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Reddish A, Golds L, MacBeth A. "It is not all glowing and kale smoothies": An exploration of mental health difficulties during pregnancy through women's voices. Psychol Psychother 2024; 97:456-476. [PMID: 38661270 DOI: 10.1111/papt.12527] [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: 03/25/2022] [Revised: 02/29/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study aimed to explore the experiences of women with moderate-to-severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. DESIGN In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. METHODS Semi-structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. RESULTS Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the 'wrong' feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. CONCLUSIONS These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs-matched care.
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Affiliation(s)
- Alison Reddish
- NHS Grampian, Aberdeen, UK
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lisa Golds
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Angus MacBeth
- NHS Grampian, Aberdeen, UK
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
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2
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Dubreucq M, Thiollier M, Tebeka S, Fourneret P, Leboyer M, Viaux-Savelon S, Massoubre C, Dupont C, Dubreucq J. Toward recovery-oriented perinatal healthcare: A participatory qualitative exploration of persons with lived experience and health providers' views and experiences. Eur Psychiatry 2023; 66:e86. [PMID: 37860880 DOI: 10.1192/j.eurpsy.2023.2464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression. METHODS We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis. RESULTS We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration. DISCUSSION This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.
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Affiliation(s)
- Marine Dubreucq
- Centre Referent de Rehabilitation Psychosociale, GCSMS REHACOOR 42, Saint-Étienne, France
- INSERM U1290, Research on Healthcare Performance (RESHAPE), University Lyon 1, Lyon, France
| | | | - Sarah Tebeka
- Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences, Team 1, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Pierre Fourneret
- Department of Psychopathology of Child and Adolescent Development, Hospices Civils de Lyon, Lyon, France
- Marc Jeannerod Institute of Cognitive Sciences UMR 5229, CNRS & Claude Bernard University, Lyon, France
| | - Marion Leboyer
- Fondation Fondamental, Créteil, France
- Université Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Sylvie Viaux-Savelon
- Marc Jeannerod Institute of Cognitive Sciences UMR 5229, CNRS & Claude Bernard University, Lyon, France
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Catherine Massoubre
- University Hospital of Saint-Étienne & EA 7423, Troubles du Comportement Alimentaire, Addictions et Poids Extrêmes (TAPE), Université Jean Monnet, Saint-Etienne, France
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290 & AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Julien Dubreucq
- Marc Jeannerod Institute of Cognitive Sciences UMR 5229, CNRS & Claude Bernard University, Lyon, France
- Department of Child and Adolescent Psychiatry, University Hospital of Saint-Étienne, Saint-Etienne, France
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3
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Butterworth S, Butterworth R, Law GU. Birth trauma: the elephant in the nursery. J Reprod Infant Psychol 2023:1-22. [PMID: 37791520 DOI: 10.1080/02646838.2023.2264877] [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: 02/02/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
METHOD The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. RESULTS Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. DISCUSSION Parents described a shared experience of birth trauma during birth. However, fathers' perceived trauma ended in the delivery room whilst mothers' continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. CONCLUSION The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
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Affiliation(s)
| | - Ruth Butterworth
- Northwest Neonatal ODN, Alder Hey Children's NHS Foundation Trust, liverpool, UK
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Family treatment for postpartum depression: acceptability, feasibility, and preliminary clinical outcomes. Arch Womens Ment Health 2023; 26:127-134. [PMID: 36472675 DOI: 10.1007/s00737-022-01282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
The level of support from family members-and degree of family dysfunction-can shape the onset and course of maternal postpartum depression (PPD). In spite of this, family members are typically not included in treatments for PPD. Developing and disseminating intervention approaches that involve partners or other family members may lead to more effective treatment for perinatal women and potentially promote improved family functioning and wellbeing of multiple members of the family. To evaluate the feasibility and acceptability of a family-based treatment for PPD, we conducted an open pilot trial with 16 postpartum mother-father couples (N = 32 participants) and measured session attendance, patient satisfaction, and changes in key symptoms and functional outcomes. At the time of enrollment, mothers were 1-7 months postpartum, met criteria for major depressive disorder, and had moderate-severe symptoms of depression. Treatment involved 10-12 sessions attended by the mother along with an identified family member (all fathers) at each session. Findings provide strong support for the acceptability and feasibility of the intervention: session attendance rates were high, and participants evaluated the treatment as highly acceptable. Improvements in depression were observed among both mothers and fathers, and family functioning improved by the endpoint across several domains. Symptomatic and functional gains were sustained at follow-up. The current findings provide support for a larger randomized trial of family-based treatment for PPD.
