1
|
Kobylski LA, Arakelian MH, Freeman MP, Gaw ML, Cohen LS, Vanderkruik R. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health 2024; 27:637-647. [PMID: 38396143 DOI: 10.1007/s00737-024-01447-z] [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: 08/22/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. METHODS Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics. RESULTS 139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization. CONCLUSION This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
Collapse
Affiliation(s)
- Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA.
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Vanderkruik R, Kobylski LA, Dunk MM, Arakelian MH, Gaw ML, Dineen H, Kanamori M, Freeman MP, Cohen LS. The lived experiences of individuals with postpartum psychosis: A qualitative analysis. J Affect Disord 2024; 348:367-377. [PMID: 38160890 DOI: 10.1016/j.jad.2023.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Postpartum psychosis (PP) is a severe psychiatric illness that occurs in about 1 to 2 per 1000 people in the perinatal period. To date, qualitative research investigating PP has focused on specific topics, such as treatment experiences or the impact of the illness on patients' lives and families. These studies have included small samples of women with histories of PP, often limited to certain geographical areas or treatment centers. Given the heterogeneity in presentations of PP and access to care, larger and geographically diverse samples are needed to broadly understand this complex illness. Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. In addition to the specific aims of MGHP3, which include to better understand the phenomenology and potential genetic underpinnings of PP, this investigation invites participants to qualitatively describe their narratives of postpartum psychosis. This analysis included 130 participants who reported on 133 episodes of PP. Participants' responses to the PP narrative prompt fell under several overarching categories: 1) broad psychosocial experiences surrounding postpartum psychosis, 2) impact on the mother-baby dyad, 3) treatment experiences, and 4) recovery experiences. Our findings shed light on a range of ways in which individuals' lives are impacted by this illness, and point to areas for future research and clinical directions to improve the support and care for individuals with PP and their families.
Collapse
Affiliation(s)
- Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychological & Brain Sciences, George Washington University, Washington, DC, United States of America
| | - Madison M Dunk
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hannah Dineen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaux Kanamori
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
3
|
Wass N, Chadwick R, Caygill L, O'Mara O. "It kind of strips down your relationship to its defining features……it just kind of shone a light on what was already there": A grounded theory of the impact of postpartum psychosis on the couple's relationship. J Reprod Infant Psychol 2024; 42:281-298. [PMID: 35912867 DOI: 10.1080/02646838.2022.2103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Postpartum psychosis is a severe mental health illness following childbirth. Studies to date have developed from initial focus on experiences of women to address the role and experiences of partners, and recently to touch on the effect on their relationship. This study aimed to build on this work, by focussing directly on the impact of postpartum psychosis on the couple's relationship, from the perspectives of both the woman and her partner. METHOD A constructivist grounded theory approach was utilised to generate a theory that explained the impact of postpartum psychosis on the couple's relationship. In-depth semi-structured interviews were completed with a sample of eight women and six partners. RESULTS Four stages and five general categories described the processes that the couple experienced, and the impact postpartum psychosis had on their relationship. DISCUSSION The grounded theory adds to current evidence and helps increase understanding of factors that play a role in adjustment and outcomes. New insights were identified, including postpartum psychosis amplifying existing relational patterns; and the mediating role of the pre-existing relationship and couplehood. Clinical implications and areas for further research are considered.
