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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use. OBJECTIVE Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences. DESIGN Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy. FINDINGS We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported. CONCLUSIONS Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Dudeney E, Coates R, Ayers S, McCabe R. Acceptability and content validity of suicidality screening items: a qualitative study with perinatal women. Front Psychiatry 2024; 15:1359076. [PMID: 38666087 PMCID: PMC11044181 DOI: 10.3389/fpsyt.2024.1359076] [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: 12/20/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Suicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited. Aims This study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth. Methods Twenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches. Results Findings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as 'better off dead' or 'killing myself' uncomfortable. Most women preferred the phrase 'ending your life' as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret 'harming myself' to include suicidality, nor did they feel that abstract language such as 'leave this world' was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support. Conclusions Existing suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose McCabe
- Centre for Mental Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
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Broberg L, Bendix JM, Røhder K, Løkkegaard E, Væver M, Grew JC, Johnsen H, Juhl M, de Lichtenberg V, Schiøtz M. Combining the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale in Early Pregnancy in Danish Antenatal Care-A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:454. [PMID: 38673365 PMCID: PMC11050197 DOI: 10.3390/ijerph21040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.
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Affiliation(s)
- Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
- Department of Gynecology and Obstetrics, Slagelse Hospital, Fælledvej 14, 4200 Slagelse, Denmark
| | - Jane M. Bendix
- Department of Gynecology and Obstetrics, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark; (J.M.B.); (E.L.)
| | - Katrine Røhder
- Center for Early Intervention and Family Research, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark; (K.R.); (M.V.)
| | - Ellen Løkkegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark; (J.M.B.); (E.L.)
| | - Mette Væver
- Center for Early Intervention and Family Research, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark; (K.R.); (M.V.)
| | - Julie C. Grew
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
| | - Helle Johnsen
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Mette Juhl
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Michaela Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
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Clarke JR, Gibson M, Savaglio M, Navani R, Mousa M, Boyle JA. Digital screening for mental health in pregnancy and postpartum: A systematic review. Arch Womens Ment Health 2024:10.1007/s00737-024-01427-3. [PMID: 38557913 DOI: 10.1007/s00737-024-01427-3] [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: 03/31/2022] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard care (paper-and pen-based screening or no screening). The second aim was to identify barriers and enablers to implementing digital screening in pregnancy and postpartum. METHOD OVID MEDLINE, PsycINFO, SCOPUS, CINAHL, Embase, Web of Science, Joanna Briggs Database and All EMB reviews incorporating Cochrane Database of Systematic Reviews (OVID) were systematically searched for articles that evaluated digital screening for mental health in pregnancy and postpartum between 2000 and 2021. Qualitative articles were deductively mapped to the Theoretical Domains Framework (TDF). RESULTS A total of 34 articles were included in the analysis, including qualitative, quantitative and mixed-methods studies. Digital screening was deemed acceptable, feasible and effective. TDF domains for common barriers included environmental context and resources, skills, social/professional role and identity and beliefs about consequences. TDF domains for common enablers included knowledge, social influences, emotion and behavioural regulation. CONCLUSION When planning to implement digital screening, consideration should be made to have adequate training, education and manageable workload for healthcare professionals (HCP's). Organisational resources and support are important, as well as the choice of the appropriate digital screening assessment and application setting for women. Theory-informed recommendations are provided for both healthcare professionals and women to inform future clinical practice.
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Affiliation(s)
- Jocelyn R Clarke
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Melanie Gibson
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Wellington Faculty of Health,, Victoria University of Wellington,, Wellington, New Zealand
| | - Melissa Savaglio
- Health and Social Care Unit (HSCU), School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Australia
| | | | - Mariam Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Jacqueline A Boyle
- Health Systems and Equity, Eastern Health Clinical School,, Monash University, Melbourne, Australia.
