-making power regarding their reproductive rights.
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Ulrich, Yvonne Campbell, Laura Smith Mckenna, Christine King, Doris W. Campbell, Josephine Ryan, Sara Torres, Patricia Price Lea i in. "Postpartum Mothers' Disclosure of Abuse, Role, and Conflict". Health Care for Women International 27, nr 4 (maj 2006): 324–43. http://dx.doi.org/10.1080/07399330500511733.

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Pereira, Cynara M., Rodolfo C. Pacagnella, Mary A. Parpinelli, Carla B. Andreucci, Dulce M. Zanardi, Renato T. Souza, Carina R. Angelini, Carla Silveira i José G. Cecatti. "Postpartum psychoactive substance abuse after severe maternal morbidity". International Journal of Gynecology & Obstetrics 147, nr 3 (30.09.2019): 368–74. http://dx.doi.org/10.1002/ijgo.12967.

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Rozprawy doktorskie na temat "Postpartum abuse"

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Stephens, Rose, Andrea D. Clements i Beth A. Bailey. "The Relationship Between Breastfeeding Practices and Postpartum Depressive Symptoms at Six Months Postpartum in Appalachian Women". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7243.

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Introduction: Postpartum Depression and postpartum depressive symptoms have been found to have a strong association with breastfeeding duration in a significant portion of women across a variety of geographical locations. The aim of this study was to explore the correlation between postpartum depressive symptoms at 6 months postpartum and total duration of breastfeeding measured at 15 months postpartum in Appalachian women. Methods: A longitudinal study was conducted in which 1,063 mostly low socioeconomic status women were recruited across 6 prenatal practices in Appalachia. At 6 weeks, 6 months, and 15 months postpartum, depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). From the original sample, 134 completed a self-report measure of breastfeeding initiation and duration at 15 months postpartum. Results: EPDS score did not predict whether or not women breastfed, only their duration of breastfeeding. Women who scored in the clinically significant range (13 or higher) on the EPDS at 6 months postpartum breastfed a significantly shorter length of time (Mean = 1.75 months, SD = 2.70) than women who scored below 13 on the EPDS (Mean = 4.48 months, SD 5.22; t(133) = 3.61, p = .001). Conclusion: Clinically significant Edinburgh Postnatal Depression Scale scores were predictive of shorter duration of breastfeeding.
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Sricamsuk, Amornrat, i n/a. "Domestic Violence Against Pregnant Women: A Thai Perspective". Griffith University. School of Nursing and Midwifery, 2006. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070116.154749.

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Little is known about domestic violence experienced by Thai pregnant women. This exploratory descriptive study aimed to investigate the prevalence of domestic violence during pregnancy and immediate postpartum period among Thai women aged between 18 and 45 years. The study also aimed to investigate maternal and neonatal outcomes for childbearing women, the ways in which they dealt with domestic violence, barriers that inhibited them from seeking help or resisting violence, as well as the needs and support that would be helpful in dealing with domestic violence. A cohort of 421 women in their third trimester of pregnancy was recruited from two tertiary public hospital antenatal clinics located in Khon Kaen Province, Northeastern Thailand. Structured questionnaires were used. Participants were again contacted at six weeks postpartum either in person at the family planning clinics or by telephone. Two hundred and seventy-four women were able to be contacted. The results showed that 53.7% of women reported psychological abuse, 26.6% experienced threats of and/or acts of physical abuse, and 19.2% experienced sexual violence during the current pregnancy. In the postpartum period, 35.4% of women reported psychological abuse, 9.5% reported threats of and/or acts of physical abuse, and 11.3% experienced sexual abuse. Women who were abused during pregnancy showed significantly poorer health status compared to non-abused women in role emotional functioning, vitality, bodily pain, mental health and social functioning. Women who experienced postpartum abuse reported significantly lower mean scores in mental health and social functioning than women who did not. Antepartum haemorrhage was also found to be statistically associated with physical abuse. No statistical differences were found between abuse status and neonatal outcomes. There were several strategies used by abused women in dealing with domestic violence to maximize their safety including crying, keeping quiet, leaving violent situations and temporarily staying with relatives, seeking help from others, and notifying local authorities. Support services that would be helpful for abused women in dealing with the problem included emotional support, social legal assistance, and community health promotion. Domestic violence during pregnancy and after birth is an increasing but under-recognized problem in Thailand. It has pervasive consequences on maternal health. The findings from this study suggest more interventions and urgent domestic violence support services need to be established in this remote area of Thailand. This study also suggests routine screening for domestic violence should be established to provide effective early intervention and prevention of adverse consequences of violence, as pregnancy is a time when most pregnant women seek health care.
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Sricamsuk, Amornrat. "Domestic Violence Against Pregnant Women: A Thai Perspective". Thesis, Griffith University, 2006. http://hdl.handle.net/10072/365872.