Collapse
Affiliation(s)
- Nicola Wass
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Raymond Chadwick
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Lisa Caygill
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Oliver O'Mara
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| |
Collapse
|
4
|
Lyons T, Hennesey T, Noonan M. A systematic review of qualitative evidence: Perspectives of fathers whose partner experienced postpartum psychosis. J Adv Nurs 2024; 80:413-429. [PMID: 37658618 DOI: 10.1111/jan.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023]
Abstract
AIMS This study aimed to systematically identify, appraise and synthesize qualitative evidence which explored fathers' experiences and perspectives of their partners' postpartum psychosis. DESIGN Qualitative evidence synthesis (QES). DATA SOURCES Seven databases (CINAHL, PsycINFO, Medline, Scopus, Google Scholar, ProQuest Dissertations and Open Grey) were systematically searched for qualitative studies from each database's inception to the 17th of February 2022. REVIEW METHODS Studies that utilized a qualitative research design to explore fathers' experiences and perspectives of their partners' postpartum psychosis were included. Studies were appraised using the Critical Appraisal Skills Programme to determine their methodological quality. Qualitative data were extracted and synthesized using the process of thematic synthesis to form analytical themes. RESULTS Eleven reports (seven journal articles and four theses), representing six unique qualitative studies were included in the review. Two analytical themes and eight subthemes were identified. The analytical themes were 'a sense of loss across multiple domains of their lives', and 'informational and emotional support needs'. CONCLUSION Postpartum psychosis is a severe mental health condition which also impacts the woman's partner. Fathers experienced an array of emotions which they attributed to a lack of knowledge and understanding of postpartum psychosis. The development of appropriate support structures is needed to better support fathers in supporting their partners. REPORTING METHOD This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and ENTREQ reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution. IMPACT WHAT PROBLEM DID THIS STUDY ADDRESS?: Fathers play a pivotal role in supporting their partner who has postpartum psychosis, and a supportive father has a positive impact on the mental health of the mother. Several qualitative studies have explored fathers' experiences of their partners' psychosis. This QES integrated findings from these studies to gain a deeper understanding and knowledge of the father's experience. WHAT ARE THE MAIN FINDINGS?: Fathers reported a significant sense of loss across multiple domains of their lives, from a perceived loss of their relationship with their partner to a loss of the future they had planned together. Fathers experienced an array of emotions, such as fear and shock which they attributed to their lack of knowledge and awareness of postpartum psychosis. WHERE AND ON WHOM WILL THIS RESEARCH HAVE AN IMPACT?: This review provides a deeper insight and understanding into the father's experiences and perspectives of their partners' postpartum psychosis. This insight can inform healthcare professionals and policymakers in the development of appropriate support structures which meet the needs of this population. The provision of appropriate support structures could have a positive impact on the father's well-being and ability to support their partner.
Collapse
Affiliation(s)
- Theresa Lyons
- Louth Meath Mental Health Services, Community Healthcare Organisation 8, Dublin, Ireland
| | - Therese Hennesey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
5
|
Forde R, Peters S, Wittkowski A. Recovery from postpartum psychosis: a systematic review and metasynthesis of women's and families' experiences. Arch Womens Ment Health 2020; 23:597-612. [PMID: 32020314 PMCID: PMC7497301 DOI: 10.1007/s00737-020-01025-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/26/2020] [Indexed: 01/20/2023]
Abstract
Postpartum psychosis is a serious disorder that can result in adverse consequences for the mother and baby. It is important that we understand the experiences of women, to develop effective interventions during this critical period. The aim of this systematic review was to conduct a metasynthesis of qualitative research exploring women's experiences of postpartum psychosis and factors involved in recovery from the perspective of women and family members. A comprehensive literature search of five databases was conducted and the findings were appraised and synthesised, following a thematic synthesis approach. Fifteen studies, capturing the views of 103 women and 42 family members, met the inclusion criteria. Four main themes incorporating 13 subthemes were identified following synthesis: (1) Experiencing the unspeakable, (2) Loss and disruption, (3) Realigning old self and new self and the integrative theme of (4) Social context. The findings offer new insight into the unique experience of postpartum psychosis and demonstrate that recovery does not follow a linear path. To improve clinical outcomes, a more integrative and individualised approach is needed which incorporates long-term psychological and psychosocial support, and considers the needs of the family. Further areas for staff training, service development and future research are highlighted.
Collapse
Affiliation(s)
- R Forde
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| |
Collapse
|
6
|
Powell C, Bedi S, Nath S, Potts L, Trevillion K, Howard L. Mothers' experiences of acute perinatal mental health services in England and Wales: a qualitative analysis. J Reprod Infant Psychol 2020; 40:155-167. [PMID: 32883099 DOI: 10.1080/02646838.2020.1814225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Perinatal mental health services are a current NHS priority and services are being increased for women. There is limited research on mothers' perspectives of these services and most research focuses on mother and baby units (MBUs). This study explored women's views of their experiences of generic wards, MBUs and crisis resolution teams. METHODS A qualitative thematic analysis was conducted on written feedback on a service-user-designed questionnaire. One hundred and thirty-nine women recruited across 42 mental health trusts made comments. RESULTS Two key themes were identified: support networks and staff authority. Support networks included subthemes relating to families, peers and staff. The theme of staff authority incorporated subthemes about communication, confidence in staff and service-user autonomy. All themes contributed to whether mothers felt safe in these services. Mothers reported the benefits of positive, non-coercive relationships with family and staff for their recovery. The findings highlight that the challenges women face in perinatal settings reflect the literature on general psychiatric services, particularly around coercion. CONCLUSIONS Specific implications for mothers accessing perinatal mental health services: 1) integrated mental health care and support with babies; 2) support with separation from babies for mothers in acute wards; 3) improvement of women's relationships with social services across all services.
