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Hurwitz E, Butzin-Dozier Z, Master H, O'Neil ST, Walden A, Holko M, Patel RC, Haendel MA. Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study. JMIR Mhealth Uhealth 2024; 12:e54622. [PMID: 38696234 PMCID: PMC11099816 DOI: 10.2196/54622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. OBJECTIVE The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. METHODS Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. RESULTS Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method's specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. CONCLUSIONS This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies.
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Affiliation(s)
- Eric Hurwitz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zachary Butzin-Dozier
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Shawn T O'Neil
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anita Walden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Holko
- International Computer Science Institute, Berkeley, CA, United States
| | - Rena C Patel
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melissa A Haendel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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2
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Xiao M, Huang S, Liu Y, Tang G, Hu Y, Fu B, Lei J. Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study. Midwifery 2024; 132:103973. [PMID: 38442529 DOI: 10.1016/j.midw.2024.103973] [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: 05/04/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors. METHODS A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors. FINDINGS Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help. CONCLUSION Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.
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Affiliation(s)
- Meili Xiao
- Department of Nursing, Hunan Normal University School of Medicine, 371 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Sasa Huang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Yongrong Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Guanxiu Tang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Ying Hu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Bing Fu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Jun Lei
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
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3
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Nelson HO. Experiencing birth trauma: Individualism and isolation in postpartum. Soc Sci Med 2024; 345:116663. [PMID: 38364723 DOI: 10.1016/j.socscimed.2024.116663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
Approximately 25-35% of individuals report experiencing a traumatic birth in the United States. Birth trauma has commonly been focused on the experience of labor and delivery itself, with definitions frequently pointing to specific clinical interventions, interactions with providers, and individual expectations during labor and delivery. These definitions however remain too limited, assuming that birth trauma has a discrete temporality-emerging in childbirth-and largely underestimate the social and structural factors that drive trauma. Drawing from interviews conducted between November 2021 and April 2023 with thirty cisgender women who have given birth at least once in the United States, I reveal how the postpartum period is a particularly vulnerable time for trauma emergence, even when absent of difficult delivery experiences. I reveal how social and structural factors in the postpartum period trigger trauma that remains largely invisible, leaving individuals isolated. I situate these women's experiences within the sociological scholarship on trauma, (bio)medicalization, neoliberalism, and risk, to reveal a critical need to expand definitions of, and approaches to, birth trauma.
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Affiliation(s)
- Hyeyoung Oh Nelson
- Department of Health and Behavioral Sciences, University of Colorado-Denver, USA.
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4
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Borrero L, Dietsch A, Santurri LE, Ewen HH. New Mothers With Postpartum Depression: A Qualitative Exploration of Healthcare Decision-Making. QUALITATIVE HEALTH RESEARCH 2024; 34:217-226. [PMID: 37997365 DOI: 10.1177/10497323231206783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Postpartum depression (PPD) is a significant health issue for many new mothers in the weeks and months following a child's birth. Quantitative data suggest that a mother's PPD negatively impacts healthcare decision-making for the child via routine well-baby visits and pediatric care. However, little is known from a qualitative perspective about the factors that challenge or facilitate these healthcare decisions. The purpose of this descriptive qualitative study was to understand the perceptions of new mothers about factors contributing to their healthcare decision-making, for themselves and for their children, while living with PPD. The researchers used purposive sampling to recruit eight women from clinics, community organizations, and social media support groups who met the study's inclusion criteria. Individual semi-structured interviews were carried out with eight participants about their PPD experiences, motherhood, and healthcare decision-making influences. Transcribed interviews and initial themes were shared with participants to verify researcher interpretations and aid in the analysis process. The researchers analyzed interview data using thematic analysis to cultivate an understanding of the phenomenon by identifying and interpreting patterns in the data. Three primary themes were drawn from the data analysis: (1) Importance of Clinician Trust and Support; (2) Balancing the Health of the Mother and Child; and (3) Other Support Structures That Facilitate Healthcare Decision-Making for the Mother and Baby Dyad. Participant experiences underscored the need for cohesive approaches by clinical providers of pre- and postnatal care. Group model approaches to postnatal care appear to mitigate or reduce the impact of PPD.
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Affiliation(s)
- Lisa Borrero
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Aimee Dietsch
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Laura E Santurri
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Heidi H Ewen
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
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5
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Powell DN, Leonhardt ND. A Longitudinal Examination of Mothers' Early Postnatal Adaptation: Relative Stability Across the First Eight Weeks. Matern Child Health J 2023; 27:2175-2184. [PMID: 37768532 DOI: 10.1007/s10995-023-03776-4] [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] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Using person-centered analyses, this study examined the trajectories of women's early postnatal adaptation and explored whether there were differences in their trajectories based on women's status as a first-time or more experienced mother. METHODS Data were collected from women (N = 137; Mage = 28.6 years, SD = 4.49; 48.2% first-time mothers) at 2-, 4-, 6-, and 8-weeks postpartum. At each wave of data collection, mothers reported on their parenting self-efficacy, parenting satisfaction, anxiety, parenting stress, and depressive feelings. RESULTS The creation of an amalgamated measure of postnatal adaptation demonstrated acceptable fit. Latent class growth analysis revealed four distinct trajectories of postnatal adaptation; two revealed stability across the early postnatal period and two had relative stability except for a change between weeks four to six. Women's parity was not associated with differences in their trajectories. CONCLUSIONS FOR PRACTICE These findings reiterate the importance of collecting data from women in the early postnatal period and identifying if a woman is struggling in those early weeks, as the women in our sample demonstrated relative stability in their postnatal adaptation across the first eight weeks. Furthermore, the findings suggest that work should be taken to dismantle the commonly held belief that parenting is "easier" after having already navigated the early postnatal period with an infant once before.
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Affiliation(s)
- Darcey N Powell
- Psychology, Roanoke College, 221 College Lane, Salem, VA, 24153, USA.
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6
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Alshahrani SASAS, Al-Saleh NF, Siddiqui AF, Khalil SN, Alsaleem MA, AlHefdhi HA, Al-Qadi SA, Asiri AA. Burden and Risk Factors of Postpartum Depression in Southwest Saudi Arabia. J Clin Med 2023; 12:jcm12103444. [PMID: 37240551 DOI: 10.3390/jcm12103444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES The burden of postpartum depression (PPD) is significant because it remains unrecognized, and it not only affects the mother adversely but also has a negative consequence on the family life and the development of the infant. The aim of the study was to measure the prevalence of PPD and identify the risk factors of PPD among mothers attending the well-baby clinic of six Primary Health Care centers in Abha city, Southwest Saudi Arabia. MATERIALS AND METHODS A total of 228 Saudi women having a child aged between two weeks to one year were recruited in the study by using a consecutive sampling technique. The Arabic version of the Edinburgh Postnatal Depression Scale (EPDS) was used as a screening tool to measure the prevalence of PPD. The mothers were also inquired about their socio-demographic characteristics and risk factors. RESULTS The prevalence rate of postpartum depression was 43.4%. Family conflict, and lack of support by spouse and family during pregnancy were found to be the strongest predictors of developing PPD. Women who had reported family conflict were at six times higher risk for developing PPD compared to those who did not have a family conflict (aOR = 6.5, 95% CI = 2.3-18.4). Women who reported a lack of spousal support during pregnancy encountered 2.3 fold increased risk for PPD (aOR = 2.3, 95% CI = 1.0-4.8) and women who had not received family support during pregnancy period were more than three times (aOR = 3.5, 95 % CI 1.6-7.7) likely to experience PPD. CONCLUSION The risk of PPD among Saudi postnatal women was high. PPD screening should be an integral part of postnatal care. Awareness of women, spouses and families about potential risk factors can be a preventive strategy. The early identification of high-risk women during the antenatal and post-natal period could help to prevent this condition.
