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Bailey S, Hurley J, Plummer K, Hutchinson M. Parenting interventions targeting early parenting difficulty: A scoping review. J Child Health Care 2024; 28:429-450. [PMID: 35930709 DOI: 10.1177/13674935221116696] [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: 11/16/2022]
Abstract
Parent and child wellbeing are reciprocal. Attentive, responsive parenting, is contingent on parental wellbeing. Insights into mechanisms of early parenting interventions that seek to improve parent and child outcomes are needed. This scoping review aimed to systematically map research reporting on parenting interventions for parents experiencing early parenting difficulty. A secondary aim was to synthesise existing research using a realist lens, to provide context, mechanism and outcome insights into elements of early parenting interventions. A systematic search was conducted across six databases within the publication period of 2010-2020, to identify evidence on interventions targeting early parenting difficulty. Using pre-determined inclusion criteria, fifteen studies were selected for review. Deductive reflexive thematic analysis identified three themes: conceptual disparities in early parenting difficulty, early parenting intervention diversity and an absence of theory to explain interventions or outcomes. Neither early parenting difficulty nor the theoretical basis for early parenting interventions were well defined. Identification of contexts, mechanisms and outcomes of early parenting interventions is a unique contribution of this study. These insights may be used to inform planning, implementation and evaluation activities to promote context-focused, early parenting interventions targeting a critical phase of child development.
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Affiliation(s)
- Sherryn Bailey
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Karin Plummer
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
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Dahlen HG, Schmied V, Fowler C, Peters LL, Ormsby S, Thornton C. Characteristics and co-admissions of mothers and babies admitted to residential parenting services in the year following birth in NSW: a linked population data study (2000-2012). BMC Pregnancy Childbirth 2022; 22:428. [PMID: 35597917 PMCID: PMC9123292 DOI: 10.1186/s12884-022-04736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women. Methods A linked population data study of all women giving birth in NSW 2000–2012. Statistical differences were calculated using chi-square and student t-tests. Results Over the 12-year timeframe, 32,071 women and 33,035 babies were admitted to RPS, with 5191 of these women also having one or more hospital admissions (7607 admissions). The comparator group comprised of 99,242 women not admitted to RPS but having hospital admissions over the same timeframe (136,771 admissions). Statistically significant differences between cohorts were observed for the following parameters (p ≤ .001). Based upon calculated percentages, women who were admitted to RPS were more often older, Australian born, socially advantaged, private patients, and having their first baby. RPS admitted women also had more multiple births and labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy). Their infants were also more often male and admitted to Special Care Nursery/Neonatal Intensive Care. Additionally, RPS admitted women had more admissions for mental health and behavioural disorders, which appeared to increase over time. There was no statistical difference between cohorts regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses. Conclusion Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Cathrine Fowler
- School of Nursing and Midwifery, University of Technology, Broadway, Sydney, NSW, 2007, Australia
| | - Lilian L Peters
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Department of Midwifery Science AVAG, Amsterdam UMC (location Vumc), Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Simone Ormsby
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Fatmawati A, Ridlayanti A, Nurlatifah N. The Effectiveness of Murrotal Al-Quran in Third Trimester Pregnant with Maternal Mental Disorder. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pregnant women experience physiological and psychological changes during pregnancy. Psychological changes experienced by pregnant women show symptoms of anxiety, worry, and depression. The use of Al-Quran therapy by means of Murottal Al-Quran is one of an intervention for mental health problems of pregnant women.
AIM: This research was carried out by aimed to determine the effect of the murottal Al-Quran on pregnant women who experience Maternal Mental Disorder (MMD).
METHODS: This was a quantitative study using design pre and post experimental testing without control group. The participants in this study were 25 respondents aged 15-21 years, on the 3rd trimester of pregnancy, are able to read the Al-Quran, routinely carry out pregnancy checks at the health center or posyandu (pos pelayanan terpadu) (integrated healthcare, willing to become respondents, and her ANRQ score which was ≥ 23. Respondents were asked to listen to the murottal every day for 30 minutes on 05.00 and 20.00 WIB for 2 weeks. After two weeks, the respondents were checked for their mental condition using the ANRQ questionnaire through the google form application. The bivariate analysis used was the Wilcoxon test.
