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Eakley R, Lyndon A. Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review. J Midwifery Womens Health 2024. [PMID: 39054664 DOI: 10.1111/jmwh.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/22/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy. METHODS Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria. RESULTS Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access. DISCUSSION Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.
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Affiliation(s)
- Rachel Eakley
- New York University, Rory Meyers College of Nursing, New York, New York
| | - Audrey Lyndon
- New York University, Rory Meyers College of Nursing, New York, New York
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Schaefer AJ, Mackie T, Veerakumar ES, Sheldrick RC, Moore Simas TA, Valentine J, Cowley D, Bhat A, Davis W, Byatt N. Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model. Health Aff (Millwood) 2024; 43:557-566. [PMID: 38560809 DOI: 10.1377/hlthaff.2023.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.
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Affiliation(s)
- Ana J Schaefer
- Ana J. Schaefer , Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | | | - Deborah Cowley
- Deborah Cowley, University of Washington, Seattle, Washington
| | | | - Wendy Davis
- Wendy Davis, Postpartum Support International, Portland, Oregon
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Al-Abri K, Armitage CJ, Edge D. Views of healthcare professionals and service users regarding anti-, peri- and post-natal depression in Oman. J Psychiatr Ment Health Nurs 2023; 30:795-812. [PMID: 36719270 DOI: 10.1111/jpm.12908] [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: 10/03/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Anti-, peri- and post-natal depression negatively affect the relationship between mothers and their children. At least half of cases of anti-, peri- and post-natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives. Previous qualitative studies considered women's experiences relating to anti-, peri- and post-natal depression separately from studies looking at the views of HCPs. There is a lack of research in Middle Eastern countries, despite the high prevalence of anti-, peri- and post-natal depression. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti-, peri- and post-natal depression from the Middle East perspective, particularly in Oman. This study revealed that anti-, peri- and post-natal depression has been neglected in primary healthcare systems in Oman. The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti-, peri- and post-natal depression in the primary healthcare system. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help-seeking behaviours with their patients. Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti-, peri- and post-natal depression. ABSTRACT INTRODUCTION: Anti-, peri- and post-natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti-, peri- and post-natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti-, peri- and post-natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti-, peri- and post-natal depression globally. AIM This study aimed to explore the views and experiences of HCPs and service users relating to anti-, peri- and post-natal depression from the Middle East perspective. METHOD A qualitative descriptive study using semi-structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2-20 years of clinical experience in anti-, peri- and post-natal primary care and 13 pregnant patients plus 2 post-birth patients were interviewed. Audio-recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. RESULTS A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti-, peri- and post-natal depression; (2) how to deal with anti-, peri- and post-natal depression; (3) barriers to addressing anti-, peri- and post-natal depression in primary anti-, peri- and post-natal care settings and (4) bridging the gap: facilitators in detecting and managing anti-, peri- and post-natal depression. CONCLUSIONS Improving the identification and management of anti-, peri- and post-natal depression in primary healthcare systems will require a whole-system approach with interventions at the patient, practice and comprehensive primary care team levels. IMPLICATIONS FOR PRACTICE The findings suggest implications for improving the identification and management of anti-, peri- and post-natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti-, peri- and post-natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills.
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Affiliation(s)
- Khalood Al-Abri
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Christopher J Armitage
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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Choongo J, Apenteng B, Nkemjika S, Telfair J. Social ecological approach to factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Women Health 2023; 63:229-240. [PMID: 36710486 DOI: 10.1080/03630242.2023.2169806] [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: 01/31/2023]
Abstract
Perinatal mental illness pertains to pregnancy-related mental health complications, which could last as long as one year post-delivery. Despite the high prevalence of PMI, there remains a poor accessibility and utilization of mental health services, especially in the rural America. Hence, using the Social Ecological Model (SEM), we aim to identify factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Using a random sampling method, we recruited 15 mental health providers in Bulloch County through professional networks who completed open-ended surveys between January 31 and March 5 of 2021. The open-ended survey was guided by the SEM constructs, which included Individual, Interpersonal, Organizational, Community, and Policy factors. The Qualitative thematic analysis was conducted using NVivo software. Major barriers among providers include lack of available resources and lack of rapport among patients and providers. Major facilitator themes included increase in mental health screening, rapport building, education, and awareness. This study suggests the introduction of group therapies in public communal areas is helpful. Findings from this study will be useful in developing tailored interventions to address barriers to perinatal mental health-care utilization experienced by both women and perinatal mental health-care providers.
