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Yang Y, Wang T, Wang D, Liu M, Lun S, Ma S, Yin J. Gaps between current practice in perinatal depression screening and guideline recommendations: a systematic review. Gen Hosp Psychiatry 2024; 89:41-48. [PMID: 38733723 DOI: 10.1016/j.genhosppsych.2024.04.011] [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: 02/05/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Screening for perinatal depression is recommended by many guidelines to reduce the disease burden, but current implementation practices require clarification. METHOD Fifteen databases were searched for observational studies using a pre-tested search strategy. In addition, the websites of academic organizations were searched for guidelines, recommendations, and reports. Literature published between January 1, 2010, and December 19, 2021, in either English or Chinese, was included. The standard form of the Joanna Briggs Institute (JBI) was used to assess risk of bias of the included studies. RESULTS The data analysis covered 103 studies, 21 guidelines, 11 recommendations, five position statements, three reports, two committee opinions, three consensuses, one consultation, and one policy statement. All but one guideline recommended that mothers be routinely screened for perinatal depression at least once during the perinatal period. In addition, 39 documents recommended that perinatal mothers at risk of perinatal depression be provided with or referred to counseling services. In original studies, however, only 8.7% of the original studies conducted routine screenings, and only one-third offered referral services after the screening process. The EPDS emerged as the most frequently used screening tool to measure perinatal depression. 32% (n = 33) of studies reported the technology used for screening. The most commonly used method was face-to-face interviews (n = 22). Screening personnel the agents conducting the screening comprised researchers (n = 26), nurses (n = 15), doctors (n = 11). CONCLUSIONS A significant disparity was observed between the recommendations and implementation of perinatal depression screening, highlighting the need to integrate routine screening and referral processes into maternal care services.
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Affiliation(s)
| | - Ting Wang
- School of Nursing, Dalian University, China
| | - Di Wang
- School of Nursing, Dalian University, China
| | | | - Shi Lun
- School of Nursing, Dalian University, China
| | - Shuang Ma
- School of Nursing, Dalian University, China
| | - Juan Yin
- School of Nursing, Dalian University, China.
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2
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Masters C, Lewis JB, Hagaman A, Thomas JL, Carandang RR, Ickovics JR, Cunningham SD. Discrimination and perinatal depressive symptoms: The protective role of social support and resilience. J Affect Disord 2024; 354:656-661. [PMID: 38484882 DOI: 10.1016/j.jad.2024.03.039] [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: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms. METHODS Pregnant people (N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum. RESULTS The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p ≤0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time. LIMITATIONS The study relied on self-reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability. CONCLUSIONS Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period.
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Affiliation(s)
- Claire Masters
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06510, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT 06510, USA
| | - Jordan L Thomas
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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Ayhan F, Akalin A, Balsak H, Erden A. Psychometric testing and the predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Turkish women. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100965. [PMID: 38460396 DOI: 10.1016/j.srhc.2024.100965] [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: 12/05/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the validity and reliability of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) and to examine the predictive validity of PDPI-R in Turkish women, considering two gold standards to determine postpartum depression (PPD). METHODS This prospective longitudinal study was conducted between August 2021 and September 2023. A total of 301 pregnant women participated in the study. Participants completed the PDPI-R during the third trimester of pregnancy (T1) and at 4 weeks postpartum (T2). At T2, participants also completed the Edinburgh Postnatal Depression Scale (EPDS), and women were interviewed using the Structured Clinical Interview for DSM-IV Disorders. RESULTS The prenatal version of the PDPI-R predicted PPD with 64% (R:0.64) accuracy on the basis of the EPDS and 78% accuracy (R:0.78) according to DSM IV criteria. The postnatal version of the PDPI-R predicted PPD with 71% (R:0.71) accuracy on the basis of the EPDS and 81% accuracy (R:0.781) based on DSM IV criteria. The cut-off points exhibited the highest sensitivity and specificity values at 8.5 for the prenatal version and 10.5 for the postnatal version. CONCLUSIONS The PDPI-R is a valid and reliable screening tool for identifying Turkish women at high risk of developing PPD and for estimating the psychosocial risk associated with PPD.
