OBJETIVOS: Avaliar associações prospectivas dos transtornos de humor e da religiosidade com o risco de suicídio em adultos jovens provenientes da população geral. MÉTODO: Coorte prospectiva de base populacional. Adultos jovens (18-24 anos) foram recrutados e acompanhados em média cinco anos depois. Risco de suicídio, transtornos de humor e de ansiedade foram avaliados usando o Mini-International Neuropsychiatric Interview. Transtornos por uso de substâncias foram avaliados utilizando o Alcohol, Smoking and Substance Involvement Screening Test. A religiosidade foi avaliada na linha de base e agrupada de acordo com a afiliação religiosa e de acordo com a freqüência de participação. RESULTADOS: A amostra incluiu 1560 adultos jovens na linha de base, com 1244 reavaliados no seguimento (80,6%). Os episódios depressivos, tanto atuais como prévios, tiveram um impacto significativo no risco de suicídio. Os episódios maníacos prévios, no entanto, foram associados com uma menor consistência a um risco de suicídio. Nenhuma associação da religiosidade com o risco de suicídio foi encontrada nas duas etapas da pesquisa. Este resultado permaneceu na análise em todas as afiliações religiosas, mesmo quando subdivididas de acordo com a freqüência de participação. CONCLUSÕES: Os episódios depressivos têm um robusto efeito prospectivo, independente, sobre o risco de suicídio. O efeito dos episódios maníacos, por outro lado, foi dependente da análise e merece uma melhor investigação. Embora existam evidências prévias sugerindo um papel protetor da religiosidade sobre o risco de suicídio, essas não foram confirmadas nessa amostra específica de adultos jovens. / OBJECTIVES: To assess the prospective associations of mood disorders, religiosity and suicidality in a community sample of young adults. METHODS: Prospective population-based cohort study. Young adults (18-24 years old) were recruited and followed-up five years later. Suicidality, mood and anxiety disorders were assessed using the Mini-International Neuropsychiatric Interview. Substance use disorders were assessed using the Alcohol, Smoking and Substance Involvement Screening Test. Religiosity were assessed at baseline and grouped according to religious affiliation and according to attendance frequency. RESULTS: The sample included 1560 young adults at baseline, with 1244 reassessed at follow-up (80.6%). Depressive episodes, both current and past had a significant impact on suicidality. Previous manic episodes, however, were less consistently associated with suicidality. No association of religiosity with suicidality was found in the two waves of the research. This effect is maintained in all religious affiliations, even when subdivided the analysis according to the frequency of attendance in religious service. CONCLUSIONS: Depressive episodes have an independent and robust effect on prospective suicidality. The effect of manic episodes, on the other hand, was dependent on the analysis and deserves further exploration. Although there is prior general evidence suggesting a protective role of religiosity on suicidality, these were not confirmed in this specific sample of young adults.

A Doença de Alzheimer (DA) vem apresentando aumento progressivo, sendo a causa de demência mais comum nos idosos (acima de 60 anos). Diante disso, há preocupação com alterações do estado de saúde dos cuidadores que compreendem na sua maioria familiares. Cuidar dos pacientes com demência por Doença de Alzheimer pode levar ao estresse crônico e má qualidade de vida. O presente estudo teve como objetivo avaliar fatores de risco cardiovascular, cognição e humor em cuidadoras idosas de pacientes com demência por Doença de Alzheimer, comparando-as com as não cuidadoras. As cuidadoras foram selecionadas por meio da revisão de prontuários do Hospital das Clínicas e do Centro de Saúde Escola da FMRP-USP. As idosas do grupo controle foram selecionadas na mesma área de moradia das idosas cuidadoras. Todas as participantes assinaram o Termo de Consentimento Livre e Esclarecido. Foram realizadas visitas previamente agendadas na casa de todas as participantes. Critérios de exclusão: diabetes; neoplasias malignas e doenças autoimunes, além de outras doenças debilitantes. Foram avaliadas idade, escolaridade, peso, altura, circunferência abdominal e Indice de Massa corpórea (IMC). Foi realizada avaliação laboratorial: dosagem de insulina de jejum; glicemia de jejum; colesterol total e HDL; triglicérides; creatinina; ureia; sódio; potássio; cálcio e TSH. Além disso, foi feita a avaliação da pressão arterial (PA) em domicílio pela pesquisadora e com a Medida Residencial de Pressão Arterial (MRPA), além da avaliação da cognição e humor, com a Escala