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Affiliation(s)
| | | | - Aesha Farheen Siddiqui
- Family and Community Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Shamsun Nahar Khalil
- Family and Community Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Mohammed Abadi Alsaleem
- Family and Community Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Hayfa A AlHefdhi
- Family and Community Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
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7
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Min W, Jiang C, Li Z, Wang Z. The effect of mindfulness-based interventions during pregnancy on postpartum mental health: A meta-analysis. J Affect Disord 2023; 331:452-460. [PMID: 36963518 DOI: 10.1016/j.jad.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Mindfulness helps reduce negative emotions, but its ability to prevent postpartum psychological problems remains unclear. This study aimed to assess the effects of mindfulness-based interventions (MBIs) during pregnancy on postpartum mental health, especially postpartum depression. METHODS Online databases regarding the effect of mindfulness on pregnancy were searched and a meta-analysis was conducted. RESULTS Eight randomized controlled trials (RCTs) and a self-controlled study were included. We found consistent results showing that MBIs significantly improve the depressive symptoms of all pregnant women in both the case-control (SMD = -0.90, 95 % CI (-2.71, -1.82), p = 0.01) and self-control (SMD = 1.24, 95 % CI (0.37, 2.11), p = 0.005) comparisons. However, MBIs were ineffective for high-risk pregnant women with severe depressive symptoms before delivery in both the case-control (SMD = -1.07, 95 % CI (-3.40, 1.25), p = 0.36) and self-control comparisons (SMD = 2.10, 95 % CI (-0.26, 4.47), p = 0.08). Furthermore, MBIs did not have significant advantages over other intervention methods (SMD = -0.45, 95 % CI (-1.17, 0.28), p = 0.23). LIMITATIONS There were few high-quality RCTs, and the sample size was small. CONCLUSION MBIs can relieve maternal depressive and anxiety symptoms, especially for the prevention of postpartum depression in healthy pregnant women. However, MBIs do not have significant advantages over other interventions and may not be useful for all pregnant women. These findings contribute to the optimization of perinatal mental health intervention programs and the improvement of pregnancy outcomes, playing an important guiding role in clinical decision-making.
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Affiliation(s)
- Wenjiao Min
- Psychosomatic Department, Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences, Provincial People's Hospital, Chengdu, China
| | - Caixia Jiang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, China
| | - Zuxing Wang
- Psychosomatic Department, Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences, Provincial People's Hospital, Chengdu, China.
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8
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Huang S, Hu Y, Fu B, Tang G, Chen Z, Zhang L, Xiao M, Lei J. Help-Seeking Intentions for Depression and Associated Factors among Chinese Perinatal Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2288. [PMID: 36767654 PMCID: PMC9916212 DOI: 10.3390/ijerph20032288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
A low help-seeking intention for depression is an important reason for the low number of women with perinatal depression who have sought professional help. However, evidence of help-seeking intentions for depression is still lacking in Chinese perinatal women. We aimed to investigate the help-seeking intention for depression and its associated factors among Chinese perinatal women. Participants were recruited from three comprehensive hospitals in Changsha. A total of 874 perinatal women were included in the study. The score for the help-seeking intention for depression in Chinese perinatal women was 3.65 ± 0.79, with about half of participants (58.3%) reporting that they were "likely" and "strongly likely" to seek professional help if they suffered from depression during the perinatal period. Favorable help-seeking attitudes and sufficient knowledge of mental illness help-seeking resources were positively associated with help-seeking intentions for depression. However, self-stigma decreased the help-seeking intention for depression. Chinese perinatal women had relatively positive help-seeking intentions for depression. Reducing the stigma of mental illness and help-seeking, enhancing mental health literacy, and improving attitudes toward professional psychological help-seeking of perinatal women may be the potential key components of interventions to encourage perinatal women to actively seek professional psychological help.
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Affiliation(s)
- Sasa Huang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Ying Hu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Guanxiu Tang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Zhihong Chen
- Department of Pediatric Intensive Care Unit, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Lijuan Zhang
- Department of Emergency Pediatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Meili Xiao
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
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Lamere K, Golova N. Screening for Postpartum Depression During Infant Well Child Visits: A Retrospective Chart Review. Clin Pediatr (Phila) 2022; 61:699-706. [PMID: 35588233 DOI: 10.1177/00099228221097272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics (AAP) recommends that pediatricians screen mothers for postpartum depression (PPD) at the infant's 1, 2, 4, and 6-month well child (WC) visits. Despite these recommendations, less than 50% of mothers are screened nationally. We evaluated the impact of a statewide quality improvement initiative that implemented routine screening for PPD utilizing the Edinburgh Postpartum Depression Scale (EPDS) at AAP recommended WC visits. A total of 224 patients were included. Screening rates increased significantly at all four WC visits (P < .01). A higher prevalence of positive EPDS screens was detected in mothers with a history of a mental health condition (P = .009) and in mothers who reported recent food or housing insecurity (P = .02). EPDS screening was successfully implemented through a statewide initiative in a busy hospital-based pediatric clinic. Pediatricians play an important role in identifying mothers with PPD and referring them to adequate treatment.
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Affiliation(s)
- Kathryn Lamere
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Natalia Golova
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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10
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Schilling S, Bigal L, Powell BJ. Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221091219. [PMID: 37091079 PMCID: PMC9924241 DOI: 10.1177/26334895221091219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This practical implementation report describes a primary care-based group parenting intervention—Child–Adult Relationship Enhancement in Primary Care (PriCARE)—and the approach taken to understand and strengthen the referral process for PriCARE within a pediatric primary care clinic through the deployment of synergistic implementation strategies to promote physician referrals. PriCARE has evidence of effectiveness for reducing child behavior problems, harsh and permissive parenting, and parent stress from three randomized controlled trials (RCTs). The integration of evidence-based parenting interventions into pediatric primary care is a promising means for widespread dissemination. Yet, even when integrated into this setting, the true reach will depend on parents knowing about and attending the intervention. A key factor in this process is the endorsement of and referral to the intervention by the child's pediatrician. Therefore, identifying strategies to improve physician referrals to parenting interventions embedded in primary care is worthy of investigation. Method: Through lessons learned from the RCTs and key informant interviews with stakeholders, we identified barriers and facilitators to physician referrals of eligible parent–child dyads to PriCARE. Based on this data, we selected and implemented five strategies to increase the PriCARE referral rate. We outline the selection process, the postulated synergistic interactions, and the results of these efforts. Conclusions: The following five discrete strategies were implemented: physician reminders, direct advertising to patients, incentives/public recognition, interpersonal patient narratives, and audit and feedback. These discrete strategies were synergistically combined to create a multifaceted approach to improve physician referrals. Following implementation, referrals increased from 13% to 55%. Continued development, application, and evaluation of implementation strategies to promote the uptake of evidence-based parenting interventions into general use in the primary care setting are discussed. Plain Language Summary There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Luisa Bigal
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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11
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Jarvis L, Long M, Theodorou P, Barclay Hoffman S, Soghier L, Beers L. Perinatal Mental Health Task Force: Integrating Care Across a Pediatric Hospital Setting. Pediatrics 2021; 148:183439. [PMID: 34814188 DOI: 10.1542/peds.2021-050300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide a leading cause of postpartum deaths. PMADs are associated with poor maternal, infant, and family outcomes. Identification and early intervention are imperative for successful treatment. This case study describes the implementation and outcomes of a multidisciplinary Perinatal Mental Health Task Force ("Task Force") at one urban academic children's hospital that was created to promote systems change and health care policy solutions for improved identification and treatment of PMADs. Using the social ecological model as a framework, the Task Force addressed care at the individual, interpersonal, organizational, community, and policy levels. The Task Force applied lessons learned from division-specific screening initiatives to create best practices and make hospital-wide recommendations. This foundational work enabled us to build community bridges and break down internal barriers to shift our pediatric hospital toward prioritizing perinatal mental health. As a result, screening expanded to multiple hospital locations and became a hospital corporate goal, the Perinatal Mental Health Screening Tool Kit was created and disseminated within the community, Task Force members testified in governmental hearings and joined national organizations to inform policy, and Task Force and community collaborations resulted in significant grant funding. Lessons learned have been disseminated nationally. Moving forward, we aim to expand our program and partnerships to ensure that caregivers of infants receive appropriate mental health support to strengthen family well-being. The Task Force can serve as a model for advocates looking to expand and integrate PMAD care.
