Publications

Abstract

PURPOSE: Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs.METHODS: A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire.CONCLUSIONS: Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NP's workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire.IMPLICATIONS FOR PRACTICE: Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers.

Abstract

Objective The purpose of this study was to evaluate trajectories of and predictors for changes in upper extremity (UE) function in women (n = 396) during the first year after breast cancer treatment. Design Prospective, longitudinal assessments of shoulder range of motion (ROM), grip strength, and perceived interference of function were performed before and for 1 year after surgery. Demographic, clinical, and treatment characteristics were evaluated as predictors of postoperative function. Results Women had a mean (SD) age of 54.9 (11.6) years, and 64% were white. Small but statistically significant reductions in shoulder ROM were found on the affected side over 12 months (P < 0.001). Predictors of interindividual differences in ROM at the 1-month assessment were ethnicity, neoadjuvant chemotherapy, type of surgery, axillary lymph node dissection, and preoperative ROM. Predictors of interindividual differences in changes over time in postoperative ROM were living alone, type of surgery, axillary lymph node dissection, and adjuvant chemotherapy. Declines in mean grip strength from before through 1 month after surgery were small and not clinically meaningful. Women with greater preoperative breast pain interference scores had higher postoperative interference scores at all postoperative assessments. Conclusion Some of the modifiable risk factors identified in this study can be targeted for intervention to improve UE function in these women.

Abstract

Purpose: The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes. Methods: Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946). Results: When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes. Conclusion: When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.

Abstract

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the “driver’s seat.” The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens (n = 22) and parents (n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research.

Abstract

Aim: To assess the impact of adding nursing support workers to ward staffing. Background: Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and system outcomes has not been systematically evaluated. Design: A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a sample of wards. Methods: Payroll data will identify wards on which unregulated staff work. To assess the impact on nursing-sensitive outcomes, retrospective analysis of morbidity and mortality data of all patients admitted to Western Australia hospitals for over 24 hours across 4 years will be undertaken. For the cross-sectional study, a sample of 20 pairs of matched wards will be selected: 10 with unregulated workers added and 10 where they have not. From this sample the impact on patients will be assessed using the Patient Evaluation of Emotional Care during Hospitalisation survey. The impact on nurses will be assessed by a nurse survey used extensively which includes variables such as job satisfaction and intention to leave. The impact on system outcomes will be explored using work sampling of staff activities and the Practice Environment Scale. Interviews will determine nurses' experience of working with nursing support workers. Discussion: The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment.

Abstract

Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care.

Abstract

Objective To explore factors contributing to intentional and unintentional medication nonadherence in adults with chronic heart failure (HF). Background Medication nonadherence is prevalent in HF but the factors contributing to it are not well understood. Methods This secondary data analysis of qualitative data explored narrative accounts about medication adherence from four previous studies (N = 112). The Necessity–Concerns–Framework derived from the Common Sense Model (CSM) of Self-Regulation guided the interpretation of themes. Results In this diverse sample (39% Black, 6% Hispanic, 63% male; mean age 59 ± 15 years), 90% reported at least intermittent nonadherence. For many (60%), missing medication was unintentional but 27% reported intentional nonadherence. Four interconnected patterns of behavior emerged: 1) rarely nonadherent, 2) frequently nonadherent, 3) intentionally nonadherent, and 4) reformed nonadherent. Misperceptions about HF, beliefs, concerns, and contextual factors contributed to both intentional and unintentional nonadherence. Conclusion Medication nonadherence is prevalent in HF and influenced by modifiable factors.