RESULT: Most of the pregnant women experienced MMD as many as 76% while after being given the intervention, most of the pregnant women who did not experience MMD were 72%. Median pretest 24,76 and posttest 21,88. Giving Murottal Al-Quran therapy to pregnant women in the third trimester had an influence on their MMD status (p < 0.000).
CONCLUSIONS: Chanting holy verses that are played can stimulate the hypothalamus to produce endorphins, cortisone, and catecholamine, thus making pregnant women relax. Murottal Al-Quran treatment can be utilized to help pregnant women with mental health issues.
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Reilly N, Egan N, Austin MP, Forder PM, Loxton D. Increases in use of Medicare Benefits Schedule mental health items among women who gave birth in New South Wales, 2009-2015. Aust N Z J Public Health 2021; 46:75-80. [PMID: 34897905 DOI: 10.1111/1753-6405.13189] [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: 02/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To report rates of Medicare Benefits Schedule (MBS) mental health item use among a sample of women who gave birth in NSW (2009-2015) and examine if the SAFE START policy increased use of these items among perinatal women. METHODS Data was drawn from women participating in the Australian Longitudinal Study on Women's Health 1973-1978 cohort, linked to data from the NSW Perinatal Data Collection and MBS. RESULTS Use of Medicare-subsidised mental health items increased 2.7-fold among perinatal women (n=1,453) between 2009 and 2015 (4.1% versus 11.0% respectively), compared to a 1.3-fold increase among non-perinatal women (n=1,800, 6.3% versus 8.4% respectively). However, the increased use of MBS mental health items among perinatal women was not observed to be impacted by the SAFE START policy, after accounting for time trends. CONCLUSION There was a substantial increase in the use of MBS mental health items among women in NSW between 2009 and 2015, with a more pronounced increase among women who had given birth compared to those who had not. Implications for public health: This study provides important information about changes in mental health service use during a time of significant investment in perinatal mental health, and demonstrates the value of longitudinal survey data linked with administrative health data to evaluate the impact of health policy.
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Affiliation(s)
- Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, New South Wales.,School of Psychiatry, UNSW Medicine, New South Wales
| | - Nicholas Egan
- Centre for Women's Health Research, College of Medicine, Public Health and Wellbeing, University of Newcastle, New South Wales
| | - Marie-Paule Austin
- School of Psychiatry, UNSW Medicine, New South Wales.,Royal Women's Hospital, Victoria
| | - Peta M Forder
- Centre for Women's Health Research, College of Medicine, Public Health and Wellbeing, University of Newcastle, New South Wales
| | - Deborah Loxton
- Centre for Women's Health Research, College of Medicine, Public Health and Wellbeing, University of Newcastle, New South Wales.,Australian Longitudinal Study on Women's Health, University of Newcastle, New South Wales
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Reilly N, Austin MP. Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study. J Med Internet Res 2021; 23:e18517. [PMID: 33769302 PMCID: PMC8088843 DOI: 10.2196/18517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women's awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers. OBJECTIVE The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined. METHODS Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later. RESULTS A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help. CONCLUSIONS Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.
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Affiliation(s)
- Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.,Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital & School of Psychiatry, University of New South Wales, Burwood, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital & School of Psychiatry, University of New South Wales, Burwood, Australia.,Royal Hospital for Women, Randwick, Australia
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Brake E, Berle D, Reilly NM, Austin M. The relationship between emotion dysregulation and postnatal attachment in women admitted to a mother baby unit. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1111/ajpy.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elloise Brake
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, New South Wales, Australia,
| | - David Berle
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, New South Wales, Australia,
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia,
| | - Nicole M. Reilly
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia,
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia,
| | - Marie‐paule Austin
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia,
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Burwood Hospital, Sydney, New South Wales, Australia,
- Royal Hospital for Women, Sydney, New South Wales, Australia,
- Black Dog Institute, Sydney, New South Wales, Australia,
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Panza R, Baldassarre ME, Di Mauro A, Cervinara A, Capozza M, Laforgia N. Infantile Functional Gastrointestinal Disorders and Maternal Psychological Status: A Narrative Review. Curr Pediatr Rev 2021; 17:111-119. [PMID: 33557737 DOI: 10.2174/1573396317666210208155106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders are often extremely distressing for the infant and parents, leading to infant discomfort and crying, parental anxiety, repeated healthcare consultations, and escalating healthcare costs. AIM In this narrative review, we analyzed the relationship between maternal psychological status during pregnancy and postpartum and the main infantile functional gastrointestinal disorders. MATERIALS AND METHODS The narrative review was conducted searching scientific databases for articles reporting on infantile functional gastrointestinal disorders in association with maternal depressive or anxiety disorders. RESULTS Seven studies were suitable. DISCUSSION Maternal psychological disorders may be correlated to infantile functional gastrointestinal disorders. Whether it is the excessive crying that favors the onset of maternal psychological disorders or, in contrast, an altered attachment style due to the maternal status that facilitates the onset of functional gastrointestinal disorders in the infant is still an open question. Recent findings revealed that both anxious and depressed mothers are more likely to have an adverse gut microbiome. CONCLUSION A healthy interaction of the mother-baby dyad is advantageous in ensuring the mental and physical development of the offspring. Gynecologists, general practitioners and pediatricians should be alert for early identification of mothers at risk with the aim to initiate timely targeted interventions. Further research on the role of microbiota and the possible therapeutic approaches with probiotics is required.