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Fairbrother N, Stagg B, Scoten O, Keeney C, Cargnelli C. Perinatal anxiety disorders screening study: a study protocol. BMC Psychiatry 2024; 24:162. [PMID: 38395837 PMCID: PMC10893673 DOI: 10.1186/s12888-024-05575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. METHODS A large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks' gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. DISCUSSION This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Bryn Stagg
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Olivia Scoten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Claudia Cargnelli
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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Pathirana MM, Andraweera PH, Leemaqz S, Aldridge E, Arstall MA, Dekker GA, Roberts CT. Anxiety and Depression in Early Gestation and the Association with Subsequent Gestational Diabetes Mellitus in a Disadvantaged Population. Matern Child Health J 2023; 27:2185-2193. [PMID: 37823988 PMCID: PMC10618298 DOI: 10.1007/s10995-023-03778-2] [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] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Evaluate the association between poor mental health and risk of developing gestational diabetes mellitus (GDM) in a cohort of women from a socioeconomically disadvantaged community. METHODS A total of 1363 nulliparous women with singleton pregnancies recruited to the Screening Tests to Predict Poor Outcomes of Pregnancy study in Adelaide, Australia. Women were assessed for mental health in the first trimester, including likelihood of depression, high functioning anxiety, perceived stress and risk of developing a mental health disorder. GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Socioeconomic status was measured using the New Zealand Socioeconomic Index (NZSEI). RESULTS Complete mental health data was available for 1281 participants. There was no statistically significant difference in SEI, depression, risk of mental health issues, high functioning anxiety and perceived stress between women who developed GDM and those who did not. There was no difference in history of depression nor risk of developing a high mental health disorder in first trimester after adjusting for SEI, BMI in first trimester, smoking status in first trimester and maternal age between women with a GDM pregnancy and those who did not. CONCLUSIONS FOR PRACTICE There was no difference in markers of poor mental health in early pregnancy between women who subsequently did or did not develop GDM. Cohort participants were socioeconomically disadvantaged, potentially contributing to the lack of apparent differences in depression observed between groups. Socioeconomically disadvantaged women should be targeted in pre-conception planning to reduce risk of GDM.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia.
| | - Prabha H Andraweera
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Shalem Leemaqz
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Emily Aldridge
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Margaret A Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Division of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Claire T Roberts
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Doyle FL, Dickson SJ, Eapen V, Frick PJ, Kimonis ER, Hawes DJ, Moul C, Richmond JL, Mehta D, Dadds MR. Towards Preventative Psychiatry: Concurrent and Longitudinal Predictors of Postnatal Maternal-Infant Bonding. Child Psychiatry Hum Dev 2023; 54:1723-1736. [PMID: 35616764 PMCID: PMC10582133 DOI: 10.1007/s10578-022-01365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/08/2022] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
Maternal-infant bonding is important for children's positive development. Poor maternal-infant bonding is a risk factor for negative mother and infant outcomes. Although researchers have examined individual predictors of maternal-infant bonding, studies typically do not examine several concurrent and longitudinal predictors within the same model. This study aimed to evaluate the unique and combined predictive power of cross-sectional and longitudinal predictors of maternal-infant bonding. Participants were 372 pregnant women recruited from an Australian hospital. Data were collected from mothers at antenatal appointments (T0), following their child's birth (T1), and at a laboratory assessment when their child was 5-11-months-old (T2). Poorer bonding at T2 was predicted at T0 by younger maternal age, higher education, and higher antenatal depressive symptoms. Poorer bonding at T2 was predicted at T1 by younger maternal age, higher education, and higher postnatal depressive symptoms. Poorer bonding at T2 was predicted at T2 by younger maternal age, higher education, higher postnatal depression symptoms, higher concurrent perceived social support, and more difficult infant temperament, when controlling for child age at T2. To promote positive maternal-infant bonding, global and targeted interventions in the perinatal period may benefit from targeting maternal psychopathology, perceived lack of social support, and coping with difficult infant temperament.