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Affiliation(s)
- Fatma Ayhan
- Division of Psychiatric Nursing, Department of Nursing, Faculty of Health Science, Batman University, Batman, Türkiye.
| | - Ayse Akalin
- Department of Nursing, Faculty of Health Sciences, Duzce University, Duzce, Türkiye.
| | - Habip Balsak
- Midwifery Department, Faculty of Health Sciences, Batman University, Batman, Türkiye
| | - Arzu Erden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Karadeniz Technical University, Trabzon, Türkiye
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Fairbrother N, Stagg B, Scoten O, Keeney C, Cargnelli C. Perinatal anxiety disorders screening study: a study protocol. BMC Psychiatry 2024; 24:162. [PMID: 38395837 PMCID: PMC10893673 DOI: 10.1186/s12888-024-05575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. METHODS A large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks' gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. DISCUSSION This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Bryn Stagg
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Olivia Scoten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Claudia Cargnelli
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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Ravaldi C, Mosconi L, Crescioli G, Lombardo G, Russo I, Morese A, Ricca V, Vannacci A. Are midwives trained to recognise perinatal depression symptoms? Results of MAMA (MAternal Mood Assessment) cross-sectional survey in Italy. Arch Womens Ment Health 2024:10.1007/s00737-024-01439-z. [PMID: 38308142 DOI: 10.1007/s00737-024-01439-z] [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: 09/06/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To assess the knowledge, clinical experience, and attitudes of Italian midwives toward perinatal depression (PND) and to explore how these factors impact the quality of care. METHODS We conducted a cross-sectional online survey among 152 midwives employed in public hospitals across Italy. The questionnaire covered a range of topics, including demographic data, professional experience, knowledge of PND symptoms, risk factors, and clinical management, as well as communication skills and personal experiences with PND cases. RESULTS A concerning 76.3% of midwives displayed inadequate knowledge of PND based on current scientific literature. Those with a more comprehensive understanding were notably more confident in their practice, expressing significantly fewer apprehensions about communicating with mothers (25.8% vs 74.2%) and lesser concerns about the mothers' future well-being (38.9% vs 62.95%). The survey results also emphasised the midwives' call for specialised guidelines and formal training in PND management and underscored the value of communication skills, continuity of care, and family engagement in supporting affected mothers. CONCLUSION This inaugural study sheds light on the current state of knowledge and attitudes among Italian midwives regarding PND. It pinpoints crucial areas for educational enhancement and practice improvement, suggesting that elevated levels of midwife expertise in PND could significantly elevate the standard of care and expedite early diagnosis and treatment.
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Affiliation(s)
- Claudia Ravaldi
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Laura Mosconi
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Giada Crescioli
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Giulia Lombardo
- Unit of Obstetrics and Gynecology, Parma University Hospital, Parma, Italy
| | - Ilenia Russo
- Unit of Obstetrics and Gynecology, "S. Marta E S. Verera" Hospital, ASP Catania, Acireale, Italy
| | - Angelo Morese
- Section of Pediatrics, Obstetrics and Gynecology and Nursing, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Section of Psychiatry, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Ravaldi C, Vannacci A. Data of the MAternal Mood Assessment (MAMA) survey for healthcare professionals: A pilot study on midwives in Italy. Data Brief 2024; 52:109902. [PMID: 38093859 PMCID: PMC10716750 DOI: 10.1016/j.dib.2023.109902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 06/16/2024] Open
Abstract
This article describes the data collected from a survey of 152 midwives in Italy on their knowledge, attitudes, and practices regarding perinatal depression. The survey used the MAternal Mood Assessment (MAMA) questionnaire, a 35-item tool that covers various aspects of perinatal depression, such as definition, prevalence, risk factors, diagnosis, management, and support. The data provides valuable insights into the training needs and experiences of midwives in the area of maternal mental health, which can inform the development of interventions and education programs. The full dataset is available in Mendeley Data repository.
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Affiliation(s)
- Claudia Ravaldi
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Alfredo Vannacci
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Cockshaw WD, Thorpe KJ, Giannotti M, Hazell-Raine K. Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers. J Affect Disord 2023; 340:167-173. [PMID: 37557985 DOI: 10.1016/j.jad.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. METHOD We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. RESULTS At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying". LIMITATIONS While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. CONCLUSIONS Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.