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Affiliation(s)
- Raffaella Panza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Antonio Di Mauro
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Alessandra Cervinara
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
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Sims D, Xu F, Fowler C, Catling C. Hospital admission for mental illness: Comparing women who gave birth in a private hospital and a public hospital. Aust N Z J Obstet Gynaecol 2020; 61:250-257. [PMID: 33179301 DOI: 10.1111/ajo.13269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Australia, perinatal care is provided through a mix of government and private funding. Women who give birth in a private hospital are less likely to receive depression screening and psychosocial assessment and are less likely to access parenting services that support mental health outcomes, compared to women who give birth in a public hospital. AIM The aim of this study was to determine the risk of one outcome of perinatal mental illness - hospital admission - for women who gave birth in private hospitals compared to women who gave birth in public hospitals. METHODS This population-based cohort study employed binary regression analysis of state government data. Linkage of the Perinatal Data Collection, Registry of Births, Deaths and Marriages, and Admitted Patients Data Collection (2003-2009) has provided comparative information on women admitted to any hospital during the first year after birth with a primary diagnosis of mental illness. RESULTS In the first year after birth, women who gave birth in private hospitals were more likely to be admitted to a hospital with a primary diagnosis of mental illness (rate = 2.54%, 95% CI = 2.40-2.68%) than women who gave birth in public hospitals (rate = 1.68%, 95% CI = 1.61-1.75%). CONCLUSION The increased likelihood of admission for postnatal mental illness may indicate increased risk of developing a mental illness for women who gave birth in a private hospital.
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Affiliation(s)
- Deborah Sims
- Faculty of Health, University Technology Sydney, Sydney, New South Wales, Australia
| | - Fenglian Xu
- Faculty of Health, University Technology Sydney, Sydney, New South Wales, Australia
| | - Cathrine Fowler
- Tresillian Chair Child and Family Health, University Technology Sydney, Sydney, New South Wales, Australia
| | - Christine Catling
- Faculty of Health, University Technology Sydney, Sydney, New South Wales, Australia
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Reilly N, Brake E, Briggs N, Austin MP. Trajectories of clinical and parenting outcomes following admission to an inpatient mother-baby unit. BMC Psychiatry 2019; 19:336. [PMID: 31675945 PMCID: PMC6825337 DOI: 10.1186/s12888-019-2331-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to examine trajectories of clinical and parenting outcomes following admission to a mother-baby unit (MBU), and to explore factors associated with these trajectories. METHODS Women admitted to an MBU completed the Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS-21), Karitane Parenting Confidence Scale (KPCS) and Maternal Postnatal Attachment Scale (MPAS) at admission, discharge and 3 months following discharge. Questions assessing psychosocial risk and adult attachment style were also completed at admission, and information relating to service engagement in the time since discharge was collected at follow-up. Additional clinical and demographic information was extracted from the patient medical record. RESULTS Seventy-five women participated in the study. Overall, significant improvements in mean scores on measures of anxiety and parenting confidence were maintained 3-months following discharge. However, the majority of women (93.3%) followed trajectories that were characterised by deterioration in self-reported mother-infant attachment following discharge. 62.9 and 34.6% of women followed trajectories of increased symptoms of depression and stress between discharge and follow-up, respectively. Across measures, the least optimal trajectories, or least optimal scores, at follow-up were associated with less secure maternal attachment style (associated with more anxiety symptoms, poorer parenting confidence and maternal-infant attachment), older maternal age (more depressive symptoms) and increased psychosocial risk (more anxiety symptoms). CONCLUSIONS The findings of this study highlight the clinical implications of anxious attachment style for the mental health and parenting outcomes of women admitted to an MBU and the importance of incorporating mother-infant therapy as part of an ongoing management plan. Comprehensive discharge planning and transitional care to help ensure women discharged from an MBU are best supported in the longer term is recommended.
