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Varambally M, Layton H, Jack SM, Van Lieshout RJ. Mothers' and birthing parents' experiences with 1-day cognitive behavioural therapy-based workshops for postpartum depression: A descriptive qualitative study. J Psychiatr Ment Health Nurs 2024; 31:507-514. [PMID: 38078565 DOI: 10.1111/jpm.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 07/03/2024]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: One in five mothers and birthing parents are affected by postpartum depression (PPD), yet only a small proportion of those with PPD receive treatment. Given cost and accessibility barriers to treatment, brief therapies (e.g. 1 day) could help address PPD on a large scale, though understanding participants' unique experiences with this novel treatment will help guide its refinement and use. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes the experiences, perspectives and satisfaction of participants who attended a 1-day workshop for PPD. Participants appreciate being taught practical techniques and the receipt of social support from facilitators and other attendees in the group setting, while some recommended further 'booster sessions' to enhance effectiveness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: One-day CBT-based workshops may be an effective, low-intensity treatment option that provides helpful skills and builds social networks for individuals with PPD. Additional post-workshop booster sessions may enhance participant satisfaction with this new treatment by providing a reinforcement of their learning and an opportunity to re-connect with other birthing parents. ABSTRACT INTRODUCTION: Postpartum depression (PPD) affects up to one in five mothers and birthing parents. Understanding their perceptions of therapeutic interventions is key to their effectiveness and scalability. AIM The aim of the study was to understand participants' experiences attending an in-person or online 1-day cognitive behavioural therapy (CBT)-based workshop for PPD and compare their experiences participating in either modality. METHOD This descriptive qualitative study was embedded in two separate randomized controlled trials evaluating the effectiveness of 1-day CBT-based workshops for PPD delivered in-person or online. Responses were provided by 94 in-person and 95 online participants about their experiences. Content analysis was used to code and categorize the data. RESULTS Participants appreciated learning skills to improve PPD symptoms and joining a community of individuals with shared experiences. Integrating practical coping techniques after the workshop was reported to be most useful, though some wanted additional post-workshop support. Online participants identified additional barriers to workshop engagement. DISCUSSION Participants who attended either workshop found them to be valuable and effective. Participants valued psychoeducation, social connections and applying practical CBT techniques. IMPLICATIONS FOR PRACTICE One-day CBT-based workshops may be an accessible treatment option for individuals with PPD, providing new skills and social support, though some prefer to receive additional post-workshop support.
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Affiliation(s)
- Meghna Varambally
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Haley Layton
- Health Research Methodology Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Haight SC, Daw JR, Martin CL, Sheffield-Abdullah K, Verbiest S, Pence BW, Maselko J. Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions. Health Aff (Millwood) 2024; 43:486-495. [PMID: 38560804 DOI: 10.1377/hlthaff.2023.01434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8 percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4 percent reported receiving a PMAD diagnosis, and 52.8 percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.
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Affiliation(s)
- Sarah C Haight
- Sarah C. Haight , University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jamie R Daw
- Jamie R. Daw, Columbia University, New York, New York
| | | | | | - Sarah Verbiest
- Sarah Verbiest, University of North Carolina at Chapel Hill
| | - Brian W Pence
- Brian W. Pence, University of North Carolina at Chapel Hill
| | - Joanna Maselko
- Joanna Maselko, University of North Carolina at Chapel Hill
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Massoudi P, Strömwall LA, Åhlen J, Kärrman Fredriksson M, Dencker A, Andersson E. Women's experiences of psychological treatment and psychosocial interventions for postpartum depression: a qualitative systematic review and meta-synthesis. BMC Womens Health 2023; 23:604. [PMID: 37964250 PMCID: PMC10647124 DOI: 10.1186/s12905-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND To provide a comprehensive, systematic evaluation of the literature on experiences of psychological interventions for postpartum depression (PPD) in women. Depression is one of the most common postpartum mental disorders. Studies have identified that psychological interventions reduce depressive symptoms. However, less is known about the experiences of women who have received such treatments. METHODS A systematic review of the literature was conducted by searching five databases (CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO), in August 2022. Studies with qualitative methodology examining women's experiences of professional treatment for PPD were included and checked for methodological quality. Eight studies (total N = 255) contributed to the findings, which were synthesized using thematic synthesis. Confidence in the synthesized evidence was assessed with GRADE CERQual. FINDINGS The women had received cognitive behavioral therapy (5 studies) or supportive home visits (3 studies). Treatments were individual or group-based. Two main themes were identified: Circumstances and expectations, and Experiences of treatment, with six descriptive themes. Establishing a good relationship to their health professional was important for the women, regardless of treatment model. They also expressed that they wanted to be able to choose the type and format of treatment. The women were satisfied with the support and treatment received and expressed that their emotional well-being had been improved as well as the relationship to their infant. CONCLUSION The findings can be helpful to develop and tailor patient-centered care for women who are experiencing postnatal depression.
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Affiliation(s)
- Pamela Massoudi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Leif A Strömwall
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Johan Åhlen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maja Kärrman Fredriksson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Tunks A, Berry C, Strauss C, Nyikavaranda P, Ford E. Patients' perspectives of barriers and facilitators to accessing support through primary care for common mental health problems in England: A systematic review. J Affect Disord 2023; 338:329-340. [PMID: 37348656 DOI: 10.1016/j.jad.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. METHODS A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. RESULTS Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. LIMITATIONS The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. CONCLUSION Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
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Affiliation(s)
- Alice Tunks
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clio Berry
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clara Strauss
- School of Psychology, University of Sussex, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom.
| | - Patrick Nyikavaranda
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Elizabeth Ford
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
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Franklin MK, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Brosig CL, Jackson EA, Lihn S, Zyblewski SC, Kazak AE, Sood E. Barriers and facilitators to discussing parent mental health within child health care: Perspectives of parents raising a child with congenital heart disease. J Child Health Care 2023; 27:360-373. [PMID: 34879743 PMCID: PMC9174345 DOI: 10.1177/13674935211058010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child's health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team's scope of practice, (2) perceived expectation to "stay strong," (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team's ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.