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5
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Atmore KH, Taylor BL, Potts LC, Trevillion K, Howard LM. Caregiving and mental health needs in the significant others of women receiving inpatient and home treatment for acute severe postpartum mental illness. Arch Womens Ment Health 2023; 26:49-56. [PMID: 36565312 PMCID: PMC9908709 DOI: 10.1007/s00737-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2022] [Indexed: 01/01/2023]
Abstract
To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24-69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family.
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Affiliation(s)
- Katie H. Atmore
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Billie Lever Taylor
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Laura C. Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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6
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Roxburgh E, Morant N, Dolman C, Johnson S, Taylor BL. Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study. Community Ment Health J 2023; 59:243-252. [PMID: 35900686 PMCID: PMC9859833 DOI: 10.1007/s10597-022-01002-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
Postpartum psychosis has been found to affect 0.89-2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. Our aim in this study was to understand women's experiences of mental health care and services for psychosis in the postnatal period. Semi-structured interviews were conducted with 12 women who reported being treated for postpartum psychosis. Findings were analysed thematically. Women reported that healthcare professionals across maternity and mental health services often lacked awareness and knowledge of postpartum psychosis and did not always keep them or their partners/families informed, supported, and involved. Women wanted better collaboration between and within services, and more efficient, appropriate, and timely care. They valued inpatient services that could meet their needs, favouring Mother and Baby Units over general psychiatric wards. Early Intervention in Psychosis services and specialist perinatal community mental health teams were also well liked.
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Affiliation(s)
- Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Clare Dolman
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Davidson C, Raouna A, Malcolm R, Ibrahim R, MacBeth A. "There's more love between us": The parental experience of attending Mellow Babies, a targeted, early intervention program for parents and their babies. Infant Ment Health J 2023; 44:100-116. [PMID: 36519512 PMCID: PMC10107458 DOI: 10.1002/imhj.22029] [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: 10/18/2021] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape interpersonal interactions. Findings are discussed within the context of perinatal and infant mental health.
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Affiliation(s)
- Ciera Davidson
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Aigli Raouna
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Mellow Parenting, Glasgow, UK
| | | | | | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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8
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de Waal N, Alyousefi-van Dijk K, Buisman RSM, Verhees MWFT, Bakermans-Kranenburg MJ. The prenatal video-feedback intervention to promote positive parenting for expectant fathers (VIPP-PRE): Two case studies. Infant Ment Health J 2022; 43:730-743. [PMID: 35913699 PMCID: PMC9545228 DOI: 10.1002/imhj.22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022]
Abstract
Although parenting interventions including expectant fathers are scarce, they yield promising results. The Prenatal Video‐feedback Intervention to promote Positive Parenting (VIPP‐PRE) is a recently developed intervention, that is both manualized and personalized, aiming to enhance paternal sensitivity and involvement before the birth of the baby. Illustrating the intervention process, the current study presents two case studies of expectant fathers receiving VIPP‐PRE (clinical trial registration NL62696.058.17). The VIPP‐PRE program is described along with the individual dyads’ prenatal video fragments and feedback specific for each father‐fetus dyad. In addition, changes in paternal sensitivity and involvement levels are presented, as well as fathers’ and intervener's evaluation of the intervention. VIPP‐PRE promises to be a feasible short‐term and potentially effective parenting intervention for expectant fathers. Currently, a randomized controlled trial (RCT) is under review that systematically investigates the efficacy of the VIPP‐PRE. Here we aim to provide further information on the intervention process, as well as fathers’ and intervener's evaluations of this process, and the benefits of using ultrasound imaging in a parenting intervention.