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Affiliation(s)
- Nicole Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134, Australia.
| | - Elloise Brake
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
| | - Nancy Briggs
- 0000 0004 4902 0432grid.1005.4Stats Central, Mark Wainwright Analytical Centre, Biological Sciences South Building, UNSW, Sydney, 2052 Australia
| | - Marie-Paule Austin
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
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Ghanbari-Homayi S, Fardiazar Z, Meedya S, Mohammad-Alizadeh-Charandabi S, Asghari-Jafarabadi M, Mohammadi E, Mirghafourvand M. Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study. BMC Pregnancy Childbirth 2019; 19:182. [PMID: 31117987 PMCID: PMC6532129 DOI: 10.1186/s12884-019-2333-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.
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Affiliation(s)
| | - Zahra Fardiazar
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | | | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
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Fowler C, Dickinson M, Daggar L, Goodwin G. Mothers' experiences while admitted to a residential parenting unit: a qualitative study. Contemp Nurse 2019; 55:95-108. [PMID: 31020893 DOI: 10.1080/10376178.2019.1611379] [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: 10/27/2022]
Abstract
Background: In Australia, most states have residential parenting units that provide parenting support to parents (usually mothers) who are experiencing significant parenting difficulties with their infants or toddlers. The three most common reasons for admission to a residential service are: sleep and settling issues, adjustment to parenting, and feeding issues. Aim: The overall study aim was to explore mothers' experience of a residential admission, as one tool to increase the "patient (mother) voice" within the residential parenting service and provide a mechanism for staff to understand the impact of their interactions with mothers on the care delivery process. Design: A qualitative descriptive approach and thematic analysis were used. One hundred mothers provided responses to a routinely collected questionnaire that asked about their experience while admitted to one of three residential parenting units. All mothers were eligible to participate. Results: Three major themes were identified: not knowing what to expect; working collaboratively with parents; and facilitating maternal learning. Mothers identified that they had increased parenting confidence levels, and gained new parenting knowledge and skills as an outcome of the residential stay. Conclusions: The value of a residential stay is clearly articulated by the mothers in the stories collected. These themes have affirmed that the residential units are parent-focused. Some mothers were surprised by the nurses' willingness to listen to their preferences about their child's care and to work with them adapting interventions to their cultural and home context.
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Affiliation(s)
- Cathrine Fowler
- a Faculty of Health, University of Technology Sydney , PO Box 123, 15 Broadway, Ultimo 2007 , NSW , Australia.,b Tresillian Family Care Centre , McKenzie St, Belmore 2192 , NSW , Australia
| | - Marie Dickinson
- b Tresillian Family Care Centre , McKenzie St, Belmore 2192 , NSW , Australia
| | - Leanne Daggar
- b Tresillian Family Care Centre , McKenzie St, Belmore 2192 , NSW , Australia
| | - Glenda Goodwin
- b Tresillian Family Care Centre , McKenzie St, Belmore 2192 , NSW , Australia
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MacKinnon AL, Houazene S, Robins S, Feeley N, Zelkowitz P. Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress. Front Psychol 2018; 9:2379. [PMID: 30618902 PMCID: PMC6279867 DOI: 10.3389/fpsyg.2018.02379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022] Open
Abstract
Childbirth-related post-traumatic stress has potentially negative and enduring consequences for the well-being of women and their families. Although research to date has identified attachment style and trauma history as individual risk factors, they have yet to be examined as integrative processes in the development and maintenance of childbirth-related post-traumatic stress. The current investigation aimed to examine whether attachment style may moderate the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology across the first 6 months of the postpartum period. A large community sample of women were recruited from two Canadian urban hospitals. Childbirth-related post-traumatic stress symptoms were assessed longitudinally at 5 weeks, 2 months, and 6 months postpartum. Latent growth curve modeling (n = 251) revealed that attachment style moderated the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology, while controlling for other well-established psychosocial (e.g., trait anxiety, previous psychopathology, lack of perceived support) and childbirth-related (e.g., mode of birth, labor pain, subjective experience) risk factors. More secure attachment conferred resiliency and more fearful attachment conferred vulnerability among women without a history of interpersonal trauma, while more preoccupied and more dismissing attachment conferred resiliency among women with a history of interpersonal trauma. These findings highlight the importance of understanding the integrative processes among risk and protective factors underlying the development of and ability to cope with childbirth-related post-traumatic stress. Attachment style and trauma history, which can be quickly measured, should be considered as targets in antenatal screening.