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Affiliation(s)
- Melanie K. Franklin
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA
| | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Linda G. McWhorter
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Abigail C. Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences & Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin & Department of Pediatrics, Medical College of Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Emily A. Jackson
- Department of Patient and Family Services, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Al-Abri K, Armitage CJ, Edge D. Views of healthcare professionals and service users regarding anti-, peri- and post-natal depression in Oman. J Psychiatr Ment Health Nurs 2023; 30:795-812. [PMID: 36719270 DOI: 10.1111/jpm.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Anti-, peri- and post-natal depression negatively affect the relationship between mothers and their children. At least half of cases of anti-, peri- and post-natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives. Previous qualitative studies considered women's experiences relating to anti-, peri- and post-natal depression separately from studies looking at the views of HCPs. There is a lack of research in Middle Eastern countries, despite the high prevalence of anti-, peri- and post-natal depression. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti-, peri- and post-natal depression from the Middle East perspective, particularly in Oman. This study revealed that anti-, peri- and post-natal depression has been neglected in primary healthcare systems in Oman. The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti-, peri- and post-natal depression in the primary healthcare system. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help-seeking behaviours with their patients. Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti-, peri- and post-natal depression. ABSTRACT INTRODUCTION: Anti-, peri- and post-natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti-, peri- and post-natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti-, peri- and post-natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti-, peri- and post-natal depression globally. AIM This study aimed to explore the views and experiences of HCPs and service users relating to anti-, peri- and post-natal depression from the Middle East perspective. METHOD A qualitative descriptive study using semi-structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2-20 years of clinical experience in anti-, peri- and post-natal primary care and 13 pregnant patients plus 2 post-birth patients were interviewed. Audio-recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. RESULTS A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti-, peri- and post-natal depression; (2) how to deal with anti-, peri- and post-natal depression; (3) barriers to addressing anti-, peri- and post-natal depression in primary anti-, peri- and post-natal care settings and (4) bridging the gap: facilitators in detecting and managing anti-, peri- and post-natal depression. CONCLUSIONS Improving the identification and management of anti-, peri- and post-natal depression in primary healthcare systems will require a whole-system approach with interventions at the patient, practice and comprehensive primary care team levels. IMPLICATIONS FOR PRACTICE The findings suggest implications for improving the identification and management of anti-, peri- and post-natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti-, peri- and post-natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills.
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Affiliation(s)
- Khalood Al-Abri
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Christopher J Armitage
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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Sufredini F, Catling C, Zugai J, Chang S. The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review. J Affect Disord 2022; 319:119-141. [PMID: 36108877 DOI: 10.1016/j.jad.2022.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood. AIMS To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period. METHOD A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form. RESULTS Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support. LIMITATIONS Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible. CONCLUSION Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.
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Affiliation(s)
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Joel Zugai
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame, Australia
| | - Sungwon Chang
- Improving Care for Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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Bull E, Al-Janabi S, Gittens CB. Are women with traits of perfectionism more likely to develop perinatal depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:67-78. [PMID: 34592658 DOI: 10.1016/j.jad.2021.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Women who present with a maladaptive form of the perfectionism trait may be vulnerable to perinatal depression (PND). The studies examining this association, though, differ in the specific time-points at which PND is measured, the tool/s used to assess PND and/or perfectionism, and the sample of women used; consequently, extant results reflecting this association can be difficult to integrate and interpret. This systematic review and meta-analysis seeks to clarify the association between PND and perfectionism by surveying literature on the relationship. Literature search strategies were developed using medical subject headings (MeSH) and text words related to PND and perfectionism. Nine electronic databases of published and unpublished literature were searched for relevant studies, which were selected for inclusion in this systematic review and meta-analysis if they contained data on female participants aged 18 or over and pregnant or who were within 12 months post-birth; additionally, studies were included if they contained quantitative reporting of depressive symptoms and trait perfectionism symptoms within the perinatal period (between pregnancy and up to 12 months post-birth). Ten publications were selected for inclusion based on independent review against the selection criteria by the authors. Eight of the 10 publications provided substantial correlational data and were analysed using meta-analytic techniques. All studies showed a significant positive relationship between measures of perfectionism and depression at various time points within the perinatal period (3rd trimester to 12-months postpartum), including concurrently in pregnancy, concurrently in postpartum, and longitudinally between pregnancy and postpartum. Interestingly, however, moderation analyses identified that the relationship between perfectionism and PND in the 3rd trimester may emerge only when a perinatal-specific, but not when a general, depression screening tool is used. These analyses also revealed that the strength of the relationship between perfectionism and PND may increase with length of time postpartum. The findings of this systematic review and meta-analysis, thus, suggest that medical professionals should consider perfectionism when formulating PND prevention strategies and assessing for PND using perinatal-specific screening tools.
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Affiliation(s)
- Emilie Bull
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Shahd Al-Janabi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Catherine B Gittens
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
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Listening Visits for maternal depression: a meta-analysis. Arch Womens Ment Health 2021; 24:595-603. [PMID: 33452571 DOI: 10.1007/s00737-020-01101-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Listening Visits are a non-directive counseling intervention delivered by nurses to depressed postpartum women. In 2007, Listening Visits were listed as a recommended treatment in British national guidelines. They were removed from the guideline update, due to the small effect size drawn from a meta-analysis of five clinical trials with depressed and non-depressed postpartum women. The purpose of this meta-analysis is to provide an estimate of the true population effect of Listening Visits as a treatment for maternal depression compared to control conditions. A meta-analytic review was conducted of studies published before October 2020. Inclusion criteria required that the study was a pragmatic or randomized trial of Listening Visits delivered by non-mental health specialists to mothers with elevated symptoms of maternal depression. Post-treatment depression rates for the treatment and control groups were extracted from eligible studies. Six studies met eligibility criteria which included 703 participants. Analyses of observed effect sizes corrected for study artifacts revealed an estimate of 0.66 (95% CI: 0.32, 0.99) with high heterogeneity (Q = 17.95, p = 0.003, I2 = 72.14). After removing outliers and addressing heterogeneity across observed effect sizes, the meta-analytic estimate across four methodologically similar studies and 651 participants was 0.43 (95% CI: 0.24, 0.62). The moderate effect size for Listening Visits, considered together with the advantages afforded by how, where, and who provides this treatment, supports Listening Visits as a first-line intervention in a stepped care approach for mothers with mild to moderately severe depression symptoms.