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Affiliation(s)
- Lenore Jarvis
- Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Melissa Long
- Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | | | - Lamia Soghier
- Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Lee Beers
- Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Ruybal AL, Siegel JT. Increasing social support for women with postpartum depression through attribution theory guided vignettes and video messages: The understudied role of effort. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2021. [DOI: 10.1016/j.jesp.2021.104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Socioeconomic and racial/ethnic disparities in postpartum consultation for mental health concerns among US mothers. Arch Womens Ment Health 2021; 24:781-791. [PMID: 33855652 DOI: 10.1007/s00737-021-01132-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
Limited research has examined factors that impact access to postpartum mental healthcare. We investigated the predisposing, enabling, and need factors associated with postpartum consultation for mental health concerns in US mothers with or without depressive symptoms and examined potential disparities in access. We utilized cross-sectional data from the Listening to Mothers II Survey, the second national US survey of women's childbearing experiences. The survey recruited 1573 women, aged 18-45 years, who spoke English and had given birth. Depressive symptoms were measured with the Postpartum Depression Screening Scale (PDSS-SF). The dependent variable was postpartum consultation for mental health concerns. Logistic regression analyses showed that mothers with scores of 14-21 and 22-35 on the PDSS-SF had higher odds of consulting a provider for mental health concerns (OR 3.97; OR 12.91). Latinas had lower odds of seeking mental health consultations than Whites (OR 0.39). Mothers who were employed prenatally full-time or part-time had lower odds of seeking consultations than non-employed mothers (OR 0.62; OR 0.52). Mothers with household incomes of $50,000-$74,999 had higher odds of seeking consultations than those with incomes less than $25,000 (OR 2.20). When regression analyses were restricted to mothers with PDSS-SF scores ≥ 14, findings were similar by race/ethnicity and prenatal employment. Significant depressive symptoms are common in women after giving birth and few sought any form of mental health consultation. Latinas and low-income women are less likely to seek postpartum mental health consultations. Mental health care interventions could be geared towards targeting these at-risk groups.
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14
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Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105226. [PMID: 34069073 PMCID: PMC8156805 DOI: 10.3390/ijerph18105226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Abstract
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
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15
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Hamwi S, Lorthe E, Barros H. Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094782. [PMID: 33947149 PMCID: PMC8125143 DOI: 10.3390/ijerph18094782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.
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Affiliation(s)
- Sousan Hamwi
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Correspondence: ; Tel.: +351-22-206-1820
| | - Elsa Lorthe
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, 1205 Geneva, Switzerland;
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, F-75004 Paris, France
| | - Henrique Barros
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
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16
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Premji S, McDonald SW, McNeil DA, Spackman E. Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada. J Affect Disord 2021; 281:839-846. [PMID: 33239243 DOI: 10.1016/j.jad.2020.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment. METHODS We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented. RESULTS Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening. LIMITATIONS We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children. CONCLUSIONS The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.
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Affiliation(s)
- Shainur Premji
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Sheila W McDonald
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary; Paediatrics, Cumming School of Medicine, University of Calgary
| | - Deborah A McNeil
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary
| | - Eldon Spackman
- Community Health Sciences, Cumming School of Medicine, University of Calgary
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Wang Q, Song B, Di J, Yang X, Wu A, Lau J, Xin M, Wang L, Mo PKH. Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study. JMIR Ment Health 2021; 8:e24162. [PMID: 33570500 PMCID: PMC7879730 DOI: 10.2196/24162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. OBJECTIVE We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. METHODS A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. RESULTS More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services. CONCLUSIONS Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Bo Song
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Xue Yang
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anise Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, Macao
| | - Joseph Lau
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Meiqi Xin
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phoenix Kit-Han Mo
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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18
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Albanese AM, Geller PA, Sikes CA, Barkin JL. The Importance of Patient-Centered Research in the Promotion of Postpartum Mental Health. Front Psychiatry 2021; 12:720106. [PMID: 34603105 PMCID: PMC8481568 DOI: 10.3389/fpsyt.2021.720106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ariana M Albanese
- Women's Health Psychology Laboratory, Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Pamela A Geller
- Women's Health Psychology Laboratory, Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Christina A Sikes
- Houston Country Health Department, Georgia Department of Public Health, Warner Robbins, GA, United States
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, United States
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19
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Rosander M, Berlin A, Forslund Frykedal K, Barimani M. Maternal depression symptoms during the first 21 months after giving birth. Scand J Public Health 2020; 49:606-615. [PMID: 33308010 PMCID: PMC8512257 DOI: 10.1177/1403494820977969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims: The first year after childbirth involves a major transition for women, which
can accentuate inadequacies and feelings of powerlessness, making them
vulnerable to depression. The aim of this study was to investigate the
prevalence and frequency of maternal postpartum depressive symptoms at
different times after giving birth (0–21 months). Methods: Data were collected cross-sectionally using a web questionnaire containing
the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with
children in the age range 0–21 months responded. Results: The results showed different levels of depression over the range of months
included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%.
There were higher levels at 9–12 months and 17–21 months. The highest levels
of symptoms of depression were found at nine, 12, and 17 months after birth,
and the lowest levels at two and 16 months. Conclusions: Many mothers experience symptoms of depression after giving birth that
can continue well beyond the child’s first year. We have identified
different levels of depression at different points in time after giving
birth, with highs and lows throughout the first 21 months. This
highlights a need to screen for depression more than once during the
first years, as well as a closer cooperation between midwives and child
healthcare nurses in supporting mothers in the transition to motherhood.
This is an important aspect of public health, which not only involves
mothers with symptoms of depression, but also their ability to care for
their child and a possible negative impact on the child’s
development.