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Affiliation(s)
- Anna L. MacKinnon
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Houazene
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Nancy Feeley
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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Salehi-Pourmehr H, Niroomand S, Shakouri SK, Asgarlou Z, Farshbaf-Khalili A. Association Between Antenatal and Postpartum Depression and Anxiety with Weight Retention 1 Year After Childbirth: A Longitudinal Study. Community Ment Health J 2018; 54:1284-1294. [PMID: 30140991 DOI: 10.1007/s10597-018-0324-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/07/2018] [Indexed: 01/11/2023]
Abstract
This was an observational, longitudinal study investigated the association between anxiety and depression in trimesters of pregnancy and early postpartum with weight retention 1 year after childbirth. Sixty-two pregnant women aged 18-35 years with a BMI of 35 or higher and 245 pregnant women with normal BMI (BMI 18.5-24.9 kg/m2) were recruited at their initial prenatal visit in the health centers. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Anxiety Inventory (BAI-II) were completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Pre-pregnancy weight and weight retention at 1 year postpartum was measured. A significant relationship was found between first trimester (adjusted mean difference: aMD 3.416; 95% CI 1.392-5.441) and postpartum (aMD 3.042; 95% CI 0.538-5.547) depression as well as first trimester's anxiety (aMD 3.050; 95% CI 0.631-5.470) with weight retention at 1 year after childbirth.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Evidence Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soudabeh Niroomand
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyed Kazem Shakouri
- Aging Research Institute, Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zoleikha Asgarlou
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azizeh Farshbaf-Khalili
- Aging Research Institute, Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
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Sims DJ, Fowler C. Postnatal psychosocial assessment and clinical decision-making, a descriptive study. J Clin Nurs 2018; 27:3739-3749. [PMID: 29775993 DOI: 10.1111/jocn.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. DESIGN A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. METHODS This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment. RESULTS The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. CONCLUSION The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. RELEVANCE TO CLINICAL PRACTICE Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.
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Affiliation(s)
- Deborah Jane Sims
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Cathrine Fowler
- Faculty of Health, Tresillian Chair in Child and Family Health, University of Technology Sydney, Ultimo, NSW, Australia
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Dahlen HG, Foster JP, Psaila K, Spence K, Badawi N, Fowler C, Schmied V, Thornton C. Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000-2011). BMC Pediatr 2018; 18:30. [PMID: 29429411 PMCID: PMC5808415 DOI: 10.1186/s12887-018-0999-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/21/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12 months following birth (2000-2011). METHODS A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n = 869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW. RESULTS There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12 months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38 weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?" CONCLUSIONS Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular).
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Ingham Institute, Liverpool, NSW Australia
| | - Jann P. Foster
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Ingham Institute, Liverpool, NSW Australia
- Central Clinical School, Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW Australia
| | - Kim Psaila
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Kaye Spence
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW 2145 Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW 2145 Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Cathrine Fowler
- Tresillian Chair in Child and Family Health, University of Technology, Broadway, Sydney, NSW 2007 Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Fatmawati A, Nur Rachmawati I, Budiati T. The influence of adolescent postpartum women’s psychosocial condition on mother-infant bonding. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30068-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Choi KW, Sikkema KJ. Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:427-453. [PMID: 25985988 DOI: 10.1177/1524838015584369] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes.