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Affiliation(s)
- Frances L. Doyle
- School of Psychology, Faculty of Science, University of Sydney, 2006 Sydney, NSW Australia
- School of Psychology; MARCS Institute for Brain Behaviour and Development; Transforming early Education And Child Health Research Centre, Translational Health Research Institute, Western Sydney University, 2750 Penrith, NSW Australia
| | - Sophie J. Dickson
- School of Psychology, Faculty of Science, University of Sydney, 2006 Sydney, NSW Australia
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, 2109 Sydney, NSW Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, 2052 Kensington, NSW Australia
| | - Paul J. Frick
- Department of Psychology, Louisiana State University, 70803 Baton Rouge, LA USA
| | - Eva R. Kimonis
- School of Psychology, University of New South Wales, 2052 Kensington, NSW Australia
| | - David J. Hawes
- School of Psychology, Faculty of Science, University of Sydney, 2006 Sydney, NSW Australia
| | - Caroline Moul
- School of Psychology, Faculty of Science, University of Sydney, 2006 Sydney, NSW Australia
| | - Jenny L. Richmond
- School of Psychology, University of New South Wales, 2052 Kensington, NSW Australia
| | - Divya Mehta
- Centre for Genomics and Personalised Health, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, 4059 Brisbane, Queensland Australia
| | - Mark R. Dadds
- School of Psychology, Faculty of Science, University of Sydney, 2006 Sydney, NSW Australia
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Matthey S, Reilly N, Mule V, Robinson J, Della Vedova AM, Austin MP. Screening women for distress during pregnancy: the impact of including 'Possibly' as a response option. J Reprod Infant Psychol 2023; 41:528-539. [PMID: 35234553 DOI: 10.1080/02646838.2022.2042798] [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: 05/26/2021] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the impact of including the response option of 'Possibly' in the Distress question on the Matthey Generic Mood Questionnaire (MGMQ) during antenatal emotional health screening in English-speaking women. BACKGROUND Some distress screening questions only allow respondents to choose between 'Yes' or 'No' to the presence of distress. The MGMQ, however, allows respondents to chose between 'Yes', 'Possibly', or 'No', which may be preferable if a participant is reluctant to state she definitely feels distressed. METHOD In Study 1, women undergoing routine antenatal psychosocial screening were allocated to either completing the MGMQ Distress question with the usual three-option response format of 'Yes, Possibly, No' (N = 960), or just a 'Yes, No' response format (N = 771). The proportion of responses were compared in each group, as were the proportion then screening positive on the MGMQ's Bother question. In Study 2, women (N = 113) attending routine antenatal clinic appointments were asked about their preference between these response formats. RESULTS Including 'Possibly' resulted in only a slight increase in the proportion giving a positive response to the Distress question, and then also screening positive on the Bother question. In Study 2, a substantial majority of women (80%) preferred having 'Possibly' in the response options. CONCLUSION While the impact of including 'Possibly' is small, it allows for more women to communicate how they are feeling on the full MGMQ. Given the large majority of women preferring having 'Possibly' included, we believe that the Distress Question is enhanced by having this as a response option.