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Affiliation(s)
- Janet Choongo
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Bettye Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Stanley Nkemjika
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.,Department of Behavioral Sciences and Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Joseph Telfair
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA.,Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA.,Office for Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
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5
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Schipani Bailey E, Byatt N, Carroll S, Brenckle L, Sankaran P, Kroll-Desrosiers A, Smith NA, Allison J, Simas TAM. Results of a Statewide Survey of Obstetric Clinician Depression Practices. J Womens Health (Larchmt) 2021; 31:675-681. [PMID: 34491103 PMCID: PMC9133971 DOI: 10.1089/jwh.2021.0147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Perinatal depression affects upwards of one in seven women and is associated with significant negative maternal and child consequences. Despite this, it remains under-detected and under-treated. We sought to identify clinician practices, self-efficacy, and remaining barriers to comprehensively addressing perinatal depression care. Materials and Methods: Surveys were administered to obstetric clinicians in Massachusetts that queried frequency of depression screening and Likert questions about subsequent depression management. Results: Approximately 79.0% of clinicians approached completed the survey. Whereas most clinicians (93.5%) screened for perinatal depression at 6 weeks postpartum, fewer clinicians (66.1%) screened during pregnancy. Most reported they were comfortable providing support to their patients (98.4%), but fewer endorsed being able to treat them on their own (43.0%). Most noted an ability to treat with antidepressants (77.9%); however, fewer endorsed adequate access to nonmedication treatment (45.5%). Conclusions: The majority of surveyed clinicians screen for depression consistent with guidelines. However, efforts are focused on the postpartum period, despite literature citing two-thirds of patients experiencing onset before or during pregnancy. Respondents indicated an ability to treat with medication management, while noting greater challenge with referral. These findings describe the challenges of interdisciplinary coordination as a barrier to comprehensive perinatal mental health care. Clinical Trial Registration Number: NCT02760004.
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Affiliation(s)
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Smita Carroll
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Aimee Kroll-Desrosiers
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Massachusetts Memorial Healthcare, Worcester, Massachusetts, USA
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Muzik M. Achieving Comprehensive Treatment in Perinatal Mental Health: Is Educating Obstetric Providers Sufficient? J Womens Health (Larchmt) 2021; 30:1367-1369. [PMID: 33926218 DOI: 10.1089/jwh.2021.0164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Muzik
- Departments of Psychiatry and Obstetrics & Gynecology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
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Browne PD, Bossenbroek R, Kluft A, van Tetering EMA, de Weerth C. Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care. J Womens Health (Larchmt) 2020; 30:1116-1126. [PMID: 33275492 DOI: 10.1089/jwh.2019.8198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.
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Affiliation(s)
- Pamela D Browne
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Earth & Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Rineke Bossenbroek
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Arne Kluft
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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Salameh TN, Hall LA, Crawford TN, Staten RR, Hall MT. Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014. J Psychosom Obstet Gynaecol 2020; 41:298-307. [PMID: 31718367 DOI: 10.1080/0167482x.2019.1689949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Ruth R Staten
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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Moore Simas TA, Brenckle L, Sankaran P, Masters GA, Person S, Weinreb L, Ko JY, Robbins CL, Allison J, Byatt N. The PRogram In Support of Moms (PRISM): study protocol for a cluster randomized controlled trial of two active interventions addressing perinatal depression in obstetric settings. BMC Pregnancy Childbirth 2019; 19:256. [PMID: 31331292 PMCID: PMC6647165 DOI: 10.1186/s12884-019-2387-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Perinatal depression, the most common pregnancy complication, is associated with negative maternal-offspring outcomes. Despite existence of effective treatments, it is under-recognized and under-treated. Professional organizations recommend universal screening, yet multi-level barriers exist to ensuring effective diagnosis, treatment, and follow-up. Integrating mental health and obstetric care holds significant promise for addressing perinatal depression. The overall study goal is to compare the effectiveness of two active interventions: (1) the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a state-wide, population-based program, and (2) the PRogram In Support of Moms (PRISM) which includes MCPAP for Moms plus a proactive, multifaceted, practice-level intervention with intensive implementation support. METHODS This study is conducted in two phases: (1) a run-in phase which has been completed and involved practice and patient participant recruitment to demonstrate feasibility for the second phase, and (2) a cluster randomized controlled trial (RCT), which is ongoing, and will compare two active interventions 1:1 with ten Ob/Gyn practices as the unit of randomization. In phase 1, rates of depressive symptoms and other demographic and clinical features among patients were examined to inform practice randomization. Patient participants to be recruited in phase 2 will be followed longitudinally until 13 months postpartum; they will have 3-5 total study visits depending on whether their initial recruitment and interview was at 4-24 or 32-40 weeks gestation, or 1-3 months postpartum. Sampling throughout pregnancy and postpartum will ensure participants with different depressive symptom onset times. Differences in depression symptomatology and treatment participation will be compared between patient participants by intervention arm. DISCUSSION This manuscript describes the full two-phase study protocol. The study design is innovative because it combines effectiveness with implementation research designs and integrates critical components of participatory action research. Our approach assesses the feasibility, acceptance, efficacy, and sustainability of integrating a stepped-care approach to perinatal depression care into ambulatory obstetric settings; an approach that is flexible and can be tailored and adapted to fit unique workflows of real-world practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02760004, registered prospectively on May 3, 2016.