de Depressão Geriátrica (EDG), Mini Exame do Estado Mental (MEEM) e Mini International Neuropsychiatric Interview (M.I.N.I.). A análise estatística foi realizada com o Teste Quiquadrado, Teste \"t\" de Student, Mann-Whiney e regressão logística simples e múltipla para a estimação do Odds Ratio bruto e ajustado (ORA). Foram avaliadas 62 idosas, sendo 31 cuidadoras de pacientes com Doença de Alzheimer e 31 do grupo controle. Verificou-se que os níveis de colesterol total foram mais elevados em idosas cuidadoras. Não houve diferenças entre os valores de PA sistólica e diastólica entre os grupos em relação às medidas realizadas pela pesquisadora e com a MRPA. De acordo com os resultados, as idosas cuidadoras apresentaram rastreio positivo para depressão em 58%, enquanto que o grupo controle apresentou apenas 16% (ORA=6,62, p<0,01). Em relação ao diagnóstico feito pelo M.I.N.I, 38,7% das cuidadoras apresentaram episódio depressivo, sendo superior ao controle (9,7%) (ORA=5,42, p=0,02). Verificouse que 35,5% das cuidadoras apresentaram transtorno de ansiedade diagnosticado, com 16% no grupo controle (ORA=4,79, p=0,03). A presença do companheiro interferiu para que as cuidadoras apresentassem mais transtorno de ansiedade (p=0,04). Não houve diferença entre a cognição dos grupos pela avaliação do MEEM. Cuidadoras idosas de pacientes dementados com Doença de Alzheimer apresentaram níveis de colesterol mais elevados, mais episódios depressivos e mais transtorno de ansiedade do que as não cuidadoras. A presença do companheiro interferiu para que apresentassem mais transtorno de ansiedade / Alzheimer´s disease (AD) has shown a progressive increase in incidence, being the most common cause of dementia in the older individuals (above 60 years old). Therefore, there is concern with health status change in caregivers, who are mostly relatives. Taking care of AD patients with dementia can lead to chronic stress and poor quality of life. This study aimed to evaluate cardiovascular risk factors, cognition and mood in older caregivers of patients with AD dementia, comparing them with non-caregivers. The caregivers were selected through the review of the Hospital\'s medical records and School Health Center of FMRP-USP. Control group of elderly women were selected in the same housing area of older caregivers. All participants signed a consent form. Visits were previously scheduled and were at the home of all participants. Exclusion criteria: diabetes; malignancies and autoimmune diseases, and other debilitating diseases. Were evaluated: age, education, weight, height, waist circumference and body mass index (BMI). Laboratory testing was performed: fasting insulin; fasting glucose; Total and HDL cholesterol; triglycerides; creatinine; urea; sodium; potassium; calcium and TSH. In addition, blood pressure (BP) evaluation was made at home by the researcher and by the Home Blood Pressure Monitoring (HBPM), and the assessment of cognition and mood, with the Geriatric Depression Scale (GDS), Mini Exam Mental State Examination (MMSE) and Mini International Neuropsychiatric Interview (MINI). Statistical analysis was performed with Chi-square test, test \"t\" test, Mann-whiney and multiple logistic regression and simple to estimate the gross and adjusted Odds Ratio (AOR). 62 older women were assessed, 31 caregivers of demented AD patients and 31 control group It was found that the total cholesterol levels were higher in elderly caregivers (AOR = 3.57, p = 0.03). There was no difference between the systolic and diastolic values between the groups in relation to the measures carried out by the researcher and HBPM. According to the results, older caregivers had a positive screening for depression in 58%, while the control group showed only 16% (AOR = 6.62, p <0.01). Regarding the diagnosis made by M.I.N.I, 38.7% of caregivers had depressive episode, higher than the control (9.7%) (AOR = 5.42, p = 0.02). It was found that 35.5% of caregivers had diagnosis of anxiety disorder, with 16% in the control group (AOR = 4.79, p = 0.03). The presence of the companion interfered, so that the caregivers presented more anxiety disorder (p = 0.04). There was no difference between cognition groups by assessing the MMSE. Concluding, caregivers of patients with AD have higher cholesterol levels, more depressive episodes and anxiety disorder than non-caregivers. The presence of the companion interfered to submit more anxiety disorder