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Affiliation(s)
- S Matthey
- Academic Unit of Child Psychaitry, South Western Sydney Local Health District, Sydney, Australia
- School of Psychiatry, UNSW, Sydney, Australia
| | - N Reilly
- School of Psychiatry, UNSW, Sydney, Australia
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
| | - V Mule
- School of Psychiatry, UNSW, Sydney, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
| | - J Robinson
- Academic Unit of Child Psychaitry, South Western Sydney Local Health District, Sydney, Australia
| | - A M Della Vedova
- Dept of Clinical and Experimental Science (Area Disciplinare Medicina e Chirurgia), University of Brescia, Brescia, Italy
| | - M-P Austin
- School of Psychiatry, UNSW, Sydney, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
- Royal Hospital for Women, Sydney, Australia
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Bjertrup AJ, Væver MS, Miskowiak KW. Prediction of postpartum depression with an online neurocognitive risk screening tool for pregnant women. Eur Neuropsychopharmacol 2023; 73:36-47. [PMID: 37119561 DOI: 10.1016/j.euroneuro.2023.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
Postpartum depression (PPD) is a severe mental illness affecting 10-15% of mothers. Emerging evidence indicates that negative neurocognitive bias in response to infant distress during pregnancy marks an increased risk of PPD. This proof-of-concept study aimed to investigate the association between negatively biased neurocognitive processing of infant distress during pregnancy and subsequent PPD and to explore the feasibility of an online risk screening tool. In the second or third trimester of pregnancy, 87 participants underwent two online tests of reactivity to and evaluation of infant distress and completed questionnaires regarding psychosocial risk factors. After birth, participants rated their depressive symptoms online and underwent a diagnostic telephone interview concerning PPD. Irrespective of depressive symptoms during pregnancy, negative reactivity to and evaluation of infant distress predicted PPD (reactivity: Exp(B)=1.33, p = 0.04) and depressive symptoms after birth (reactivity: B = 0.04, p = 0.048; evaluation: B = 0.10, p = 0.04). The negative reactivity toward infant distress showed high sensitivity and moderate specificity (89% and 77%, respectively), while the evaluation of infant distressed cries showed lower sensitivity and specificity (67% and 66%, respectively). The relatively small sample size prevented the inclusion of additional risk variables in the regression models. The replication of an association between negative neurocognitive bias during pregnancy with PPD risk is noteworthy and has clinical implications in terms of early prevention. However, the low response rate indicates that this tool is not feasible in its current form. Future larger-scale studies are needed to further investigate candidate risk factors in a brief online screening tool.
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Affiliation(s)
- Anne Juul Bjertrup
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Hovedvejen 17, DK-2000 Frederiksberg, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Mette Skovgaard Væver
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Hovedvejen 17, DK-2000 Frederiksberg, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark.
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10
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Moureau A, Cordemans L, Gregoire C, Benoît P, Delvenne V. A 5 years' experience of a parent-baby day unit: impact on baby's development. Front Psychiatry 2023; 14:1121894. [PMID: 37398587 PMCID: PMC10308312 DOI: 10.3389/fpsyt.2023.1121894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Psychiatric Mother-Baby Units are well established in France, United Kingdom, and Australia, mostly in full-time hospitalization. Inpatient units are considered as best practice for improving outcomes for mothers and babies when the mother is experiencing severe mental illness and many studies have showed the effectiveness of care for the mother or the mother-infant relationship. Only a limited number of studies have focused on the day care setting or on the development of the baby. Our parent-baby day unit is the first day care unit in child psychiatry in Belgium. It offers specialized evaluation and therapeutic interventions focused on the baby and involves parents with mild or moderate psychiatric symptoms. The advantages of day care unit is to reduce the rupture with social and family living. Aims The objective of this study is to evaluate the effectiveness of parent-baby day unit in prevention of babies' developmental problems. First, we present the clinical characteristics of the population treated in the day-unit in comparison to the features presented in the literature review about mother-baby units, which usually receive full-time treatment. Then, we will identify the factors that might contribute to a positive evolution of the baby's development. Materials and methods In this study, we retrospectively analyze data of patients admitted between 2015 and 2020 in the day unit. Upon admission, the 3 pillars of perinatal care - babies, parents, and dyadic relationships - have systematically been investigated. All the families have received a standard perinatal medico-psycho-social anamnesis, including data on the pregnancy period. In this unit, all the babies are assessed at entry and at discharge using the diagnostic 0 to 5 scale, a clinical withdrawal risk, and a developmental assessment (Bayley). Parental psychopathology