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Canidate SS, Cook CL, Varma D, Carnaby GD, Ennis N, Stetten NE, Cook RL. Recruitment, experience, and retention among women with HIV and hazardous drinking participating in a clinical trial. BMC Public Health 2020; 20:1169. [PMID: 32718308 PMCID: PMC7385856 DOI: 10.1186/s12889-020-09233-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite efforts by the NIH to enhance the participation of women and minorities in clinical research, women with HIV continue to remain underrepresented in alcohol intervention research. The purpose of this study is to better understand the reasons why women with HIV and hazardous drinking participated in the WHAT-IF? study and to discuss their experience (positive or negative) in the study. The WHAT-IF? study was a randomized clinical trial that evaluated pharmacotherapy for a reduction in drinking among women with HIV. METHODS Convenience and theoretical sampling were used to recruit women with HIV and hazardous drinking to complete qualitative interviews. These women had previously completed a clinical alcohol intervention trial and had consented to be contacted in the future for study-related purposes. The biopsychosocial model was used to frame the interview questions that assessed multiple determinants of drinking behavior and helped explain linkages to broader health constructs. RESULTS A total of 20 women with HIV and hazardous drinking completed the qualitative interview. Several factors were identified by the women as influential in their decision to participate in the WHAT-IF? study, such as the ability to quit or reduce their drinking to nonhazardous levels (biological), the ability to gain knowledge or a greater understanding of the negative effects of hazardous drinking on HIV disease progression (psychological), and peer pressure and monetary compensation (social). Also, the women identified factors (positive or negative) associated with their clinical trial experience, such as the effects of the study medication on the woman's body (biological), thoughts and feelings toward study procedures (i.e. medication, lab work, study assessments) and the length of the study (psychological), and the interactions with the WHAT-IF? study staff (social). CONCLUSION Recruiting and retaining women with HIV in alcohol intervention research remains a challenge. Findings from this study suggest that women with HIV who are hazardous drinkers may benefit from participating in research studies that could help them to reduce or quit their drinking, increase their knowledge about specific behavior changes, and earn monetary compensation. Also, positive staff interactions may be instrumental in retaining minority women in alcohol intervention research.
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Affiliation(s)
- Shantrel S Canidate
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA.
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA.
| | - Christa L Cook
- College of Nursing, University of Central Florida, Orlando, FL, 32816, USA
| | - Deepthi Varma
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Giselle D Carnaby
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, 32816, USA
| | - Nicole Ennis
- College of Medicine, Florida State University, Tallahassee, FL, 32304, USA
| | - Nichole E Stetten
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Robert L Cook
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
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Predictors of postpartum depression service use: A theory-informed, integrative systematic review. Women Birth 2020; 33:e24-e32. [DOI: 10.1016/j.wombi.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
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12
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Mahdi A, Dembinsky M, Bristow K, Slade P. Approaches to the prevention of postnatal depression and anxiety - a review of the literature. J Psychosom Obstet Gynaecol 2019; 40:250-263. [PMID: 30204522 DOI: 10.1080/0167482x.2018.1512577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Introduction: Poor maternal mental health during the perinatal period has been shown to have potentially long-lasting effects for mother and child. In recognition of this, maternal mental health is receiving increased attention from political and healthcare organizations, with a growing focus on preventing the onset of common mental health disorders. Objective: The objective for this review is to provide an update of randomized controlled trials examining the use of interventions targeted to prevent the onset of postnatal depression and anxiety in nondiagnostic populations with universal or selected samples. Methods: A total of four databases, EBSCO Host, Science Direct, Scopus, and Web of Science, incorporating PsychINFO were searched and papers selected according to clearly specified inclusion criteria. A large Health Technology review was published in 2016, for which the final search was conducted in December 2012. Therefore inclusion criteria were studies published from January 2013 onwards, available in English language, had a focus on prevention of postnatal maternal depression and anxiety, and used psychological interventions. Drug intervention trials were excluded. Findings: 12 studies were identified as examining antenatal or postnatal intervention trials with an aim of preventing maternal postnatal depression and/or anxiety. There continues to be limited evidence to recommend specific prevention strategies for universal samples without further testing. There is evidence to suggest the use of rational-emotive behavioral therapy in an antenatal sample may have some utility, and the use of psychotherapy-based interventions in a postnatal setting is also supported although both require further investigation. Additionally, there is a need to gather information on acceptability, as many trials were hindered by poor adherence to interventions and high attrition that were otherwise unexplained.
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Affiliation(s)
- Amy Mahdi
- NHS Foundation Trust, Liverpool Women's Hospital , Liverpool , UK
| | - Melanie Dembinsky
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK
| | - Katie Bristow
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK.,Improving Mental Health, NIHR CLAHRC North West Coast, University of Liverpool , Liverpool , UK
| | - Pauline Slade
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK
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13
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Lowenhoff C, Davison-Fischer J, Pike N, Appleton JV. Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross-sectional survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e824-e836. [PMID: 31293024 DOI: 10.1111/hsc.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/17/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.
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Affiliation(s)
- Catherine Lowenhoff
- Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
- European Academy of Nursing Studies, Brussels, Belgium
| | | | - Nick Pike
- Oxford Brookes University, Oxford, UK
| | - Jane V Appleton
- Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
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14
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Henderson C, Dixon S, Bauer A, Knapp M, Morrell CJ, Slade P, Walters SJ, Brugha T. Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial. Psychol Med 2019; 49:1324-1334. [PMID: 30157976 PMCID: PMC6518383 DOI: 10.1017/s0033291718001940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal. METHODS Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12). RESULTS In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%). CONCLUSIONS PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
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Affiliation(s)
- Catherine Henderson
- Personal Social Services Unit, London School of Economics and Political Science, London, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Annette Bauer
- Personal Social Services Unit, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Personal Social Services Unit, London School of Economics and Political Science, London, UK
| | - C. Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Stephen J. Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
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15
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A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe. PLoS One 2019; 14:e0210587. [PMID: 30695019 PMCID: PMC6351025 DOI: 10.1371/journal.pone.0210587] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
Background Women from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds. Aim The aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe. Data sources Searches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies. Design This was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically. Results The 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want. Conclusion Lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.