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Little is known about domestic violence experienced by Thai pregnant women. This exploratory descriptive study aimed to investigate the prevalence of domestic violence during pregnancy and immediate postpartum period among Thai women aged between 18 and 45 years. The study also aimed to investigate maternal and neonatal outcomes for childbearing women, the ways in which they dealt with domestic violence, barriers that inhibited them from seeking help or resisting violence, as well as the needs and support that would be helpful in dealing with domestic violence. A cohort of 421 women in their third trimester of pregnancy was recruited from two tertiary public hospital antenatal clinics located in Khon Kaen Province, Northeastern Thailand. Structured questionnaires were used. Participants were again contacted at six weeks postpartum either in person at the family planning clinics or by telephone. Two hundred and seventy-four women were able to be contacted. The results showed that 53.7% of women reported psychological abuse, 26.6% experienced threats of and/or acts of physical abuse, and 19.2% experienced sexual violence during the current pregnancy. In the postpartum period, 35.4% of women reported psychological abuse, 9.5% reported threats of and/or acts of physical abuse, and 11.3% experienced sexual abuse. Women who were abused during pregnancy showed significantly poorer health status compared to non-abused women in role emotional functioning, vitality, bodily pain, mental health and social functioning. Women who experienced postpartum abuse reported significantly lower mean scores in mental health and social functioning than women who did not. Antepartum haemorrhage was also found to be statistically associated with physical abuse. No statistical differences were found between abuse status and neonatal outcomes. There were several strategies used by abused women in dealing with domestic violence to maximize their safety including crying, keeping quiet, leaving violent situations and temporarily staying with relatives, seeking help from others, and notifying local authorities. Support services that would be helpful for abused women in dealing with the problem included emotional support, social legal assistance, and community health promotion. Domestic violence during pregnancy and after birth is an increasing but under-recognized problem in Thailand. It has pervasive consequences on maternal health. The findings from this study suggest more interventions and urgent domestic violence support services need to be established in this remote area of Thailand. This study also suggests routine screening for domestic violence should be established to provide effective early intervention and prevention of adverse consequences of violence, as pregnancy is a time when most pregnant women seek health care.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Full Text
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Stephens, Rose, Andrea D. Clements, Valerie M. Hoots i Beth A. Bailey. "The Relationship Between Breastfeeding Practices and Postpartum Depressive Symptoms in Appalachian Women". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7231.

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Hoots, Valerie M., R. A. Stephens, Andrea D. Clements i Beth A. Bailey. "Perinatal Risk Factors of Postpartum Depression in Adolescent Mothers of South-Central Appalachia". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7224.

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Clements, Andrea D., Tifani R. Fletcher, Lawrence D. Childress, Robert A. Montgomery i Beth A. Bailey. "Social Support, Religious Commitment, and Depression Among Pregnant and Postpartum Women". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7203.

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Objective: Social support and religious commitment were examined in relation to antenatal and postpartum depressive symptoms in a prospective, longitudinal study to determine whether religious commitment explained variance in depression scores beyond that accounted for by social support. Background: Social support and religiosity are positively related to good mental/physical health, and depression is related to poor health outcomes in pregnancy and postpartum. It was hypothesised that social support and religious commitment would be inversely related to depressive symptoms, and that religious commitment would predict variance in depression scores over and above social support. Methods: In 106 mostly low SES Appalachian pregnant women, social support and religious commitment were measured during the first trimester. First and third trimester (Center for Epidemiological Studies Depression Scale – 10 item version), and 6 weeks and 6 months postpartum (Edinburgh Postnatal Depression Scale) depression symptoms were measured. Hierarchical regression examined relative contributions of social support (Prenatal Psychosocial Profile) and religious commitment (Religious Surrender and Attendance Scale – 3 Item Version) to depressive symptoms at each time point while controlling for education and marital status. Results: Regression results indicated that social support and religious commitment explained 10–18% and 0–3% of the variability in depression scores, respectively. Conclusion: Both social support (all time points) and religious commitment (only at 6 months postpartum) were inversely related to depression. Pregnant women low in social support and postpartum women low in social support or religious commitment may be at increased risk for depression.
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Bailey, Beth A., i Andrea D. Clements. "Postpartum Smoking Relapse: The Role of Family in the Health Behavior Choices of New Mothers". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7250.

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Teeters, Angelique R. "Effects of Childhood Maltreatment History on Maternal Sensitivity to Infant Facial Expressions of Emotion". Xavier University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1396716594.

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Rubertsson, Christine. "Depression and partner violence before and after childbirth /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-974-9/.

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Clements, Andrea D., Tifani A. Fletcher i Beth A. Bailey. "Depression Is More Prevalent Throughout Pregnancy and the First Six Months Postpartum in Women Low in Religious Commitment and Social Support". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7253.