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Affiliation(s)
- Michael Rosander
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Michael Rosander, Department of Behavioural
Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. E-mail:
| | - Anita Berlin
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Karin Forslund Frykedal
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Department of Social and Behavioural
Studies, University West, Trollhättan, Sweden
| | - Mia Barimani
- Academic Primary Care Centre, Region
Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary
Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet,
Stockholm, Sweden
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20
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Abstract
OBJECTIVES The aim of this study was to determine the (1) proportion of screened postpartum depression (PPD)-positive mothers, (2) associated risk factors, and (3) impact of PPD screening in a pediatric emergency department (PED). STUDY DESIGN We performed a pilot cohort study using a convenience sample of mothers (n = 209, all ages) of infant patients 6 months or younger presenting to a PED. Mothers completed a computerized survey that included the Edinburgh Postnatal Depression Scale. We assessed frequency of positive screens and performed multivariable logistic regression to identify associated risk factors. We assessed maternal attitudes toward screening at enrollment and 1-month follow-up with positive-screen mothers. Differences in ED utilization were measured. RESULTS Fifty-seven of 209 mothers (27%; 95% confidence interval [CI], 21%-33%) screened positive for PPD, with 14 (7%) reporting suicidal thoughts. Forty-seven percent (97/209) had never previously been screened, including 58% (33/57) of PPD screen-positive mothers. Current unemployment status (adjusted odds ratio [aOR], 2.76; 95% CI, 1.25-6.13) and first-time motherhood (aOR, 3.92; 95% CI, 1.72-8.91) were associated with a positive screen. At 1-month follow-up, mothers (35/37) reported PED-based PPD screening was important. After adjustment for sociodemographic factors, PPD screen-positive mothers had increased PED utilization (aOR, 1.29; 95% CI, 1.03-1.61). CONCLUSIONS Approximately 1 in 4 mothers screened positive for PPD in a PED, with almost 1 in 10 reporting suicidal thoughts. The majority of PPD screen-positive mothers had not been screened previously. Our study helps to inform future efforts for interventions to support mothers of young infants who use the PED for care.
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21
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Nakamura Y, Okada T, Morikawa M, Yamauchi A, Sato M, Ando M, Ozaki N. Perinatal depression and anxiety of primipara is higher than that of multipara in Japanese women. Sci Rep 2020; 10:17060. [PMID: 33051530 PMCID: PMC7555526 DOI: 10.1038/s41598-020-74088-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022] Open
Abstract
The proportion of women who experience a depressive state after delivery differs between primiparas and multiparas, so it is important to clarify the different factors related to depression between the two groups. In this study, we confirmed the differences in depressive states, the perinatal period, and social support between primiparas and multiparas, and clarified their characteristics. Data were extracted from a prospective cohort questionnaire survey conducted on pregnant women in Japan that included sociodemographic questions, the Edinburgh Postnatal Depression Scale, and the Japanese version of the Social Support Questionnaire. We carried out the chi-square test, Student's t-test, and analysis of covariance to compare responses between primiparas and multiparas. A total of 1138 primiparas and 380 multiparas provided valid responses. We found that primiparas had higher rates of experiencing maternity blues and postpartum depression than multiparas. We also found that primiparas had higher anxiety scores than multiparas. Primiparas with postpartum depression perceived a lower number of persons available to provide social support than primiparas without postpartum depression. These findings suggest that it is important to provide pregnant women, especially for primiparas, with information that allows them to increase the number of people who can provide them with support.
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Affiliation(s)
- Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Okada
- Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Mako Morikawa
- Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Aya Yamauchi
- Psychiatry/Child and Adolescent Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Maya Sato
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Data Coordinating Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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22
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Smith JD, Cruden GH, Rojas LM, Van Ryzin M, Fu E, Davis MM, Landsverk J, Brown CH. Parenting Interventions in Pediatric Primary Care: A Systematic Review. Pediatrics 2020; 146:e20193548. [PMID: 32581000 PMCID: PMC7329253 DOI: 10.1542/peds.2019-3548] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 01/13/2023] Open
Abstract
CONTEXT More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.
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Affiliation(s)
- Justin D Smith
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | | | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Emily Fu
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew M Davis
- Division of Academic General Pediatrics, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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23
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Cacciola E, Psouni E. Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3887. [PMID: 32486285 PMCID: PMC7313466 DOI: 10.3390/ijerph17113887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.
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Affiliation(s)
| | - Elia Psouni
- Department of Psychology, Lund University, P.O. Box 213, SE221-00 Lund, Sweden;
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24
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Le HN, Perry DF, Villamil Grest C, Genovez M, Lieberman K, Ortiz-Hernandez S, Serafini C. A mixed methods evaluation of an intervention to prevent perinatal depression among Latina immigrants. J Reprod Infant Psychol 2020; 39:382-394. [PMID: 32186924 DOI: 10.1080/02646838.2020.1733504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The effectiveness of a cognitive behavioural intervention to prevent perinatal depression in low-income Latina immigrant pregnant women and mothers receiving WIC services was evaluated in a mixed methods study using a community based observational design.Background: The Mothers and Babies Course is a preventive intervention for perinatal depression that is based on cognitive behavioural theory (CBT). CBT is an evidence-based treatment and preventive intervention for perinatal depression.Method: Phase 1 includes 86 Latinas, predominantly Central American immigrant women at high risk for depression, who self-selected into the Mothers and Babies Course, a six-week Spanish CBT group intervention aimed at teaching women mood regulation skills to prevent the onset of depression. Participants, who were recruited from the Women, Infants, and Children services, completed measures of depression and psychopathology at pre-, 6 weeks, and 3 months post-intervention. Phase 2 includes qualitative interviews with a randomly selected subsample (n = 26) from Phase 1 to understand the mechanisms and impact of participants' experiences with the intervention and study.Results: Results indicated no significant differences in depressive symptoms among participants with varied attendance levels (0 class; 1-3 classes = non-completers; 4-6 classes = completers). None of the participants met diagnostic criteria for major depressive disorder at the final data collection period. Despite the varied attendance, both quantitative and qualitative results indicated that completers and non-completers reported similar experiences in the intervention and benefiting from study participation.Conclusion: Conducting mixed methods research highlights the complexity of understanding who can benefit from preventive interventions.
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Affiliation(s)
- Huynh-Nhu Le
- George Washington University, Washington, DC, USA
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25
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Le HN, Rodríguez-Muñoz MF, Soto-Balbuena C, Olivares Crespo ME, Izquierdo Méndez N, Marcos-Nájera R. Preventing perinatal depression in Spain: a pilot evaluation of Mamás y Bebés. J Reprod Infant Psychol 2019; 38:546-559. [PMID: 31729261 DOI: 10.1080/02646838.2019.1687859] [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: 12/16/2022]
Abstract
Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioural intervention to prevent perinatal depressive symptoms in pregnant women at high risk for perinatal depression in Spain. Background: Perinatal depression (PD) can negatively affect maternal and infant outcomes. Mamás y Bebés/The Mothers and Babies Course (MBC) is an evidence-based CBT intervention aimed at teaching women at high risk for depression mood regulation skills to prevent depression in the United States, including Spanish-speaking perinatal women in the United States. However, there is limited research on preventive interventions for PD in Spain. Method: Pregnant women screened for high risk for PD were recruited in their first trimester in an obstetrics clinic at two urban hospitals in Spain. In a non-experimental design, 30 women completed eight weekly group sessions of the MBC. The Patient Health Questionnaire was the main depression outcome at four time points: pre-intervention, post-intervention, and at 3 months and 6 months postpartum. Participants completed an evaluation questionnaire at the end of each session to assess the acceptability of the intervention. Results: The MBC was effective in reducing depressive symptoms from baseline to all three time points: post-intervention, 3 and 6 months postpartum. Attendance was high (76.7% attended all eight sessions). Mothers reported positive feedback from the participating in the MBC. Conclusion: This pilot study suggests that the intervention is feasible, acceptable, and provides promising evidence for reducing depressive symptoms in urban Spanish perinatal women. Larger and rigorous randomised trials are needed to confirm these findings.