Many social processes influence the amount, quality, and availability of support from an individual's social network. Trait influences are characteristics of the individual that generalize across relationships and affect how much support is received and perceived on average from other people. Social influences comprise characteristics of the individual's social network. They are relationship specific and account for the variability in supportiveness among an individual's providers. Recent studies have taken a multilevel approach to studying social support in order to partition the variance in sets of relationship-specific support measures into trait and social components. These studies have also used multivariate generalizability (G) theory to examine the correlations between social support and other constructs, such as negative mood, at the trait and social level. These multilevel studies have begun to clarify the relative contributions of trait and social influences on social support, but much is yet to be learned about the nature and measurement of social support's trait and social components. One set of aims within this project was to identify characteristics of support recipients and characteristics of support providers that were related to the reception and perception of social support. Another set of aims focused on validating the measurement strategies used by G theory researchers and understanding how the trait and social components of support and mood derived from relationship-specific measures relate to traditional measures of these constructs. My final set of aims involved the application of multilevel analyses of social support and negative mood to three existing theories in the social support literature--the buffering hypothesis, the matching hypothesis, and the platinum rule. The participants in this study comprised two samples--one group of 755 undergraduate psychology students, and one group of 430 community members from across the United States. Participants completed measures of their personality traits, recent depressive symptoms, recent experiences of life adversity and perceived control over life adversity. They also reported on three close relationships including support from those relationships, satisfaction with those relationships, and mood experienced when interacting with those three people. Several multilevel analyses were used in the study. Univariate G theory analyses were used to quantify the relative variance in support, mood, and relationship satisfaction attributable to trait and social influences. Multivariate G theory analyses were used to estimate the links between these variables at the trait and social levels of analysis. Mixed effects models were used to identify trait and relationship-specific constructs that that might partly constitute the trait and social influences on social support. Multilevel Structural Equation Modeling (SEM) was used to evaluate the validity of several constructs employed in previous multilevel studies on social support. Finally, mixed effects and multivariate G theory analyses were used to test the buffering hypothesis, the matching hypothesis, and the platinum rule. Consistent with previous multilevel studies of social support, recipients who received more support, on average, from their social networks also reported more negative mood when interacting with their providers. After taking those average tendencies into account, the amount of support received from an individual support provider was not associated with negative mood experienced when with that provider. The investigation of the trait influences on social support showed that recipients who were younger, more extraverted, and more open to new experiences tended to receive more social support. Women tended to receive more support than men. With respect to social influences, romantic partners tended to provide the most support whereas friends and siblings provided significantly less support on average. Women tended to provide more support than men. The validity assessment showed that the social component of support availability was only modestly distinct from the social component of generic relationship satisfaction. The trait component of support availability showed good discriminant validity from relationship satisfaction and good convergent validity with global support availability. The trait component of relationship-specific mood showed moderate convergent validity with general mood. The buffering and matching hypotheses were not supported by my findings. The platinum rule was supported at the trait level in that recipients who reported greater support adequacy, on average, tended to report more positive mood and less negative mood. The platinum rule was also supported at the social level in that recipients tended to report experiencing the most positive mood and least negative mood when interacting with individual providers who tended to supply the most adequate support.