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Affiliation(s)
- Noor de Waal
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kim Alyousefi-van Dijk
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Renate S M Buisman
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.,Forensic Family and Youth Care Studies, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
| | - Martine W F T Verhees
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.,Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Marian J Bakermans-Kranenburg
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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9
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Howard LM, Abel KM, Atmore KH, Bick D, Bye A, Byford S, Carson LE, Dolman C, Heslin M, Hunter M, Jennings S, Johnson S, Jones I, Taylor BL, McDonald R, Milgrom J, Morant N, Nath S, Pawlby S, Potts L, Powell C, Rose D, Ryan E, Seneviratne G, Shallcross R, Stanley N, Trevillion K, Wieck A, Pickles A. Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/ccht9881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background
It is unclear how best to identify and treat women with mental disorders in pregnancy and the year after birth (i.e. the perinatal period).
Objectives
(1) To investigate how best to identify depression at antenatal booking [work package (WP) 1]. (2) To estimate the prevalence of mental disorders in early pregnancy (WP1). (3) To develop and examine the efficacy of a guided self-help intervention for mild to moderate antenatal depression delivered by psychological well-being practitioners (WP1). (4) To examine the psychometric properties of the perinatal VOICE (Views On Inpatient CarE) measure of service satisfaction (WP3). (5) To examine the clinical effectiveness and cost-effectiveness of services for women with acute severe postnatal mental disorders (WPs 1–3). (6) To investigate women’s and partners’/significant others’ experiences of different types of care (WP2).
Design
Objectives 1 and 2 – a cross-sectional survey stratified by response to Whooley depression screening questions. Objective 3 – an exploratory randomised controlled trial. Objective 4 – an exploratory factor analysis, including test–retest reliability and validity assessed by association with the Client Satisfaction Questionnaire contemporaneous satisfaction scores. Objective 5 – an observational cohort study using propensity scores for the main analysis and instrumental variable analysis using geographical distance to mother and baby unit. Objective 6 – a qualitative study.
Setting
English maternity services and generic and specialist mental health services for pregnant and postnatal women.
Participants
Staff and users of mental health and maternity services.
Interventions
Guided self-help, mother and baby units and generic care.
Main outcome measures
The following measures were evaluated in WP1(i) – specificity, sensitivity, positive predictive value, likelihood ratio, acceptability and population prevalence estimates. The following measures were evaluated in WP1(ii) – participant recruitment rate, attrition and adverse events. The following measure was evaluated in WP2 – experiences of care. The following measures were evaluated in WP3 – psychometric indices for perinatal VOICE and the proportion of participants readmitted to acute care in the year after discharge.
Results
WP1(i) – the population prevalence estimate was 11% (95% confidence interval 8% to 14%) for depression and 27% (95% confidence interval 22% to 32%) for any mental disorder in early pregnancy. The diagnostic accuracy of two depression screening questions was as follows: a weighted sensitivity of 0.41, a specificity of 0.95, a positive predictive value of 0.45, a negative predictive value of 0.93 and a likelihood ratio (positive) of 8.2. For the Edinburgh Postnatal Depression Scale, the diagnostic accuracy was as follows: a weighted sensitivity of 0.59, a specificity of 0.94, a positive predictive value of 0.52, a negative predictive value of 0.95 and a likelihood ratio (positive) of 9.8. Most women reported that asking about depression at the antenatal booking appointment was acceptable, although this was reported as being less acceptable for women with mental disorders and/or experiences of abuse. Cost-effectiveness analysis suggested that both the Whooley depression screening questions and the Edinburgh Postnatal Depression Scale were more cost-effective than with the Whooley depression screening questions followed by the Edinburgh Postnatal Depression Scale or no-screen option. WP1(ii) – 53 women with depression in pregnancy were randomised. Twenty-six women received modified guided self-help [with 18 (69%) women attending four or more sessions] and 27 women received usual care. Three women were lost to follow-up (follow-up for primary outcome: 92%). At 14 weeks post randomisation, women receiving guided self-help reported fewer depressive symptoms than women receiving usual care (adjusted effect size −0.64, 95% confidence interval −1.30 to 0.06). Costs and quality-adjusted life-years were similar, resulting in a 50% probability of guided self-help being cost-effective compared with usual care at National Institute for Health and Care Excellence cost per quality-adjusted life-year thresholds. The slow recruitment rate means that a future definitive larger trial is not feasible. WP2 – qualitative findings indicate that women valued clinicians with specialist perinatal expertise across all services, but for some women generic services were able to provide better continuity of care. Involvement of family members and care post discharge from acute services were perceived as poor across services, but there was also ambivalence among some women about increasing family involvement because of a