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Affiliation(s)
- Huynh-Nhu Le
- Department of Psychology, The George Washington University , Washington, DC, USA
| | - María F Rodríguez-Muñoz
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia , Madrid, Spain
| | - Cristina Soto-Balbuena
- Department of Obstetrics and Gynecology, Central University Hospital of Asturias , Oviedo, Spain
| | | | - Nuria Izquierdo Méndez
- Department of Obstetrics and Gynecology, San Carlos Clinic Hospital, Universidad Complutense , Madrid, Spain
| | - Rosa Marcos-Nájera
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia , Madrid, Spain
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Morgenlander MA, Tyrrell H, Garfunkel LC, Serwint JR, Steiner MJ, Schilling S. Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic. Acad Pediatr 2019; 19:868-874. [PMID: 30862512 DOI: 10.1016/j.acap.2019.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/12/2019] [Accepted: 02/24/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Describe current practices in systematic screening for social determinants of health (SDH) in pediatric resident clinics enrolled in the Continuity Research Network (CORNET). METHODS CORNET clinic directors were surveyed on demographics, barriers to screening, and screening practices for 15 SDH, including the screen source, timing of screening, process of administering the screen, and personnel involved in screening. Incidence rate ratios were tabulated to investigate relationships among screening practices and clinic staff composition. RESULTS Clinic response rate was 41% (65/158). Clinics reported screening for between 0 and 15 SDH (median, 7). Maternal depression (86%), child educational problems (84%), and food insecurity (71%) were the items most commonly screened. Immigration status (17%), parental health literacy (19%), and parental incarceration (21%) were least commonly screened. Within 3 years, clinics plan to screen for 25% of SDH not currently being screened. Barriers to screening included lack of time (63%), resources (50%), and training (46%). CONCLUSIONS Screening for SDH in our study population of CORNET clinics is common but has not been universally implemented. Screening practices are variable and reflect the complex nature of screening, including the heterogeneity of the patient populations, the clinic staff composition, and the SDH encountered.
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Affiliation(s)
| | | | - Lynn C Garfunkel
- Department of Pediatrics (LC Garfunkel), University of Rochester School of Medicine and Rochester Regional Health, Rochester, NY
| | - Janet R Serwint
- Department of Pediatrics (JR Serwint), The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Michael J Steiner
- Department of Pediatrics (MJ Steiner and S Schilling), University of North Carolina at Chapel Hill
| | - Samantha Schilling
- Department of Pediatrics (MJ Steiner and S Schilling), University of North Carolina at Chapel Hill
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Abstract
Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.
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van Steijn ME, Scheepstra KWF, Zaat TR, van der Post JAM, Olff M, van Pampus MG. Posttraumatic stress disorder in partners following severe postpartum haemorrhage: A prospective cohort study. Women Birth 2019; 33:360-366. [PMID: 31307939 DOI: 10.1016/j.wombi.2019.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Partners of women are increasingly present during childbirth and may be exposed to a traumatic experience. Since parents' mental health issues (i.e. posttraumatic stress disorder) have been shown to increase the risk of problems in the child's development, it is important to identify these risk factors. Partners often describe severe postpartum haemorrhage as traumatic. AIM Whether witnessing severe postpartum haemorrhage is a risk factor for developing posttraumatic stress disorder in partners. METHODS In this prospective cohort study, we compared partners of women with severe postpartum haemorrhage (≥2000 mL) and partners of women with ≤500 mL of blood loss (controls). Four weeks after birth partners were screened for posttraumatic stress disorder symptoms with a self-report questionnaire. Scores ≥11 were followed by a gold standard clinical interview to diagnose posttraumatic stress disorder. FINDINGS We included 123 severe postpartum haemorrhage partners and 62 control partners. Partners of women with severe postpartum haemorrhage reported higher scores than control partners (median 3.0 (0.0-7.0) vs 2.0 (0.0-4.0), p = 0.04) on symptoms of posttraumatic stress, but no significant difference in probable posttraumatic stress disorder diagnosis according to the self-report questionnaire was found. According to the clinical interview no partners were diagnosed with posttraumatic stress disorder. Severe postpartum haemorrhage was experienced as traumatic by the partners who felt excluded. CONCLUSION None of the partners developed posttraumatic stress disorder, revealing the resilience of young fathers. Because some partners reported severe postpartum haemorrhage as traumatic, we recommend sufficient information and support is provided during childbirth.
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Affiliation(s)
- Minouk E van Steijn
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Karel W F Scheepstra
- Department of Psychiatry, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tjitske R Zaat
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
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Russomagno S, Waldrop J. Improving Postpartum Depression Screening and Referral in Pediatric Primary Care. J Pediatr Health Care 2019; 33:e19-e27. [PMID: 31227124 DOI: 10.1016/j.pedhc.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Postpartum depression (PPD) affects up to 20% of American mothers and, if left untreated, can have serious, lifelong effects on women and their children. The American Academy of Pediatrics recommends that pediatric practices screen for PPD at the 1-, 2-, 4-, and 6-month well-child checks; however, few pediatric practices oblige. METHODS This project standardized the PPD screening schedule and developed a novel referral algorithm that was concurrently implemented in a rural primary care pediatric practice. RESULTS The project significantly increased the clinic's screening rate from 33% to 80% (p < .001) and improved referral rates from 66% to 79%. DISCUSSION By standardizing PPD screening and implementing a referral algorithm in the ambulatory pediatric setting, more PPD cases can be identified, further evaluated, and, hopefully, treated to improve maternal and infant health outcomes.
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30
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Bray N, Grasby KL, Lind PA, Painter JN, Colodro-Conde L, Medland SE. The psychosocial impact of nausea and vomiting during pregnancy as a predictor of postpartum depression. J Health Psychol 2019; 26:1061-1072. [PMID: 31244342 DOI: 10.1177/1359105319859048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the extent to which psychosocial impact of nausea and vomiting during pregnancy predicts postpartum depression using a retrospective design. Data from a cross-sectional survey investigating women's experiences of nausea and vomiting during pregnancy were used (N = 861). Hierarchical logistic regression models revealed that the psychosocial impact of nausea and vomiting in pregnancy appears to be predictive of postpartum depression, independent of depression status before and during pregnancy. Our findings indicate that assessing the psychosocial impact of nausea and vomiting in pregnancy during antenatal care may identify women at risk of postpartum depression.