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Affiliation(s)
- Wendell D Cockshaw
- Wesley Research Institute, Brisbane, Australia; Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Karen J Thorpe
- Queensland Brain Institute, The University of Queensland, St Lucia, Australia; Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Michele Giannotti
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
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Camacho EM, Shields GE, Eisner E, Littlewood E, Watson K, Chew-Graham CA, McMillan D, Ali S, Gilbody S. An economic evaluation of universal and targeted case-finding strategies for identifying antenatal depression: a model-based analysis comparing common case-finding instruments. Arch Womens Ment Health 2023:10.1007/s00737-023-01377-2. [PMID: 37851079 DOI: 10.1007/s00737-023-01377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023]
Abstract
Half of women with depression in the perinatal period are not identified in routine care, and missed cases reflect inequalities in other areas of maternity care. Case finding (screening) for depression in pregnant women may be a cost-effective strategy to improve identification, and targeted case finding directs finite resources towards the greatest need. We compared the cost-effectiveness of three case-finding strategies: no case finding, universal (all pregnant women), and targeted (only pregnant women with risk factors for antenatal depression, i.e. history of anxiety/depression, age < 20 years, and adverse life events). A decision tree model was developed to represent case finding (at around 20 weeks gestation) and subsequent treatment for antenatal depression (up to 40 weeks gestation). Costs include case finding and treatment. Health benefits are measured as quality-adjusted life years (QALYs). The sensitivity and specificity of case-finding instruments and prevalence and severity of antenatal depression were estimated from a cohort study of pregnant women. Other model parameters were derived from published literature and expert consultation. The most cost-effective case-finding strategy was a two-stage strategy comprising the Whooley questions followed by the PHQ-9. The mean costs were £52 (universal), £61 (no case finding), and £62 (targeted case finding). Both case-finding strategies improve health compared with no case finding. Universal case finding is cost-saving. Costs associated with targeted case finding are similar to no case finding, with greater health gains, although targeted case finding is not cost-effective compared with universal case finding. Universal case finding for antenatal depression is cost-saving compared to no case finding and more cost-effective than targeted case finding.
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Affiliation(s)
- Elizabeth M Camacho
- School of Health Sciences, University of Manchester, Manchester, UK.
- Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Gemma E Shields
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Emily Eisner
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Kylie Watson
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
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Strowel C, Raynes-Greenow C, Pham L, Carter S, Birkness K, Moles RJ, O'Reilly CL, Chen TF, Raduescu C, Murphy A, Gardner D, El-Den S. Perinatal depression screening in community pharmacy: Exploring pharmacists' roles, training and resource needs using content analysis. Int J Clin Pharm 2023; 45:1212-1222. [PMID: 37792255 PMCID: PMC10600310 DOI: 10.1007/s11096-023-01647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Perinatal depression (PND) screening is often recommended in primary care settings, which includes the community pharmacy setting. However, there is limited research exploring pharmacists' perspectives on their roles in screening for perinatal mental illness. AIM This study aimed to explore pharmacists' views of pharmacists' roles in PND screening, as well as training and resource needs for PND screening in community pharmacy settings. METHOD A questionnaire including three open-ended questions focusing on pharmacists' perspectives of their role in PND screening, their training, and resource needs in this area, was disseminated to pharmacists across Australia via professional organisations and social media. Each open-ended question was separately analysed by inductive content analysis. Subcategories were deductively mapped to the Theoretical Framework of Acceptability. RESULTS Responses (N = 149) from the first open-ended question about pharmacists' roles in PND screening resulted in three categories (PND screening in primary care settings will support the community, community pharmacy environment, and system and policy changes) and ten subcategories. Responses to question two on training needs (n = 148) were categorised as: training content, training length, and training delivery while responses about resource needs (n = 147) fell into three categories: adapting community pharmacy operating structures, pharmacist-specific resources, and consumer-specific resources. CONCLUSION While some pharmacists were accepting of a role in PND screening due to pharmacists' accessibility and positive relationships with consumers, others had concerns regarding whether PND screening was within pharmacists' scope of practice. Further training and resources are needed to facilitate pharmacists' roles in PND screening, referral and care.