complex range of factors. WP3(i) – for the perinatal VOICE, measures from exploratory factor analysis suggested that two factors gave an adequate fit (comparative fit index = 0.97). Items loading on these two dimensions were (1) those concerning aspects of the service relating to the care of the mother and (2) those relating to care of the baby. The factors were positively correlated (0.49; p < 0.0001). Total scores were strongly associated with service (with higher satisfaction for mother and baby units, 2 degrees of freedom; p < 0.0001) and with the ‘gold standard’ Client Service Questionnaire total score (test–retest intraclass correlation coefficient 0.784, 95% confidence interval 0.643 to 0.924; p < 0.0001). WP3(ii) – 263 of 279 women could be included in the primary analysis, which shows that the odds of being readmitted to acute care was 0.95 times higher for women who were admitted to a mother and baby unit than for those not admitted to a mother and baby unit (0.95, 95% confidence interval 0.86 to 1.04; p = 0.29). Sensitivity analysis using an instrumental variable found a markedly more significant effect of admission to mother and baby units (p < 0.001) than the primary analysis. Mother and baby units were not found to be cost-effective at 1 month post discharge because of the costs of care in a mother and baby unit. Cost-effectiveness advantages may exist if the cost of mother and baby units is offset by savings from reduced readmissions in the longer term.
Limitations
Policy and service changes had an impact on recruitment. In observational studies, residual confounding is likely.
Conclusions
Services adapted for the perinatal period are highly valued by women and may be more effective than generic services. Mother and baby units have a low probability of being cost-effective in the short term, although this may vary in the longer term.
Future work
Future work should include examination of how to reduce relapses, including in after-care following discharge, and how better to involve family members.
Trial registration
This trial is registered as ISRCTN83768230 and as study registration UKCRN ID 16403.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kathryn M Abel
- Centre for Women’s Mental Health, The University of Manchester, Manchester, UK
| | - Katie H Atmore
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Debra Bick
- Division of Women and Children’s Health, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Amanda Bye
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lauren E Carson
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Clare Dolman
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Myra Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stacey Jennings
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | - Rebecca McDonald
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jeannette Milgrom
- Department of Clinical and Health Psychology, Parent–Infant Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Selina Nath
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Potts
- Biostatistics and Health Informatics, King’s College London, London, UK
| | - Claire Powell
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth Ryan
- Biostatistics and Health Informatics, King’s College London, London, UK
| | | | - Rebekah Shallcross
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Harrington, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King’s College London, London, UK
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10
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Battle CL, Londono Tobon A, Howard M, Miller IW. Father's Perspectives on Family Relationships and Mental Health Treatment Participation in the Context of Maternal Postpartum Depression. Front Psychol 2021; 12:705655. [PMID: 34659020 PMCID: PMC8511320 DOI: 10.3389/fpsyg.2021.705655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To understand the perspectives of fathers whose partners experienced postpartum depression, particularly (1) views on how fathers and family relationships were impacted by maternal PPD, and (2) attitudes regarding inclusion of fathers within the treatment process. Methods: We conducted qualitative interviews with 8 postpartum couples using a semi-structured protocol, and administered questionnaires assessing demographics, depression, and family functioning. We abstracted data from hospital records regarding the mother's depressive episode. We summarized quantitative data using descriptive statistics, and analyzed interview transcripts using qualitative analysis techniques, focusing specifically on fathers' input on postpartum relationships and treatment involvement. Results: Over one-third of fathers had elevated symptoms of depression, and family functioning scores suggested that most couples were experiencing dysfunction in their relationships. Qualitative analysis identified three major categories of themes, and subthemes in each category. Major themes included: (1) fathers' experiences during the postpartum period, including not understanding postpartum mental health conditions and desiring more information, experiencing a range of emotions, and difficulty of balancing work with family; (2) fathers' views on postpartum relationships, such as communication problems, empathy for partner, and relationship issues with other family members; (3) fathers' attitudes toward postpartum treatment, including openness to be involved, perceived benefits, and barriers and facilitators to the inclusion of partners in treatment. Conclusion: Though barriers exist, many fathers are motivated to be included in the treatment process. In addition to supporting maternal wellbeing, fathers view treatment as a means to improve issues in the couple or family system, such as communication difficulties.