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The acute phase of stroke recovery may be a key factor in influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The current approach to treating PSD is medication. However, psychotherapy approaches have demonstrated more promise in preventing PSD. Investigations into music-based treatments have shown encouraging results following acquired brain injuries with active music therapy interventions demonstrating large effect sizes for mood improvement. Therefore, the purpose of this three-part dissertation was to examine the effects of active music therapy on mood and describe the clinical decision making process of using music therapy to target mood elevation for hospitalized adults following a first-time acute ischemic stroke. The first study examined the effect of one treatment of active music therapy on mood following a first-time ischemic stroke during acute hospitalization. Active music therapy was defined as music making interventions that elicit and encourage active participation from participants. The Faces Scale was used to assess mood immediately prior to and following treatment. Forty-four adults received at least one treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience. The second study investigated the impact of receiving two treatments of active music therapy on mood as compared to one. No significant difference was found between those who received one treatment and those who received two. Both dosing groups demonstrated significant mood improvement; however Group 2 (two treatments) had more severe strokes and did not improve until the second session. The purpose of the third study was to describe the clinical decision-making (CDM) process of a music therapist targeting mood elevation for hospitalized patients following a first-time acute ischemic stroke. The Three Phase Process Model of Collaborative Self-Study was selected as a guiding qualitative methodological framework. Data was collected from four sources: (a) electronic medical records, (b) audio recordings of eight music therapy treatments, (c) a researcher journal, and (d) patient and caregiver/visitor comments. Results indicate that factors influencing CDM included progression through a four-stage treatment process, use of a variety of music-based and therapy-based techniques, and the monitoring and influencing of participant levels of arousal, affect, salience, and engagement. In conclusion, active music therapy during acute hospitalization following a first-time ischemic stroke is effective in significantly improving mood. Components of clinical decision making to elevate mood are illustrated in a provided conceptual framework. Continued investigation is warranted with consideration of stroke severity, dosing amounts, and additional outcomes of interest. Longitudinal investigation is needed to evaluate the impact of treatment on the trajectory of post-stroke depression.

Glass Shoulders is a collection of poems that embody events from my life which have served as catalysts in the process of integrating myself emotionally, psychologically, and spiritually. In the poetry, the speaker searches for spiritual knowledge, and is guided toward meditation of Spirit as an internal reality to find healing. The narrative of the manuscript portrays the speaker’s deep introspection of self, exploring loss and resiliency through challenges surrounding grief, unrecovered abuses, and mood disorders. The inspiration for these poems arose from my contemplations on the incongruities between fate and free will, and how behaviors are influenced by the attitude of each. The poems explore her innermost conflicts as she contemplates whether she is director of her own destiny, or subject to a predestined fate, and seek to illumine how these differences effect her choices, behaviors, and attitude towards Spirit. The speaker is bipolar, and the paradox of the book debates whether the union of her polar selves is the ingredient to healing her phobias and disconnections, granting Spirit integration, or do her fractured selves support greater sensory experience that enhance her perceptions of self and Spirit toward new levels of recognition. The poems contain a variety of humor, tone, and voice. The humor in the poetry is unconscious to the speaker and shields her from her sense of loss and separation from her partner, her family, and divinity. At times she appears sarcastic and flippant, curious and gullible, yet always there is an undercurrent of deep thought. My visions and images for the poems are sourced from the philosophies of metaphysics, and are inspired by both Western and Eastern teachings of mysticism and myth that leads to Self-realization, or God-communion. It is through my studies of these sciences and methodologies that I have sourced my life long aspirations of spiritual knowledge for greater understanding of the human condition. Glass Shoulders is my attempt to show Self-realization as a gnosis of healing. This is a tale of freedom of psyche.

Prior to the 1990s, bipolar disorder, a behavioral disorder characterized by severe mood fluctuations, was not considered an suitable diagnosis for children. However, in recent decades, an increase in pediatric bipolar disorder (PBD) diagnosis has occurred in the U.S. The purpose of this study was to explore the perceptions and lived experiences of licensed mental health clinicians regarding their decision-making processes used during assessment and diagnosis of PBD. This phenomenographic study utilized individual, semi-structured interviews to explore the perceptions and lived experiences of 14 licensed clinicians in the Commonwealth of Massachusetts who assess and diagnose PBD. Data were collected with a 7-question face to face interview. Using NVivo 10 software several key phrases and words were identified, coded, and used to locate patterns, themes, and concepts. Data analysis revealed that significant issues related to PBD assessment and diagnosis may exist, including: inconsistencies in assessment/diagnostic processes; reticence to diagnose the disorder; failure to use available assessment instruments; a lack of attention to comorbidities; and trouble differentiating between PBD symptoms and other issues, such as trauma or dysfunctional family dynamics. Given the reluctance of these mental health professionals to diagnose PBD, implications for social change underscore the important role of education, training, and ongoing clinical supervision to help other mental health professionals accurately assess and diagnose PBD. Recommendations emanating from study findings suggest further research on PBD assessment and diagnosis to help professionals develop more effective diagnostic frameworks for clinical training and practice.