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16
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Sambrook Smith M, Lawrence V, Sadler E, Easter A. Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open 2019; 9:e024803. [PMID: 30679296 PMCID: PMC6347898 DOI: 10.1136/bmjopen-2018-024803] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/17/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. This review examines women, their family members' and healthcare providers' perspectives of barriers to accessing mental health services for women with perinatal mental illness in the UK. DESIGN A systematic review and meta-synthesis of qualitative studies. DATA SOURCES Qualitative studies, published between January 2007 and September 2018, were identified in MEDLINE, PsycINFO, EMBASE and CINAHL electronic databases, handsearching of reference lists and citation tracking of included studies. Papers eligible for inclusion were conducted in the UK, used qualitative methods and were focused on women, family or healthcare providers working with/or at risk of perinatal mental health conditions. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies. RESULTS Of 9882 papers identified, 35 studies met the inclusion criteria. Reporting of emergent themes was informed by an existing multilevel conceptual model. Barriers to accessing mental health services for women with perinatal mental illness were identified at four levels: Individual (eg, stigma, poor awareness), organisational (eg, resource inadequacies, service fragmentation), sociocultural (eg, language/cultural barriers) and structural (eg, unclear policy) levels. CONCLUSIONS Complex, interlinking, multilevel barriers to accessing mental health services for women with perinatal mental illness exist. To improve access to mental healthcare for women with perinatal mental illness multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway. PROSPERO REGISTRATION NUMBER CRD42017060389.
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Affiliation(s)
- Megan Sambrook Smith
- Global Mental Health, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Vanessa Lawrence
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Euan Sadler
- Centre for Implementation Science, Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Abigail Easter
- Centre for Implementation Science, Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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17
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Noonan M, Doody O, Jomeen J, O'Regan A, Galvin R. Family physicians perceived role in perinatal mental health: an integrative review. BMC FAMILY PRACTICE 2018; 19:154. [PMID: 30193572 PMCID: PMC6128990 DOI: 10.1186/s12875-018-0843-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023]
Abstract
Background Responding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Family physicians are ideally placed to provide an effective response as it is recognised that they are responsible for organising care and supports for women and their families. This paper reports an integrative review undertaken to examine family physicians’ perceived role in perinatal mental health care and concludes with recommendations for health policy, research and practice. Method A systematic search of literature in seven databases from January 2000 to March 2016 identified a total of 1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored family physicians’ experiences of caring for women who experience perinatal mental health problems. Results Thirteen articles reporting 11 studies met the inclusion criteria for this review and quality of included studies were assessed using published criteria for the critical appraisal of qualitative and quantitative research methods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes: identification of perinatal mental health problems, management of perinatal mental health problems and barriers to care provision. While family physicians recognise their role in relation to perinatal mental health the collective interpretation revealed that; they receive variable levels of preparation for this role, no consistent approach to screening exists, pharmacological management of mood disorders is the main treatment modality and limited access to specialist perinatal mental health services exists which impacts on pharmacology decisions. Conclusion Family physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines. Research that examines training needs in relation to perinatal mental health could be used to inform family physician training programmes and curriculum development around perinatal mental health.
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Affiliation(s)
- Maria Noonan
- Department of Nursing and Midwifery, Faculty of Education & Health Sciences Health Sciences Building, University of Limerick, Limerick, Ireland.
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education & Health Sciences Health Sciences Building, University of Limerick, Limerick, Ireland
| | - Julie Jomeen
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Andrew O'Regan
- Graduate Entry Medical School, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education & Health Sciences, Health Sciences Building, University of Limerick, Limerick, Ireland
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18
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Nagle U, Farrelly M. Women's views and experiences of having their mental health needs considered in the perinatal period. Midwifery 2018; 66:79-87. [PMID: 30149202 DOI: 10.1016/j.midw.2018.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore women's views and experiences of having their mental health needs considered in the perinatal period in an Irish maternity hospital setting. DESIGN A qualitative design using semi-structured interviews was used to explore women's views and experiences. Data were analysed using Thematic Analysis (Braun and Clarke, 2006). SETTING A voluntary maternity hospital in Dublin, Ireland which had access to a perinatal mental health team. PARTICIPANTS In total 8 women who met the inclusion criteria were recruited and participated in this study. The women were interviewed in the early postpartum period. FINDINGS The study offers important insights into how women feel about having their mental health needs considered in the perinatal period. Women reported pregnancy was an emotional time, feeling expected to be happy, and women with significant mental health histories preferred not to be referred to available services unless they asked for help. Women reported barriers to disclosure including stigma/shame, lack of time. Screening tools were viewed with mixed opinions. In getting help, the baby was a motivator for some women, attitudes of healthcare professionals and lack of time affected this. KEY CONCLUSIONS Women appreciated all methods of enquiry about their mental health and being given time to discuss concerns with healthcare professionals. Perceived busy staff workloads was a barrier in asking for help, as was lack of continuity of care. Screening tools were viewed as a tick box exercise, but also as a 'modality' to assist detection of women at risk. Mental health enquiry focused on depression and anxiety, with little or no enquiry about less common disorders. Women with significant histories were less likely to engage or accept referral to perinatal mental health services, preferring to access help if they felt they needed to. IMPLICATIONS FOR PRACTICE HCPs should enquire regularly about women's emotional wellbeing at every antenatal and postnatal contact, offering support where required. Detailed enquiry about mental health should encompass the broad spectrum of perinatal mental health problems, including but not limited to depression and anxiety. Screening tools can assist in the identification of women at risk of developing perinatal mental health problems. A specialist mental health midwife should link with high-risk women at the first antenatal booking visit and provide information on early intervention and access to services.
