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Kobylski LA, Arakelian MH, Freeman MP, Gaw ML, Cohen LS, Vanderkruik R. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health 2024; 27:637-647. [PMID: 38396143 DOI: 10.1007/s00737-024-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. METHODS Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics. RESULTS 139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization. CONCLUSION This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
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Affiliation(s)
- Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA.
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
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Faghih M, Kaveh MH, Nazari M, Khademi K, Hasanzadeh J. Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial. Front Public Health 2024; 12:1250152. [PMID: 38356945 PMCID: PMC10864535 DOI: 10.3389/fpubh.2024.1250152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction The highest incidence of overweight among adults is found among women, predominantly middle-aged women. While it has been demonstrated that being overweight increases mortality by compromising physical and mental health, it also imposes substantial costs on the healthcare system. Lack of physical activity is a primary contributing factor to becoming overweight. The majority of inactive adults are women, particularly middle-aged women. Consequently, this study investigated the training program for overweight women based on the health belief model (HBM) and social support approach. Methods A randomized, controlled trial involving 73 overweight middle-aged women (control group: 37, intervention group: 36) was conducted using simple random sampling. The intervention group participated in six 120-min sessions per week for 6 weeks of a training program based on HBM and social support through physical activity, group discussion, role play, and media. Data were collected using the Physical Activity Questionnaire (IPAQ), Bandura's Exercise Self-Efficacy Scale (Bandura's ESE), and a researcher-made questionnaire before and 4 weeks after the training. The collected data were analyzed using descriptive and inferential statistics via SPSS 27 software. p-values <0.05 were considered statistically significant. Results A training program based on HBM and social support led to improved perceived benefits (p < 0.001), cues to action (p = 0.03), and self-efficacy (p < 0.001) of physical activity; decreased perceived barriers (p = 0.001); increased social support (p = 0.001); and increased physical activity (p < 0.001). In addition, the BMI of the intervention group decreased after the training program (p = 0.01). Conclusion The findings of the study demonstrate the efficacy of the training program based on HBM and the social support approach in improving social support and physical activity of women. In addition, the study evaluates the long-term outcome in populations with varying social, economic, and cultural standings. Clinical Trials Registration https://clinicaltrials.gov/, (IRCT201706236261N17).
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Affiliation(s)
- Masoumeh Faghih
- Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Kaveh
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahin Nazari
- Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadijeh Khademi
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hasanzadeh
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Schmidt-Hantke J, Jacobi C. Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview. PLOS DIGITAL HEALTH 2023; 2:e0000326. [PMID: 37611049 PMCID: PMC10446204 DOI: 10.1371/journal.pdig.0000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/12/2023] [Indexed: 08/25/2023]
Abstract
Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions.
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Affiliation(s)
| | - Corinna Jacobi
- Department of Psychology, Technical University Dresden, Dresden, Germany
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Selective Serotonin Reuptake Inhibitor Use in Pregnancy and Protective Mechanisms in Preeclampsia. Reprod Sci 2023; 30:701-712. [PMID: 35984571 PMCID: PMC9944568 DOI: 10.1007/s43032-022-01065-z] [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: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
Depression and preeclampsia share risk factors and are bi-directionally associated with increased risk for each other. Despite epidemiological evidence linking selective serotonin reuptake inhibitors (SSRIs) in pregnancy to preeclampsia, serotonin (5-HT) and vasopressin (AVP) secretion mechanisms suggest that SSRIs may attenuate preeclampsia risk. However, there is a need to clarify the relationship between SSRIs and preeclampsia in humans to determine therapeutic potential. This retrospective cohort study included clinical data from 9558 SSRI-untreated and 9046 SSRI-treated pregnancies. In a subcohort of 233 pregnancies, early pregnancy (< 20 weeks) maternal plasma copeptin, an inert and stable AVP prosegment secreted 1:1 with AVP, was measured by enzyme-linked immunosorbent assay. Diagnoses and depression symptoms (Patient Health Questionnaire-9 [PHQ-9]) were identified via medical records review. Descriptive, univariate, and multivariate regression analyses were conducted (α = 0.05). SSRI use was associated with decreased preeclampsia after controlling for clinical confounders (depression severity, chronic hypertension, diabetes, body mass index, age) (OR = 0.9 [0.7-1.0], p = 0.05). Moderate-to-severe depression symptoms were associated with significantly higher copeptin secretion than mild-to-no depression symptoms (240 ± 29 vs. 142 ± 10 ng/mL, p < 0.001). SSRIs significantly attenuated first trimester plasma copeptin (78 ± 22 users vs. 240 ± 29 ng/ml non-users, p < 0.001). In preeclampsia, SSRI treatment was associated with significantly lower copeptin levels (657 ± 164 vs. 175 ± 134 ng/mL, p = 0.04). Interaction between SSRI treatment and preeclampsia was also significant (p = 0.04). SSRIs may modulate preeclampsia risk and mechanisms, although further studies are needed to investigate the relationships between 5-HT and AVP in depression and preeclampsia.
