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Philip B, Kemp L, Taylor C, Schmied V. Indian immigrants' constructions of mental health and mental illness in the perinatal period: A qualitative study. J Adv Nurs 2024; 80:3797-3811. [PMID: 38268132 DOI: 10.1111/jan.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
AIM The aim of this study is to explore how immigrant women and men from India construct mental health and mental illness in the perinatal period. DESIGN Qualitative interpretive design. METHODS Data were collected by conducting in-depth interviews with 19 participants. Photo elicitation, free listing and pile sorting were used during the interviews. Purposive sampling was used, and data were collected in 2018 and 2019. Data were analysed using thematic analysis. FINDING/RESULTS One major theme and three subthemes were identified. 'We do not talk about it' was the major theme and the subthemes: (1) 'living peacefully and feeling happy' described the views on mental health; (2) 'that's the elephant in the room still' captures how participants felt when talking about mental illness; and (3) 'why don't we talk about it' offers reasons why the Indian community does not talk about mental health and illness. CONCLUSION The findings of this study have highlighted the importance of understanding the impact of immigration and being culturally sensitive when assessing mental health in the perinatal period. IMPACT The findings of this study identify some of the reasons for non-disclosure of mental health issues by immigrants. Incorporating these findings during psychosocial assessment by health professionals in the perinatal period will help translate the cultural aspects into more effective communication. PATIENT OR PUBLIC CONTRIBUTION Patient and public contribution to the study was provided by the Community Stakeholders Group; these were members of the immigrant community from India who had expertise in mental health. They contributed to the study design and the key terms and phrases for the free list used in interviews.
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Affiliation(s)
- Bridgit Philip
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Clinical Midwife Consultant, Perinatal and Infant Mental Health, Nepean Hospital, NBMLHD, Kingswood, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Christine Taylor
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- NSW Centre for Evidence-Based Health Care: A Joanna Briggs Institute Affiliated Group, Sydney, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use. OBJECTIVE Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences. DESIGN Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy. FINDINGS We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported. CONCLUSIONS Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Xiao X, Ma H, Zhu S, Li Q, Chen Y. The perceptions and attitudes of obstetric staff and midwives towards perinatal mental health disorders screening: a qualitative exploratory study in Shenzhen, China. BMC Nurs 2023; 22:313. [PMID: 37705010 PMCID: PMC10498526 DOI: 10.1186/s12912-023-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task. METHODS This is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019. RESULTS A total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening. CONCLUSION Medical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women's perinatal mental disorders, and provide continuous and holistic care for pregnant women.
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Affiliation(s)
- Xiao Xiao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Haixia Ma
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Kowloon, Hong Kong, China
| | - Shening Zhu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Qiaomeng Li
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, China.
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Andersen CG, Thomsen LLH, Gram P, Overgaard C. ‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme. Midwifery 2023; 122:103675. [PMID: 37043942 DOI: 10.1016/j.midw.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. DESIGN a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. SETTING nine community-based and hospital-based midwife clinics in the North Region of Denmark. INTERVENTION a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. PARTICIPANTS AND DATA 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. FINDINGS contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. CONCLUSION midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.
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Marshman A, Saunders E, Chaves D, Morton Ninomiya ME. Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review. Midwifery 2023; 117:103544. [PMID: 36580794 DOI: 10.1016/j.midw.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients. METHODS A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care. RESULTS Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels. DISCUSSION While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels. CONCLUSION Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.
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Affiliation(s)
| | | | | | - Melody E Morton Ninomiya
- Wilfrid Laurier University; Centre for Addiction and Mental Health; Canada Research Chair (Tier II) in Community-Driven Knowledge Mobilization and Pathways to Wellness.
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Cull J, Thomson G, Downe S, Fine M, Topalidou A. Views from women and maternity care professionals on routine discussion of previous trauma in the perinatal period: A qualitative evidence synthesis. PLoS One 2023; 18:e0284119. [PMID: 37195971 DOI: 10.1371/journal.pone.0284119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/23/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Over a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period. METHODS Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual. RESULTS We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians. CONCLUSION Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.