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Affiliation(s)
- Clara Strowel
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lily Pham
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephen Carter
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Rebekah J Moles
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire L O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Corina Raduescu
- The University of Sydney Business School, University of Sydney, Sydney, NSW, 2050, Australia
| | - Andrea Murphy
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - David Gardner
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Ginsberg KH, Serlachius A, Rogers J, Alsweiler J. Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey. J Pediatr 2023; 259:113456. [PMID: 37172808 DOI: 10.1016/j.jpeds.2023.113456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. STUDY DESIGN A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. RESULTS Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. CONCLUSIONS Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.
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Affiliation(s)
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Camacho EM, Shields GE, Eisner E, Littlewood E, Watson K, Chew-Graham CA, McMillan D, Ali S, Gilbody S. An economic evaluation of targeted case-finding strategies for identifying postnatal depression: A model-based analysis comparing common case-finding instruments. J Affect Disord 2023; 334:26-34. [PMID: 37142002 DOI: 10.1016/j.jad.2023.04.106] [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: 10/25/2022] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Half of women with postnatal depression (PND) are not identified in routine care. We aimed to estimate the cost-effectiveness of PND case-finding in women with risk factors for PND. METHODS A decision tree was developed to represent the one-year costs and health outcomes associated with case-finding and treatment for PND. The sensitivity and specificity of case-finding instruments, and prevalence and severity of PND, for women with ≥1 PND risk factor were estimated from a cohort of postnatal women. Risk factors were history of anxiety/depression, age < 20 years, and adverse life events. Other model parameters were derived from published literature and expert consultation. Case-finding for high-risk women only was compared with no case-finding and universal case-finding. RESULTS More than half of the cohort had one or more PND risk factor (57.8 %; 95 % CI 52.7 %-62.7 %). The most cost-effective case-finding strategy was the Edinburgh Postnatal Depression Scale with a cut-off of ≥10 (EPDS-10). Among high-risk women, there is a high probability that EPDS-10 case-finding for PND is cost-effective compared to no case-finding (78.5 % at a threshold of £20,000/QALY), with an ICER of £8146/QALY gained. Universal case-finding is even more cost-effective at £2945/QALY gained (versus no case-finding). There is a greater health improvement with universal rather than targeted case-finding. LIMITATIONS The model includes costs and health benefits for mothers in the first year postpartum, the broader (e.g. families, societal) and long-term impacts are also important. CONCLUSIONS Universal PND case-finding is more cost-effective than targeted case-finding which itself is more cost-effective than not case-finding.
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Affiliation(s)
| | - Gemma E Shields
- School of Health Sciences, University of Manchester, United Kingdom
| | - Emily Eisner
- School of Health Sciences, University of Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Kylie Watson
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom
| | - Shehzad Ali
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom; Schulich School of Medicine & Dentistry, Western University, Canada
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom
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12
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Sroka AW, Mbayiwa K, Ilyumzhinova R, Meyer W, Fowle J, Gipson CJ, Norcott C, Hipwell AE, Keenan K. Depression screening may not capture significant sources of prenatal stress for Black women. Arch Womens Ment Health 2023; 26:211-217. [PMID: 36797547 DOI: 10.1007/s00737-023-01297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Exposure to stress during pregnancy, including depression, has a significant impact on maternal health. Black women experience varied stressors that impact pregnancy outcomes. Although the move to engage in universal screening of women for depression is a positive step toward improving women's health, it has been deployed without a comprehensive examination of its utility for capturing exposure to other stressors with known associations with perinatal and neonatal health problems for Black women such as discrimination stress. In the present study, we examine the overlap between several sources of stress and a positive screen on the Edinburgh Postnatal Depression Scale (EPDS) in Black pregnant women. Data were gathered from a study examining the effects of stress on prenatal health (N = 168). Discrimination stress, structural and systemic racism stress, perceived stress, and partner abuse were measured using standardized questionnaires during pregnancy. Using a score of ≥ 13 to indicate probable depression the sensitivity of the EPDS to identify women who experienced high levels of discrimination stress (41.7%), structural and systemic racism (39.5%), perceived stress (63.4%), and partner abuse (45.2%) was suboptimal. Lowering the threshold for a positive screen on the EPDS to a score of 10 improved sensitivity but did not solve the problem of under-identification of women whose health is at risk. The focus on depression screening for pregnant women should be re-considered. A screening toolkit that more rigorously and broadly assesses risk and need for support and intervention is needed to improve perinatal health outcomes for Black women.