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Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605 USA
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, UMass Memorial Health Care, 119 Belmont Street, Worcester, MA 01605 USA
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Grace A. Masters
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Sharina Person
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Fallon Health, Worcester, MA USA
| | - Jean Y. Ko
- Centers for Disease Control and Prevention, Atlanta, GA USA
- U.S. Public Health Service, Comissioned Corps, Maryland, USA
| | | | - Jeroan Allison
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Nancy Byatt
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Psychiatry, UMass Memorial Health Care, 6 Lake Avenue, Worcester, MA 01655 USA
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10
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Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N. A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings. Clin Obstet Gynecol 2018; 61:573-590. [PMID: 29553986 PMCID: PMC6059986 DOI: 10.1097/grf.0000000000000360] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, and sustainability through novel reimbursement mechanisms.
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Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
- Department of Pediatrics
| | - Michael P. Flynn
- University of Massachusetts Medical School, Worcester, MA
- Department of Obstetrics and Gynecology
| | | | | | - Leonard L. Levin
- University of Massachusetts Medical School, Worcester, MA
- Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA
- Department of Family and Community Medicine
| | - Kathleen Biebel
- University of Massachusetts Medical School, Worcester, MA
- Department of Psychiatry
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
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11
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Fedock GL, Alvarez C. Differences in Screening and Treatment for Antepartum Versus Postpartum Patients: Are Providers Implementing the Guidelines of Care for Perinatal Depression? J Womens Health (Larchmt) 2018; 27:1104-1113. [DOI: 10.1089/jwh.2017.6765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gina L. Fedock
- University of Chicago, School of Social Service Administration, Chicago, Illinois
| | - Carmen Alvarez
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
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12
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Place JMS, Allen-Leigh B, Billings DL, Dues KM, de Castro F. Detection and care practices for postpartum depressive symptoms in public-sector obstetric units in Mexico: Qualitative results from a resource-constrained setting. Birth 2017; 44:390-396. [PMID: 28833511 DOI: 10.1111/birt.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is amenable to detection and treatment, but effectively addressing it is contingent on policies, practices, and health care providers working together to address the issue. The aim of this study is to describe a sample of health care providers' existing practices in public-sector obstetric units in Mexico related to detecting and offering care to women with depressive symptomology. METHODS Semi-structured interviews with 40 health care providers (16 physicians, 13 nurses, three social workers, and eight psychologists) from one tertiary-level and two secondary-level, public-sector obstetric units, were conducted by members of a trained research team from May to July 2012. Qualitative data were analyzed in Spanish according to Grounded Theory, using Nvivo 10 software. RESULTS Lack of hospital guidelines, training, and time constraints are reasons given for not detecting PPD symptoms among women. Providers reported that their role is cursory and limited to giving women anticipatory guidance for what to expect emotionally after childbirth or providing a trusting atmosphere for women to express their feelings. Care is fragmented and inadequate, in part because of the lack of protocols that define who makes mental health referrals and where. Providers indicated PPD is important but not prioritized in health care for pregnant and postpartum women. CONCLUSION Critical needs in obstetric units include formal mental health care detection and care protocols during the perinatal period, strategies to address mental health needs despite short hospital stays, and training for providers on how to implement detection and care protocols and strategies.
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Affiliation(s)
- Jean Marie S Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Betania Allen-Leigh
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Deborah L Billings
- Choose Well Initiative, Columbia, SC, USA.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kiya M Dues
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Abstract
BACKGROUND The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period. METHODS Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well. RESULTS A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting. CONCLUSIONS Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.
