"We Don't Want to be Judged": Perceptions about Professional Help and Attitudes Towards Help-Seeking among Pregnant and Postpartum Mexican-American Adolescents

Racial Disparities in Diagnosis of Postpartum Mood and Anxiety Disorders Among Symptomatic Medicaid Enrollees, 2012-2015

OBJECTIVE

This study quantified the prevalence of postpartum mood and anxiety disorder (PMAD) diagnoses among symptomatic Michigan Medicaid enrollees and explored factors associated with receiving a diagnosis.

METHODS

Data sources comprised Michigan Medicaid administrative claims and Phase 7 Michigan Pregnancy Risk Assessment Monitoring System (MI-PRAMS) survey responses, linked at the individual level. Participants were continuously enrolled in Michigan Medicaid, delivered a live birth (2012-2015), responded to the survey, and screened positive for PMAD symptoms on the adapted two-item Patient Health Questionnaire. Unadjusted and adjusted weighted logistic regression analyses were used to predict the likelihood of having a PMAD diagnosis (for the overall sample and stratified by race).

RESULTS

The weighted analytic cohort represented 24,353 deliveries across the 4-year study. Only 19.8% of respondents with symptoms of PMAD had a PMAD diagnosis between delivery and 3 months afterward. Black respondents were less likely to have PMAD diagnoses (adjusted odds ratio [AOR]=0.23, 95% CI=0.11-0.49) compared with White respondents. Among White respondents, no covariates were significantly associated with having a diagnosis. However, among Black respondents, more comorbid conditions and more life stressors were statistically significantly associated with having a diagnosis (AOR=3.18, 95% CI=1.27-7.96 and AOR=3.12, 95% CI=1.10-8.88, respectively).

CONCLUSIONS

Rate of PMAD diagnosis receipt differed by race and was low overall. Black respondents were less likely than White respondents to receive a diagnosis. Patient characteristics influencing diagnosis receipt also differed by race, indicating that strategies to improve detection of these disorders require a tailored approach.

Psychosocial Factors Associated With Perinatal Anxiety and Perinatal Depression Among Adolescents: A Rapid Review

The current review examined the influence of psychosocial factors on adolescents' perinatal anxiety (PA) and perinatal depression (PND) across geographical regions. Three databases were searched for articles published between 2017 and 2022 and 15 articles were reviewed. We categorized factors into social, cultural, and environmental domains. Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for PA and PND. Further research is necessary to examine the influence of cultural and environmental factors on PA, PND, and perinatal outcomes among adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 13-22.].

Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis

BACKGROUND

Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited.

AIMS

This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth.

METHOD

For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12).

RESULTS

In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping.

CONCLUSIONS

Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

Maternal postpartum depression literacy subtypes: A latent profile analysis

Aim

To explore the potential categories and characteristic differences of maternal postpartum depression literacy.

Design

Cross-sectional survey.

Methods

From February 2023 to April 2023, convenience sampling was used to survey 278 women attending postnatal visits to three tertiary level A hospitals. The study included general demographic characteristics, postpartum depression literacy scale, and family caring index scale. Latent profile analysis was performed to identify the categories of maternal postpartum depression literacy, and multiple disordered logistic regression was used to analyze the influencing factors of different categories.

Results

Maternal postpartum depression literacy was divided into three categories: low literacy (41.0 %), moderate literacy (32.4 %), and high literacy (26.6 %). The results showed that work status, education level, whether the pregnancy was planned, whether or not they had participated in mental health-related courses, and family functioning status were factors influencing the category of maternal postpartum depression literacy (P < 0.05).

Conclusion

There was heterogeneity in postpartum depression literacy among mothers. Medical staff should implement targeted interventions according to potential category characteristics and influencing factors to improve the level of postpartum depression literacy.

Postpartum depression literacy in Chinese perinatal women: a cross-sectional study

Background

Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group.

Methods

A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis.

Results

The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R² = 0.328, F = 24.518, p < 0.001).

Conclusion

The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.