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Affiliation(s)
- Ursula Nagle
- CMM2 Perinatal Mental Health Midwife, The Rotunda Hospital, Dublin, Ireland .
| | - Mary Farrelly
- Assistant Professor, School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
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19
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Holt L, Sellwood W, Slade P. Birth experiences, trauma responses and self-concept in postpartum psychotic-like experiences. Schizophr Res 2018; 197:531-538. [PMID: 29402582 DOI: 10.1016/j.schres.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/07/2017] [Accepted: 12/26/2017] [Indexed: 11/20/2022]
Abstract
The frequency of psychotic-like experiences (PLEs) amongst new mothers is beginning to be explored but the mechanisms underlying such experiences are yet to be understood. First time mothers (N=10,000) receiving maternity care via the UK National Health Service were contacted postnatally via Emma's Diary, an online resource for mothers. Measures assessed birth experience, trauma appraisals, post-traumatic stress symptoms, adjustment to motherhood, self-concept clarity and PLEs (in the form of hallucinations and delusions). There was a 13.9% response rate (N=1393) and 1303 participants reported experiencing at least one PLE (93.5%). Three competing nested path models were analysed. A more negative birth experience directly predicted delusions, but not hallucinations. Trauma appraisals and poorer adjustment to motherhood indirectly predicted PLEs, via disturbed self-concept clarity. Post-traumatic stress symptoms directly predicted the occurrence of all PLEs. PLEs in first time mothers may be more common than previously thought. A key new understanding is that where new mothers have experienced birth as traumatic and are struggling with adjustment to their new role, this can link to disturbances in a coherent sense of self (self-concept clarity) and be an important predictor of PLEs. Understanding the development of PLEs in new mothers may be helpful in postnatal care, as would public health interventions aimed at reducing the sense of abnormality or stigma surrounding such experiences.
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Affiliation(s)
- Lyndsey Holt
- Mersey Care NHS Foundation Trust, Park Lodge CMHT, Orphan Drive, Liverpool L6 7UN, UK.
| | - William Sellwood
- Division of Health Research, University of Lancaster, Bailrigg LA1 4YW, UK.
| | - Pauline Slade
- Institute of Psychology, Health & Society, University of Liverpool, Brownlow Hill, Liverpool LG9 3GB, UK.
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20
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Shen J, Nakashima T, Karasawa I, Furui T, Morishige K, Saijo T. Examining Japanese women's preferences for a new style of postnatal care facility and its attributes. Int J Health Plann Manage 2018; 33:890-901. [PMID: 29781211 DOI: 10.1002/hpm.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
Perinatal care in rural Japan is currently facing a crisis because of the lack of medical staff, especially obstetricians. In this study, a new style of postnatal care facility that combines both medical and nonmedical support is considered. Contrary to most postnatal care facilities in Japan, this new postnatal care facility accepts a puerperant from the cooperating maternity facility soon after birth (≤2 days). We conducted a hypothetical choice experiment to investigate whether this new postnatal care facility could be accepted by women in Gero City, Hida, Gifu Prefecture and how these women evaluate different kinds of postnatal care services. The results show that after a 2-day hospital stay, women from Gero City preferred to move to the new postnatal care facility over the other alternatives (continued hospitalization or discharge home). In addition, the estimated choice probabilities for selecting the postnatal care facility under different scenarios show a high level of acceptance for this new postnatal care facility.
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Affiliation(s)
- Junyi Shen
- Research Institute for Economics and Business Administration, Kobe University, Kobe, Japan
| | - Takako Nakashima
- Faculty of Economics, University of Marketing and Distribution Sciences, Kobe, Japan
| | - Izumi Karasawa
- Department of Midwifery, Gifu University of Medical Science, Seki, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kenichiro Morishige
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tatsuyoshi Saijo
- Research Institute for Humanity and Nature, Kyoto, and Research Institute for Future Design, Kochi University of Technology, Kami, Japan
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21
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Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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22
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Littlewood E, Ali S, Dyson L, Keding A, Ansell P, Bailey D, Bates D, Baxter C, Beresford-Dent J, Clarke A, Gascoyne S, Gray C, Hackney L, Hewitt C, Hutchinson D, Jefferson L, Mann R, Marshall D, McMillan D, North A, Nutbrown S, Peckham E, Pervin J, Richardson Z, Swan K, Taylor H, Waterhouse B, Wills L, Woodhouse R, Gilbody S. Identifying perinatal depression with case-finding instruments: a mixed-methods study (BaBY PaNDA – Born and Bred in Yorkshire PeriNatal Depression Diagnostic Accuracy). HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background
Perinatal depression is well recognised as a mental health condition but < 50% of cases are identified in routine practice. A case-finding strategy using the Whooley questions is currently recommended by the National Institute for Health and Care Excellence.
Objectives
To determine the diagnostic accuracy, acceptability and cost-effectiveness of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to identify perinatal depression.
Design
A prospective diagnostic accuracy cohort study, with concurrent qualitative and economic evaluations.
Setting
Maternity services in England.
Participants
A total of 391 pregnant women.
Main outcome measures
Women completed the Whooley questions, EPDS and a diagnostic reference standard (Clinical Interview Schedule – Revised) during pregnancy (20 weeks) and postnatally (3–4 months). Qualitative interviews were conducted with health professionals (HPs) and a subsample of women.