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Hendrix CL, Werchan D, Lenniger C, Ablow JC, Amstadter AB, Austin A, Babineau V, Bogat GA, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Elliott AJ, Fifer W, Firestein M, Gao W, Gotlib I, Graham A, Gregory KD, Gustafsson H, Havens KL, Hockett C, Howell BR, Humphreys KL, Jallo N, King LS, Kinser PA, Levendosky AA, Lonstein JS, Lucchini M, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Rogers C, Salisbury A, Shuffrey LC, Smith BA, Smyser CD, Smith L, Sullivan E, Zhou J, Brito NH, Thomason ME. Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic. Arch Womens Ment Health 2022; 25:943-956. [PMID: 35962855 PMCID: PMC9375091 DOI: 10.1007/s00737-022-01252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 01/21/2023]
Abstract
Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.
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Affiliation(s)
- Cassandra L Hendrix
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA.
| | - Denise Werchan
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Carly Lenniger
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | | | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Autumn Austin
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - G Anne Bogat
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah Medical School, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah Medical School, Salt Lake City, UT, USA
| | - Dani Dumitriu
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Amy J Elliott
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - William Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Morgan Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Gao
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ian Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kimberly D Gregory
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hanna Gustafsson
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kathryn L Havens
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christine Hockett
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - Brittany R Howell
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Human Development and Family Science, Virginia Tech University, Blacksburg, VA, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Nancy Jallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lucy S King
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Joseph S Lonstein
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Marcus
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara Moyer
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, VA, USA
| | - Amy K Nuttall
- Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | | | - Cynthia Rogers
- Department of Psychiatry, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Beth A Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, CA, USA
- Division of Research On Children, Youth, and Families, Childrens Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Lynne Smith
- The Lundquist Institute, Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Elinor Sullivan
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
- Neuroscience Institute, New York University Medical Center, New York, NY, USA
- Department of Population Health, New York University Medical Center, New York, NY, USA
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Peacock-Chambers E, Buckley D, Lowell A, Clark MC, Friedmann PD, Byatt N, Feinberg E. Relationship-Based Home Visiting Services for Families Affected by Substance Use Disorders: A Qualitative Study. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2121-2133. [PMID: 36909674 PMCID: PMC9997720 DOI: 10.1007/s10826-022-02313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/18/2023]
Abstract
Home visiting programs face many challenges when providing evidence-based services to families affected by substance use disorders (SUDs). We conducted interviews and focus groups with community stakeholders and parents to elucidate important considerations when intentionally attempting to meet the needs of families affected by SUDs through home visiting programs. We identified one primary theme "Who is the client?" that describes how to ensure caregivers perceive themselves as an important focus of the program. Collectively, participants revealed that understanding caregivers' emotional experiences was critical for effectively transforming their subjective experiences of the program. These emotional experiences were related to the quality of their relationships with their children, other family members, and service providers. Three sub-themes illustrate specific examples: 1) responding to the unique emotional needs of mothers in recovery, 2) considering emotional states to inform inclusion in programs, and 3) addressing complex family dynamics related to SUDs in the home. Implications of these findings are discussed.