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Affiliation(s)
- Karmel W Choi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health 2016; 16:69. [PMID: 27782825 PMCID: PMC5078921 DOI: 10.1186/s12905-016-0344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor mental health in the perinatal period can impact negatively on women, their infants and families. Australian State and Territory governments are investing in routine psychosocial assessment and depression screening with referral to services and support, however, little is known about how well these services are used. The aim of this paper is to report on the health services used by women for their physical and mental health needs from pregnancy to 12 months after birth and to compare service use for women who have been identified in pregnancy as having moderate-high psychosocial risk with those with low psychosocial risk. METHODS One hundred and six women were recruited to a prospective longitudinal study with five points of data collection (2-4 weeks after prenatal booking, 36 weeks gestation, 6 weeks postpartum, 6 months postpartum and 12 months postpartum) was undertaken. Data were collected via face-to-face and telephone interviews, relating to psychosocial risk factors, mental health and service use. The prenatal psychosocial risk status of women (data available for 83 of 106 women) was determined using the Antenatal Risk Questionnaire (ANRQ) and was used to compare socio-demographic characteristics and service use of women with 'low' and 'moderate to high' risk of perinatal mental health problems. RESULTS The findings indicate high use of postnatal universal health services (child and family health nurses, general practitioners) by both groups of women, with limited use of specialist mental health services by women identified with moderate to high risk of mental health problems. While almost all respondents indicated that they would seek help for mental health concerns most had a preference to seek help from partners and family before accessing health professionals. CONCLUSION These preliminary data support local and international studies that highlight the poor uptake of specialist services for mental health problems in postnatal women, where this may be required. Further research comparing larger samples of women (with low and psychosocial high risk) are needed to explore the extent of any differences and the reasons why women do not access these specialist services.
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Affiliation(s)
- Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia.
| | - Rachel Langdon
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
- Centre for Applied Nursing Research (a joint facility of the South Western Sydney Local Health District and Western Sydney University, Liverpool, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
| | - Stephen Matthey
- School of Psychology, University of Sydney and Research Director, Infant, Child & Adolescent Mental Health Service, South West Sydney Local Health District, Sydney, Australia
| | - Lynn Kemp
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
| | - Marie-Paule Austin
- Chair, Perinatal Mental Health Unit University of New South Wales & St John of God Health Care, Burwood , Sydney, Australia
- The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
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Fowler C, Schmied V, Dickinson M, Dahlen HG. Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia. J Clin Nurs 2016; 26:524-534. [PMID: 27461911 DOI: 10.1111/jocn.13478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. BACKGROUND For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. DESIGN A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. RESULTS Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. CONCLUSIONS There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. RELEVANCE TO CLINICAL PRACTICE Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.
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Affiliation(s)
- Cathrine Fowler
- Centre for Midwifery, Child & Family Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | | | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Ingham Institute, Liverpool, NSW, Australia
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Christl B, Reilly N, Yin C, Austin MP. Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit. Arch Womens Ment Health 2015; 18:805-16. [PMID: 25591925 DOI: 10.1007/s00737-014-0492-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/24/2014] [Indexed: 11/27/2022]
Abstract
This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant attachment-would also enhance our ability to tailor therapeutic interventions.
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Affiliation(s)
- Bettina Christl
- Perinatal & Women's Mental Health Unit, St John of God Health Care & School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Reilly
- Perinatal & Women's Mental Health Unit, St John of God Health Care & School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Carolyn Yin
- Perinatal & Women's Mental Health Unit, St John of God Health Care & School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit, St John of God Health Care & School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. .,The Black Dog Institute, Sydney, NSW, Australia. .,The Royal Women's Hospital, Randwick, NSW, Australia.
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21
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A systematic review on the acceptability of perinatal depression screening. J Affect Disord 2015; 188:284-303. [PMID: 26386439 DOI: 10.1016/j.jad.2015.06.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perinatal depression (PND) affects approximately 10-15% of women, worldwide. PND screening, using screening tools, has been undertaken by a broad range of healthcare professionals in different settings. Our objective was to explore the acceptability of PND screening and how acceptability was being assessed. METHODS A systematic literature review of studies that explored the acceptability of PND screening was carried out throughout MEDLINE, PsycINFO, PubMed, CINAHL, Embase, Maternity and Infant Care and Joanna Briggs Institute databases. RESULTS Twenty-eight out of twenty-nine publications reported PND screening to be acceptable to most participants. A wide range of terms, questions and statements was used to infer, assess or report on acceptability. There was no uniform, psychometrically tested tool used to measure acceptability across the studies. LIMITATIONS Broad inclusion criteria and methodological differences limited comparisons, but are overcome by the comprehensiveness of the data and the lack of uniformity across studies. CONCLUSIONS Even though PND screening appears acceptable, it is difficult to draw conclusions about PND screening acceptability as studies used different methods to infer, assess or report on acceptability. The lack of a uniform, psychometrically tested tool to measure acceptability is not unique to PND. Nonetheless, the majority of perinatal women and healthcare professionals reported positive attitudes towards PND screening using different tools in different settings, indicating that it may be the responsibility of all healthcare professionals who come into contact with perinatal women.
