Acceptance and Experience of Treatment for Postnatal Depression in a Community Mental Health Setting

Stigma and attitudes towards antenatal depression and antidepressant use during pregnancy in healthcare students

Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare professionals hold stigma against patients who experience mental health conditions, including depression. The public, as well as healthcare professionals may have negative attitudes towards antidepressant use during pregnancy, despite evidence that many antidepressants are relatively safe for use in pregnancy. The objective of this project was to determine what knowledge and opinions healthcare students may hold towards antenatal depression and its treatment, and whether further knowledge and experience lessened the stigma. Medical, pharmacy, and nursing students (n = 309) were given a scenario regarding a woman with AD based on Corrigan's Attribution Questionnaire and asked seven questions based on the scenario that assessed their level of stigma and questions related to treatment. Each student group demonstrated some stigma towards the woman and all groups lacked knowledge regarding treatment of AD. Overall, the nursing students were the most stigmatizing of the three groups. The study demonstrates that healthcare students hold stigma towards people with mental health problems, including pregnant depressed women. It points to a need to increase education about antenatal depression and its treatment.

A review of postnatal mental health websites: help for healthcare professionals and patients

The internet offers an accessible and cost-effective way to help women suffering with various types of postnatal mental illness and also can provide resources for healthcare professionals. Many websites on postnatal mental illness are available, but there is little information on the range or quality of information and resources offered. The current study therefore aimed to review postnatal health websites and evaluate their quality on a variety of dimensions. A systematic review of postnatal health websites was conducted. Searches were carried out on four search engines (Google, Yahoo, Ask Jeeves and Bing) which are used by 98% of web users. The first 25 websites found for each key word and their hyperlinks were assessed for inclusion in the review. Websites had to be exclusively dedicated to postnatal mental health or have substantial information on postnatal mental illness. Eligible websites (n=114) were evaluated for accuracy of information, available resources and quality. Results showed that information was largely incomplete and difficult to read; available help was limited and website quality was variable. The top five postnatal mental illness websites were identified for (1) postnatal mental illness sufferers and (2) healthcare professionals. It is hoped these top websites can be used by healthcare professionals both for their own information and to advise patients on quality online resources.

Older first-time mothers and early postpartum depression: a prospective cohort study of women conceiving spontaneously or with assisted reproductive technologies

OBJECTIVE

To evaluate whether older first-time mothers (≥37 years) have higher rates of postpartum depression compared with younger first-time mothers, controlling for mode of conception and known risk factors for postpartum depression.

DESIGN

Prospective cohort study.

SETTING

Assisted reproductive technology (ART) clinics in two large Australian cities and public and private antenatal clinics and/or classes in the vicinity of ART clinics.

PATIENT(S)

Nulliparous women who had conceived spontaneously (n = 295) or through ART (n = 297) in three age-groups: younger, 20 to 30 years (n = 173); middle, 31 to 36 years (n = 214); and older, ≥37 years (n = 189).

INTERVENTION(S)

Semistructured interviews and questionnaires.

MAIN OUTCOME MEASURE(S)

Major depressive disorder in the first 4 months after birth as assessed by structured diagnostic interview.

RESULT(S)

The study performed 592 complete pregnancy assessments and 541 postpartum assessments. The prevalence of major depressive disorder was 7.9%, at the lower end of community rates. Neither maternal age-group nor mode of conception was statistically significantly related to depression.

CONCLUSION(S)

Older first-time mothers, whether conceiving through ART or spontaneously, do not show increased vulnerability to postnatal depression.

Depression in pregnancy: time of screening and access to psychiatric care

OBJECTIVE

To determine the timing of screening for postpartum depression that optimizes access to psychiatric care.

METHODS

Cross-sectional evaluation of women receiving obstetric care in a community-based medical center clinic from March to July 2006, who were screened for depression at 36 weeks gestation, delivery, and 6 weeks postpartum using the Edinburgh Postnatal Depression Scale. Positive screens generated referrals for psychiatric evaluation. The rate of positive screens for depression and psychiatric follow-up at each time point was evaluated.

RESULTS

Of the 293 patients evaluated, the distribution of the first screen which occurred during the study period was 21% at 36 weeks, 31% at delivery, and 48% at 6 weeks postpartum. The incidence of a positive screen was 5% at 36 weeks, 16% at delivery and 14% at 6 weeks postpartum. Access to psychiatric care occurred in 33% at 36 weeks, 15% at 6 weeks postpartum and 100% at delivery (p = 0.001).

CONCLUSION

Screening for depression in the hospital after delivery improves access to psychiatric care.

Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study

BACKGROUND

Universal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorized, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women.

METHODS

A before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat.

RESULTS

In total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group.

CONCLUSIONS

A universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history.

TRIAL REGISTRATION

ACTRN 12605000567628.

Barriers to mental health treatment among obstetric patients at risk for depression

OBJECTIVE

The objective of the study was to examine mental health referrals outcomes among obstetric patients at risk for depression.

STUDY DESIGN

Fifty-one perinatal women who were offered mental health referrals were queried about their behaviors at 4 steps in the treatment engagement process and factors facilitating or impeding each step.

RESULTS

Although 59% of at-risk women accepted mental health referrals, only 27% ultimately engaged in treatment. Women who proactively sought help via a hotline were more likely to accept referrals (P < .001), contact a referred provider (P < .001), and engage in treatment (P < .05) than those who received unsolicited referrals after screening at-risk for depression. Barriers to successful treatment linkage were identified at the patient, provider, and system levels.

CONCLUSION

Only a minority of women who are at risk for perinatal depression and receive mental health referrals ultimately engage in treatment. Successful linkage may be enhanced via interventions targeting identified barriers; such interventions require prospective evaluation.

Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.

Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression

BACKGROUND

Perinatal depression is associated with potential negative consequences for the mother and infant, and therefore efforts to improve treatment access and efficacy are warranted. The purpose of this study was to examine pregnant women's preferences and attitudes about treatment for depression, and perceived potential barriers to accessing treatment.

METHODS

Data were collected by means of a questionnaire from a convenience sample of 509 predominantly well-educated, high-income, married women in the northeastern United States during the last trimester of pregnancy. Participants were queried as to treatment modalities in which they would most likely participate if they wanted help for depression, their attitudes toward psychotherapeutic and pharmacological treatments, and perceived barriers to receiving help.

RESULTS

Most women (92%) indicated that would likely participate in individual therapy if help was needed. Only 35 percent stated that they would likely take medication if recommended, and 14 percent indicated that they would participate in group therapy. The greatest perceived potential barriers to treatment were lack of time (65%), stigma (43%), and childcare issues (33%). Most women indicated a preference to receive mental health care at the obstetrics clinic, either from their obstetrics practitioner or from a mental health practitioner located at the clinic. Factors associated with acceptability of various depression treatments are presented.

CONCLUSIONS

Understanding what prevents women from seeking or obtaining help for depression and determining what they prefer in the way of treatment may lead to improved depression treatment rates and hold promise for improving the overall health of childbearing women.