Abstract

Background: Approximately half of veterans with low-risk prostate cancer receive guideline-discordant imaging. Our objective was to identify and describe (1) physician knowledge, attitudes, and practices related to the use of imaging to stage prostate cancer, (2) patient attitudes and behaviors related to use of imaging, and (3) to compare responses across three VA medical centers (VAMCs). Methods: A qualitative approach was used to explore patient and provider knowledge and behaviors relating to the use of imaging. We conducted 39 semi-structured interviews total-including 22 interviews with patients with newly diagnosed with prostate cancer and 17 interviews with physicians caring for them-between September 2014 and July 2015 at three VAMCs representing a spectrum of inappropriate imaging rates. After core theoretical concepts were identified, the Theoretical Domains Framework (TDF) was selected to explore linkages between themes within the dataset and existing domains within the framework. Interviews were audio-recorded, transcribed verbatim, and then coded and analyzed using Nvivo software. Results: Themes from patient interviews were categorized within four TDF domains. Patients reported little interest in staging as compared to disease treatment (goals), and many could not remember if they had imaging at all (knowledge). Patients tended to trust their doctor to make decisions about appropriate tests (beliefs about capabilities). Some patients expressed a minor concern for radiation exposure, but anxiety about cancer outcomes outweighed these fears (emotion). Themes from physician interviews were categorized within five TDF domains. Most physicians self-reported that they know and trust imaging guidelines (knowledge) yet some were still likely to follow their own intuition, whether due to clinical suspicion or years of experience (beliefs about capabilities). Additionally, physicians reported that medico-legal concerns, fear of missing associated diagnoses (beliefs about consequences), influence from colleagues who image frequently (social influences), and the facility where they practice influences rates of imaging (environmental context). Conclusions: Interviews with patients and physicians suggest that physicians are the primary (and in some cases only) decision-makers regarding staging imaging for prostate cancer. This finding suggests a physician-targeted intervention may be the most effective strategy to improve guideline-concordant prostate cancer imaging.

Abstract

Background Little is known about racial-ethnic differences in the distribution of maternal serum levels of angiogenic and antiangiogenic factors and their associations with early-onset preeclampsia. Objective We sought to investigate the distribution of midtrimester maternal serum levels of placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor 1 and their associations with early-onset preeclampsia in whites, Hispanics, and blacks. Study Design A population-based nested case-control design was used to identify cases and controls of white, Hispanic, and black origin from a 2000 through 2007 live-birth cohort in 5 southern California counties. Cases included 197 women (90 whites, 67 Hispanics, and 40 blacks) with early-onset preeclampsia defined as hypertension and proteinuria with onset <32 weeks according to hospital records. Controls included a random sample of 2363 women without early-onset preeclampsia. Maternal serum specimens collected at 15-20 weeks’ gestation as part of routine prenatal screening were tested for placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor 1. Serum levels of the 3 factors were log-normally distributed. Adjusted natural logarithmic means were compared between cases and controls and between racial-ethnic groups. Odds ratios and 95% confidence intervals derived from logistic regression models were calculated to measure the magnitude of the associations. Results Cases showed lower adjusted logarithmic means of placental growth factor but higher adjusted logarithmic means of soluble endoglin than controls across all 3 groups (P <.05). Cases also had higher adjusted means of soluble vascular endothelial growth factor receptor 1 than controls in whites (7.75 vs 7.52 log pg/mL, P <.05) and Hispanics (7.73 vs 7.40 log pg/mL, P <.05) but not in blacks (7.85 vs 7.69 log pg/mL, P =.47). Blacks were found to have higher levels of placental growth factor in both cases and controls when compared to whites and Hispanics (adjusted means: 4.69 and 5.20 log pg/mL in blacks, 4.08 and 4.78 log pg/mL in whites, and 3.89 and 4.70 log pg/mL in Hispanics, respectively, P <.05). Hispanic cases had the highest adjusted mean of soluble endoglin compared to white and black cases (9.24, 9.05, and 8.93 log pg/mL, respectively, P <.05). The weakest association of early-onset preeclampsia with placental growth factor and soluble endoglin was observed in blacks. The adjusted odds ratio per log pg/mL increase of the 2 analytes were 0.219 (95% confidence interval, 0.124–0.385) and 5.02 (95% confidence interval, 2.56–9.86) in blacks in comparison to 0.048 (95% confidence interval, 0.026–0.088) and 36.87 (95% confidence interval, 17.00–79.96) in whites (P <.05) and 0.028 (95% confidence interval, 0.013–0.060) and 86.68 (95% confidence interval, 31.46–238.81) in Hispanics (P <.05), respectively. As for soluble vascular endothelial growth factor receptor 1, the association was not significantly different among the racial-ethnic groups. Conclusion Racial-ethnic differences were observed in the distribution of midtrimester maternal levels of placental growth factor and soluble endoglin and in the associations with early-onset preeclampsia. These differences should be considered in future studies to improve etiologic and prognostic understanding of early-onset preeclampsia.