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Affiliation(s)
- Elizabeth Peacock-Chambers
- Department of Pediatrics, UMass Chan Medical School-Baystate, Springfield, MA, USA
- Department for Healthcare Delivery and Population Science, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Deirdre Buckley
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Amanda Lowell
- Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Maria Carolina Clark
- Department of Pediatrics, UMass Chan Medical School-Baystate, Springfield, MA, USA
- Department for Healthcare Delivery and Population Science, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Peter D. Friedmann
- Department of Medicine, UMass Chan Medical School-Baystate, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, 222 Maple Ave – Chang Building, Shrewsbury, MA 01655, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
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Daehn D, Rudolf S, Pawils S, Renneberg B. Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public - a systematic review. BMC Pregnancy Childbirth 2022; 22:574. [PMID: 35854232 PMCID: PMC9295513 DOI: 10.1186/s12884-022-04865-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background The perinatal period is a time of increased vulnerability to mental health problems, however, only a small proportion of women seek help. Poor mental health literacy (MHL) is a major barrier to seeking help for mental health problems. This study aimed to collect the existing evidence of MHL associated with perinatal mental health problems (PMHP) among perinatal women and the public. This review analysed which tools were used to assess perinatal MHL as well as the findings concerning individual components of perinatal MHL. Methods Four electronic databases (PubMed, PsycINFO, Web of Science, and CINAHL) were analysed from their inception until September 1, 2020. Not only quantitative studies reporting on components of MHL (knowledge, attitudes, and help-seeking), but also studies reporting overall levels of MHL relating to PMHP were taken into account. Two independent reviewers were involved in the screening and extraction process and data were analysed descriptively. Results Thirty-eight of the 13,676 retrieved articles satisfied the inclusion criteria. The majority of selected studies examined MHL related to PMHP in perinatal women (N = 28). The most frequently examined component of MHL in the selected data set was help-seeking. A lack of uniformity in assessing MHL components was found. The most common focus of these studies was postpartum depression. It was found that the ability to recognize PMHP and to identify relevant symptoms was lacking among both perinatal women and the public. Perinatal women had low intentions of seeking help for PMHP and preferred seeking help from informal sources while reporting a variety of structural and personal barriers to seeking help. Stigmatizing attitudes associated with PMHP were found among the public. Conclusions There is a need for educational campaigns and interventions to improve perinatal MHL in perinatal women and the public as a whole. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04865-y.
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Affiliation(s)
- Daria Daehn
- Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.
| | - Sophie Rudolf
- Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
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Li H. Affective Instability, Depression, and Anxiety Symptoms in a Community Sample of Pregnant and Postpartum Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063171. [PMID: 35328868 PMCID: PMC8951286 DOI: 10.3390/ijerph19063171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although perinatal women experience an elevated level of affective instability (AI), limited research has been conducted to examine perinatal AI and its relation to depression and anxiety. The current study investigated correlations between AI and depression, between AI and anxiety during the perinatal period, and between current depression and anxiety and the latent factors of the Affective Lability Scale-18 (ALS-18). METHODS 202 Canadian perinatal women participated in this cross-sectional study. The ALS-18 was used to assess AI, while the Depression, Anxiety, and Stress Scale-21 measured depression, anxiety, and stress. Multiple logistic regression was performed to investigate the relationship between AI and depression and anxiety, and multiple linear regression was conducted to examine the association between current depression and anxiety and the three latent factors of ALS-18. RESULTS The findings revealed a significant association between AI and depression and between AI and anxiety. Current depression and anxiety were correlated with ALS-18 factors of depression/anxiety shift and depression/elation shift, while current depression was linked to ALS-18 factor of anger. CONCLUSIONS The study findings have important implications for early detection and intervention of maternal anxiety and depression. In order to improve maternal mental health, AI should be included in routine perinatal check-ups.