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Kohlhoff J, Barnett B, Eapen V. Adult separation anxiety and unsettled infant behavior: Associations with adverse parenting during childhood and insecure adult attachment. Compr Psychiatry 2015; 61:1-9. [PMID: 26094158 DOI: 10.1016/j.comppsych.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study examined the prevalence and correlates of Adult Separation Anxiety Disorder (ASAD) and Adult Separation Anxiety (ASA) symptoms in a sample of first-time mothers with an unsettled infant during the first postpartum year. METHODS Eighty-three primiparous women admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis and questionnaires assessing ASA symptoms, adult attachment and childhood parenting experiences. Nurses recorded infant behavior using 24-hour charts. RESULTS The prevalence of ASAD in this sample was 19.3% and women with ASAD were, on average, more likely to be diagnosed with depression and anxiety disorders, report aversive parenting experiences during childhood and show adult attachment style insecurity. Both ASAD and ASA symptoms were predicted by adult attachment anxiety, and ASAD was associated with unsettled infant behavior. Attachment anxiety and attachment avoidance mediated relations between parental over-control and ASAD diagnosis, and between parental abuse and ASAD diagnosis. Attachment anxiety mediated the relation between parental over-control and ASA symptoms, and attachment avoidance mediated the relations of parental over-control and parental abuse with ASA symptoms. CONCLUSIONS This study highlights the prevalence of ASAD among first time mothers experiencing early parenting difficulties and the roles of childhood parenting experiences and adult attachment style in the development of the disorder. This points to the importance of introducing universal screening for ASAD in postnatal settings, and for the development of targeted interventions.
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Affiliation(s)
- Jane Kohlhoff
- Karitane, PO Box 241, Villawood, NSW, 2163, Australia.
| | - Bryanne Barnett
- St John of God Raphael Services, 36-38 First Avenue, Blacktown, NSW, 2148, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District, Mental Health Centre, L1 Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia; School of Psychiatry & Ingham Institute, University of New South Wales
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Reilly N, Yin C, Monterosso L, Bradshaw S, Neale K, Harrison B, Austin MP. Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Reilly
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Carolyn Yin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Leanne Monterosso
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
- University of Notre Dame Australia; Murdoch Western Australia Australia
- School of Nursing and Midwifery; Edith Cowan University of Western Australia; Joondalup Western Australia Australia
| | - Sue Bradshaw
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Kizzi Neale
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Beate Harrison
- Murdoch Raphael Centre; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
- The Black Dog Institute; Prince of Wales Hospital; Burwood New South Wales Australia
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Trauma-Informed Care With Childhood Maltreatment Survivors: What Do Maternity Professionals Want to Learn? INTERNATIONAL JOURNAL OF CHILDBIRTH 2014. [DOI: 10.1891/2156-5287.4.3.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) affects 8% of pregnant women, and the biggest risk factor for pregnancy PTSD is childhood maltreatment. The care they receive can lead to positive outcomes or to retraumatization and increased morbidity. The purpose of this study is to gather information from a range of clinicians about their continuing education needs to provide perinatal care to women with a maltreatment history and PTSD.METHOD: Maternity health care professionals were interviewed by telephone. Network sampling and purposive sampling were used to include physicians, nurse practitioners, midwives, nurses, and doulas (n = 20), and results were derived from content analysis.RESULTS: Most providers received little or no training on the issue of caring for women with a history of childhood maltreatment or PTSD during their original education but find working with this type of patient rewarding and wish to learn how to provide better care. Providers identified a range of educational needs and recommend offering a range of formats and time options for learning.CONCLUSIONS: Maternity health care providers desire to work effectively with survivor moms and want to learn best practices for doing so. Thus, educational programming addressing provider needs and preferences should be developed and tested to improve care experiences and pregnancy outcomes for women with a history of trauma or PTSD.
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