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Książki na temat "Postpartum abuse"

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National Clearinghouse for Alcohol and Drug Information (U.S.), red. Pregnant/postpartum women and their infants. [Rockville, Md.?]: U.S. Dept. of Health and Human Services, Substance Abuse Resource Guide, Center for Substance Abuse Prevention, 1997.

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Schrager, Laura. Substance abuse, treatment, and birth outcomes for pregnant and postpartum women in Washington State. Olympia, Wash: Dept. of Social and Health Services, Planning, Research and Development, Office of Research and Data Analysis, First Steps Databse, 1995.

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Calkins, Richard F. Substance abuse and need for treatment among pregnant and postpartum women in Michigan: Final report. [Lansing, Mich.]: Michigan Dept. of Community Health, 1999.

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Cawthon, Laurie. First Steps database: Postpartum family planning services. Olympia, Wash: Research and Data Analysis, Dept. of Social and Health Services, 2001.

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Cawthon, Laurie. Substance abuse, treatment, and birth outcomes for pregnant and postpartum women in Washington State. Olympia, Wash: Office of Research and Data Analysis, Dept. of Social and Health Services, 1995.

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I remember, Daddy: The harrowing true story of a daughter haunted by memories too terrible to forget. London: HarperElement, 2011.

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Zahn, Tina. Why I jumped: My true story of postpartum depression, dramatic rescue & return to hope. Grand Rapids, MI: Fleming H. Revell, 2006.

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Adjustment disorders. Philadelphia: Mason Crest Publishers Inc., 2014.

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G, Madry Karen, i Texas Commission on Alcohol and Drug Abuse., red. 1990 Texas survey of postpartum women and drug-exposed infants. [Austin, Tex.] (720 Brazos, Suite 403, Austin 78701): Texas Commission on Alcohol and Drug Abuse, 1991.

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Committee on Gender and Mental Health, Group for the Advancement of Ps. Postpartum Mental Health Disorders: A Casebook. Redaktorzy Gail Erlick Robinson, Carol C. Nadelson i Gisele Apter. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190849955.001.0001.

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Postpartum Mental Health Disorders: A Casebook describes the recognition and management of psychiatric disorders that present in the postpartum period. Case vignettes illustrate the type of complaints that may present to the psychiatrist, primary care physician, obstetrician, nurse practitioner, doula, or other health care professionals. Chapters cover depression, anxiety disorders, obsessive compulsive disorder, psychotic disorders, bipolar disorders, posttraumatic stress disorders, personality disorders, and drug abuse. Each chapter includes information about differential and provisional diagnoses, epidemiology, treatment, and prognosis with advice as to when to refer to a specialist. More general chapters address risk factors for developing postpartum disorders, prevention, and the uses and safety of psychotropic medication during breastfeeding. Two frequently used screening questionnaires are included with instructions as to use. Some key references or links are included.
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Części książek na temat "Postpartum abuse"

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Blanco, Carlos, John C. Markowitz i Myrna M. Weissman. "Interpersonal psychotherapy for depression and other disorders". W New Oxford Textbook of Psychiatry, 1318–27. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0169.

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Interpersonal psychotherapy (IPT) is a time-limited, diagnosis-focused therapy. IPT was defined in a manual. Research has established its efficacy as an acute and chronic treatment for patients with major depressive disorder (MDD) of all ages, as an acute treatment for bulimia nervosa, and as adjunct maintenance treatment for bipolar disorder. The research findings have led to its inclusion in treatment guidelines and increasing dissemination into clinical practice. Demonstration of efficacy in research trials for patients with major depressive episodes (MDEs) has led to its adaptation and testing for other mood and non-mood disorders. This has included modification for adolescent and geriatric depressed patients patients with bipolar and dysthymic disorders; depressed HIV-positive and depressed pregnant and postpartum patients; depressed primary care patients; and as a maintenance treatment to prevent relapse of the depression. Most of the modifications have been relatively minor and have retained the general principles and techniques of IPT for major depression. Non-mood targets have included anorexia, bulimia, substance abuse, borderline personality disorder, and several anxiety disorders. In general, outcome studies of IPT have suggested its promise for most psychiatric diagnoses in which it has been studied, with the exceptions of anorexia, dysthymic disorder, and substance use disorders. IPT has two complementary basic premises. First, depression is a medical illness, which is treatable and not the patient's fault. Second, depression does not occur in a vacuum, but rather is influenced by and itself affects the patient's psychosocial environment. Changes in relationships or other life events may precipitate depressive episodes; conversely, depressive episodes strain relationships and may lead to negative life events. The goal of treatment is to help the patient solve a crisis in his or her role functioning or social environment. Achieving this helps the patient to gain a sense of mastery over his or her functioning and relieves depressive symptoms. Begun as a research intervention, IPT has only lately started to be disseminated among clinicians and in residency training programmes. The publication of efficacy data, the promulgation of practice guidelines that embrace IPT among antidepressant treatments, and economic pressures on length of treatment have led to increasing interest in IPT. This chapter describes the concepts and techniques of IPT and its current status of adaptation, efficacy data, and training. The chapter provides a guide to developments and a reference list, but not a comprehensive review.
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Streszczenia konferencji na temat "Postpartum abuse"

