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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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Loyal D, Sutter AL, Rascle N. Changes in Mothering Ideology After Childbirth and Maternal Mental Health in French Women. SEX ROLES 2021. [DOI: 10.1007/s11199-021-01242-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Jidong DE, Husain N, Francis C, Murshed M, Roche A, Ike TJ, Karick H, Dagona ZK, Pwajok JY, Nyam PP, Mwankon SB, Gumber A. Mental health experiences of mothers in Jos, Nigeria: An interpretative phenomenological analysis. SAGE Open Med 2021; 9:2050312120970714. [PMID: 33889409 PMCID: PMC8040383 DOI: 10.1177/2050312120970714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There is an increasing mental health disease burden in mothers with infants and young children, especially in low- and middle-income countries such as Nigeria. Children of distressed mothers suffer early-life exposure from the effects of maternal distress which contributes to the risk of physical and mental health problems in their childhood and beyond. This study explored mental health lived experiences of mothers in Jos, Nigeria. METHODS Purposive and Snowball sampling techniques were adopted, and a total of 40 mothers participated with 8 to 11 participants in one of the four focus group discussions. Participants were between the ages of 18 and 43 years, self-identified as mothers with each having a child between the ages of 3 and 48 months. Each focus group lasted approximately 60 minutes and was audio-recorded. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS Three overarching themes emerged from the data set such as (1) experience of persisting psychological distress from the time of labour/birth; (2) cultural practices that influence feelings; and (3) anxiety due to limited knowledge about childcare, access to support and healthy food. CONCLUSION Maternal mental health in Nigeria is under-researched and distressed mothers have limited knowledge about evidence-based early child development. The study recommends developing and testing culturally appropriate parenting interventions in Jos, Nigeria. This is likely to be beneficial for the mother and may also improve child health outcomes.
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Affiliation(s)
| | | | | | - Maisha Murshed
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Ayesha Roche
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | | | | | | | | | - Pam P Nyam
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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Sakina R, Chaudhry AG, Khan SE. An Exploration of Illness Narratives of Mothers with Maternal Depression in Semi-Urban Areas. Psychiatr Q 2021; 92:147-159. [PMID: 32488820 DOI: 10.1007/s11126-020-09781-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study explores the pre-diagnosis perceptions and experiences of semi-urban women regarding maternal depression and the issues in the follow-up of its treatment. Using the patient's end of Kleinman's Explanatory Model of Illness, it documents the whole episode of maternal depression in women. The main focus group of this study includes the women diagnosed with maternal depression and registered in the health facilities of Rawalpindi. Research was conducted in one primary health facility i.e. rural health centre of Khayaban e Sir Syed and one secondary health facility i.e. the Tehsil Headquarter Hospital of Taxila that were subject to the Mother and Child Health Program under the Rural Health Sector Reform Project in Punjab. The data shows that the socio-cultural setting of the women affects their perspectives and beliefs regarding maternal depression as well as shapes their health-seeking behavior, as there seemed to be a preference of religious and cultural coping mechanisms resulting in poor compliance with medical services and hurdles in the follow-up of medical treatment. Through understanding the illness beliefs of these women, effective measures can be taken for the provision of better health facilities and ensuring their follow-up.
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Affiliation(s)
- Rabab Sakina
- Bahria University Islamabad Campus, Islamabad, Pakistan.
| | | | - Shaheer Ellahi Khan
- Department of Humanities and Social Sciences, Bahria University Islamabad, Islamabad, Pakistan
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Moore D, Drey N, Ayers S. A meta-synthesis of women's experiences of online forums for maternal mental illness and stigma. Arch Womens Ment Health 2020; 23:507-515. [PMID: 31646392 DOI: 10.1007/s00737-019-01002-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
Abstract
Perinatal mental illness affects 15% of women; however, only half of these women access treatment. Some women with untreated perinatal mental illness may continue to suffer with mental illness after the perinatal period. Evidence suggests that one barrier to accessing treatment is stigma. Forums may provide an acceptable place for women to converse about the stigmatised symptoms of maternal mental illness. Reducing stigma may increase treatment uptake. This study aimed to review and synthesise the qualitative research on maternal mental illness forums and stigma so that stigma can be addressed and treatment improved. A meta-synthesis was conducted to describe and interpret qualitative studies regarding forum use and maternal mental illness stigma. A systematic search of seven electronic databases and Google Scholar was performed. Additional references were collected through screening references of the identified studies. Five studies were identified that reported women's experiences of online forums for maternal mental illness and stigma. The synthesis identified four key themes: (1) a safe place to talk; (2) virtual support; (3) stigma and identity; and (4) repair of the mother identity. Stigma maybe reduced by forum discourse that reconceptualises what is to be a "good mother" and separates stigma and maternal identity. This synthesis provides a novel and more detailed framework for the stigma of maternal mental illness and forum use. This suggests forums may enable women to explore their dual identity and repair their maternal identity, and this may reduce stigma. Healthcare providers could discuss forum use with their clients.