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Affiliation(s)
- Anna W Sroka
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Kimberley Mbayiwa
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Rimma Ilyumzhinova
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Willa Meyer
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Jill Fowle
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Cherrelle J Gipson
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Candice Norcott
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA.
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13
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Chen YL, Tseng CH, Cheong ML, Lien YJ, Wang SH, Chang CM, Liao SC, Wu CS. Associations between antenatal education program and mental health outcomes in Taiwan: A population-based cohort study. Psychiatry Res 2023; 322:115128. [PMID: 36870316 DOI: 10.1016/j.psychres.2023.115128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/04/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
Universal antenatal education has been offered to expectant mothers in Taiwan since 2014. Depression screening is included in the offered education sessions. This study aimed to examine the association of antennal education and depression screening with mental health outcomes, including perinatal depression diagnosis and psychiatrist visits. Data was obtained from the antenatal education records and Taiwan's National Health Insurance claims database. A total of 789,763 eligible pregnant women were included in the current study. The psychiatric-related outcomes were measured between antenatal education and the six-month after delivery. It was found that the antenatal education was widely used in Taiwan, and the attendance rate has increased to 82.6% since its launch. The attenders were more likely to be from disadvantaged backgrounds, and 5.3% of them were screened positive for depressive symptoms. They were also more likely to visit a psychiatrist but less likely to be diagnosed with depression than the non-attenders. Factors including young age, high healthcare utilization, and comorbid psychiatric disorder history were consistently associated with depression symptoms, perinatal depression diagnoses and psychiatrist visits. Further research is needed to understand the reasons for the nonattendance at antenatal education programmes and the barriers to utilizing mental health services.
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Affiliation(s)
- Yu-Ling Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Physical Education, National Taiwan University of Sport, Taichung City, Taiwan
| | - Ching-Hsuan Tseng
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Mei-Leng Cheong
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Shi-Heng Wang
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan.
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14
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Pham L, Moles RJ, O’Reilly CL, Carter S, Raynes-Greenow C, Chen TF, Raduescu C, Randall S, Bloomfield J, Strowel C, Murphy A, Gardner D, El-Den S. Perinatal Women's Views of Pharmacist-Delivered Perinatal Depression Screening: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16295. [PMID: 36498368 PMCID: PMC9738857 DOI: 10.3390/ijerph192316295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Internationally, 20% of women experience perinatal depression (PND). Healthcare providers including general practitioners and midwives are critical in providing PND screening and support; however, the current workforce is unable to meet growing demands for PND care. As accessible and trusted primary healthcare professionals, pharmacists could provide PND care to complement existing services, thereby contributing to early detection and intervention. This study aimed to explore perinatal women's views of community pharmacist-delivered PND screening and care, with a focus on their attitudes towards and acceptability of PND screening implementation in community pharmacy. Semi-structured interviews with women (n = 41) were undertaken, whereby interview data were transcribed verbatim and then inductively and thematically analysed. Five overarching themes emerged; "patient experience with existing PND support and screening services"; "familiarity with pharmacists' roles"; "pharmacist visibility in PND screening care"; "patient-pharmacist relationships" and "factors influencing service accessibility". Themes and subthemes were mapped to the Consolidated Framework for Implementation Research. Findings highlight participants' generally positive attitudes towards community pharmacist-delivered PND screening and care, and the potential acceptability of such services provided pharmacists are trained and referral pathways are established. Addressing perceived barriers and facilitators would allow community pharmacist-delivered PND screening and care to support existing PND care models.
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Affiliation(s)
- Lily Pham
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Rebekah J. Moles
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Claire L. O’Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Stephen Carter
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Timothy F. Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Corina Raduescu
- The University of Sydney Business School, University of Sydney, Sydney, NSW 2050, Australia
| | - Sue Randall
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Clara Strowel
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Andrea Murphy
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - David Gardner
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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