Results
Diagnostic accuracy results: depression prevalence rates were 10.3% during pregnancy and 10.5% postnatally. The Whooley questions and EPDS (cut-off point of ≥ 10) performed reasonably well, with comparable sensitivity [pregnancy: Whooley questions 85.0%, 95% confidence interval (CI) 70.2% to 94.3%; EPDS 82.5%, 95% CI 67.2% to 92.7%; postnatally: Whooley questions 85.7%, 95% CI 69.7% to 95.2%; EPDS 82.9%, 95% CI 66.4% to 93.4%] and specificity (pregnancy: Whooley questions 83.7%, 95% CI 79.4% to 87.4%; EPDS 86.6%, 95% CI 82.5% to 90.0%; postnatally: Whooley questions 80.6%, 95% CI 75.7% to 84.9%; EPDS 87.6%, 95% CI 83.3% to 91.1%). Diagnostic accuracy of the EPDS (cut-off point of ≥ 13) was poor at both time points (pregnancy: sensitivity 45%, 95% CI 29.3% to 61.5%, and specificity 95.7%, 95% CI 93.0% to 97.6%; postnatally: sensitivity 62.9%, 95% CI 44.9% to 78.5%, and specificity 95.7%, 95% CI 92.7% to 97.7%). Qualitative evaluation: women and HPs were supportive of screening/case-finding for perinatal depression. The EPDS was preferred to the Whooley questions by women and HPs, mainly because of its ‘softer’ wording. Whooley question 1 was thought to be less acceptable, largely because of the terms ‘depressed’ and ‘hopeless’, leading to women not revealing their depressive symptoms. HPs identified a ‘patient-centred’ environment that focused on the mother and baby to promote discussion about mental health. Cost-effectiveness results: screening/case-finding using the Whooley questions or the EPDS alone was not the most cost-effective strategy. A two-stage strategy, ‘Whooley questions followed by the Patient Health Questionnaire’ (a measure assessing depression symptomatology), was the most cost-effective strategy in the range between £20,000 and £30,000 per quality-adjusted life-year in both the prenatal and postnatal decision models.
Limitations
Perinatal depression diagnosis was not cross-referenced with women’s medical records so the proportion of new cases identified is unknown. The clinical effectiveness and cost-effectiveness of screening/case-finding strategies was not assessed as part of a randomised controlled trial.
Conclusions
The Whooley questions and EPDS had acceptable sensitivity and specificity, but their use in practice might be limited by low predictive value and variation in their acceptability. A two-stage strategy was more cost-effective than single-stage strategies. Neither case-finding instrument met National Screening Committee criteria.
Future work
The yield of screening/case-finding should be established with reference to health-care records. The clinical effectiveness and cost-effectiveness of screening/case-finding for perinatal depression needs to be tested in a randomised controlled trial.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Elizabeth Littlewood
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lisa Dyson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Pat Ansell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Della Bailey
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Debrah Bates
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Catherine Baxter
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Jules Beresford-Dent
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha Gascoyne
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Carol Gray
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Lisa Hackney
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Dorothy Hutchinson
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Laura Jefferson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rachel Mann
- Department of Health Sciences, University of York, York, UK
| | - David Marshall
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Alice North
- Patient and public involvement representative, York, UK
| | - Sarah Nutbrown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kelly Swan
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Holly Taylor
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Bev Waterhouse
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Louise Wills
- Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Harrogate, UK
| | - Rebecca Woodhouse
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
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Button S, Thornton A, Lee S, Shakespeare J, Ayers S. Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. Br J Gen Pract 2017; 67:e692-e699. [PMID: 28847773 PMCID: PMC5604833 DOI: 10.3399/bjgp17x692549] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/10/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. AIM To understand the factors affecting women's decision to seek help for perinatal distress. DESIGN AND SETTING Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. METHOD Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. RESULTS In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. CONCLUSION Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress.
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Affiliation(s)
- Susan Button
- Department of Adult Nursing and Paramedic Science, Faculty of Education and Health, University of Greenwich, London
| | - Alexandra Thornton
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London
| | - Suzanne Lee
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London
| | | | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London
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24
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Hogan S, Sheffield D, Woodward A. The value of art therapy in antenatal and postnatal care: A brief literature review with recommendations for future research. INTERNATIONAL JOURNAL OF ART THERAPY 2017. [DOI: 10.1080/17454832.2017.1299774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. Br J Gen Pract 2017; 67:e538-e546. [PMID: 28716994 DOI: 10.3399/bjgp17x691889] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/17/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. AIM This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. DESIGN AND SETTING Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. METHOD A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. RESULTS Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. CONCLUSION GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients.
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Husain N, Chaudhry N, Furber C, Fayyaz H, Kiran T, Lunat F, Rahman RU, Farhan S, Fatima B. Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan. World J Psychiatry 2017; 7:98-105. [PMID: 28713687 PMCID: PMC5491481 DOI: 10.5498/wjp.v7.i2.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention.
METHODS The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play (LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews.
RESULTS Framework analysis procedures were used to analyse the qualitative data. Four themes emerged: (1) the women’s contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare; (2) women’s isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare; (3) the impact of the intervention (LTP-Plus): Women felt “listened to” and seemed empowered; and (4) empowered transformed women within the same contextual environment: The facilitator provided a “gardening role” in nurturing the women resulting in a positive transformation within the same environment. The women’s homes seemed to be more happy homes and there was a positive change in their behaviour towards their children.
CONCLUSION Findings informed the further development and testing of culturally-appropriate psychosocial intervention (LTP+) for addressing maternal depression.
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Ashford MT, Ayers S, Olander EK. Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1257-1264. [PMID: 28105764 DOI: 10.1111/hsc.12428] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety.
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Affiliation(s)
- Miriam T Ashford
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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28
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Ashford MT, Olander EK, Rowe H, Fisher JRW, Ayers S. Internet-based interventions for postpartum anxiety: exploring health visitors’ views. J Reprod Infant Psychol 2017. [DOI: 10.1080/02646838.2017.1313966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Miriam Thiel Ashford
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Ellinor K. Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane R. W. Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, UK
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29
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Scope A, Booth A, Morrell CJ, Sutcliffe P, Cantrell A. Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis. J Affect Disord 2017; 210:100-110. [PMID: 28024220 DOI: 10.1016/j.jad.2016.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/28/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND More women experience depressive symptoms antenatally than postnatally. Supporting women through the antenatal period is recognised as important in mitigating negative outcomes and in preventing postnatal depression (PND). A systematic review was conducted which aimed to provide a detailed service user and service provider perspective on the uptake, acceptability, and perception of harms of antenatal interventions and postnatal interventions for preventing PND. METHODS A comprehensive literature search was conducted in 12 major bibliographic databases in November 2012 and updated in December 2014. Studies were included if they contained qualitative evidence on the perspectives and attitudes of pregnant women and postnatal women who had taken part in, or healthcare professionals (HCPs) involved in delivering, preventive interventions for PND. RESULTS Twenty-two studies were included. Support and empowerment through education were identified as particularly helpful to women as intervention components, across all intervention types. Implications for accessing the service, understanding the remit of the service and women's preferences for group and individual care also emerged. LIMITATIONS The majority of the included studies were of moderate or low quality, which may result in a lack of rich data consistently across all studies, limiting to some degree interpretations that can be made. CONCLUSION The synthesis demonstrated important considerations for devising new interventions or adapting existing interventions. Specifically, it is important that individual or group interventions are carefully tailored to women's needs or preferences and women are aware of the remit of the HCPs role to ensure they feel able to access the support required.