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Affiliation(s)
- Hua Li
- College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4248, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
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9
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Wenzel E, Penalver Bernabe B, Dowty S, Nagelli U, Pezley L, Gibbons R, Maki P. Using computerised adaptive tests to screen for perinatal depression in underserved women of colour. EVIDENCE-BASED MENTAL HEALTH 2022; 25:23-28. [PMID: 34489361 PMCID: PMC8792164 DOI: 10.1136/ebmental-2021-300262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Compared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder. CAT measures have been tailored to perinatal women but have not been studied in low-income women of colour despite high rates of perinatal depression (PND). OBJECTIVE This study aimed to examine the concordance between CAT and traditional measures of depression in a sample of primarily low-income black and Latina women. METHODS In total, 373 women (49% black; 29% Latina) completed the Patient Health Questionnaire-9 (PHQ-9), CAD-MDD and CAT-DI at 845 visits across pregnancy and postpartum. We examined the concordance between continuous CAT-DI and PHQ-9 scores and between binary measures of PND diagnosis on CAD-MDD and the PHQ-9 (cut-off score >10). We examined cases with a positive PND diagnosis on the CAD-MDD but not on the PHQ-9 ('missed' cases) to determine whether clinic notes were consistent with CAD-MDD results. FINDINGS CAT-DI and PHQ-9 scores were significantly associated (concordance correlation coefficient=0.67; 95% CI 0.58 to 0.74). CAD-MDD detected 5% more case of PND compared with PHQ-9 (p<0.001). The average per-visit rate of PND was 14.4% (14.5% in blacks, 14.9% in Latinas) on the CAD-MDD, and 9.5% (9.8% in blacks, 8.8% in Latinas) on the PHQ-9. Clinical notes were available on 60% of 'missed' cases and validated CAD-MDD PND diagnosis in 89% of cases. CONCLUSIONS CAD-MDD detected 5% more cases of PND in women of colour compared with traditional tests, and the majority of these cases were verified by clinician notes. CLINICAL IMPLICATIONS Use of CAT in routine clinic care may address health disparities in PND screening.
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Affiliation(s)
| | | | - Shannon Dowty
- Psychiatry, University of Illinois, Chicago, Illinois, USA
| | | | - Lacey Pezley
- Psychiatry, University of Illinois, Chicago, Illinois, USA
| | - Robert Gibbons
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Pauline Maki
- Psychiatry, University of Illinois, Chicago, Illinois, USA
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Schoppmann J, Teismann T, Holleck-Weithmann VA, Hundertmark E, Jandewerth K, Obereiner P, Rudolph D, Seehagen S. Infant carrying is associated with reduced maternal repetitive negative thinking and increased maternal mental health. J Reprod Infant Psychol 2021:1-14. [PMID: 34882494 DOI: 10.1080/02646838.2021.2012647] [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: 10/19/2022]
Abstract
INTRODUCTION Mental disorders, such as postnatal depression, are common in mothers. Repetitive negative thinking has been identified as a cognitive factor underlying the resulting difficulties in mother-infant interactions. METHOD The present online survey investigated associations between infant carrying (baby-wearing) and maternal repetitive negative thinking and positive mental health. RESULTS Repetitive negative thinking was significantly lower, and positive mental health was significantly higher while carrying compared to overall levels. There were no relations between maternal mental health and frequency of carrying. Maternal activities during carrying are portrayed. CONCLUSION These results are the first indication that carrying could be a low threshold, easily administered intervention method for maternal mental health problems.