Abstract

Context To accurately investigate diurnal variations in fatigue, a measure needs to be psychometrically sound and demonstrate stable item function in relationship to time of day. Rasch analysis is a modern psychometric approach that can be used to evaluate these characteristics. Objectives To evaluate, using Rasch analysis, the psychometric properties of the Lee Fatigue Scale (LFS) in a sample of oncology patients. Methods The sample comprised 587 patients (mean age 57.3 ± 11.9 years, 80% women) undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer. Patients completed the 13-item LFS within 30 minutes of awakening (i.e., morning fatigue) and before going to bed (i.e., evening fatigue). Rasch analysis was used to assess validity and reliability. Results In initial analyses of differential item function, eight of the 13 items functioned differently depending on whether the LFS was completed in the morning or in the evening. Subsequent analyses were conducted separately for the morning and evening fatigue assessments. Nine of the morning fatigue items and 10 of the evening fatigue items demonstrated acceptable goodness-of-fit to the Rasch model. Principal components analyses indicated that both morning and evening assessments demonstrated unidimensionality. Person-separation indices indicated that both morning and evening fatigue scales were able to distinguish four distinct strata of fatigue severity. Conclusion Excluding four items from the morning fatigue scale and three items from the evening fatigue scale improved the psychometric properties of the LFS for assessing diurnal variations in fatigue severity in oncology patients.

Abstract

Background: Evidence internationally suggests that staffing constraints and non-supportive work environments result in the rationing of nursing interventions (that is, limiting or omitting interventions for particular patients), which in turn may influence patient outcomes. In the neonatal intensive care unit (NICU), preliminary studies have found that discharge preparation and infant comfort care are among the most frequently rationed nursing interventions. However, it is unknown if the rationing of discharge preparation is related to lower perceptions of parent and infant readiness for NICU discharge, and if reports of increased rationing of infant comfort care are related to lower levels of perceived neonatal pain control. The purpose of this study was to assess these relationships. Methods: In late 2014, a cross-sectional survey was mailed to 285 Registered Nurses (RNs) working in one of 7 NICUs in the province of Quebec (Canada). The survey contained validated measures of care rationing, parent and infant readiness for discharge, and pain control, as well as items measuring RNs' characteristics. Multivariate regression was used to examine the association between care rationing, readiness for discharge and pain control, while adjusting for RNs' characteristics and clustering within NICUs. Results: Overall, 125 RNs completed the survey; a 44.0 % response rate. Among the respondents, 28.0 and 40.0 % reported rationing discharge preparation and infant comfort care "often" or "very often", respectively. Additionally, 15.2 % of respondents felt parents and infants were underprepared for NICU discharge, and 54.4 % felt that pain was not well managed on their unit. In multivariate analyses, the rationing of discharge preparation was negatively related to RNs' perceptions of parent and infant readiness for discharge, while reports of rationing of parental support and teaching and infant comfort care were associated with less favourable perceptions of neonatal pain control. Conclusions: The rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs. Future investigations, in neonatal nursing care as well as in other nursing specialties, should address objectively measured patient outcomes (such as objective pain assessments and post-discharge outcomes assessed through administrative data).