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Affiliation(s)
- Nicola Bray
- The University of Queensland, Australia.,QIMR Berghofer Medical Research Institute, Australia
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Premji S, McDonald SW, Metcalfe A, Faris P, Quan H, Tough S, McNeil DA. Examining postpartum depression screening effectiveness in well child clinics in Alberta, Canada: A study using the All Our Families cohort and administrative data. Prev Med Rep 2019; 14:100888. [PMID: 31193116 PMCID: PMC6517566 DOI: 10.1016/j.pmedr.2019.100888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/28/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
Abstract
Affecting 10-15% of women, postpartum depression (PPD) can be debilitating and costly. While early identification has the potential to improve timely care, recommendations regarding the implementation of routine screening are inconsistent. In Alberta, screening is completed using the Edinburgh Postnatal Depression Scale during public health well child clinic visits. The objective of this study was to examine the effectiveness of screening in identifying, diagnosing and treating women at increased risk for PPD over the first year postpartum, compared to those unscreened. The All Our Families prospective pregnancy cohort was linked to public health, inpatient, outpatient, physician claims and community pharmaceutical data over the first year postpartum. Descriptive statistics and bivariate analyses examined differences in sample characteristics and PPD and non-PPD related utilization by screening category. Odds ratios and 95% confidence intervals for PPD diagnosis and mental health drugs dispensed were generated using crude and multivariable logistic regression models. Within our sample, 87% of the eligible population were screened, with 3% receiving a high-risk score, and 13% were unscreened. Compared to those unscreened, women screened high-risk had higher odds of being diagnosed with PPD (OR: 3.88, 95% CI: 2.18-6.92) and women screened low/moderate-risk had reduced odds of receiving a diagnosis (OR: 0.51, 95% CI: 0.35-0.74). High-risk women had an increased likelihood of diagnosis, higher PPD-related utilization and drugs dispensed compared to those unscreened. This information suggests that screening was effective at streamlining resources in Alberta. Future work should focus on evaluating the cost-effectiveness of PPD screening.
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Key Words
- 1H2P, 1 hospitalization, 2 physician claims
- ANOVA, analysis of variance
- AOF, All Our Families
- CI, confidence interval
- EPDS, Edinburgh Postnatal Depression Scale
- Evaluation
- IQR, interquartile range
- OR, odds ratio
- PPD, postpartum depression
- Perinatal depression
- Public health
- SD, standard deviation
- Screening
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Affiliation(s)
- Shainur Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada
| | - Sheila W McDonald
- Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Department of Obstetrics and Gyneacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Deborah A McNeil
- Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada.,Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N1N4, Canada
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Improving Postpartum Depression Screening in Pediatric Primary Care: A Quality Improvement Project. J Pediatr Nurs 2019; 46:83-88. [PMID: 30865875 DOI: 10.1016/j.pedn.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite recommendations for standardized postpartum depression screening in primary care pediatrics, few pediatric healthcare providers are adequately screening mothers for postpartum depression. AIMS To improve standardized screening for postpartum depression in the pediatric primary care setting. Secondary aims were to determine if infant and family characteristics (gender of infant, feeding method, insurance type, income level, ethnicity of infant) were associated with positive postpartum depression screening. METHODS This quality improvement project involved implementing a standardized postpartum depression screening tool into pediatric primary care practice. Independent samples t-test and logistic regression were used for data analysis. RESULTS Postpartum depression screening practices improved from 83% to 88% (p = 0.096). Although not statistically significant, infant characteristics of male gender, Medicaid or sliding-scale payment for services, and Hispanic ethnicity were associated with higher rates of positive postpartum depression screens. CONCLUSIONS Pediatric health care providers can effectively screen for postpartum depression. Certain infant and family characteristics may alert the provider to higher risks for mothers.
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Afshari P, Tadayon M, Abedi P, Yazdizadeh S. Prevalence and related factors of postpartum depression among reproductive aged women in Ahvaz, Iran. Health Care Women Int 2019; 41:255-265. [PMID: 30924721 DOI: 10.1080/07399332.2019.1578779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this study authors aimed to identify the prevalence and related factors of postpartum depression in Ahvaz, Iran. A total of 505 women enrolled in this study from six public health centers in Ahvaz city, Republic of Iran. This study started in February and completed in September 2014. Data was gathered using a socio-demographic and Edinburgh Postnatal Depression Scale Persian version. Authors screened women from 14 days to 6 months postpartum. Mothers with a score of >12 were classified as a postpartum depression (PPD). Our results revealed that 196 individuals (38.8%) had PPD. Women with PPD had significantly more of the following characteristics: undesired pregnancy, neonatal hospitalization, congenital abnormalities, history of postpartum depression, history of lifetime episode of depression, stressful events during pregnancy and an experience of domestic violence during pregnancy (p < 0.05). Our results showed that congenital abnormalities (OR = 2.99, 95% CI: 1.44-5.90), history of PPD (OR = 2.61, 95% CI:1.53-4.44), a lifetime episode of depression (OR = 3.26, 95% CI: 1.63-6.49) and having stressful events in the last year (OR = 4.1, CI: 2.19-7.80) were significantly contributed to the PPD. PPD is a common health problem among mothers and screening should be performed after childbearing to identify mothers at the risk.
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Affiliation(s)
- Poorandokht Afshari
- Midwifery Department, Menopause Andropause Research Centre, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mitra Tadayon
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Midwifery Department, Menopause Andropause Research Centre, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shiva Yazdizadeh
- Midwifery Department, Menopause Andropause Research Centre, Jundishapur University of Medical Sciences, Ahvaz, Iran
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Prevatt BS, Desmarais SL. Facilitators and Barriers to Disclosure of Postpartum Mood Disorder Symptoms to a Healthcare Provider. Matern Child Health J 2018; 22:120-129. [PMID: 28766092 DOI: 10.1007/s10995-017-2361-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n = 211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient's perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking "extremely difficult" or "impossible." Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers' social support networks.
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Affiliation(s)
- Betty-Shannon Prevatt
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC, 27695-7650, USA.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC, 27695-7650, USA
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Alves S, Fonseca A, Canavarro MC, Pereira M. Predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Portuguese women. Midwifery 2018; 69:113-120. [PMID: 30496938 DOI: 10.1016/j.midw.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD). DESIGN Prospective longitudinal study conducted between November 2015 and September 2017. SETTING One public referral maternity hospital in the central region of Portugal. PARTICIPANTS A total of 140 Portuguese women participated in the study. MEASUREMENTS Participants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS. FINDINGS Rates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Despite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.
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Affiliation(s)
- Stephanie Alves
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
| | - Ana Fonseca
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Grissette BG, Spratling R, Aycock DM. Barriers to Help-Seeking Behavior Among Women With Postpartum Depression. J Obstet Gynecol Neonatal Nurs 2018; 47:812-819. [PMID: 30296405 DOI: 10.1016/j.jogn.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 10/28/2022] Open
Abstract
Postpartum depression affects approximately 900,000 women annually, but only approximately 6% of these women seek psychological help (Postpartum, Progress, 2016). This lack of help-seeking behavior must be addressed to decrease the negative effects of postpartum depression on maternal and infant outcomes. The purpose of this article is to describe the barriers that prevent women from seeking psychological help and provide suggestions to address these barriers.