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Affiliation(s)
- Alison Scope
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK.
| | - Andrew Booth
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK.
| | - C Jane Morrell
- University of Nottingham, School of Health Sciences, Nottingham, UK
| | - Paul Sutcliffe
- University of Warwick, Warwick Medical School, Warwick, UK
| | - Anna Cantrell
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
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30
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Cummings E, Whittaker K. Listening visits by health visitors as an intervention for mild-to-moderate postnatal depression or anxiety. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/johv.2016.4.5.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brugha TS, Smith J, Austin J, Bankart J, Patterson M, Lovett C, Morgan Z, Morrell CJ, Slade P. Can community midwives prevent antenatal depression? An external pilot study to test the feasibility of a cluster randomized controlled universal prevention trial. Psychol Med 2016; 46:345-356. [PMID: 26482473 PMCID: PMC4682479 DOI: 10.1017/s003329171500183x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Repeated epidemiological surveys show no decline in depression although uptake of treatments has grown. Universal depression prevention interventions are effective in schools but untested rigorously in adulthood. Selective prevention programmes have poor uptake. Universal interventions may be more acceptable during routine healthcare contacts for example antenatally. One study within routine postnatal healthcare suggested risk of postnatal depression could be reduced in non-depressed women from 11% to 8% by giving health visitors psychological intervention training. Feasibility and effectiveness in other settings, most notably antenatally, is unknown. METHOD We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMWs), recruitment of pregnant women of all levels of risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women 'at increased risk' to complete CMW-provided psychological support sessions. RESULTS Seventy-nine percent of eligible women approached agreed to take part. Two hundred and ninety-eight women in eight clusters participated and 186 termed 'at low risk' for depression, based on an Edinburgh Perinatal Depression Scale (EPDS) score of <12 at 12 weeks gestation, provided baseline and outcome data at 34 weeks gestation. All trial protocol procedures were shown to be feasible. Antenatal effect sizes in women 'at low risk' were similar to those previously demonstrated postnatally. Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women. CONCLUSION A fully powered trial testing universal prevention of depression in pregnancy is feasible, acceptable and worth undertaking.
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Affiliation(s)
- T. S. Brugha
- Department of Health Sciences, Section of Adult Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - J. Smith
- Department of Health Sciences, Section of Adult Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - J. Austin
- Division of Women's and Children's CMG, Leicester Royal Infirmary, Jarvis Building, Infirmary Square, Leicester, UK
| | - J. Bankart
- Department of Health Sciences, Section of Adult Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - M. Patterson
- Division of Women's and Children's CMG, Leicester Royal Infirmary, Jarvis Building, Infirmary Square, Leicester, UK
| | - C. Lovett
- Department of Health Sciences, Section of Adult Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - Z. Morgan
- Department of Health Sciences, Section of Adult Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - C. J. Morrell
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - P. Slade
- Clinical Psychology – Ground Floor Whelan Building, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health 2015; 18:745-59. [PMID: 26184835 DOI: 10.1007/s00737-015-0548-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Pregnancy and the first postnatal year can be a difficult and distressing period for women with mental health problems, particularly if they are not able to access appropriate and timely assessment and treatment. The aim of this systematic review was to synthesise qualitative evidence on experiences of care for women with (or at risk of developing) antenatal or postnatal mental health problems across a range of disorders (including non-psychotic mental disorders). METHODS Six electronic databases were searched for papers published from 2000 to April 2014. Thirty-nine studies were identified that met the inclusion criteria. Findings were synthesised using secondary framework and thematic analysis approaches. RESULTS Seven key themes were identified across mental disorder groups: an unmet need for collaborative and integrated care; stigma and fears about loss of custody; healthcare professionals unable or unwilling to address psychological needs; focus on babies over mothers; importance of non-judgmental and compassionate support; an unmet need for information; importance of service user involvement in treatment decisions. CONCLUSIONS Women's experience of accessing and engaging with care for mental health problems could be improved if given the opportunity to develop trusting relationships with healthcare professionals who acknowledge and reinforce the woman's role in caring for her baby in a non-judgmental and compassionate manner, and foster hope and optimism about treatment. Information for women, their families and healthcare professionals, and the provision of individualised care and treatment, are also crucial to enable full implementation of a person-centred programme of care.
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Affiliation(s)
- Odette Megnin-Viggars
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK.
| | - Iona Symington
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. .,Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Stephen Pilling
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. .,Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
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A systematic review on the acceptability of perinatal depression screening. J Affect Disord 2015; 188:284-303. [PMID: 26386439 DOI: 10.1016/j.jad.2015.06.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perinatal depression (PND) affects approximately 10-15% of women, worldwide. PND screening, using screening tools, has been undertaken by a broad range of healthcare professionals in different settings. Our objective was to explore the acceptability of PND screening and how acceptability was being assessed. METHODS A systematic literature review of studies that explored the acceptability of PND screening was carried out throughout MEDLINE, PsycINFO, PubMed, CINAHL, Embase, Maternity and Infant Care and Joanna Briggs Institute databases. RESULTS Twenty-eight out of twenty-nine publications reported PND screening to be acceptable to most participants. A wide range of terms, questions and statements was used to infer, assess or report on acceptability. There was no uniform, psychometrically tested tool used to measure acceptability across the studies. LIMITATIONS Broad inclusion criteria and methodological differences limited comparisons, but are overcome by the comprehensiveness of the data and the lack of uniformity across studies. CONCLUSIONS Even though PND screening appears acceptable, it is difficult to draw conclusions about PND screening acceptability as studies used different methods to infer, assess or report on acceptability. The lack of a uniform, psychometrically tested tool to measure acceptability is not unique to PND. Nonetheless, the majority of perinatal women and healthcare professionals reported positive attitudes towards PND screening using different tools in different settings, indicating that it may be the responsibility of all healthcare professionals who come into contact with perinatal women.