Does Anyone Suffer From Teenage Motherhood? Mental Health Effects of Teen Motherhood in Great Britain Are Small and Homogeneous

Teen mothers experience disadvantage across a wide range of outcomes. However, previous research is equivocal with respect to possible long-term mental health consequences of teen motherhood and has not adequately considered the possibility that effects on mental health may be heterogeneous. Drawing on data from the 1970 British Birth Cohort Study, this article applies a novel statistical machine-learning approach-Bayesian Additive Regression Trees-to estimate the effects of teen motherhood on mental health outcomes at ages 30, 34, and 42. We extend previous work by estimating not only sample-average effects but also individual-specific estimates. Our results show that sample-average mental health effects of teen motherhood are substantively small at all time points, apart from age 30 comparisons to women who first became mothers at age 25‒30. Moreover, we find that these effects are largely homogeneous for all women in the sample-indicating that there are no subgroups in the data who experience important detrimental mental health consequences. We conclude that there are likely no mental health benefits to policy and interventions that aim to prevent teen motherhood.

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

BACKGROUND

Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC.

METHODS

Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies.

RESULTS

Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs.

CONCLUSION

Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately.

PROSPERO REGISTRATION NUMBER

CRD42019139183.

Experiences of Postpartum Depression in Women of Color

PURPOSE

To examine the experiences of postpartum depression among U.S.-born women of color via an integrative review.

STUDY DESIGN AND METHOD

Databases searched were PubMed, CINAHL, Scopus, and PsycInfo. Sample inclusion criteria included qualitative research published in English that explored U.S.-born women of color's experiences of postpartum depression. There was no time limitation on when studies were published. Krippendorff's thematic content analysis method was used.

RESULTS

In this integrative review, eight qualitative studies investigating Black and Hispanic women's postpartum depression experiences and eight blog postings were synthesized. Five themes were identified that described postpartum depression experiences of Black and Hispanic women: (1) Struggling with an Array of Distressing Symptoms , (2) Cultural Stigma as a Powerful Roadblock, (3) Complicating Barriers to Seeking Much-Needed Professional Help, (4) Support as a Lifeline or "Just Pulling Yourself up by Your Bootstraps," and (5) Preferences for Help with Postpartum Depression .

CLINICAL IMPLICATIONS

Cultural stigma of mental illness plus lack of knowledge of postpartum depression were strong barriers to women of color seeking timely professional mental health care. Nurses can share information about perinatal mental illness with women in cultural communities to help decrease stigma and increase mental health literacy. All health care providers and policy makers need to focus attention on the impact that women of color's economic and social stressors have on their postpartum depression.

Walking on Eggshells: An Update on the Stigmatizing of Teen Mothers

Teen mothers are stigmatized for violating age norms for parenting and for being members of devalued racial or socioeconomic groups. Stereotypes of young mothers perpetuate stigma by teen pregnancy prevention campaigns, television shows, sex education programs, professionals, and the general public. How teen mothers became a stigmatized group; updates on research about their experience of stigma; and resources for reducing stigma are presented. Because stigma is pervasive and has damaging effects, nurses are urged to reduce stigma and discrimination by assuring that health settings are safe and welcoming, and that pregnant and parenting teens are treated with respect and dignity. Doing so is consistent with our professional commitment to promote social justice and mitigate the social inequities that contribute to health disparities for all parents, irrespective of age, gender, ethnicity, immigration status, or income.

Engaging Expectant and Parenting Adolescents: Lessons from the Massachusetts Pregnant and Parenting Teen Initiative

INTRODUCTION

Programs supporting adolescent parents have been shown to increase socio-economic opportunities and promote healthy child development for young families, but retaining young parents is challenging. The Massachusetts Pregnant and Parenting Teen Initiative (MPPTI) offers case management and linkages to community and clinical services to young families. We examine engagement strategies identified by MPPTI participants and staff members in relation to participant retention by program site to identify potential strategies for increasing program engagement.