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Trussell TM, Ward WL, Conners Edge NA. The Impact of Maternal Depression on Children: A Call for Maternal Depression Screening. Clin Pediatr (Phila) 2018; 57:1137-1147. [PMID: 29658310 DOI: 10.1177/0009922818769450] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Wendy L Ward
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
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38
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Yogman M, Lavin A, Cohen G, Lemmon KM, Mattson G, Rafferty JR, Wissow LS. The Prenatal Visit. Pediatrics 2018; 142:peds.2018-1218. [PMID: 29941679 DOI: 10.1542/peds.2018-1218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A pediatric prenatal visit during the third trimester is recommended for all expectant families as an important first step in establishing a child's medical home, as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant, and may identify psychosocial risks early and high-risk conditions that may require special care. There are several possible formats for this first visit. The one used depends on the experience and preference of the parents, the style of the pediatrician's practice, and pragmatic issues of payment.
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Affiliation(s)
- Michael Yogman
- Harvard Medical School and Mount Auburn Hospital, Boston, Massachusetts; and
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39
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Postpartum Depression Screening for New Mothers at Well Child Visits. MCN Am J Matern Child Nurs 2018; 43:139-145. [DOI: 10.1097/nmc.0000000000000426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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van der Zee-van den Berg AI, Boere-Boonekamp MM, IJzerman MJ, Haasnoot-Smallegange RME, Reijneveld SA. Screening for Postpartum Depression in Well-Baby Care Settings: A Systematic Review. Matern Child Health J 2018; 21:9-20. [PMID: 27520555 PMCID: PMC5226980 DOI: 10.1007/s10995-016-2088-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Postpartum depression (PPD) is a mental health problem frequently experienced by mothers in the first year postpartum. Early detection and treatment can help to reduce its negative effect on the development of the newborn child. Well-baby care (WBC) is a promising screening setting for early detection of PPD. This systematic review investigates the evidence of the effectiveness of screening for PPD in WBC settings regarding mother and child outcomes. Methods Three electronic databases were searched: SCOPUS, PsychINFO and CINAHL. Two reviewers independently performed the study selection. Data extraction was based on a predefined data extraction form. Results Six studies were included; a quality assessment rated two studies as strong and four as weak. Four studies measuring outcomes at process level showed improvement in detection, referral and/or treatment rates. Four studies, including the two strong ones, where screening and enhanced care were combined, showed improvements in the Edinburgh Postnatal Depression Scale scores of the mothers in the intervention groups. No improvements were reported on other outcomes at parent level or at child level. At child level, weight was the only outcome that was measured. Discussion This review provides limited yet positive evidence for the value of screening for PPD in a WBC setting. The outcomes are comparable with studies on screening for PPD in general. The evidence that we found is very promising but the small number of available studies shows a need for additional high-quality studies, to strengthen the evidence regarding the potential benefits of screening in a WBC setting.
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Affiliation(s)
- Angarath I van der Zee-van den Berg
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Magda M Boere-Boonekamp
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Maarten J IJzerman
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands
| | | | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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41
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Racial Disparities in Children's Health: A Longitudinal Analysis of Mothers Based on the Multiple Disadvantage Model. J Community Health 2018; 41:753-60. [PMID: 26754044 DOI: 10.1007/s10900-016-0149-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This secondary data analysis of 4373 mothers and their children investigated racial disparities in children's health and its associations with social structural factors, social relationships/support, health/mental health, substance use, and access to health/mental health services. The study drew on longitudinal records for mother-child pairs created from data in the Fragile Families and Child Wellbeing Study. Generalized estimating equations yielded results showing children's good health to be associated positively with mother's health (current health and health during pregnancy), across three ethnic groups. For African-American children, good health was associated with mothers' education level, receipt of informal child care, receipt of public health insurance, uninsured status, and absence of depression. For Hispanic children, health was positively associated with mothers' education level, receipt of substance-use treatment, and non-receipt of public assistance. Implications for policy and intervention are discussed.
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42
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Gross TT, Rahman M, M Wright A, M Hirth J, Sarpong KO, Rupp RE, D Barrett A, Berenson AB. Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance. Matern Child Health J 2017; 20:154-163. [PMID: 27316631 DOI: 10.1007/s10995-016-2030-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction The objective of this qualitative study was to assess healthcare providers' acceptability of an ongoing postpartum human papillomavirus (HPV) vaccination program in Southeast Texas and its integration into everyday clinical care. Methods In 2012, the Department of Obstetrics & Gynecology at the University of Texas Medical Branch (UTMB) began offering HPV vaccination as part of standard postpartum care to increase vaccination rates among young women in Galveston County. Initial vaccine doses were offered on the postpartum unit while subsequent doses were coordinated with postpartum and well-baby visits. Thirty months after project initiation, semi-structured interviews of physicians (n = 12) and nurses (n = 6) involved in postpartum and pediatric care at UTMB were conducted. Interview transcripts were analyzed using thematic analysis in Nvivo10. Results Overall, providers demonstrated "pro-vaccine" attitudes and stated the program was an effective strategy for vaccinating hard-to-reach women. Cancer prevention was the main perceived benefit while follow-up compliance was the primary perceived patient barrier. The initial challenges with integrating postpartum HPV vaccination included miscommunication between providers regarding vaccine orders and coordination issues with well-baby visits for follow-up doses. One novel finding was providers' beliefs that women's personal HPV vaccine practices may positively impact their decisions about later vaccinating their children against HPV. Providers' suggestions to improve the program included: enhancing postpartum HPV vaccine education for patients, offering more continuing education for providers, and increasing community awareness of HPV vaccination. Discussion These findings can help providers of postpartum care understand how to integrate postpartum HPV vaccination into their current practices and how to overcome perceived vaccination barriers.
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Affiliation(s)
- Tyra T Gross
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA.,Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Mahbubur Rahman
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA
| | | | - Jacqueline M Hirth
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA
| | - Kwabena O Sarpong
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard E Rupp
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA
| | - Alan D Barrett
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA.
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43
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Gilbert AL, Balio C, Bauer NS. Making the Legal and Ethical Case for Universal Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Curr Probl Pediatr Adolesc Health Care 2017; 47:267-277. [PMID: 28916453 DOI: 10.1016/j.cppeds.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postpartum depression (PPD), part of a larger spectrum of perinatal mood and anxiety disorders, affects up to 15% of women following the birth of an infant. Fathers may also be affected. PPD not only affects caregivers, but also impacts infants through mechanisms such as inadequate caregiver-infant interactions and non-adherence to safety practices. The negative impact on infants may extend across the life course through adulthood. This article seeks to move the needle toward universal screening for PPD using validated tools in pediatric primary care settings for new caregivers by making the legal and ethical case for this course of action in a manner that is both compelling and accessible for clinicians. Toward this end, we summarize current literature as it applies to provider responsibilities, liabilities and perspectives; and caregiver autonomy, confidentiality, and privacy. We then assess utility by balancing the benefits and burdens of this approach to practices, providers, and caregivers; and take the analysis one step further by looking across multiple populations to assess distributive justice. We conclude that there is a strong ethical case for universal screening for PPD in pediatric primary care settings using validated tools when informed consent can be obtained and appropriate follow-up services are available and accessible. Clinical considerations, practical resources, and areas ripe for future research are also addressed.