is assessed with the DSM5 diagnostic scale and the Edinburgh scale for depression. Parent-child interactions are categorized according to Axis II of the 0 to 5 scale. We have evaluated the improvement of children symptomatology, the child development and the mother-child relation between the entrance (T1) and the discharge (T2) and we have compared two groups of clinical situations: a group of patients with a successful evolution (considering baby's development and the alliance with the parents) and a group of unsuccessful evolution during hospitalization. Statistical analysis We use descriptive statistics to characterize our population. To compare the different groups of our cohort, we use the T-test and non-parametric tests for continue variables. For discrete variables, we used the Chi2 test of Pearson. Discussion The clinical population of the day unit is comparable to the mother-baby units in terms of psychosocial fragility but the psychopathological profile of the parents entering the day unit shows more anxiety disorder and less post-partum psychosis. The babies' development quotient is in the average range at T1 and is maintained at T2. In the day unit, the number of symptoms as well as the relational withdrawal of the babies is reduced between T1 and T2. The quality of parent-child relationship is improved between T1 and T2. The children of the group of pejorative evolution had a lower developmental quotient at the T1 and an overrepresentation of traumatic life events. Conclusion These results indicate that parent-baby day unit lead to positive outcomes in clinical situations with anxio-depressive parents, relational withdrawal of the babies, functional problems of the babies but not when a significant impact on the development of the baby already exists. The results of this study can guide therapeutic approaches for the benefit of care in parent-baby day units, and improve the development of the child and of the dyadic relationships.
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Affiliation(s)
- Audrey Moureau
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
| | - Louise Cordemans
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Gregoire
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Pirmez Benoît
- Faculty of Statistics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Veronique Delvenne
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
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Mestermann S, Fasching PA, Beckmann MW, Gerlach J, Kratz O, Moll GH, Kornhuber J, Eichler A. The Benefit of a Retrospective Pregnancy Anamnesis in Child and Adolescent Psychiatry: The Reliability of Maternal Self-Report during Childhood Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050866. [PMID: 37238414 DOI: 10.3390/children10050866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Pregnancy anamnesis is a crucial part of child and adolescent psychiatry diagnostics. In previous works, the reliability of retrospective maternal self-report on perinatal characteristics was heterogeneous. This prospective longitudinal study aimed to evaluate women's recall of prenatal events in a within-subject design. A sample of 241 women gave a self-report on prenatal alcohol, smoking, partnership quality, pregnancy satisfaction, and obstetric complications during the 3rd trimester (t0), childhood (t1, 6-10 y), and adolescence (t2, 12-14 y). The intra-individual agreement was examined. The t0-t1-(t2) agreement was poor to substantial; this was highest for smoking and worst for obstetric complications, followed by alcohol (Fleiss' κ = 0.719 to -0.051). There were significant t0-t1-(t2) differences for all pregnancy variables (p < 0.017), except for 3rd trimester satisfaction (p = 0.256). For alcohol (t0 25.8%, t1 17.4%, t2 41.0%) and smoking (t0 11.9%, t1 16.4%, t2 22.6%), the highest self-reported rates were found during adolescence. During childhood, fewer obstetric complications (t0 84.9%, t1 42.2%) and worse partnerships were reported (t0 M = 8.86, t1 M = 7.89). Thought to be due to social stigmata and memory effects, pregnancy self-reports cannot be precisely reproduced. Creating a respectful and trusting atmosphere is essential for mothers to give honest self-reports that are in the best interest of their children.
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Affiliation(s)
- Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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Andersen CG, Thomsen LLH, Gram P, Overgaard C. ‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme. Midwifery 2023; 122:103675. [PMID: 37043942 DOI: 10.1016/j.midw.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. DESIGN a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. SETTING nine community-based and hospital-based midwife clinics in the North Region of Denmark. INTERVENTION a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. PARTICIPANTS AND DATA 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. FINDINGS contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. CONCLUSION midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.
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Basirat Z, Ramaezani F, Sepidarkish M, Kashifard M, Faramarzi M. Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:186-191. [PMID: 37224840 PMCID: PMC10208729 DOI: 10.1055/s-0043-1768997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period. METHODS This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ). RESULTS The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036). CONCLUSION Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.