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Affiliation(s)
- Joanne Cull
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Michelle Fine
- Public Science Project, The Graduate Center, City University of New York, New York, United States of America
| | - Anastasia Topalidou
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
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Yılmaz M, Değirmenci F, Yılmaz DV. A psychosocial examination of feelings and thoughts about pregnancy: A qualitative study. Midwifery 2021; 103:103106. [PMID: 34352598 DOI: 10.1016/j.midw.2021.103106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND during pregnancy, which is a developmental period, there are risks that may cause pathological changes when physical, mental and social adaptation is not achieved. During antenatal appointments, it is possible to provide necessary care for pregnant women at the right time by screening for risks that threaten health. In addition to physical risk factors, psychosocial risk factors that can have significant effects on the health of pregnant women should also be included in antenatal appointments. A woman's inability to meet her needs or difficulties encountered in psychosocial areas, such as mental health, family relations, social life and job status during pregnancy, may result in mental and social problems as well as physical problems. Insufficient social support, job loss and family communication problems can leave pregnant women vulnerable to stress and cause many pregnancy complications, such as preterm labor. When problems in these areas cannot be detected at an early stage, they can threaten the life of the woman and the fetus. As such, knowledge of the specific feelings and thoughts of pregnant women from a psychosocial perspective will be useful in the evaluation of psychosocial risk factors. PURPOSE to determine the feelings and thoughts of pregnant women from a psychosocial perspective. METHOD this study used a qualitative descriptive approach to investigate pregnancy-related feelings and thoughts in a sample of 23 healthy pregnant women. Data were collected using a personal information form and a semi-structured interview form. The interviews, which were conducted using the semi-structured interview form and individual in-depth interviews, were recorded on a voice recorder. A thematic approach was used to analyze the data. RESULTS according to the results, the mean age of the pregnant women was 30.39 (standard deviation 4.03) years, 73.9% were university graduates and 78.3% were multiparous. Three main themes ('Pregnancy perception', 'Emotions in pregnancy' and 'Psychosocial dimension of pregnancy') and eight subthemes emerged from the data analysis. For 'Pregnancy perception', the subtheme was 'Meaning of pregnancy'. For 'Emotions in pregnancy', the subthemes were 'Emotional status (mood) in pregnancy' and 'Fear in pregnancy'. For 'Psychosocial dimension of pregnancy', the subthemes were 'Reflections of pregnancy on social life', 'Reflections of pregnancy on body image', 'Reflections of pregnancy on sexual life', 'Reflections of pregnancy on marital relationship' and 'Reflections of pregnancy on working life'. CONCLUSIONS in order to protect and maintain the health of the mother and fetus during pregnancy, it is recommended that women should be provided with the best physical and psychosocial care within the context of social and cultural structure, not only in this period but in every stage of their lives.
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Affiliation(s)
- Mualla Yılmaz
- Department of Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Filiz Değirmenci
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey.
| | - Duygu Vefikuluçay Yılmaz
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey
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Heinonen K. Strengthening Antenatal Care towards a Salutogenic Approach: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105168. [PMID: 34068114 PMCID: PMC8152723 DOI: 10.3390/ijerph18105168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
The aim was to explore how midwives, public health nurses and nurses view caring in antenatal care (ANC) as provided for mothers and fathers/partners. Based on Noblit and Hare (1988), meta-ethnography was used to address meaning by synthesizing knowledge and understanding inductively through selected qualitative studies (n = 16). Four core themes were identified: (1) supporting the parents to awaken to parenthood and creating a firm foundation for early parenting and their new life situation; (2) guiding parents on the path to parenthood and new responsibility; (3) ensuring normality and the bond between baby and parents while protecting life; and (4) promoting the health and wellbeing of the family today and in the future. The overarching theme can be expressed as "helping the woman and her partner prepare for their new life with the child by providing individualized, shared care, firmly grounded and with a view of the future". Caring in antenatal care (ANC) is being totally present, listening and using multidimensional professional competence but also being open-minded to new aspects and knowledge. The health promotion and positive health aspects should be considered an important part of supporting parents and the whole family now and in the future. A more conscious salutogenic approach to ANC would lead to more favorable results and could be a fruitful research topic in the future. There is a need to provide midwives/nurses with enough time to allow them to concentrate on specific needs and support for different kind of families in ANC but also training for midwives to make them more familiar with online and other options.
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Affiliation(s)
- Kristiina Heinonen
- Health Care and Health Promotion, Metropolia University of Applied Sciences, P.O. Box 4000, FI-00079 Helsinki, Finland;
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, FI-70210 Kuopio, Finland
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Frederiksen MS, Schmied V, Overgaard C. Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position. J Clin Nurs 2021; 30:2386-2398. [PMID: 33870548 DOI: 10.1111/jocn.15778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive. OBJECTIVES This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care. DESIGN Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi-structured interviews with parents and 51 field visits during parent-professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used. RESULTS The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured. CONCLUSION Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non-judgmental way. RELEVANCE TO CLINICAL PRACTICE Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period.