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Affiliation(s)
- D Moore
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK. .,The Open University, Walton Hall, Milton Keynes, UK.
| | - N Drey
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - S Ayers
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
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Cacciola E, Psouni E. Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3887. [PMID: 32486285 PMCID: PMC7313466 DOI: 10.3390/ijerph17113887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.
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Affiliation(s)
| | - Elia Psouni
- Department of Psychology, Lund University, P.O. Box 213, SE221-00 Lund, Sweden;
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Pedley R, Berry K, Bee P, Gellatly J, Wearden A. Testing the psychometric properties of the illness perceptions questionnaire for OCD (IPQ-O). BMC Psychiatry 2019; 19:217. [PMID: 31291916 PMCID: PMC6617616 DOI: 10.1186/s12888-019-2195-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that our perceptions about illness are important determinants of how we respond and adjust to health threats. To examine whether illness perceptions affect illness responses in OCD (e.g. help-seeking), this study aimed to develop and test the psychometric properties of a new OCD-specific tool to assess illness perceptions, the illness perceptions questionnaire for OCD (IPQ-O). METHODS A cross-sectional questionnaire-based design was used. Following adaptation of the IPQ-R based on qualitative interviews with people with OCD, adults (age ≥ 16) with OCD completed the IPQ-O (online or postal), alongside measures of depression, anxiety, OCD severity, attitudes to seeking mental health services and behaviours (e.g. treatment seeking intentions). A sub-sample re-completed the IPQ-O after two-weeks to obtain test-retest reliability. Factor analysis was used to derive the IPQ-O factor structure; internal consistency of subscales was calculated. Convergent validity was explored. RESULTS Three hundred forty-eight people with OCD completed the IPQ-O. After factor analysis, seven main sub-scales and four cause sub-scales were identified, explaining 45.5 and 41.6% of the variance after extraction and rotation respectively. Three sub-scales from the original IPQ-R were validated; other dimensions differed from original IPQ-R sub-scales. The new 'spectrum' sub-scale measures the strength of the view that OCD is a trait that presents to varying extents within the general population. The IPQ-O demonstrated internal consistency, test re-test reliability (Kendall's tau = .51-.75) and convergent validity. Illness perceptions were associated with important aspects of adjustment (depression, anxiety) and condition management (receipt of treatment, plans to seek help). In particular, emerging data showed that those who had not received medication for OCD endorsed stronger spectrum beliefs. Though longitudinal study is needed to verify the direction of this association, this raises the question of whether spectrum beliefs deter people with OCD from using pharmacological treatments. CONCLUSIONS The IPQ-O provides a valuable tool for subsequent testing of whether illness perceptions drive outcomes as proposed by the CSM. If perceptions are found to drive adjustment and behaviour, therapists could elicit and subsequently challenge perceptions that have negative effects on adjustment and coping, as part of psychological therapy.
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Affiliation(s)
- Rebecca Pedley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK. .,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Katherine Berry
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Penny Bee
- 0000000121662407grid.5379.8Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Judith Gellatly
- 0000000121662407grid.5379.8Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Alison Wearden
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences & Manchester Centre for Health Psychology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Stewart SA. Parents' Experience During a Child's Resuscitation: Getting Through It. J Pediatr Nurs 2019; 47:58-67. [PMID: 31048114 DOI: 10.1016/j.pedn.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to elucidate the experiences of parents during their child's resuscitation in the hospital setting. DESIGN AND METHODS This qualitative descriptive study took place in a 280 bed children's hospital with parents whose children experienced resuscitation while they were present in the room or nearby. Semi-structured interviews were conducted between one and twelve months following a child's resuscitation. A rigorous thematic analysis was performed. RESULTS This study elucidates parent experience during a child's resuscitation using four overarching themes; "Overwhelming chaos", "Getting through it", "Cognitive presence" and "Joy mixed with heartache". Parents described their experience to be stressful, yet identified things that helped them get through it and make sense of the experience. CONCLUSIONS During a child's resuscitation parents perceived a sense of overwhelming chaos, yet still had an innate need to be present and know what was going on. While emotional support was appreciated, most important was to receive real time clinical information from healthcare staff and to see and feel that the team was personally invested in their child. PRACTICE IMPLICATIONS During a child's resuscitation, parents should be allowed to choose their level of presence to meet their individual needs. A clinical staff member should answer questions and share clinical information with parents. In addition, clinicians should allow themselves to connect with parents on a personal level. This research provides a foundation for further study, including parents' experience after experiencing a child's resuscitation.