The first year postpartum is often a challenging time for romantic partners. During this time, couples tend to experience less relationship intimacy and sexual satisfaction, which may be further exacerbated by individual stressors and vulnerabilities. Little is known about whether a maternal history of adverse life events and mental health prior to the infant’s birth negatively interfere with postpartum relationship and sexual well-being. Accordingly, the current study examined whether maternal trauma history, prenatal posttraumatic stress, and prenatal depressed mood were risk factors for poor postpartum couple adjustment. It also investigated whether perceiving a partner as motivated to meet one’s interest and disinterest in sexual activity, referred to as sexual communal strength for having sex (SCS for having sex) and sexual communal strength not having sex (SCS for not having sex), were buffers to relationship deterioration among mothers with this history of adversity. One hundred and sixty women (N = 160) who had completed an earlier study during pregnancy participated in a subsequent online survey between six and twelve months postpartum. Using path analysis to investigate the prospective relationships between maternal trauma history, prenatal mental health difficulties, and postpartum relationship and sexual well-being, trauma history was found to significantly predict sexual satisfaction and desire. Specifically, childhood maltreatment predicted poorer sexual well-being following childbirth, whereas adult sexual victimization predicted improved sexual well-being. No other pathways in the model were significant. Additionally, contrary to predictions, sexual communal strength did not moderate associations between maternal prenatal adversity and postpartum relationship outcomes in the primary analyses. However, follow-up analyses including only mothers who reported some symptoms of PTSD revealed that SCS for having sex moderated the association between these symptoms and relationship satisfaction. Results from this research highlight that childhood maltreatment likely has enduring detrimental implications for women’s sexual well-being as they transition- either again or for the first time - to motherhood. Further implications and directions for future research in this area are discussed. / Graduate

Background: Inverse associations have been reported between homocysteine concentrations and poor cognitive performance in several cross-sectional studies of healthy elderly subjects. Folate supplementation with or without vitamins B-12 and B-6 is an effective means of lowering homocysteine concentrations. Mood disturbances, from mild mood changes to clinical depression, are common in older populations. Several studies have shown that depressed people have lower levels of folate and vitamin B-12 and higher levels of homocysteine than non-depressed people. Improvement of mood has been reported in depressed people following supplementation with folic acid. Clinical trials are required to determine if lowering homocysteine concentration with vitamins improves cognitive function and/or mood in healthy elderly participants. Objective: The primary aim of this research project was to carry-out a 2 year randomised, double-blind, placebo-controlled trial to determine if a supplement containing folate (1mg L-Mefolinic acid), vitamin B-12 (500(mu)g) and vitamin B-6 (10mg) improves scores or prevents decline on tests of cognition in a group of healthy older people ([greater than or equal to]̲ 65 years) with a plasma homocysteine concentration [greater than or equal to]̲13 (mu)mol/L. A second aim of this study was to determine if homocysteine lowering vitamins improved scores on tests of mood in this group. Methods: Four hundred and sixty-five individuals, aged 65 and over, were recruited from Dunedin and surrounds, and asked to attend a screening clinic and provide a fasting blood sample. Two-hundred and seventy-six volunteers with a plasma homocysteine concentration [greater than or equal to]13(mu)mol/L were randomised to take either a combination of 1mg L-Mefolinic acid, 500(mu)g vitamin B-12 and 10mg vitamin B-6 or placebo for 2 years. A battery of cognitive tests and indices of mood was administered at baseline, one year, and two years. A fasting blood sample was collected at baseline and every six months thereafter. Results: From baseline to 6 months of the intervention, homocysteine concentrations decreased by 37.5%, from 16.7 to 10.5 (mu)mol/L in the vitamin supplemented group and then plateaued. In the vitamin supplemented group there was a 181% increase in red blood cell folate concentration from a mean of 977 to 2752 nmol/L, and a 90.1% increase in plasma vitamin B-12 (from a mean 283 to 538 (mu)mol/L) over the study period of two years. In the vitamin supplemented group there was a trend to poorer performance on almost all tests of cognition compared to placebo group. The vitamin group was 8% slower on Part B of the Reitan Trail Making Test, a test of speeded attention, mental tracking, visual search and mental flexibility (p=0.009). The vitamin group scored significantly lower on tests of short-term recall, Weschler Paragraphs (p=0.03) after 2 years, and the Rey Auditory Verbal Learning Test ((p=0.04) after one year, than the placebo group. There was no difference in mood score by treatment in this largely non-depressed group. Conclusion: These results suggest a detrimental effect of high dose homocysteine lowering vitamin supplements on cognitive function in healthy older people. These results need to be confirmed in other randomised controlled trials.