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Affiliation(s)
- Marianne Stistrup Frederiksen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Fletcher A, Murphy M, Leahy-Warren P. Midwives' experiences of caring for women's emotional and mental well-being during pregnancy. J Clin Nurs 2021; 30:1403-1416. [PMID: 33527534 DOI: 10.1111/jocn.15690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To explore midwives' experiences of caring for women's emotional and mental well-being during pregnancy. BACKGROUND Transitioning to motherhood is a major life event for any woman and while it is a joyful experience for the majority, 15%-25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women's emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area; therefore, this study addressed this gap in the literature. DESIGN Qualitative descriptive design. METHODS Semi-structured interviews were conducted with a purposive sample of 10 midwives recruited from the Irish midwifery e-group. Data were analysed using Burnard (Nurse Educ. Today, 11, 1991, 461) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories were then evolved into subthemes, and eventually, three themes were emerged using the COREQ checklist. RESULTS Three salient themes emerged from the data are as follows: 'awareness of Perinatal Mental Health', 'discussing emotional well-being' and 'the woman has something to divulge'. The themes convey the midwife's awareness, recognition and perceptions of mental well-being during pregnancy. How midwives discuss and assess emotional well-being, the observational skills they use, and what they perceive as the barriers and facilitators to discussing mental well-being were all identified. CONCLUSIONS Midwives reported an awareness and acceptance that women's emotional health was as important as their physical health. Midwives used every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk. RELEVANCE TO CLINICAL PRACTICE Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women's emotional well-being.
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Affiliation(s)
- Antoinette Fletcher
- Centre for Midwifery Education, Located at the Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Brookfield Health Sciences Complex, Cork, Ireland
| | - Patricia Leahy-Warren
- School of Nursing and Midwifery, University College Cork, Brookfield Health Sciences Complex, Cork, Ireland
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Brunton R, Gosper K, Dryer R. Psychometric evaluation of the pregnancy-related anxiety scale: Acceptance of pregnancy, avoidance, and worry about self subscales. J Affect Disord 2021; 278:341-349. [PMID: 32992068 DOI: 10.1016/j.jad.2020.09.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/14/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Increasingly pregnancy-related anxiety is acknowledged as a distinct anxiety type, characterised by specific fears/worries. The Pregnancy-related Anxiety Scale (PrAS) screens for this distinct anxiety and refinements to the scale have prompted further validity examination. This study aims to: replicate findings that distinguished pregnancy-related anxiety from general anxiety/depression using the PrAS; confirm the PrAS's factor structure, and examine the validity of the PrAS subscales: Acceptance of Pregnancy, Avoidance and Worry About Self. METHODS Pregnant women (N = 608) were recruited online and completed the PrAS, Pregnancy Acceptance Questionnaire, Ways of Coping Questionnaire, Cambridge Worry Scale, Parenting Sense of Competence Scale, State Trait Anxiety Inventory and the Edinburgh Depression Scale. RESULTS Multiple regression analysis confirmed general anxiety/depression contributed little to the PrAS's variance, supporting the scale's validity and distinctiveness of pregnancy-related anxiety. Structural equation modelling confirmed the PrAS's factor structure, and the three PrAS subscales generally correlated more highly with convergent measures than the discriminant measures. LIMITATIONS Limitations included the cross-sectional design of the study and the use of some convergent/discriminant measures that lacked validity evidence for prenatal use. CONCLUSIONS This study provides evidence of the distinctiveness of pregnancy-related anxiety from state/trait anxiety and depression and also adds to the psychometric properties of the PrAS. The PrAS is a useful screening scale that can be used for antenatal screening potentially reducing the risk of adverse outcomes associated with pregnancy-related anxiety. The PrAS is also a useful research tool providing a more comprehensive assessment of pregnancy-related anxiety.
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Affiliation(s)
- Robyn Brunton
- School of Psychology, Charles Sturt University, Bathurst New South Wales 2795, Australia.
| | - Katrina Gosper
- Australian College of Applied Psychology, Sydney New South Wales 2000, Australia
| | - Rachel Dryer
- Australian Catholic University, Strathfield Campus, New South Wales 2135, Australia
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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Kornaros K, Zwedberg S, Nissen E, Salomonsson B. A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives. Infant Ment Health J 2019; 41:108-125. [PMID: 31583752 DOI: 10.1002/imhj.21828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.