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Affiliation(s)
- Cynthia L Battle
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Butler Hospital, Providence, RI, United States.,Women and Infants Hospital of Rhode Island, Providence, RI, United States
| | - Amalia Londono Tobon
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Women and Infants Hospital of Rhode Island, Providence, RI, United States
| | - Margaret Howard
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Women and Infants Hospital of Rhode Island, Providence, RI, United States
| | - Ivan W Miller
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Butler Hospital, Providence, RI, United States
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11
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Martin-Key NA, Spadaro B, Schei TS, Bahn S. Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study. J Med Internet Res 2021; 23:e27132. [PMID: 34033582 PMCID: PMC8183599 DOI: 10.2196/27132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the United Kingdom, with outbreaks of disease, like the COVID-19 pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. Objective The aim of this study was to conduct a mixed methods evaluation of the current state of perinatal mental health care provision in the United Kingdom, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. Methods Women, partners, and midwives were recruited to participate in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Behavior model and summarized using descriptive statistics. Results A total of 829 women, 103 partners, and 90 midwives participated in the study. The provision of adequate perinatal mental health care support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The majority of respondents (n=781, 76.42%) expressed that they would feel comfortable or very comfortable using or recommending a digital mental health assessment. The majority of women and partners showed a preference for in-person consultations (n=417, 44.74%), followed by a blended care approach (ie, both in-person and online consultations) (n=362, 38.84%), with fewer participants preferring online-only consultations (n=120, 12.88%). Identified benefits and barriers mainly related to physical opportunity (eg, accessibility), psychological capability (eg, cognitive skills), and automatic motivation (eg, emotions). Conclusions This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision making in the assessment of perinatal mental health concerns in the United Kingdom.
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Affiliation(s)
- Nayra Anna Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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12
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Abstract
Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Louise M. Howard
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Hind Khalifeh
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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13
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Høgh S, Navne LE, Johansen M, Svendsen MN, Sorensen JL. Postnatal consultations with an obstetrician after critical perinatal events: a qualitative study of what women and their partners experience. BMJ Open 2020; 10:e037933. [PMID: 32948568 PMCID: PMC7500287 DOI: 10.1136/bmjopen-2020-037933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore women's and their partners' experiences with attending postnatal consultations with an obstetrician after critical perinatal events. DESIGN Qualitative interview study. We did semi-structured individual narrative interviews exploring the lived experiences. Interviews were analysed using a phenomenological approach and the thematic analysis was validated by a transdisciplinary group of anthropologists, obstetricians and a midwife. SETTING Department of obstetrics at a large hospital in Denmark. PARTICIPANTS We did a qualitative study with 17 participants (10 women and 7 partners) who had experienced critical perinatal events. RESULTS Five major themes were identified: (1) a need to gain understanding and make sense of the critical perinatal events, (2) a need for relational continuity, (3) the importance of discussing emotional effects as well as physical aspects of occurred events, (4) preparing for future pregnancies and (5) closure of the story.Most of the participants emphasised the importance of knowing the obstetrician undertaking the postnatal consultation. The majority of the participants described a need to discuss the emotional effects of the experience as well as the physical aspects of occurred events. The postnatal consultation served as an approach to obtain a positive closure of their birth story and to feel confident about potential future pregnancies. CONCLUSIONS This interview-based study suggests that postnatal consultation with an obstetrician might be an important tool for women and their partners in understanding the course of events during the critical birth experience and in processing it and preparing for future pregnancies. It appears to be important to assign an obstetrician whom they already know and to encourage them to discuss not only physical aspects of what happened but also the emotional effects of the experience.