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Affiliation(s)
| | - Tobias Teismann
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | | | | | | | | | - Dinah Rudolph
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Sabine Seehagen
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Savory NA, Hannigan B, John RM, Sanders J, Garay SM. Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey. Midwifery 2021; 103:103103. [PMID: 34392103 DOI: 10.1016/j.midw.2021.103103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the prevalence of self-reported mental health problems in a cohort of women in early pregnancy. To describe the relationship between poor mental health and sociodemographic characteristics, self-efficacy and support networks. To assess if participants were representative of the local antenatal population. RESEARCH DESIGN AND SETTING The UK government has pledged money to provide more support for women with perinatal mental health issues. Understanding the prevalence and predicting women who may need support will inform clinical practice. This paper reports part of the larger 'Mothers Mood Study', which explored women's and midwives' experience of mild to moderate perinatal mental health issues and service provision. Routinely collected population level data were analysed and a smaller cross-sectional survey design used to assess predictors of poor mental health in early pregnancy in one health board in Wales. PARTICIPANTS Routinely collected data were extracted for all women who registered for maternity care between May 2017 and May 2018 (n = 6312) from the electronic maternity information system (pregnant population). Over a three month period 302 of these women completed a questionnaire at the antenatal clinic after an ultrasound scan (participants). Eligible women were aged ≥18 years, with sufficient spoken and written English to complete the questionnaire and a viable pregnancy of ≤18 weeks' gestation. The questionnaire collected data on sociodemographic status, self-efficacy and support networks, self-reported mental health problems. Current anxiety and depression were assessed using the General Anxiety Disorders Assessment and Edinburgh Postnatal Depression Scale. FINDINGS Among the pregnant population 23% (n = 1490) disclosed a mental health problem during routine questioning with anxiety and depression being the most common conditions. Participants completing the detailed questionnaire were similar in age and parity to the pregnant population with similar levels of depression (15.6%; n = 15.6 v 17.3%, n = 1092). Edinburgh Postnatal Depression Scale and General Anxiety Disorder 7 scores identified 8% with symptoms of anxiety (n = 25) or depression (n = 26) and a further 24.2% (n = 73) with symptoms of mild anxiety and 25.2% (n = 76) with mild depression. Low self-efficacy (OR 1.27, 95% CI 1.12-1.45), a previous mental health problem (OR 3.95, 95% CI 1.37-11.33) and low support from family (OR 1.13, 95% CI 1.00-1.27) were found to be associated with early pregnancy anxiety and/or depression. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Around one in five women who register for maternity care may have a mental health problem. Mild to moderate anxiety and depression are common in early pregnancy. Services need to improve for women who do not currently meet the threshold for referral to perinatal mental health services. Assessment and active monitoring of mental health is recommended, in particular for pregnant women with risk factors including a history of previous mental health difficulties, poor family support or low self-efficacy.
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Affiliation(s)
- N A Savory
- Maternity Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - B Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, United Kingdom
| | - R M John
- Biomedicine division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, United Kingdom
| | - S M Garay
- Biomedicine division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
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12
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Acute psychiatric illness and drug addiction during pregnancy and the puerperium. HANDBOOK OF CLINICAL NEUROLOGY 2021. [PMID: 32768084 DOI: 10.1016/b978-0-444-64240-0.00007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Pregnancy and the puerperium do not protect against acute psychiatric illness. During puerperium, the chance of acute psychiatric illness, such as a psychotic episode or relapse of bipolar disorder, is greatly increased. Suicide is a leading cause of maternal death. Both psychiatric disease and ongoing drug addiction impact not only the pregnant woman's somatic and mental health but also impact short-term and long-term health of the child. Indeed, prompt recognition and expeditious treatment of acute psychiatric illness during pregnancy and the puerperium optimize health outcomes for two patients. Pregnancy and puerperium represent a stage of life of great physiologic adaptations, as well as emotional and social changes. This conjunction of changes in somatic, emotional health and social health may mitigate the occurrence, clinical presentation, and clinical course of acute psychiatric illness and call for a multidisciplinary approach, taking into account both the medical and social domains. This chapter describes acute psychiatric illnesses during pregnancy and the puerperium and illicit substance abuse, from a clinical perspective, while also describing general principles of diagnosis and clinical management during this stage of life, which is an important window of opportunity for both the pregnant woman and the child.
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Mohammad KI, Sabbah H, Aldalaykeh M, ALBashtawy M, Z Abuobead K, Creedy D, Gamble J. Informative title: Effects of social support, parenting stress and self-efficacy on postpartum depression among adolescent mothers in Jordan. J Clin Nurs 2021; 30:3456-3465. [PMID: 33988270 DOI: 10.1111/jocn.15846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE This study investigated the effects of social support, parenting stress and maternal self-efficacy on postpartum depression among adolescent mothers in Jordan. BACKGROUND Adolescent pregnancy may have serious health, social and economic consequences for young women, families and communities. In Jordan, the incidence of adolescent pregnancy has increased from 5% in 2012 to 15% in 2018. Little attention has been given to postpartum depression among adolescent mothers in Arab and Middle Eastern countries. METHOD In a cross-sectional design using convenience sampling, 200 women aged less than 20 years, six to eight weeks postpartum and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment and included socio-demographic data, Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale (MSSS), Parenting Stress Scale (PSS) and Perceived Self-efficacy Scale (PSES). Data collection took place between December of 2018 and April of 2019. Reporting followed the STROBE guidelines. RESULTS Results revealed that 28.5% of adolescent mothers had probable postpartum depression. Mothers who reported high social support, high parenting stress, low self-efficacy, financial stress and marital conflict had significantly higher EPDS scores than those who did not report these stressors. CONCLUSION Prevalence of postpartum depression reported in this study warrants immediate action on early assessment, detection and intervention. High levels of social support may feel overwhelming for young mothers and contribute to high parenting stress, low maternal self-efficacy and marital conflict. RELEVANCE TO CLINICAL PRACTICE Adolescent mothers are at increased risk of PPD compared to mothers over 20 years of age. Perceived quality rather than availability of social support needs to be considered. Young mothers require education and early intervention prevention strategies to better prepared them for motherhood and manage stressors associated with their changing social role.