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Dutch midwives' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: An exploratory survey. Midwifery 2014; 30:234-41. [DOI: 10.1016/j.midw.2013.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/25/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022]
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Battle CL, Salisbury AL, Schofield CA, Ortiz-Hernandez S. Perinatal antidepressant use: understanding women's preferences and concerns. J Psychiatr Pract 2013; 19:443-53. [PMID: 24241498 PMCID: PMC4277178 DOI: 10.1097/01.pra.0000438183.74359.46] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women's concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women's treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women's preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women's concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression.
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MESH Headings
- Adult
- Antidepressive Agents/therapeutic use
- Complementary Therapies/psychology
- Decision Making/physiology
- Depression, Postpartum/diagnosis
- Depression, Postpartum/psychology
- Depression, Postpartum/therapy
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Interview, Psychological
- Patient Preference/psychology
- Postpartum Period
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/psychology
- Pregnancy Complications/therapy
- Pregnancy Trimester, Second
- Psychiatric Status Rating Scales
- Psychotherapy/methods
- Qualitative Research
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- Cynthia L Battle
- BATTLE: Warren Alpert Medical School of Brown University, Butler Hospital, and Women & Infants' Hospital of Rhode Island, Providence, RI; SALISBURY: Warren Alpert Medical School of Brown University and Women & Infants' Hospital of Rhode Island; SCHOFIELD: Warren Alpert Medical School of Brown University and Skidmore College, Saratoga Springs, NY; ORTIZ- HERNANDEZ: George Washington University, Washington, DC
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Byatt N, Biebel K, Debordes-Jackson G, Lundquist RS, Moore Simas TA, Weinreb L, Ziedonis D. Community mental health provider reluctance to provide pharmacotherapy may be a barrier to addressing perinatal depression: a preliminary study. Psychiatr Q 2013; 84:169-74. [PMID: 22941573 DOI: 10.1007/s11126-012-9236-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the first study evaluating obstetrics and gynecology (OB/Gyn) provider and staff perceptions of barriers to accessing pharmacotherapy for perinatal depression outside the obstetric setting. Four, 90 min focus groups were conducted with OB/Gyn physicians, advance practice nurses, and support and nursing staff (n = 28). Data were analyzed with a grounded theory approach. Participants perceived that community mental health providers and pharmacists often do not want to participate in pharmacotherapy for perinatal women. Participants believed the solution is training for community mental health providers in the risks and benefits of pharmacotherapy for perinatal depression and improved communication between OB/Gyn's and community mental health providers. Community mental health provider and pharmacist reluctance to provide pharmacotherapy hinders OB/Gyn's perceived ability to address perinatal depression. Community mental health provider and pharmacist training are needed to mitigate precipitous discontinuation of treatment and to improve access to pharmacotherapy for perinatal women.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA.
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Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D, Pbert L. Patient's views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals? Gen Hosp Psychiatry 2013; 35:598-604. [PMID: 23969144 PMCID: PMC4107904 DOI: 10.1016/j.genhosppsych.2013.07.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The objectives were to examine patients' perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals. METHOD Four 90-min focus groups were conducted with women 3-36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach. RESULTS Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals. CONCLUSIONS Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals' perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 01655.
| | - Kathleen Biebel
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | | | | | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
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Antenatal identification of major depressive disorder: a cohort study. Am J Obstet Gynecol 2012; 207:506.e1-6. [PMID: 23099192 DOI: 10.1016/j.ajog.2012.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/15/2012] [Accepted: 09/28/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the frequency of identification of major depressive disorder by providers during prenatal care. STUDY DESIGN A cohort of pregnant women who were participating in a randomized controlled trial and who had received a diagnosis of major depressive disorder was examined. Women were included in the current study if prenatal clinic records were available and legible. RESULTS Clinical depression was noted in 56% of prenatal charts and on 24% of problem lists. Physicians and certified nurse midwives noted depression equally (P = .935); physicians more frequently noted mental health referral (23% vs 0%; P = .01), and midwives more frequently included depression on the problem list (P = .01). Recent medication use, which was stopped before conception or study participation, predicted notation of depression in the chart (P = .001). CONCLUSION Depression frequently is missed during pregnancy and, when identified, is underacknowledged as a problem. Women who have not recently used antidepressant medication are more likely to be missed. Better screening and acknowledgment are needed.
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Byatt N, Simas TAM, Lundquist RS, Johnson JV, Ziedonis DM. Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. J Psychosom Obstet Gynaecol 2012. [PMID: 23194018 DOI: 10.3109/0167482x.2012.728649] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment. METHOD Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment. RESULTS Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources. CONCLUSION Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Ob/Gyn, UMass Medical School, Worcester, MA 01655, USA.
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