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Affiliation(s)
- Stinne Høgh
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Laura Emdal Navne
- The Danish Centre for Social Science Research, VIVE, Copenhagen, Denmark
- Public Health, Faculty of Health Sciences, University of Copenhagen, Kobenhavn, Denmark
| | | | | | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction Section 4074, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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14
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Schwartz H, McCusker J, Law S, Zelkowitz P, Somera J, Singh S. Perinatal Mental Healthcare Needs Among Women at a Community Hospital. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:322-328.e1. [PMID: 33446473 DOI: 10.1016/j.jogc.2020.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Mental health problems affect up to 20% of women during pregnancy and the postpartum period. This study aimed to describe the mental health services and resources accessed by women with perinatal mental health problems (PMH) and to identify their unmet mental health care needs and preferences for support, as well as the barriers to accessing this support. METHODS Participants were 18 years of age or older and spoke English or French. Consent was obtained 24 hours after delivery (T0) to screen for symptoms of depression and anxiety at 2 weeks postpartum (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Scale (GAD-7). Women with a positive screen (EPDS ≥10 or GAD-7 ≥10) were sent informational resources and were followed-up by telephone at 4 months postpartum (T2) to determine their use of these and other resources, their unmet needs, and their preferences for other resources or services. RESULTS Seventy-three out of 344 participants (21.2%) screened positive, of whom 57 (78%) completed the T2 interview. Of those interviewed, 28% had used the informational resources provided by the study. Although 25% had consulted a health professional for mental health care, 37% had unmet mental health care needs. Preferences for additional support included web-based resources (30%), telephone support (28%), and booklets (25%). Lack of time (38%) and lack of childcare (23%) were the main barriers to seeking help. CONCLUSIONS Web- and telephone-based approaches have the potential to address the most common barriers to access support for women experiencing perinatal mental health problems.
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Affiliation(s)
- Hannah Schwartz
- St. Mary's Hospital Center, Montréal, QC; Department of Psychiatry, McGill University, Montréal, QC.
| | - Jane McCusker
- St. Mary's Research Centre, Montréal, QC; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC
| | - Susan Law
- St. Mary's Research Centre, Montréal, QC; Department of Family Medicine, McGill University, Montréal, QC; Institute for Better Health, Trillium Health Partners, Mississauga, ON
| | | | - Jennifer Somera
- St. Mary's Hospital Center, Montréal, QC; Department of Youth Program, Lakeshore General Hospital, Pointe-Claire, QC
| | - Santokh Singh
- St. Mary's Hospital Center, Montréal, QC; Department of Psychiatry, McGill University, Montréal, QC
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15
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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.
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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
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16
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Edwards BN, McLemore MR, Baltzell K, Hodgkin A, Nunez O, Franck LS. What about the men? Perinatal experiences of men of color whose partners were at risk for preterm birth, a qualitative study. BMC Pregnancy Childbirth 2020; 20:91. [PMID: 32041561 PMCID: PMC7011522 DOI: 10.1186/s12884-020-2785-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Preterm birth in the United States is associated with maternal clinical factors such as diabetes, hypertension and social factors including race, ethnicity, and socioeconomic status. In California, 8.7% of all live births are preterm, with African American and Black families experiencing the greatest burden. The impact of paternal factors on birth outcomes has been studied, but little is known about the experience of men of color (MOC). The purpose of this study was to explore the experiences of MOC who are partners to women at medical and social risk for preterm birth. METHODS This study used a qualitative research design and focus group methods. The research was embedded within an existing study exploring experiences of women of color at risk for preterm birth conducted by the California Preterm Birth Initiative. RESULTS Twelve MOC participated in the study and among them had 9 preterm children. Four themes emerged from thematic analysis of men's experiences: (1) "Being the Rock": Providing comfort and security; (2) "It's a blessing all the way around": Keeping faith during uncertainty; (3) "Tell me EVERYTHING": Unmet needs during pregnancy and delivery; (4) "Like a guinea pig": Frustration with the healthcare system. Participants identified many barriers to having a healthy pregnancy and birth including inadequate support for decision making, differential treatment, and discrimination. CONCLUSIONS This study shows novel and shared narratives regarding MOC experiences during pregnancy, birth, and postpartum periods. Healthcare providers have an essential role to acknowledge MOC, their experience of discrimination and mistrust, and to assess needs for support that can improve birth outcomes. As MOC and their families are at especially high social and medical risk for preterm birth, their voice and experience should be central in all future research on this topic.