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Affiliation(s)
- Khitam I Mohammad
- Midwifery Department, Faculty of Nursing/WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan
| | - Hanan Sabbah
- Maternal and Child Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammed Aldalaykeh
- Community and Mental Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammed ALBashtawy
- Community Health Nursing Department, Princess Salma -Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Kholoud Z Abuobead
- Adult Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan
| | - Debra Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
| | - Jenny Gamble
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
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14
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Austin MPV, Reilly N, Mule V, Kingston D, Black E, Hadzi-Pavlovic D. Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment. Women Birth 2021; 35:e125-e132. [PMID: 33895108 DOI: 10.1016/j.wombi.2021.04.005] [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: 10/05/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician. AIMS To assess the impact of psychosocial risk, current symptoms and mode of assessment on women's honesty of disclosure at psychosocial assessment. METHODS Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were 'always honest' and 'not always honest'. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk. FINDINGS 10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18-2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16-2.62, p<0.05; aOR=2.08, 95%CI: 1.11-3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest. DISCUSSION A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback. CONCLUSION Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Royal Hospital for Women, Sydney, Barker St, Randwick, NSW 2031, Australia.
| | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
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15
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Lackie ME, Parrilla JS, Lavery BM, Kennedy AL, Ryan D, Shulman B, Brotto LA. Digital Health Needs of Women With Postpartum Depression: Focus Group Study. J Med Internet Res 2021; 23:e18934. [PMID: 33404506 PMCID: PMC7817361 DOI: 10.2196/18934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although approximately 10% of new mothers in Canada develop postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, patient populations are not consistently engaged in eHealth development processes. Thus, the diversity of women’s backgrounds and needs are often not reflected in existing tools. Objective This study aims to engage women from a variety of backgrounds and locations around British Columbia (BC) who have previously experienced PPD to determine the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the management of PPD could fulfill those needs. Methods Focus groups were conducted in 7 cities across BC with a total of 31 women (mean age 34.5 years, SD 4.9), with each group ranging from 2-7 participants. Focus groups were cofacilitated by the study coordinator and a local service provider in each community using a semistructured guide to discuss participants’ needs, ideas, and opinions as they relate to the use of technology in PPD management. Transcripts were approached inductively using thematic analysis to identify themes and qualitative description to frame what was observed in the data. Results A total of 5 themes were identified: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. Each theme identified a need (eg, combatting stigma) and a way to address that need using a web-enabled intervention (eg, providing validation). At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD. Conclusions Ultimately, new mothers require accessible mental health care that promotes their agency in mental health care decision making. Our participants believed that a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line management option for PPD.
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Affiliation(s)
- Madison E Lackie
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.,Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia S Parrilla
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brynn M Lavery
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.,Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Jacques MC. Le dévoilement de soi dans la recherche d’aide et le suivi dans les services de santé mentale et psychiatrie. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073552ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Le dévoilement de soi des patients est essentiel au travail des professionnels de la santé, et ceci est encore plus critique en santé mentale où la parole du patient est le reflet du contenu de la psyché. Le dévoilement de soi concerne alors des symptômes invisibles qui sont associés à des problèmes de santé où la discrimination et la stigmatisation sont encore très présentes. Cet article explore les enjeux éthiques de ce phénomène encore très peu étudié. Le dévoilement en tant que processus décisionnel, interpersonnel, dynamique et complexe sera défini et approfondi à l’aide d’exemples tirés de la recherche. Par la suite, la vulnérabilité de la personne qui se dévoile sera abordée, suivie des enjeux liés aux normes de pratique professionnelle associées au dévoilement des patients et à leur responsabilité avers celui-ci. Ces éléments mettent en lumière de nombreuses questions éthiques et nous amènent, en dernier lieu, à une amorce de proposition pour positionner les professionnels impliqués.