Abstract

Persistently elevated blood pressure ([BP]; hypertension [HTN]) occurs at higher rates in the emergency department ([ED]; 44%) than in the general population (27%) and disproportionately affects black patients and older adults. The American College of Emergency Physicians recommends referral to primary care for HTN confirmation and management when patients are asymptomatic and their BP is persistently elevated (W. Decker, S. Godwin, E. Hess, C. Lenamond, &A. Jagoda, 2006). However, adherence to this clinical policy is suboptimal. The purpose of this study was to examine the prevalence of asymptomatic HTN, rates of BP reassessment and referral, and factors associated with it among adult patients who visit the ED and who were discharged a decade after this policy was disseminated. A retrospective chart analysis of adults with an initial BP of 140/90 mmHg or greater and who were discharged was included in the sampling frame. Appropriate bivariate analysis, followed by multivariate regression, was conducted. There were 2,367 patients who met inclusion criteria, of which 1,184 patients had asymptomatic HTN. A greater proportion of the sample was male (51.3%), Black (43.2%; p < 0.000), middle aged (μ = 50.2 ± 16), and covered by Medicaid (39.8%). Mean initial BP was 170/88 mmHg. A large proportion of patients with asymptomatic HTN (94.2%) had no previously diagnosed cardiovascular disease (CVD). The BP reassessment rate was 49% (μ = 158/88), and these patients were more likely to have no previously diagnosed CVDs (p = 0.02). Only 4.6% (n = 28) of patients with asymptomatic HTN were referred, and these patients were more likely to have no previously diagnosed CVDs (p = 0.000) and be middle-aged (p = 0.008). Adherence to follow-up was 100%.

Abstract

Aims and objectives: The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice. Background: Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area. Design: This paper is a critical review. Methods: A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults. Results: Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease. Conclusions: This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population. Relevance to clinical practice: Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.

Abstract

OBJECTIVE: To examine recurrent preterm birth and early term birth in women's initial and immediately subsequent pregnancies. METHODS: This retrospective cohort study included 163,889 women who delivered their first and second liveborn singleton neonates between 20 and 44 weeks of gestation in California from 2005 through 2011. Data from hospital discharge records and birth certificates were used for analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models adjusted for risk factors. RESULTS: Shorter gestational duration in the first pregnancy increased the risk of subsequent preterm birth (both early, before 32 weeks of gestation, and later, from 32 to 36 weeks of gestation) as well as early term birth (37-38 weeks of gestation). Compared with women with a prior term birth, women with a prior early preterm birth (before 32 weeks of gestation) were at the highest risk for a subsequent early preterm birth (58/935 [6.2%] compared with 367/118,505 [0.3%], adjusted OR 23.3, 95% CI 17.2-31.7). Women with a prior early term birth had more than a twofold increased risk for subsequent preterm birth (before 32 weeks of gestation: 171/36,017 [0.5%], adjusted OR 2.0, 95% CI 1.6-2.3; from 32 to 36 weeks of gestation: 2,086/36,017 [6.8%], adjusted OR 3.0, 95% CI 2.9-3.2) or early term birth (13,582/36,017 [37.7%], adjusted OR 2.2, 95% CI 2.2-2.3). CONCLUSION: Both preterm birth and early term birth are associated with these outcomes in a subsequent pregnancy. Increased clinical attention and research efforts may benefit from a focus on women with a prior early term birth as well as those with prior preterm birth.

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College women who experience sexual violence (SV) and disordered eating (DE) are at risk for comorbid mental health symptomology (depression, somatization) and risky health behaviors (dating status, alcohol use). The purpose of this study is to explore associations of coexisting sexual violence history and disordered eating with mental health and health behaviors in college women. This cross sectional descriptive study is a secondary analysis of survey data from college students from five universities (n = 2747). College women with both SV and DE were more likely to experience increased depressive and somatic symptoms and participate in risky health behaviors.