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Affiliation(s)
- Amy Lewis Gilbert
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
| | - Casey Balio
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Nerissa S Bauer
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
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44
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Abstract
Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother-infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.
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45
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Kimmel MC, Platt RE, Steinberg DN, Cluxton-Keller F, Osborne LM, Carter T, Payne JL, Solomon BS. Integrating Maternal Mental Health Care in the Pediatric Medical Home: Treatment Engagement and Child Outcomes. Clin Pediatr (Phila) 2017; 56:1148-1156. [PMID: 27872354 DOI: 10.1177/0009922816679510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal depression is associated with an array of poor child health outcomes, and low-income women face many barriers to accessing treatment. In this pilot study, we assessed treatment engagement in a maternal mental health clinic staffed by a case manager and psychiatrist in an urban pediatric practice. We also examined factors associated with engagement as well as child health outcomes and health care use. Nearly half of the women enrolled attended at least 4 sessions with a psychiatrist in 6 months. Text messaging with the case manager was associated with a greater compliance with psychiatrist sessions. Comparing index children with their siblings prior to enrollment, a higher percentage had immunizations up to date at 1 year of age (82% vs 43%, P = .01), and well-child visit compliance trended toward significance (65% vs 35%, P = .06). The pediatric setting holds promise as an innovative venue to deliver maternal mental health care.
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Affiliation(s)
- Mary C Kimmel
- 1 Johns Hopkins School of Medicine, Baltimore, MD, USA.,2 University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Fallon Cluxton-Keller
- 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,5 Geisel School of Medicine, Hanover, NH, USA
| | | | - Tracy Carter
- 1 Johns Hopkins School of Medicine, Baltimore, MD, USA
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46
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Almutairi AF, Salam M, Alanazi S, Alweldawi M, Alsomali N, Alotaibi N. Impact of help-seeking behavior and partner support on postpartum depression among Saudi women. Neuropsychiatr Dis Treat 2017; 13:1929-1936. [PMID: 28790828 PMCID: PMC5530055 DOI: 10.2147/ndt.s135680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies have discovered a number of factors that can contribute to the risk of developing postpartum depression (PPD), including, but not limited to, life stressors, lack of social support, low economic status, and quality of the marital relationship. However, these studies were conducted in various countries with participants from different cultural backgrounds. PURPOSE This study aimed to examine the impact of general help-seeking behavior (GHSB) and partner support (PS) on PPD among Saudi women in primary health care clinics in Riyadh city. METHODS Data were collected by using self-administered measures of the Edinburgh Postnatal Depression Scale (EPDS), General Help-Seeking Questionnaire (GHSQ), and Partner Support Scale (PSS). Frequency distribution was used to analyze the categorical data, and Student's t-test and one-way analysis of variance were employed to compare the numerical data. Linear regression analysis was used to control for all confounders. RESULTS The findings showed that 9% and 28% of women had good and poor GHSB, respectively, 16% had poor PS, and 25.7% could be classified as probably depressed. Negative relationships between GHSB versus PPD and PS versus PPD were observed. Adjusting by mode of delivery and controlling for confounders in linear regression showed that women who underwent normal vaginal delivery, with higher para rates (β=0.250, t=2.063) and lower PS scores (β=-0.238, t=-2.038), were more likely to suffer higher depression scores (adj P=0.043 and adj P=0.045, respectively). Women who underwent cesarean-section, with postpartum duration ≥6 weeks (β=0.374, t=2.082), were more likely to suffer higher depression scores (adj P=0.045) compared to those with <6 weeks of postpartum duration. CONCLUSION The prevalence of PPD among the study participants was high, especially among higher para women who underwent normal delivery and women ≥6 weeks post cesarean-section, in comparison with the results in other studies. PPD is reduced by enhancing women's GHSB and PS.
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Affiliation(s)
- Adel F Almutairi
- King Saud Bin Abdulaziz University of Health Sciences
- Science and Technology Unit, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- King Saud Bin Abdulaziz University of Health Sciences
- Science and Technology Unit, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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47
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Do Successive Preterm Births Increase the Risk of Postpartum Depressive Symptoms? J Pregnancy 2017; 2017:4148136. [PMID: 28584668 PMCID: PMC5443990 DOI: 10.1155/2017/4148136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background Postpartum depression and preterm birth (PTB) are major problems affecting women's health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS). However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was used to examine the association between PTB and PDS. Results The risk of PDS was 55% higher in women with PTB in both deliveries (aRR = 1.55; 95% CI = 1.28–1.88) and 74% higher in women with PTB in the index delivery only (aRR = 1.74; 95% CI = 1.49–2.05), compared to women with term deliveries. Conclusions Preterm birth is a risk factor for PDS. PTB in women with a prior history of PTB is not associated with an incremental risk of PDS. Routine screening for PDS should be conducted for all women and closer monitoring should be done for high risk women with PTB.
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48
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Abstract
This systematic review aims to assess the effect of mindfulness-based interventions carried out during pregnancy exploring mindfulness and mental health outcomes. A systematic review was conducted to appraise the current literature on the subject area. Inclusion and exclusion criteria were agreed and after reviewing titles, abstracts and full papers, 14 articles met the inclusion criteria and were included in the review. The quality of included articles was checked using the Quality Assessment Tool for Quantitative Studies. Pooled results of the randomised controlled trials (RCTs) reporting outcomes on anxiety, depression and perceived stress indicated no differences between the mindfulness intervention group and the control group. Pooled results of the non-RCTs reporting anxiety, depression and perceived stress showed a significant benefit for the mindfulness group. Mindfulness as an outcome was assessed in four RCTs for which the pooled results show a significant difference in favour of the mindfulness intervention when compared to a control group. The pooled results of the four non-RCTs also indicate a significant difference following mindfulness intervention. Results suggest that mindfulness-based interventions can be beneficial for outcomes such as anxiety, depression, perceived stress and levels of mindfulness during the perinatal period. Further research would be useful to explore if such benefits are sustained during the post-natal period.
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Affiliation(s)
- Anjulie Dhillon
- School of Psychology, Sport and Exercise, Staffordshire University, Stoke-on-Trent, UK
| | - Elizabeth Sparkes
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rui V. Duarte
- Institute of Applied Health Research, University of Birmingham, Room 124, Birmingham, B15 2TT UK
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49
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Olin SCS, McCord M, Stein REK, Kerker BD, Weiss D, Hoagwood KE, Horwitz SM. Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings. J Womens Health (Larchmt) 2017; 26:966-975. [PMID: 28409703 DOI: 10.1089/jwh.2016.6089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.
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Affiliation(s)
- Su-Chin Serene Olin
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Mary McCord
- 2 Department of Pediatrics, New York University School of Medicine , New York, New York.,3 Department of Pediatrics, Gouverneur Health Services , New York, New York
| | - Ruth E K Stein
- 4 Albert Einstein College of Medicine/Children's Hospital at Montefiore , New York, New York
| | - Bonnie D Kerker
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Dara Weiss
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Kimberly E Hoagwood
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Sarah M Horwitz
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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50
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Lind A, Richter S, Craft C, Shapiro AC. Implementation of Routine Postpartum Depression Screening and Care Initiation Across a Multispecialty Health Care Organization: An 18-Month Retrospective Analysis. Matern Child Health J 2017; 21:1234-1239. [DOI: 10.1007/s10995-017-2264-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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