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Affiliation(s)
- Katarina Kornaros
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen, 18 A, 171 77, Stockholm, Sweden
| | | | - Eva Nissen
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen, 18 A, 171 77, Stockholm, Sweden
| | - Björn Salomonsson
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen, 18 A, 171 77, Stockholm, Sweden
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Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e389-e405. [PMID: 30900371 DOI: 10.1111/hsc.12740] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Nursing and Midwifery Research Centre, Newcastle, Australia
- University of Newcastle, Faculty of Health and Medicine, Newcastle, Australia
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Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section. Women Birth 2018; 31:453-462. [DOI: 10.1016/j.wombi.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 01/01/2023]
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Noonan M, Jomeen J, Galvin R, Doody O. Survey of midwives’ perinatal mental health knowledge, confidence, attitudes and learning needs. Women Birth 2018; 31:e358-e366. [DOI: 10.1016/j.wombi.2018.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
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Kornaros K, Zwedberg S, Nissen E, Salomonsson B. A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses' perspectives. BMC Nurs 2018; 17:42. [PMID: 30258284 PMCID: PMC6151071 DOI: 10.1186/s12912-018-0311-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm. Methods In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach. Results Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC). Conclusion The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.
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Affiliation(s)
- Katarina Kornaros
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Nissen
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Björn Salomonsson
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Carroll M, Downes C, Gill A, Monahan M, Nagle U, Madden D, Higgins A. Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study. Midwifery 2018; 64:29-37. [DOI: 10.1016/j.midw.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/15/2018] [Accepted: 05/12/2018] [Indexed: 01/07/2023]
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Wadephul F, Jarrett PM, Jomeen J, Martin CR. A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health. J Adv Nurs 2018; 74:2258-2272. [PMID: 29989193 DOI: 10.1111/jan.13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/27/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
AIM To ascertain whether a new framework examining midwifery practice in perinatal mental health (PMH) is supported by the research literature. BACKGROUND The identification and care of women with PMH problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which have an impact on midwives' ability to identify, assess and care for women with PMH problems. DESIGN This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis. DATA SOURCES Relevant electronic databases were searched for the period from January 2007-December 2016; 33 studies from nine countries met the inclusion criteria. REVIEW METHODS Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain. RESULTS All five domains are substantially represented in the literature, thus supporting the proposed framework. Several sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organizational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organizational level. CONCLUSION The proposed framework was confirmed and can be used to inform practice, policy and research.
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Affiliation(s)
- Franziska Wadephul
- School of Health and Social Work, Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Julie Jomeen
- School of Health and Social Work, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Colin R Martin
- Institute for Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull
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20
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Barriers to antenatal psychosocial assessment and depression screening in private hospital settings. Women Birth 2018; 31:292-298. [DOI: 10.1016/j.wombi.2017.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
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Nagle U, Farrelly M. Women's views and experiences of having their mental health needs considered in the perinatal period. Midwifery 2018; 66:79-87. [PMID: 30149202 DOI: 10.1016/j.midw.2018.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore women's views and experiences of having their mental health needs considered in the perinatal period in an Irish maternity hospital setting. DESIGN A qualitative design using semi-structured interviews was used to explore women's views and experiences. Data were analysed using Thematic Analysis (Braun and Clarke, 2006). SETTING A voluntary maternity hospital in Dublin, Ireland which had access to a perinatal mental health team. PARTICIPANTS In total 8 women who met the inclusion criteria were recruited and participated in this study. The women were interviewed in the early postpartum period. FINDINGS The study offers important insights into how women feel about having their mental health needs considered in the perinatal period. Women reported pregnancy was an emotional time, feeling expected to be happy, and women with significant mental health histories preferred not to be referred to available services unless they asked for help. Women reported barriers to disclosure including stigma/shame, lack of time. Screening tools were viewed with mixed opinions. In getting help, the baby was a motivator for some women, attitudes of healthcare professionals and lack of time affected this. KEY CONCLUSIONS Women appreciated all methods of enquiry about their mental health and being given time to discuss concerns with healthcare professionals. Perceived busy staff workloads was a barrier in asking for help, as was lack of continuity of care. Screening tools were viewed as a tick box exercise, but also as a 'modality' to assist detection of women at risk. Mental health enquiry focused on depression and anxiety, with little or no enquiry about less common disorders. Women with significant histories were less likely to engage or accept referral to perinatal mental health services, preferring to access help if they felt they needed to. IMPLICATIONS FOR PRACTICE HCPs should enquire regularly about women's emotional wellbeing at every antenatal and postnatal contact, offering support where required. Detailed enquiry about mental health should encompass the broad spectrum of perinatal mental health problems, including but not limited to depression and anxiety. Screening tools can assist in the identification of women at risk of developing perinatal mental health problems. A specialist mental health midwife should link with high-risk women at the first antenatal booking visit and provide information on early intervention and access to services.