METHODS

We employed a mixed-methods approach incorporating quantitative data on program participant characteristics and program retention by site with qualitative data from staff and participant interviews and focus groups.

RESULTS

Key program engagement strategies identified by both MPPTI staff and youth participants were social-emotional supports, staffing model, and concrete supports. We found significant differences in program retention by site; the two sites with the highest levels of program retention offered all engagement strategies identified.

DISCUSSION

Quantitative data on program retention coupled with qualitative data from staff and youth interviews suggests that in our program, there may be an association between the engagement strategies identified and levels of program retention.

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

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.

Adolescent Pregnancy and Parenting: Perceptions of Healthcare Providers

BACKGROUND

Adverse maternal and child health outcomes due to adolescent pregnancy are central to public health research and practice. In addition, public health has emphasised that the care rendered by healthcare providers plays a pivotal role in the health and well-being of pregnant and parenting adolescents. Healthcare providers may differ in the ways they interpret adolescent pregnancy and parenting and consequently, this may have profound implications for healthcare decision making. The aim of this study was to explore the multiple perspectives of a diverse group of healthcare providers' delivering services and engaging with pregnant adolescents and adolescent mothers at a district hospital in Ugu, KwaZulu Natal, South Africa.

METHODS

This descriptive qualitative study used semi-structured interviews (n=33). Healthcare providers rendering care to pregnant and parenting adolescents were recruited from the maternity, antenatal, paediatrics, psychology, dietetics, physiotherapy and social work departments, as well as from the HIV/AIDS, STIs and TB (HAST) programme. The data were analysed using thematic analysis.

RESULTS

The healthcare providers acknowledged that adolescent pregnancy is a problematic issue in Ugu district. Furthermore, they felt that the postpartum sexual-related and reproductive health of adolescent mothers was not given priority. In the healthcare providers' view, the problems experienced by pregnant and parenting adolescents were school dropout, financial constraints, breakdown of relationships, abandonment, stigmatisation, parenting and child rearing difficulties, and both physical and mental health problems.

CONCLUSION

This study highlights that the issue of sexual- and reproductive-related outcomes of adolescent pregnancy and parenting is not given priority. In addition, the findings also highlighted the need for a multidisciplinary approach to the care of pregnant and parenting adolescents. Multidisciplinary communities of practices as interventions can be used to generate and share knowledge, capacitate healthcare providers and improve clinical practice. The training of healthcare providers, provision of non-judgemental counselling and tailored services for pregnant adolescents and adolescent mothers are essential. When appropriately disseminated, the findings will assist relevant healthcare providers, administrators in healthcare institutions, policymakers, and officials of the Department of Health and the Department of Education in South Africa to address the lack of appropriate care for pregnant and parenting adolescents.

A Literature Review of Health Literacy of Adolescents During Pregnancy

Adolescents who are pregnant are a vulnerable population at risk for poor health literacy. Health literacy is an important determinant of health, and poor health literacy among adolescents is correlated with high-risk health behaviors and adverse health outcomes into adulthood. A review of the literature showed a significant gap in research related to health literacy in pregnant adolescents. The limited findings indicate the need for additional research attention on health literacy in pregnant adolescents and upstream approaches to improve adolescent health literacy, such as incorporating health literacy education into secondary schools. To strengthen approaches that build health literacy capacity, it is imperative that future research focuses on pregnant adolescents' health literacy related to health behaviors, health outcomes, measurement instruments, health literacy frameworks, and targeted interventions.