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Objectives: The global challenge of accessible, affordable cancer care for all older adults requires a new research agenda for gero-oncology nursing to guide investigator skill development, identify priority areas for investigation, and direct resource distribution. Data Sources: Published peer-reviewed literature and web-based resources. Conclusion: A cross-cutting theme of the research agenda is the need to determine the gero-oncology nursing care that will preserve economic resources, promote function, provide symptom management, and incorporate patient preferences. Implications for Nursing Practice: In partnership with interprofessional colleagues, gero-oncology nurse scientists are poised to conduct global research that improves access to quality cancer care.

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Background: Patients with colorectal cancer (CRC) rarely experience a single symptom associated with their disease and its treatment. Objective: Purpose of this literature review was to summarize the current state of knowledge of multiple co-occurring symptoms in CRC patients who received chemotherapy (CTX) alone or CTX with targeted therapies. Methods: Comprehensive literature search was conducted from 1990 to 2014. These studies were evaluated in terms of the occurrence of multiple co-occurring symptoms in CRC patients who received CTX alone or CTX with targeted therapies; the most common symptom assessment and quality of life (QOL) instruments used; and the associations identified between select demographic and treatment characteristics, QOL, and multiple co-occurring symptoms. Results: Only 5 studies met this review's inclusion criteria. Two studies compared symptoms in patients who received CTX alone or CTX with targeted therapies, and only 1 study reported on symptom occurrence. Of the 5 studies identified, only 2 used the same instrument to assess symptoms, and only 2 studies evaluated for associations between demographic and treatment characteristics and symptom burden, as well as QOL outcomes. Conclusions: Given the larger number of patients with CRC, as well as the increased number of CRC patients who will receive targeted therapies with or without CTX, future studies need to describe the occurrence, severity, and distress of multiple co-occurring symptoms and their impact on CRC patients' QOL. Implications for Practice: To deliver effective symptom management interventions, the most common, severe, and distressing symptoms that CRC patients experience need to be identified.

Abstract

BACKGROUND: Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients.OBJECTIVE: To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice.METHODS: A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period.RESULTS: The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations.CONCLUSION: The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.

Abstract

Background Previous studies have demonstrated an association between mental illness and preterm birth (before 37 weeks). However, these investigations have not simultaneously considered gestation of preterm birth, the indication (eg, spontaneous or medically indicated), and specific mental illness classifications. Objective The objective of the study was to examine the likelihood of preterm birth across gestational lengths and indications among Medi-Cal (California's Medicaid program) participants with a diagnostic code for mental illness. Mental illnesses were studied by specific illness classification. Study Design The study population was drawn from singleton live births in California from 2007 through 2011 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes birth certificate and hospital discharge records. The sample was restricted to women with Medi-Cal coverage for prenatal care. Women with mental illness were identified using International Classification of Diseases, ninth revision, codes from their hospital discharge record. Women without a mental illness International Classification of Diseases, ninth revision, code were randomly selected at a 4:1 ratio. Adjusting for maternal characteristics and obstetric complications, relative risks and 95% confidence intervals were calculated for preterm birth comparing women with a mental illness diagnostic code with women without such a code. Results We identified 6198 women with a mental illness diagnostic code and selected 24,792 women with no such code. The risk of preterm birth in women with a mental illness were 1.2 times higher than women without a mental illness (adjusted relative risk, 1.2, 95% confidence interval, 1.1–1.3). Among the specific mental illnesses, schizophrenia, major depression, and personality disorders had the strongest associations with preterm birth (adjusted relative risks, 2.0, 2.0 and 3.3, respectively). Conclusion Women receiving prenatal care through California's low-income health insurance who had at least 1 mental illness diagnostic code were 1.2–3.3-times more likely to have a preterm birth than women without a mental illness, and these risks persisted across most illness classifications. Although it cannot be determined from these data whether specific treatments for mental illness contribute to the observed associations, elevated risk across different diagnoses suggests that some aspects of mental illness itself may confer risk.