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Affiliation(s)
- Ursula Nagle
- CMM2 Perinatal Mental Health Midwife, The Rotunda Hospital, Dublin, Ireland .
| | - Mary Farrelly
- Assistant Professor, School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
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Fogarty S, Elmir R, Hay P, Schmied V. The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC Pregnancy Childbirth 2018; 18:121. [PMID: 29720107 PMCID: PMC5932857 DOI: 10.1186/s12884-018-1762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is a time of enormous body transformation. For those with an eating disorder during pregnancy this time of transformation can be distressing and damaging to both the mother and the child. In this meta-ethnographic study, we aimed to examine the experiences of women with an Eating Disorder in the perinatal period; that is during pregnancy and two years following birth. METHOD A meta-ethnographic framework was used in this review. After a systematic online search of the literature using the keywords such as pregnancy, eating disorders, anorexia, bulimia, binge eating disorder, perinatal, postnatal and post-partum, 11 papers, involving 94 women, were included in the review. RESULTS A qualitative synthesis of the papers identified 2 key themes. The key theme that emerged during pregnancy was: navigating a 'new' eating disorder. The key that emerged in the perinatal period was return to the 'old' eating disorder. CONCLUSION Following a tumultuous pregnancy experience, many described returning to their pre-pregnancy eating behaviors and thoughts. These experiences highlight the emotional difficulty experienced having an eating disorder whilst pregnant but they also point to opportunities for intervention and a continued acceptance of body image changes. More research is needed on the experiences of targeted treatment interventions specific for pregnant and postpartum women with an eating disorder and the effectiveness of putative treatment interventions during this period.
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Affiliation(s)
- Sarah Fogarty
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Rakime Elmir
- Affiliate Ingham Institute for Applied Medical Research, Centre for Applied Nursing Research (CANR), Liverpool, NSW 2170 Australia
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Phillipa Hay
- School of Medicine and Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Dahlen HG, Munoz AM, Schmied V, Thornton C. The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years. BMJ Open 2018; 8:e019566. [PMID: 29695386 PMCID: PMC5922470 DOI: 10.1136/bmjopen-2017-019566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intimate partner violence (IPV) is a global health issue affecting mainly women and is known to escalate during pregnancy and impact negatively on obstetric and perinatal outcomes. The aim of this study is to determine the incidence of IPV in a pregnant multicultural population and to determine the relationship between IPV reported at booking interview and maternal and perinatal outcomes. DESIGN This is a retrospective population-based data study. We analysed routinely collected data (2006-2016) from the ObstetriX system on a cohort of pregnant women. SETTING AND PARTICIPANTS 33 542 women giving birth in a major health facility in Western Sydney. PRIMARY OUTCOMES Incidence of IPV, association with IPV and other psychosocial variables and maternal and perinatal outcomes. RESULT 4.3% of pregnant women reported a history of IPV when asked during the routine psychosocial assessment. Fifty-four per cent were not born in Australia, and this had increased significantly over the decade. Women born in New Zealand (7.2%) and Sudan (9.1%) were most likely to report IPV at the antenatal booking visit, with women from China and India least likely to report IPV. Women who reported IPV were more likely to report additional psychosocial concerns including Edinburgh Postnatal Depression Scale scores > 13 (7.6%), thoughts of self-harm (2.4%), childhood abuse (23.6%), and a history of anxiety and depression (34.2%). Women who reported IPV were more likely to be Australian born, smoke and be multiparous and to have been admitted for threatened preterm labour (Adjusted Odds Ratio (AOR) 1.8, 95% CI 1.28 to 2.39). CONCLUSIONS A report of IPV at the first antenatal booking visit is associated with a higher level of reporting on all psychosocial risks, higher antenatal admissions, especially for threatened preterm labour. More research is needed regarding the effectiveness of current IPV screening for women from other countries.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Ana Maria Munoz