Collapse
Affiliation(s)
- Claire Powell
- Section of Women's Mental Health, King's College London, London, UK.,Institute of Child Health, University College London, London, UK
| | - Simran Bedi
- Section of Women's Mental Health, King's College London, London, UK
| | - Selina Nath
- Section of Women's Mental Health, King's College London, London, UK.,Institute of Child Health, University College London, London, UK
| | - Laura Potts
- Section of Women's Mental Health, King's College London, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, King's College London, London, UK
| | - Louise Howard
- Section of Women's Mental Health, King's College London, London, UK
| |
Collapse
|
7
|
Salarzadeh Jenatabadi H, Bt Wan Mohamed Radzi CWJ, Samsudin N. Associations of Body Mass Index with Demographics, Lifestyle, Food Intake, and Mental Health among Postpartum Women: A Structural Equation Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5201. [PMID: 32708480 PMCID: PMC7400682 DOI: 10.3390/ijerph17145201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
As postpartum obesity is becoming a global public health challenge, there is a need to apply postpartum obesity modeling to determine the indicators of postpartum obesity using an appropriate statistical technique. This research comprised two phases, namely: (i) development of a previously created postpartum obesity modeling; (ii) construction of a statistical comparison model and introduction of a better estimator for the research framework. The research model displayed the associations and interactions between the variables that were analyzed using the Structural Equation Modeling (SEM) method to determine the body mass index (BMI) levels related to postpartum obesity. The most significant correlations obtained were between BMI and other substantial variables in the SEM analysis. The research framework included two categories of data related to postpartum women: living in urban and rural areas in Iran. The SEM output with the Bayesian estimator was 81.1%, with variations in the postpartum women's BMI, which is related to their demographics, lifestyle, food intake, and mental health. Meanwhile, the variation based on SEM with partial least squares estimator was equal to 70.2%, and SEM with a maximum likelihood estimator was equal to 76.8%. On the other hand, the output of the root mean square error (RMSE), mean absolute error (MSE) and mean absolute percentage error (MPE) for the Bayesian estimator is lower than the maximum likelihood and partial least square estimators. Thus, the predicted values of the SEM with Bayesian estimator are closer to the observed value compared to maximum likelihood and partial least square. In conclusion, the higher values of R-square and lower values of MPE, RMSE, and MSE will produce better goodness of fit for SEM with Bayesian estimators.
Collapse
Affiliation(s)
- Hashem Salarzadeh Jenatabadi
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia; (C.W.J.B.W.M.R.); (N.S.)
| | | | | |
Collapse
|
8
|
Johnson S, Adam S, McIntosh M. The Lived Experience of Postpartum Depression: A Review of the Literature. Issues Ment Health Nurs 2020; 41:584-591. [PMID: 32267789 DOI: 10.1080/01612840.2019.1688437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Postpartum depression has been studied from a variety of perspectives and by many disciplines. The aim of this article is to review qualitative literature exploring the first-person accounts of women diagnosed with postpartum depression and highlight the absence of work in madness discourse. Searches of multiple databases (Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Sociology Database, Web of Science, Genderwatch, PILOTS, MedLine from PubMed, PsycINFO) were undertaken. There is a significant gap in literature that exists in relation to the lived experience of women diagnosed with postpartum depression who do not identify as mentally ill.