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Affiliation(s)
- Marie-Claude Jacques
- École des sciences infirmières, Université de Sherbrooke, Longueuil, Québec, Canada
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18
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Peñalver Bernabé B, Maki PM, Dowty SM, Salas M, Cralle L, Shah Z, Gilbert JA. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology (Berl) 2020; 237:915-941. [PMID: 32065252 DOI: 10.1007/s00213-019-05436-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
Perinatal depression is the most common complication of pregnancy and affects the mother, fetus, and infant. Recent preclinical studies and a limited number of clinical studies have suggested an influence of the gut microbiome on the onset and course of mental health disorders. In this review, we examine the current state of knowledge regarding genetics, epigenetics, heritability, and neuro-immuno-endocrine systems biology in perinatal mood disorders, with a particular focus on the interaction between these factors and the gut microbiome, which is mediated via the gut-brain axis. We also provide an overview of experimental and analytical methods that are currently available to researchers interested in elucidating the influence of the gut microbiome on mental health disorders during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Peñalver Bernabé
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shannon M Dowty
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariana Salas
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Lauren Cralle
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Zainab Shah
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jack A Gilbert
- Scripts Oceanographic Institute, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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De Sousa Machado T, Chur-Hansen A, Due C. First-time mothers' perceptions of social support: Recommendations for best practice. Health Psychol Open 2020; 7:2055102919898611. [PMID: 32095254 PMCID: PMC7008558 DOI: 10.1177/2055102919898611] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Research indicates social support is imperative for postpartum well-being. The types of social support and access to preferred supports are less understood. This article considers first-time mothers' perceptions of the effectiveness of social supports and perceived barriers to accessing support and provides recommendations for best practice. A search of the literature for terms related to postpartum social support was conducted. Major themes were identified and synthesised. A critique and analysis of the literature is presented with recommendations for best practice. Much of the research around postnatal support fails to distinguish the specific type of support, meaning creating support solutions for the postpartum period may not be effectively targeted. Recommendations for individualised support are made.
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20
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Predictors of postpartum depression service use: A theory-informed, integrative systematic review. Women Birth 2020; 33:e24-e32. [DOI: 10.1016/j.wombi.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
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Goldman-Mellor S, Margerison CE. Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 2019; 221:489.e1-489.e9. [PMID: 31173749 PMCID: PMC6829056 DOI: 10.1016/j.ajog.2019.05.045] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce. OBJECTIVE We sought to examine incidence of drug-related and suicide deaths in the 12 months after delivery, including heterogeneity by sociodemographic factors. We also explored maternal decedents' health care utilization prior to death. STUDY DESIGN This retrospective, population-based cohort study followed up 1,059,713 women who delivered a live-born infant in California hospitals during 2010-2012 to ascertain maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked hospital and death data. RESULTS A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years. The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years). Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years), and suicide was the seventh leading cause (1.42 per 100,000 person-years); together these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured women, and women residing in micropolitan areas were especially likely to die from drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide, made ≥1 emergency department or hospital visit between their delivery and death. CONCLUSION Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum period and warrant increased clinical attention, including recognition by physicians and Maternal Mortality Review Committees as a medical cause of death. Importantly, emergency department and inpatient hospital visits may serve as a point of identification of, and eventually prevention for, women at risk for these deaths.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA.