- Blacktown Mount Druitt Hospitals, Blacktown, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Higgins A, Downes C, Monahan M, Gill A, Lamb SA, Carroll M. Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study. J Clin Nurs 2018; 27:1872-1883. [PMID: 29314366 DOI: 10.1111/jocn.14252] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. BACKGROUND Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. DESIGN The research used a descriptive design. METHODS A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. RESULTS Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. CONCLUSIONS Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. RELEVANCE TO CLINICAL PRACTICE Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with confidence and competence.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mark Monahan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Ailish Gill
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Stephen A Lamb
- Waterford/Wexford Mental Health Services HSE South, Waterford, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Schmied V, Black E, Naidoo N, Dahlen HG, Liamputtong P. Migrant women's experiences, meanings and ways of dealing with postnatal depression: A meta-ethnographic study. PLoS One 2017; 12:e0172385. [PMID: 28296887 PMCID: PMC5351835 DOI: 10.1371/journal.pone.0172385] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
Aim To conduct a meta-ethnographic study of the experiences, meanings and ways of ‘dealing with’ symptoms or a diagnosis of postnatal depression amongst migrant women living in high income countries. Background Prevalence of postnatal depression is highest amongst women who are migrants. Yet many women do not seek help for their symptoms and health services do not always respond appropriately to migrant women’s needs. Studies have reported migrant women’s experiences of postnatal depression and it is timely to synthesise findings from these studies to understand how services can be improved. Design A meta-ethnographic synthesis of 12 studies reported in 15 papers Data sources Five databases were searched for papers published between January 1999 and February 2016 Review methods The quality of included studies was assessed using the Critical Appraisal Skills Program tool. The synthesis process was guided by the seven steps of meta-ethnography outlined by Noblit and Hare. Findings Four key metaphors were identified: “I am alone, worried and angry—this is not me!”; ‘Making sense of my feelings’ ‘Dealing with my feelings’ and ‘What I need to change the way I feel!’. Primarily women related their feelings to their position as a migrant and as women, often living in poor socio-economic circumstances and they were exhausted keeping up with expected commitments. Many women were resourceful, drawing on their personal strengths and family / community resources. All the studies reported that women experienced difficulties in accessing appropriate services. Conclusion The meta-ethnographic study demonstrates the impact of migration on perinatal mental health, particularly for women lacking family support, who have no employment, a precarious migration status and/or relationship conflict. Migrant women are resourceful and this requires support through appropriate services. Further research is needed to evaluate effective support strategies for migrant women in the perinatal period.
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Affiliation(s)
- Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- * E-mail:
| | - Emma Black
- Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, Burwood, New South Wales, Australia
| | - Norell Naidoo
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Ingham Institute for health and Medical research, Liverpool, New South Wales, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
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Noonan M, Doody O, Jomeen J, Galvin R. Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review. Midwifery 2017; 45:56-71. [DOI: 10.1016/j.midw.2016.12.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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Scharmanski S, Renner I. Familiäre Ressourcen und Hilfebedarfe erfassen: Zur Konstruktvalidität und Reliabilität des Systematischen Explorations- und Verlaufsinventars für Gesundheitsfachkräfte in den Frühen Hilfen (SEVG). ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 118-119:1-9. [DOI: 10.1016/j.zefq.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/29/2016] [Accepted: 10/29/2016] [Indexed: 11/15/2022]
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McGarry J, Ali P. Researching domestic violence and abuse in healthcare settings: Challenges and issues. J Res Nurs 2016. [DOI: 10.1177/1744987116650923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Domestic violence and abuse (DVA) is now recognised as a significant global health and societal issue. Conducting DVA research in healthcare contexts requires the consideration and understanding of a number of practical, methodological and ethical issues. Based on their experiences of working as clinicians and researchers, the authors aim to explore some of the pertinent issues and challenges associated with DVA research conducted in healthcare settings involving patients and/or healthcare professionals or both. A number of ethical, methodological and practical challenges, particularly those associated with research design and data collection, and ethical challenges related to participants and researchers, are explored.