Collapse
Affiliation(s)
| | - Simon Adam
- School of Nursing, York University, Toronto, Canada
| | - Michele McIntosh
- Trent/Fleming School of Nursing, Trent University, Peterborough, Canada
| |
Collapse
|
9
|
Bt Wan Mohamed Radzi CWJ, Salarzadeh Jenatabadi H, Samsudin N. mHealth Apps Assessment among Postpartum Women with Obesity and Depression. Healthcare (Basel) 2020; 8:E72. [PMID: 32225114 PMCID: PMC7349810 DOI: 10.3390/healthcare8020072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pregnancy has become the main constituent for women to become overweight or obese during the postpartum phase. This could lead women to suffer from postpartum depression as well. Information technology (IT) has become more prevalent in the healthcare industry. It offers patients the opportunity to manage their health conditions via the use of several applications, one being the mHealth applications. OBJECTIVE The main purpose of this study is to experiment and understand the effects the mHealth applications (i.e., fitness and nutrition applications) have on the body mass index (BMI) and depression levels amongst postpartum women. METHODS Online questionnaires were sent to postpartum women within one year after their pregnancy, of which 819 completed questionnaires were returned. The frequency of the mHealth applications usage was categorized into daily, weekly, rarely and never streams. Therefore, the frequency of use of the mHealth applications for BMI and depression levels was analyzed based on the available statistical data. Descriptive statistics, ANOVA, and Dunnet tests were applied to analyze the experimental data. RESULTS Out of 819 respondents, 37.9% and 42.1% of them were overweight and obese, respectively. Almost 32.9% of the respondents were likely depressed, and 45.6% were at an increased risk. This study reports that only 23.4% and 28.6% of respondents never used the fitness and nutrition applications. The impact of the frequency of using the fitness applications on BMI and depression levels was obvious. This means that with the increased use of the fitness applications, there was also a significant effect in maintaining and decreasing the BMI and depression levels amongst Malaysians postpartum women. However, from the data of weekly and daily use of fitness applications, we found that the contribution toward the BMI and depression levels was high (p = 0.000). However, nutrition applications amongst the users were not significant within the main variables (p > 0.05). From the Dunnet test, the significance of using the fitness applications within the depression levels started from daily usage, whereas for BMI, it started from weekly usage. CONCLUSION The efficiency of the fitness applications toward the BMI and depression levels has been proven in this research work. While nutrition applications did not affect the BMI and depression levels, some of the respondents were still categorized as weekly and daily users. Thus, the improvements in BMI and depression levels are associated with the types of mHealth app that had been used.
Collapse
Affiliation(s)
| | - Hashem Salarzadeh Jenatabadi
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia; (C.W.J.B.W.M.R.); (N.S.)
| | | |
Collapse
|
10
|
Forde R, Peters S, Wittkowski A. Psychological interventions for managing postpartum psychosis: a qualitative analysis of women's and family members' experiences and preferences. BMC Psychiatry 2019; 19:411. [PMID: 31856785 PMCID: PMC6923990 DOI: 10.1186/s12888-019-2378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members. METHODS Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis. RESULTS Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women's psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies. CONCLUSION The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
Collapse
Affiliation(s)
- R Forde
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| |
Collapse
|
11
|
Korteland TW, Koorengevel KM, Poslawsky IE, van Meijel B. Nursing interventions for patients with postpartum psychosis hospitalized in a psychiatric mother-baby unit: A qualitative study. J Psychiatr Ment Health Nurs 2019; 26:254-264. [PMID: 31250503 DOI: 10.1111/jpm.12542] [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] [Received: 04/01/2019] [Revised: 05/31/2019] [Accepted: 06/24/2019] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother-baby unit is recommended and should focus on the maternal health, mother-baby outcomes and the care for the next of kin. The role of mental health nurses on a mother-baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members. To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother-baby unit. Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best-practice setting (i.e., a specialized mother-baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. IMPLICATIONS FOR MENTAL HEALTH NURSING Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery. To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Abstract Introduction Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother-baby unit is recommended, where care will focus on the mother's health, the mother-baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim Identifying nursing interventions used at a psychiatric mother-baby unit, when a patient is hospitalized with postpartum psychosis. Method A qualitative design using thematic analysis. Data were collected using semi-structured interviews (N = 13) with expert nurses working at such a unit. Results The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well-being; (b) care for the mother-baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well-being. Discussion Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis.
Collapse
Affiliation(s)
- Tim W Korteland
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Irina E Poslawsky
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Nursing Science, Programme in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VUmc), Amsterdam, The Netherlands.,GGZ-VS Masters of Advanced Nursing Practice, Utrecht, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
| |
Collapse
|
12
|
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: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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.
Collapse
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
| |
Collapse
|
13
|
Reid H, Wieck A, Matrunola A, Wittkowski A. The Experiences of Fathers When Their Partners are Admitted with Their Infants to a Psychiatric Mother and Baby Unit. Clin Psychol Psychother 2016; 24:919-931. [DOI: 10.1002/cpp.2056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 10/15/2016] [Accepted: 10/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Holly Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health; University of Manchester; Manchester UK
- Manchester Mental Health and Social Care NHS Trust; Manchester UK
| | - Angelika Wieck
- Manchester Mental Health and Social Care NHS Trust; Manchester UK
| | - Andrew Matrunola
- Manchester Mental Health and Social Care NHS Trust; Manchester UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health; University of Manchester; Manchester UK
- Manchester Mental Health and Social Care NHS Trust; Manchester UK
| |
Collapse
|