The purpose of this study is to present a contrastive analysis of the different types of interrogative sentences in English and Vietnamese including their structures and meanings. It is also hoped that the result of this study will be of some use to English teachers in Vietnam in their classroom teaching and in their preparation of teaching materials. It may also be useful to Vietnamese students who are learning English, especially when learning the English interrogative mood. Hitherto, there have been different models of description of language, but the systemic model is considered to be one of the most comprehensive, since it is able to bring out the functional uses of language and can be used to describe any language. For this reason, the systemic model is adopted in this paper to describe the two systems of the English and Vietnamese interrogative mood. The varieties of the two languages, English and Vietnamese, from which examples are taken for analysis in this paper, are Southern British Standard and Standard Vietnamese ranging from colloquial to literary. Throughout each chapter, the examples are numbered in consecutive order. Examples in Vietnamese are presented with a slash mark ( / ) placed between lexical items to facilitate the matching of Vietnamese with the literal English translation which follows. The literal translation is followed by a freer English translation enclosed in quotation marks. The study consists of five chapters. In the first chapter, the author begins by summarizing different views on the nature of language and their applications in language teaching and learning, and then presents a short introduction to systemic linguistics and a brief sketch of systemic grammar. The second chapter is about the English interrogative mood. This description of the English interrogative mood is largely based on the ideas on Mood presented by D. J. Young, lecturer in English in the University of Wales Institute of Science and Technology in Britain. In the third chapter, an attempt is made to provide a detailed description of the different types of interrogative sentences in Vietnamese. Chapter four moves to a contrastive analysis which consists of a textual and then a systemic comparison and contrast of the two interrogative mood systems in English and Vietnamese. A recapitulation of what has been done in the previous chapters and some suggestions for the preparation of teaching material and the teaching of English interrogative sentences to Vietnamese students are presented in chapter five, which is the last chapter of the study.

Labor may perhaps be the most painful a woman might experience, although characterized by large inter-individual variability. The perceived pain during labor is the result of diverse factors, i.e. her previous pain experiences, the analgesia she receives and maybe also her genes. The overall aim of this thesis was to investigate biological and psychological mechanisms underlying inter-individual differences in labor pain related behaviors. The mechanisms that characterize endogenous pain relief during labor are not fully understood, though it is known to be partly explained by the effects of β-endorphin (BE). BE plasma levels were followed longitudinally in a cohort of pregnant women and were found to remain unchanged between early and late pregnancy, although with a nadir in the beginning of the third trimester. Furthermore, women with low levels of BE in plasma at the end of the third trimester, required second line labor analgesia to a significantly higher extent than women with normal levels. In a population-based sample of 814 pregnant women we investigated if inter-individual differences in labor pain related behavior was influenced by the pain-protective single nucleotide polymorphism (SNP) combination of guanosine triphosphate cyclohydrolase (GCH1) and the opioid receptor µ-1 gene (OPRM1) A118G SNP. We identified a possible association between the pain-protective SNP combination of GCH1 and use of second line analgesia. No association was found between the OPRM1 and use of analgesia or labor pain related behavior. The association between self-rated antenatal depressed mood and anxiety in relation to pain behaviors and self-reported pain during labor was investigated. We found that depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.  In conclusion, although an increasing number of studies strongly suggest that genetic predisposition plays an important role in pain and pain-related mechanisms, GCH1 and OPRM1 has little to offer in terms of individual counseling on labor analgesia. To enable the future use of genetic variability for pre-labor testing and counseling, a number of different genes reflecting pain mediation pathways, involving biological and psychological mechanisms, need to be analyzed in combination.