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Affiliation(s)
- Stephanie A Stewart
- University of Iowa College of Nursing, Iowa City, Iowa United States of America; University of Iowa Stead Family Children's Hospital, Iowa City, Iowa United States of America.
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A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe. PLoS One 2019; 14:e0210587. [PMID: 30695019 PMCID: PMC6351025 DOI: 10.1371/journal.pone.0210587] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
Background Women from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds. Aim The aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe. Data sources Searches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies. Design This was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically. Results The 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want. Conclusion Lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.
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Sambrook Smith M, Lawrence V, Sadler E, Easter A. Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open 2019; 9:e024803. [PMID: 30679296 PMCID: PMC6347898 DOI: 10.1136/bmjopen-2018-024803] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. This review examines women, their family members' and healthcare providers' perspectives of barriers to accessing mental health services for women with perinatal mental illness in the UK. DESIGN A systematic review and meta-synthesis of qualitative studies. DATA SOURCES Qualitative studies, published between January 2007 and September 2018, were identified in MEDLINE, PsycINFO, EMBASE and CINAHL electronic databases, handsearching of reference lists and citation tracking of included studies. Papers eligible for inclusion were conducted in the UK, used qualitative methods and were focused on women, family or healthcare providers working with/or at risk of perinatal mental health conditions. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies. RESULTS Of 9882 papers identified, 35 studies met the inclusion criteria. Reporting of emergent themes was informed by an existing multilevel conceptual model. Barriers to accessing mental health services for women with perinatal mental illness were identified at four levels: Individual (eg, stigma, poor awareness), organisational (eg, resource inadequacies, service fragmentation), sociocultural (eg, language/cultural barriers) and structural (eg, unclear policy) levels. CONCLUSIONS Complex, interlinking, multilevel barriers to accessing mental health services for women with perinatal mental illness exist. To improve access to mental healthcare for women with perinatal mental illness multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway. PROSPERO REGISTRATION NUMBER CRD42017060389.
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Affiliation(s)
- Megan Sambrook Smith
- Global Mental Health, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Vanessa Lawrence
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Euan Sadler
- Centre for Implementation Science, Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Abigail Easter
- Centre for Implementation Science, Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Moore D, Ayers S, Drey N. The City MISS: development of a scale to measure stigma of perinatal mental illness. J Reprod Infant Psychol 2018. [PMID: 29517314 DOI: 10.1080/02646838.2017.1313967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women. BACKGROUND Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma. METHOD A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale. RESULTS The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity. CONCLUSION The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.
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Affiliation(s)
- Donna Moore
- a Centre for Maternal and Child Health, School of Health Sciences, City , University of London , London , UK
| | - Susan Ayers
- a Centre for Maternal and Child Health, School of Health Sciences, City , University of London , London , UK
| | - Nicholas Drey
- b School of Health Sciences, City , University of London , London , UK
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Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. Br J Gen Pract 2017; 67:e692-e699. [PMID: 28847773 DOI: 10.3399/bjgp17x692549] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/10/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. AIM To understand the factors affecting women's decision to seek help for perinatal distress. DESIGN AND SETTING Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. METHOD Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. RESULTS In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. CONCLUSION Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress.