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Mann R, Adamson J, Gilbody S. The acceptability of case-finding questions to identify perinatal depression. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.9.630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joy Adamson
- Senior Lecturer in Epidemiology University of York
| | - Simon Gilbody
- Director of the Mental Health and Addictions Research Group University of York and Hull York Medical School
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Bell SA, Seng J. Childhood maltreatment history, posttraumatic relational sequelae, and prenatal care utilization. J Obstet Gynecol Neonatal Nurs 2013; 42:404-15. [PMID: 23772546 PMCID: PMC4331183 DOI: 10.1111/1552-6909.12223] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To test the hypothesis that childhood maltreatment history would be associated with inadequate prenatal care utilization. DESIGN A post-hoc analysis of a prospective cohort study of the effects of post traumatic stress disorder (PTSD) on pregnancy outcomes. SETTING Recruitment took place via prenatal clinics from three academic health systems in southeast Michigan. PARTICIPANTS This analysis included 467 diverse, nulliparous, English-speaking adult women expecting their first infants. METHODS Data were gathered from structured telephone interviews at two time points in pregnancy and from prenatal medical records. RESULTS Contrary to our hypothesis, history of childhood maltreatment was associated with better likelihood of using adequate prenatal care. Risk for inadequate prenatal care occurred in association with the posttraumatic stress and interpersonal sensitivity that can result from maltreatment, with low alliance with the maternity care provider, and with public insurance coverage. Prior mental health treatment was associated with using adequate prenatal care. CONCLUSION When childhood maltreatment survivors were resilient or had used mental health treatment, they were more likely to utilize adequate prenatal care. The maternity care relationship or service delivery model (e.g., no continuity of care) as well as structural factors may adversely affect utilization among PTSD-affected survivors. Since inadequate care was associated with adverse outcomes, further studies of these modifiable factors are warranted.
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Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing. Her research focuses on the intersection of reproductive health and mental health
| | - Julia Seng
- University of Michigan School of Nursing where she studies the effects of posttraumatic stress disorder on women's health and childbearing outcomes. 204 South State Street G120 Lane Hall Ann Arbor, MI 48109 734-647-4291
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Kneipp SM, Lutz BJ, Levonian C, Cook C, Hamilton JB, Roberson D. Women's experiences in a community-based participatory research randomized controlled trial. QUALITATIVE HEALTH RESEARCH 2013; 23:847-60. [PMID: 23567297 PMCID: PMC6545486 DOI: 10.1177/1049732313483924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Integrating community-based participatory research (CBPR) into traditional study designs can enhance outcomes in studies with disadvantaged groups. Little is known, however, about study participants' experiences with these approaches, the underlying processes involved in creating more positive outcomes, and whether undesirable effects on study outcomes occur simultaneously. We conducted focus group interviews with 31 disadvantaged women who participated in a CBPR-driven randomized controlled trial (RCT) both to explore their study experiences and to obtain their interpretations of select study findings. Using dimensional analysis, we found the tailored health questionnaire, treatment by study staff members, and RCT participants' understandings of and responses to randomization were salient to what women described as transformative experiences that occurred over the course of the RCT. These findings have implications for understanding how CBPR and non-CBPR aspects of interventions and study designs have the potential to affect both process and endpoint study outcomes.
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Affiliation(s)
- Shawn M Kneipp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Abstract
BACKGROUND Epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables as postpartum depression risk factors. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of professionally-based versus lay-based interventions, (3) the effectiveness of individually-based versus group-based interventions, (4) the effects of intervention onset and duration, and (5) whether interventions are more effective in women selected with specific risk factors. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), scanned secondary references and contacted experts in the field. We updated the search on 31 December 2012 and added the results to the awaiting classification section of the review for assessment at the next update. SELECTION CRITERIA All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS Review authors and a research co-ordinator with Cochrane review experience participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Twenty-eight trials, involving almost 17,000 women, contributed data to the review. Overall, women who received a psychosocial or psychological intervention were significantly less likely to develop postpartum depression compared with those receiving standard care (average RR 0.78, 95% confidence interval (CI) 0.66 to 0.93; 20 trials, 14,727 women). Several promising interventions include: (1) the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); and (3) interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 women) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, 11,850 women). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, 12,786 women). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; eight trials, 1853 women). AUTHORS' CONCLUSIONS Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy.
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Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto and Women’s College Research Institute, Toronto, Canada.
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Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D, Pbert L. Patient's views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals? Gen Hosp Psychiatry 2013; 35:598-604. [PMID: 23969144 PMCID: PMC4107904 DOI: 10.1016/j.genhosppsych.2013.07.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The objectives were to examine patients' perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals. METHOD Four 90-min focus groups were conducted with women 3-36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach. RESULTS Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals. CONCLUSIONS Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals' perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 01655.
| | - Kathleen Biebel
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | | | | | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
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Byatt N, Simas TAM, Lundquist RS, Johnson JV, Ziedonis DM. Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. J Psychosom Obstet Gynaecol 2012. [PMID: 23194018 DOI: 10.3109/0167482x.2012.728649] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment. METHOD Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment. RESULTS Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources. CONCLUSION Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Ob/Gyn, UMass Medical School, Worcester, MA 01655, USA.
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Management of postnatal depression in primary care: a window of opportunity. Br J Gen Pract 2011; 60:801-2. [PMID: 21062546 DOI: 10.3399/bjgp10x538930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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