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"PS-121 - PREGNANCY AND DUAL DIAGNOSIS: IS THERE ANYTHING NEW?" W 24 CONGRESO DE LA SOCIEDAD ESPAÑOLA DE PATOLOGÍA DUAL. SEPD, 2022. http://dx.doi.org/10.17579/abstractbooksepd2022.ps121.

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1. Objectives: To assess the impact of the pregnancy on dual-diagnosed women. 2. Material and methods: Non-systematic review of the literature, through research on PubMed database with the keywords “dual diagnosis”, “pregnancy” and “mental illness”. 3. Results and conclusions: Dual diagnosis refers to the co-occurrence of a mental illness and substance abuse. The mean age of diagnosis for both mental illnesses and substance abuse on women is between 25 and 34 years old, which coincides with the period when women are most likely to be pregnant. One of the existent barriers on this topic is the lack of knowledge on the part of care providers as to the difficulties and treatment needs of the dual diagnosis client, with resultant anxiety and confusion about how to intervene, the efficacy of treatments, and especially how to balance the needs of the mother and fetus. The studies on this area show that patients with a substance abuse disorder or dual diagnosis had a high-risk pregnancy and less prenatal care than those with a mental illness alone, being schizophrenia the most frequent psychiatric diagnosis. For women who are dually diagnosed, the risks inherent in each disorder are combined with the potential for greater negative impact on pregnancy and the newborn.The risks of poor prenatal care, obstetric complications, and psychosocial difficulties increase and each disorder may exacerbate the other. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and postpartum with the concomitant risks to mother and baby.
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Greškovičová, Katarína, Barbora Zdechovanová i Rebeka Farkašová. "PSYCHOMETRIC ANALYSIS OF THE SLOVAK VERSION OF THE POSTPARTUM BONDING QUESTIONNAIRE FOR NON-CLINICAL SAMPLE". W International Psychological Applications Conference and Trends. inScience Press, 2021. http://dx.doi.org/10.36315/2021inpact058.

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"Bonding represents an emotional tie that one experiences towards one´s own child. There are several instruments to measure the level and quality of bonding. Among them we chose and translated the Postpartum Bonding Questionnaire by Brockington et al. (2001) into Slovak language. The aim of this study was to analyse its psychometric qualities. Our non-clinical sample consisted of women (N= 372) 18 and 44 years (M= 29.74; SD= 5.25) who recently gave birth in Slovakian hospitals. Data collection was carried out from September 2015 until March 2018. Participants filled the Postpartum bonding questionnaire by Brockington et al. (2001) and some of them other three tools: Edinburgh Postnatal Depression Scale by Cox, Holgen and Sagovsky (1987), Depression Anxiety Stress scale-42 (Lovibond & Lovibond, 1995) and Parental Stress Scale (Berry & Jones, 1995). The distributions of the items of the bonding were mostly skewed and leptokurtic. Internal consistency is high for the overall Lack of Bonding (?= .897) and varies in factors- ?= .820 for Impaired Bonding, ?= .779 for Rejection and Anger, ?= .506 for Anxiety about Care and ?= .321 for Risk of Abuse. In order to prove convergent validity, we correlated overall Lack of Bonding with depression (Edinburgh Postnatal Depression Scale, rs= .251, Depression Anxiety Stress scale-42 depression rs=.404; n=79), stress and anxiety (Depression Anxiety Stress scale-42, stress rs=.392; anxiety rs=.496; n=79) and parental stress (Parental Stress Scale score; rs= .674, n=99). We did not confirm original factor structure via confirmatory factor analysis using principal axis factoring with oblimine rotation. Then, we used principal component analysis with varimax rotation method to reduce the items. 6 components were extracted. Component 1 was comprised of 15 items that explained 35,6 % of the variance with loadings from .306 to .733. Hence, we proposed new item-structure for the Slovak PBQ. We concluded that the Slovak version of the PBQ proved to have good overall reliability. We found evidences for the convergent validity with parental stress, anxiety, stress, and partly depression, because there were two different results. We also suggest creating a shorter version based on the analysis. Among limits we can see tools used for validity evidence and sample without participants for clinical population. We advise to use the Slovak version of the Postpartum Bonding Questionnaire as a tool to measure bonding in a research context and to use overall summary index (Lack of Bonding) instead of factors."
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