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Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health 2015; 18:745-59. [PMID: 26184835 DOI: 10.1007/s00737-015-0548-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Pregnancy and the first postnatal year can be a difficult and distressing period for women with mental health problems, particularly if they are not able to access appropriate and timely assessment and treatment. The aim of this systematic review was to synthesise qualitative evidence on experiences of care for women with (or at risk of developing) antenatal or postnatal mental health problems across a range of disorders (including non-psychotic mental disorders). METHODS Six electronic databases were searched for papers published from 2000 to April 2014. Thirty-nine studies were identified that met the inclusion criteria. Findings were synthesised using secondary framework and thematic analysis approaches. RESULTS Seven key themes were identified across mental disorder groups: an unmet need for collaborative and integrated care; stigma and fears about loss of custody; healthcare professionals unable or unwilling to address psychological needs; focus on babies over mothers; importance of non-judgmental and compassionate support; an unmet need for information; importance of service user involvement in treatment decisions. CONCLUSIONS Women's experience of accessing and engaging with care for mental health problems could be improved if given the opportunity to develop trusting relationships with healthcare professionals who acknowledge and reinforce the woman's role in caring for her baby in a non-judgmental and compassionate manner, and foster hope and optimism about treatment. Information for women, their families and healthcare professionals, and the provision of individualised care and treatment, are also crucial to enable full implementation of a person-centred programme of care.
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Affiliation(s)
- Odette Megnin-Viggars
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK.
| | - Iona Symington
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. .,Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Stephen Pilling
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. .,Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
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Habel C, Feeley N, Hayton B, Bell L, Zelkowitz P. Causes of women's postpartum depression symptoms: Men's and women's perceptions. Midwifery 2015; 31:728-34. [PMID: 25921442 DOI: 10.1016/j.midw.2015.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/27/2015] [Accepted: 03/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe men's and women's perceptions of the causes of women's PPD symptoms and to explore similarities and differences between men's and women's perceptions. DESIGN Qualitative-descriptive study involving in-depth semi-structured individual interviews and content analysis. SETTING In-home interviews of participants recruited in two tertiary care hospitals, both in urban centres of the province of Quebec, Canada. PARTICIPANTS Both members of 30 heterosexual couples from which women scored at least 12 on the Edinburgh Postnatal Depression Scale. FINDINGS Participants described nine causes underlying women's depressive symptoms: societal expectations and pressure on women, physical health problems, transition to parenthood, social connectedness, personality and past psychological history, child health and temperament challenges, unmet care needs, unmet expectations for childbirth, and other life stressors. With one exception, all causes were endorsed by both men and women. Only men mentioned societal pressure on women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Men and women mainly perceived similar causes, which could be explained by socio-cultural factors and extended paternal leaves. Understanding men's and women's perceptions could help tailoring health- care professionals' interventions to couples' needs.
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Affiliation(s)
- Catherine Habel
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, QC, Canada; Center for Nursing Research & Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
| | - Barbara Hayton
- Perinatal Mental Health Service, Jewish General Hospital, Montreal, QC, Canada.
| | - Linda Bell
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
| | - Phyllis Zelkowitz
- Lady Davis Institute & Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
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Wittkowski A, McGrath LK, Peters S. Exploring psychosis and bipolar disorder in women: a critical review of the qualitative literature. BMC Psychiatry 2014; 14:281. [PMID: 25403956 PMCID: PMC4237757 DOI: 10.1186/s12888-014-0281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 09/29/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The experiences of women with severe mental illness warrant particular consideration to identify the strategies they use to facilitate recovery. This review systematically examined women's experiences of psychosis and bipolar disorder. METHODS Following an extensive database search, 13 studies met inclusion criteria. Noblit and Hare's metasynthesis approach was used to synthesise these qualitative studies exploring the experiences of 250 women, of which 78 (31.2%) were also mothers. RESULTS Twelve sub-ordinate themes were identified and categorised into three overarching themes: 1) women's beliefs about illness, 2) perceived consequences of illness, and 3) strategies used to cope with illness. Contextual factors and spiritual beliefs were found to be important in these women's illness appraisals. Women incorporated diagnosis-related information into illness models if it was concordant with their existing beliefs. CONCLUSIONS Women reported negative illness consequences relating to stigma, loss of self-determination and changes to relationships. They employed various strategies in order to cope with illness. Barriers to strategy use and clinical recommendations are presented.
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Affiliation(s)
- Anja Wittkowski
- University of Manchester, School of Psychological Sciences, Zochonis Building, Brunswick Street, Manchester, UK.
| | - Laura K McGrath
- University of Manchester, School of Psychological Sciences, Zochonis Building, Brunswick Street, Manchester, UK
| | - Sarah Peters
- University of Manchester, School of Psychological Sciences, Zochonis Building, Brunswick Street, Manchester, UK
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