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Affiliation(s)
- Brittany N Edwards
- Central California Faculty Medical Group/UCSF Fresno, 2625 E Divisadero St, Fresno, CA, 93721, USA.
| | | | | | | | - Olga Nunez
- California State University, Fresno, USA
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17
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Darwin Z, Domoney J, Iles J, Bristow F, Siew J, Sethna V. Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis. Front Psychiatry 2020; 11:585479. [PMID: 33510656 PMCID: PMC7835428 DOI: 10.3389/fpsyt.2020.585479] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: Five to 10 percentage of fathers experience perinatal depression and 5-15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period. Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies. Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes. Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.
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Affiliation(s)
- Zoe Darwin
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Jill Domoney
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jane Iles
- Department of Psychology, University of Surrey, Surrey, United Kingdom
| | - Florence Bristow
- Community Perinatal Mental Health Service for Croydon, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jasmine Siew
- Department of Experimental Clinical and Health Psychology, Research in Developmental Disorders Lab, Ghent University, Ghent, Belgium.,Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Vaheshta Sethna
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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18
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Ruffell B, Smith DM, Wittkowski A. Psychosocial support for male partners of women admitted to Mother and Baby Units. J Reprod Infant Psychol 2019; 38:378-394. [PMID: 31795728 DOI: 10.1080/02646838.2019.1698018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study explored what support male partners of women admitted to Mother and Baby Units (MBUs) wanted. BACKGROUND Although research has highlighted the need to support male partners of women admitted to specialist MBUs, little is known about the type of support men want and how they wish support to be delivered. METHODS Ten men whose partner was admitted to a MBU in the United Kingdom or Australia participated in semi-structured interviews. Data were analysed using Thematic Analysis. RESULTS Five themes were identified: (1) A smoother journey to and from the MBU, (2) Feeling included, (3) Uncertainty about 'what is going on', (4) Barriers to support and (5) Facilitators of support. CONCLUSION This is the first qualitative study to specifically explore the type of support male partners of MBU patients would like in terms of content, delivery and timing. Participants expressed the need to be involved in care decisions regarding their spouse and infant and to be offered advice from professionals. They highlighted barriers to accessing support and offered solutions to minimise those. In terms of clinical implications, we recommend a support package, which could be developed for MBUs to improve outcomes for male partners and their family.
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Affiliation(s)
- Beth Ruffell
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester, UK.,School of Social and Health Sciences, Leeds Trinity University , Hosforth, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester, UK.,Department of Clinical Psychology, Greater Manchester Mental Health Foundation NHS Trust , Manchester, UK
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19
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Lever Taylor B, Billings J, Morant N, Bick D, Johnson S. Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England. BMJ Open 2019; 9:e030208. [PMID: 31345982 PMCID: PMC6661627 DOI: 10.1136/bmjopen-2019-030208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Partners and wider family members play a vital role in relation to women's perinatal mental health. Clinical guidelines in the UK and internationally recommend that services supporting women with perinatal mental health difficulties involve and support their families too. However, little is known about family members' needs and experiences, or whether they feel included by mental health services. This study set out to explore this. METHODS This research formed part of a wider study exploring experiences of perinatal mental health care in England. The broader study included semi-structured interviews with 52 women across England who received treatment for a perinatal mental health difficulty, and 32 family members identified by the women as offering them some support. Data from these 84 interviews relating to how services work with partners and families were extracted and analysed thematically. RESULTS Analysis identified three overarching themes: (1) the centrality of women's families to their perinatal mental health/access to support, (2) experiences of partners and families being excluded by services and (3) ambivalence among women and their families about increasing family involvement/support. We found that partners and families appear to have an important influence on women's perinatal mental health, access to care and interactions with services, but that services tend to focus on individual women (and babies) with little regard for their wider family context. The complexity of involving and supporting partners and families, coupled with anxiety about this among women and their families, reinforces the tendency to marginalise them. CONCLUSION Involving women's families and providing the support they need is challenging, but important. Experiences of women and their families of services treating perinatal mental health difficulties suggests greater focus is needed on overcoming barriers to family inclusion and on challenging underlying gender roles and expectations, rather than allowing these to shape and guide practice.
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Affiliation(s)
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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