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Affiliation(s)
- Julie McGarry
- Associate Professor, School of Health Sciences, University of Nottingham, UK
| | - Parveen Ali
- Lecturer, School of Nursing and Midwifery, University of Sheffield, UK
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McGlone C, Hollins Martin CJ, Furber C. Midwives’ experiences of asking the Whooley questions to assess current mental health: a qualitative interpretive study. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2016.1188278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Carole McGlone
- School of Nursing, Midwifery and Social Work, University of Manchester , Manchester, UK
| | | | - Christine Furber
- School of Nursing, Midwifery and Social Work, University of Manchester , Manchester, UK
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Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study. BMC Pregnancy Childbirth 2015; 15:292. [PMID: 26552427 PMCID: PMC4640409 DOI: 10.1186/s12884-015-0681-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Bryanne Barnett
- School of Psychiatry, Clinical Director, St John of God Raphael Centre, Medicine, University of New South Wales, 36-38 First Avenue, Blacktown, NSW, 2148, Australia. .,St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Jane Kohlhoff
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. .,Karitane, P.O. Box 241, Villawood, 2163 NSW, Australia.
| | - Maya Elizabeth Drum
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Ana Maria Munoz
- Clinical Midwifery Consultant, Blacktown Hospital, Blacktown, Australia.
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Darwin Z, McGowan L, Edozien LC. Antenatal mental health referrals: review of local clinical practice and pregnant women's experiences in England. Midwifery 2014; 31:e17-22. [PMID: 25467596 DOI: 10.1016/j.midw.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to investigate (i) the consistency and completeness of mental health assessment documented at hospital booking; (ii) the subsequent management of pregnant women identified as experiencing, or at risk of, mental health problems; and (iii) women's experiences of the mental health referral process. DESIGN mixed methods cohort study SETTING large, inner-city hospital in the north of England PARTICIPANTS women (n=191) booking at their first formal antenatal appointment; mean gestational age at booking 13 weeks. METHODS women self-completed the routine mental health assessment in the clinical handheld maternity notes, followed by a research pack. Documentation of mental health assessment (including assessment of depression symptoms using the Whooley and Arroll questions, and mental health history), mental health referrals and their management were obtained from women's health records following birth. Longitudinal semi-structured interviews were conducted with a purposive sub-sample of 22 women during and after pregnancy. FINDINGS documentation of responses to the Whooley and Arroll questions was limited to the handheld notes and symptoms were not routinely monitored using these questions, even for women identified as possible cases of depression. The common focus of referrals was on the women's previous mental health history rather than current depression symptoms, assessed using the Whooley questions. Women referred to a Mental Health Specialist Midwife for further support were triaged based on the written referral and few met eligibility criteria. Although some women initially viewed the referral as offering a 'safety net', analysis of health records and subsequent interviews with women both indicated that communication regarding the management of referrals was inadequate and women tended not to hear back about the outcome of their referral. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE mental health assessment was introduced without ensuring that identified needs would be managed consistently. Care pathways and practices need to encompass identification, subsequent referral and management of mental ill-health, and ensure effective communication with patients and between health professionals.
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Affiliation(s)
- Zoe Darwin
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
| | - Linda McGowan
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Leroy C Edozien
- Manchester Academic Health Science Centre, University of Manchester, St Mary's Hospital, Manchester M13 9WL, UK
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Myors KA, Schmied V, Johnson M, Cleary M. 'My special time': Australian women's experiences of accessing a specialist perinatal and infant mental health service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:268-277. [PMID: 24224792 DOI: 10.1111/hsc.12079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal-infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face-to-face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, 'my special time' and three sub-themes, 'there is someone out there for me', 'it wasn't just a job' and 'swimming or stranded: feelings about leaving the service', were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self-determination in all therapeutic processes, including discharge, if recovery and self-efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, The University of Western Sydney, Penrith South DC, New South Wales, Australia
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Yelland J, Brown SJ. Asking women about mental health and social adversity in pregnancy: results of an Australian population-based survey. Birth 2014; 41:79-87. [PMID: 24571172 DOI: 10.1111/birt.12083] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Social adversity undermines health in pregnancy. The objective of this study was to examine the extent to which pregnant women were asked about their mental health and life circumstances in pregnancy checkups. METHOD Population-based postal survey of recent mothers in two Australian states. FINDINGS Around half of the 4,366 participants reported being asked about depression (45.9%) and whether they were anxious or worried about things happening in their life (49.6%); fewer reported being asked about relationship issues (29.6%), financial problems (16.6%), or family violence (14.1%). One in five women (18%) reported significant social adversity. These women were more likely to recall being asked about their mental health and broader social health issues. Far higher levels of inquiry were reported by women in the public maternity system with midwives more likely than doctors to ask about mental health, family violence, and other social hardships. CONCLUSIONS Routine pregnancy visits afford a window of opportunity for identifying and supporting women experiencing mental health problems and social adversity. Changing practice to take advantage of this opportunity will require concerted and coordinated efforts by practitioners and policy makers to build systems to support public health approaches to antenatal care.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