Social Support and Perinatal Depression: The Perspectives of Mexican-American Adolescent Mothers

Perinatal depression is estimated to affect one in seven pregnant women. As such, social support has been shown to impact the mental health of women during the perinatal period. The purpose of this qualitative descriptive study was to examine the types of social support received by pregnant and parenting Mexican-American adolescent mothers and their perceptions of how it can influence perinatal mental health. Deductive content analysis was used to analyze the data using emotional, instrumental, and informational support as primary categories. Positive and negative aspects of the adolescent's social network were also included to understand how individuals impact their mental health. A convenience sample of 20 perinatal Mexican-American adolescents were interviewed. Emotional support, such as encouragement and affirmation, as well as instrumental support, via financial assistance and help with infant care, were primarily sought from significant others, which consisted of family members and their partner. Having strained relationships with their significant others primarily contributed to emotional distress. Health care providers were often sought out for informational support concerning perinatal depression. However, some adolescents were unable to establish rapport with their health care provider, making it difficult to inquire about pertinent mental health information. Study findings suggest that identifying support needs and expectations is an important component of facilitating positive mental health outcomes for Mexican-American adolescent mothers. Future efforts to promote mental health and prevent perinatal depression among Mexican-American adolescent mothers should consider integrating a strong focus on social support.

What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

BACKGROUND

Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap.

METHODS

Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis.

RESULTS

Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements.

CONCLUSION

Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.

Family-Centered Primary Care for Teen Parents and Their Children

Although the teen birth rate in the United States continues to decline, births remain disproportionately high among disadvantaged teens and teens of color. The vulnerabilities and resilience of teen parents are described from a historical context, with recommendations for advancing primary care of these families. We endorse comprehensive primary care and clinical practices that capitalize on the strengths and resilience of these families while recognizing the social inequities that compromise their health and development. To strengthen the bonds among young mothers, fathers, and children, we recommend family-centered primary care services that are of a youth- and father-friendly, nonstigmatizing, strength-based, and trauma-informed nature.

Navigating a Minefield: Meta-Synthesis of Teen Mothers' Breastfeeding Experience

Teen mothers have lower rates of breastfeeding duration and exclusivity than older mothers. A growing body of qualitative research on teen mothers' experience helps to explain these disparities. Following a systematic search to identify relevant research, we synthesized the findings from 22 primary studies to conclude that teen mothers navigate a minefield that undermines their intention to breastfeed and their breastfeeding confidence and skill. This metaphorical minefield reflects competing norms for infant feeding and good mothering, as evident in mixed support from teens' social networks; fragmented and stigmatizing healthcare; and spaces that are inhospitable to teen mothers and breastfeeding mothers in general.In recognition of this minefield, we urge clinicians to: respect teen mothers' infant feeding decisions; develop collaborative relationships based on the principles of patient-centered and strength-based care; challenge stigmatizing healthcare practices; welcome teen mothers and their significant others to clinical settings; and press health systems to fully implement probreastfeeding policies. We also recommend further study to extend our knowledge about teen mothers' breastfeeding experiences.

Summative Content Analysis for Understanding of Romantic Relationships Among Rural Mexican American Adolescent Women

An understanding of romantic relationships among adolescent Mexican-American females is lacking yet needed to provide culturally appropriate sexual health interventions. Although explored among other populations, romantic relationships among adolescents in rural settings is under-studied. This study explores romantic relationships for rural Mexican American female adolescents as a component of sexual health promotion. Rural Mexican-American adolescent females (n = 82) aged 14-18 years were recruited via convenience sampling at a rural health clinic. They completed open-ended individual interviews describing romantic relationships. Responses to open-ended questions were analyzed using summative content analysis. The majority reported sexual activity (62.2%) of which 23.5% had been pregnant. Summative content analyses identified personal characteristics and relationship characteristics as main categories with eight additional subcategories from responses. Sex was reported as what men wanted from women while physical attractiveness was perceived as important for both genders in development of romantic relationships. They prioritized other relational and personal characteristic such as integrity, and partner treatment of self and others. More obesity was present among those reportedly in romantic relationships. Description of parental roles as a component of romantic relationships was not present. Addressing adolescent romantic relationship with an emphasis on what male and female adolescents want or perceive as expected from relationships, long-term outcomes of relationships and on parental roles may enhance sexual health among rural Mexican-American adolescent populations. This study addresses a gap in literature by exploring romantic relationships for rural Mexican American female adolescents. This understanding of romantic relationships augments existing sexual health programing for these adolescents.