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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Engagement with perinatal mental health services: a cross-sectional questionnaire survey. BMC Pregnancy Childbirth 2019; 19:170. [PMID: 31088414 PMCID: PMC6518724 DOI: 10.1186/s12884-019-2320-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Perinatal depression and/or anxiety disorders are undertreated pregnancy complications. This is partly due to low rates of engagement by women. This study aimed to identify barriers and facilitators to women accessing perinatal mental health services in an outer metropolitan hospital in Queensland, Australia. METHODS Data was collected from pregnant women through a cross-sectional survey. Women rated the extent certain factors influenced their engagement. Respondents were separated into three groups: women who were not offered a referral to perinatal mental health services, women who were offered a referral but did not engage, and women who engaged. RESULTS A total of 218 women participated. A response rate of 71% was achieved. 38.1% of participants did not believe themselves knowledgeable about mental illness in the perinatal period, and 14.7% did not recall being asked about their mental health during their pregnancy. Of those participants who recalled being asked about their mental health, 37.1% were offered a referral. Of these, just over a third (36.2%) accepted, and out of this group, 40% attended an appointment. Regardless of referral and engagement status, the factors identified as influencing participant engagement were time restraints, lack of childcare support, and encouragement by family and health care professionals. Stigma was not identified as a barrier. CONCLUSIONS Perinatal mental health service engagement could be improved by health services: ensuring universal screening and actively engaging women in the process: assisting with childcare; improving appointment immediacy and accessibility; and educating health care professionals about their influence on women's engagement.
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Diagnosis of Postpartum Depression and Timing and Types of Treatment Received Differ for Women with Private and Medicaid Coverage. Womens Health Issues 2018; 28:524-529. [DOI: 10.1016/j.whi.2018.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/23/2022]
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Prevatt BS, Lowder EM, Desmarais SL. Peer-support intervention for postpartum depression: Participant satisfaction and program effectiveness. Midwifery 2018; 64:38-47. [PMID: 29908406 DOI: 10.1016/j.midw.2018.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/12/2018] [Accepted: 05/23/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Postpartum mood disorders represent a serious problem affecting 10-20% of women and support groups offer a promising intervention modality. The current study examined participant satisfaction with and effectiveness of a peer-facilitated postpartum support group. INTERVENTION The program consists of a free, peer-support group, developed to increase social support and destigmatise postpartum mood symptoms. The weekly group is co-facilitated by former group attendees and maternal health professionals. SETTING The peer-support program is offered in an urban city in the southeastern United States. DESIGN To address study aims, a community-based participatory research approach was implemented. Participant satisfaction was assessed via mixed methods analyses. Differences in depression scores at follow-up between program attendees and a community sample were examined via weighted linear regression analysis following propensity score analysis. Finally, within-group change in depression scores for program attendees was examined using a repeated measures ANOVA. PARTICIPANTS Intake program data were provided by the sponsoring organisation (n = 73) and follow-up data were collected via an online survey from program attendees (n = 45). A community sample was recruited to establish a comparison group (n = 152). MEASUREMENTS AND FINDINGS Participant satisfaction was high with overwhelmingly positive perceptions of the program. Postparticipation depression scores were similar to those of the community sample at follow-up (p = .447). Among attendees, pre-post analyses revealed reductions in depression symptoms with significant interactions for time × complications (p ≤ .001) and time × delivery method (p ≤ .017). KEY CONCLUSIONS Overall, findings indicate this peer-support program is not only acceptable to program attendees but also they provide a potential mechanism for improving mental health outcomes; however, further evaluation is needed. Findings also emphasise the importance of integrating evaluation procedures into community-based mental health programming to support effectiveness. IMPLICATIONS FOR PRACTICE Peer-support groups are an acceptable form of intervention for women experiencing postpartum depression.
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Affiliation(s)
- Betty-Shannon Prevatt
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695-7650, United States.
| | - Evan M Lowder
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695-7650, United States.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695-7650, United States.
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Ashford MT, Olander EK, Rowe H, Fisher JR, Ayers S. Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e19. [PMID: 29678804 PMCID: PMC5938691 DOI: 10.2196/mental.9106] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/25/2017] [Accepted: 12/15/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa). OBJECTIVE This study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety. METHODS Postpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. RESULTS A total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa's accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. CONCLUSIONS Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa's future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7Bwmd).
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Affiliation(s)
- Miriam T Ashford
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Rw Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
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