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Gulliver PJ, Dixon RS. Immediate and long-term outcomes of assault in pregnancy. Aust N Z J Obstet Gynaecol 2014; 54:256-62. [DOI: 10.1111/ajo.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Pauline J. Gulliver
- New Zealand Family Violence Clearinghouse; University of Auckland; Auckland New Zealand
| | - Robyn S. Dixon
- School of Nursing; University of Auckland; Auckland New Zealand
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Reilly N, Harris S, Loxton D, Chojenta C, Forder P, Milgrom J, Austin MP. Referral for management of emotional health issues during the perinatal period: does mental health assessment make a difference? Birth 2013; 40:297-306. [PMID: 24344711 DOI: 10.1111/birt.12067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND There exists little evidence that routine assessment of current or past mental health in the perinatal period positively impacts on rates of referral for emotional health issues. This study aimed to evaluate the impact of this early intervention approach on reported referrals for emotional health issues during pregnancy and the first postpartum year. METHOD A subsample of women (N = 1,804) drawn from the Australian Longitudinal Study on Women's Health participated in the study. RESULTS Multivariate analyses showed that predictors of being given a referral for emotional health issues during pregnancy and the postnatal period, respectively, included assessment of past mental health (Adjusted Odds Ratio [AOR] = 4.40, p < 0.001, and AOR = 5.69, p < 0.001), assessment of current mental health (AOR = 2.47, p < 0.001, and AOR = 2.72, p < 0.001), and reported experience of significant emotional distress (AOR = 2.58, p < 0.001, and AOR = 2.83, p < 0.001). The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment. CONCLUSIONS This study highlights that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals. Importantly, results suggest that enquiry about current mental health is associated with appropriate rates of referral rather than a nonspecific inflation of referrals. In line with Australia's Clinical Practice Guidelines for Perinatal Mental Health, the value of a comprehensive approach to mental health assessment to aid decision making around referral for further assessment or care is particularly evident.
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Affiliation(s)
- Nicole Reilly
- Perinatal and Women's Mental Health Unit, St. John of God Health Care and University of New South Wales, Burwood, NSW, Australia
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Milgrom J, Gemmill AW. Screening for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2013; 28:13-23. [PMID: 24095728 DOI: 10.1016/j.bpobgyn.2013.08.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 06/20/2013] [Accepted: 08/22/2013] [Indexed: 01/03/2023]
Abstract
Perinatal depression is prevalent, under-diagnosed and can have serious long-term effects on the wellbeing of women, their partners and infants. In the absence of active identification strategies, most women with perinatal depression will neither seek nor receive help. To enable early detection and timely intervention, universal screening is coming to be seen as best practice in many settings. Although the strength of recommendations and the preferred methods of identification vary in different countries (e.g. the Edinburgh Postnatal Depression Scale, brief case-finding questions), appropriate training for health professionals in wider psychosocial assessment is essential to maximise usefulness while minimising potential harms. Clear pathways of systematic follow up of all positive screening results with a diagnostic procedure and access to effective treatment are centrally important both for the clinical effectiveness of screening and for health system costs. It is also necessary to further build on the emerging evidence base for the clinical effectiveness of screening.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia
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Schmied V, Johnson M, Naidoo N, Austin MP, Matthey S, Kemp L, Mills A, Meade T, Yeo A. Maternal mental health in Australia and New Zealand: A review of longitudinal studies. Women Birth 2013; 26:167-78. [DOI: 10.1016/j.wombi.2013.02.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/03/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
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Rollans M, Schmied V, Kemp L, Meade T. Digging over that old ground: an Australian perspective of women's experience of psychosocial assessment and depression screening in pregnancy and following birth. BMC WOMENS HEALTH 2013; 13:18. [PMID: 23570282 PMCID: PMC3636103 DOI: 10.1186/1472-6874-13-18] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/15/2013] [Indexed: 11/16/2022]
Abstract
Background There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women’s experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women’s experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response. Methods This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified. Results Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; ’Unexpected: a bit out of the blue’, ‘Intrusive: very personal questions’ and ‘Uncomfortable: digging over that old ground’, describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled: Approach: ’sensitivity and care’ and ’being watched’. Conclusions The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information.
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Affiliation(s)
- Mellanie Rollans
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia.
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