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Chorwe-Sungani G, Mwagomba M, Chirwa E, Jere D, Chipps J. Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi. BMC Psychiatry 2022; 22:544. [PMID: 35953774 PMCID: PMC9371629 DOI: 10.1186/s12888-022-04195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is one of the most common perinatal mental health problems that affect pregnant women. Antenatal depression can adversely affect the well-being of the pregnant woman and her foetus. Depression is rarely detected by midwives due to the unavailability of relevant screening instruments in Malawi. A Screening Protocol for Antenatal Depression (SPADe) was developed and recommended for possible use to screen for depression in antenatal clinics in the country. The acceptability and feasibility of using the SPADe protocol to screen for depression has not been established. The aim of this study was to assess the acceptability and feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre district. METHODS This study used a quantitative survey design to collect data among 60 midwives in three antenatal clinics in primary care settings. All inclusive sampling of all 60 midwives were used. The Structured Assessment of FEasibility and Ottawa Acceptability of Decision Rules Instruments were used to collect the data. Descriptive statistics and Chi square tests were used to analyse the data. RESULTS This study found that it was feasible to implement SPADe and the following enablers for screening depression had the highest ratings: the SPADe is applicable to pregnant women (M = 3.9, sd = 0.4); the intended goal of the SPADe matches the prioritised goals of Malawi Ministry of Health (M = 3.9, sd = 0.5); and the SPADe is likely to be effective (M = 3.8, sd = 0.6). On the other hand, barriers for implementing the SPADe were: the need for specific training to deliver the SPADe (M = 3.7, sd = 0.7); ongoing support and supervision (M = 3.5, sd = 0.8); and additional resources (M = 3.0, sd = 0.9). This study also found that the implementation of the SPADe was acceptable to respondents. The overall mean score for respondents on acceptability of screening antenatal depression using SPADe was found to be high (M = 4.6, sd = 0.6). However the differences in the respondents' mean scores on acceptability of screening for depression in antenatal clinics using SPADe in relation to their demographic characteristics were not significant (p > .05). CONCLUSION This study suggests that midwives feel that it is feasible and acceptable for them to implement the SPADe in antenatal clinics with ongoing training, support and clinical supervision.
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Affiliation(s)
| | - Modesta Mwagomba
- District Nursing Officer, Blantyre District Health and Social Office, Chipatala Avenue, Blantyre, Malawi
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, School of Maternal Neonatal and Reproductive Health, P/Bag 360, Blantyre, Malawi
| | - Diana Jere
- Kamuzu University of Health Sciences, School of Nursing, P/Bag 360, Blantyre, Malawi
| | - Jennifer Chipps
- University of the Western Cape, School of Nursing, Private Bag X17, Bellville, 7535, South Africa
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Nicolson S, Carron S, Paul C. Supporting early infant relationships and reducing maternal distress with the Newborn Behavioral Observations: A randomized controlled effectiveness trial. Infant Ment Health J 2022; 43:455-473. [PMID: 35531961 PMCID: PMC9324818 DOI: 10.1002/imhj.21987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Research points to the significant impact of maternal distress on the parent‐infant relationship and infant development. The Newborn Behavioral Observations (NBO) is a brief intervention supporting the infant, the parent and their relationship. This randomized controlled trial examined the effectiveness of the NBO in a population with antenatal distress and risk of postnatal depression (PND). Pregnant, first‐time mothers with current anxiety or depression symptoms or past mental illness were recruited from two Australian hospitals. Participants received three NBO sessions in the first month of life plus treatment as usual (TAU), or, TAU‐only. Outcomes assessed at infant age 4 months included mother‐infant interaction quality; maternal anxiety and depression symptoms; and depression diagnosis. Of 111 pregnant individuals randomized, 90 remained eligible and 74 completed the trial (82.2% retention). There were intervention effects on emotional availability F(6, 67) = 2.52, p = .049, Cohen's d = .90, with higher sensitivity and non‐intrusiveness in the intervention group (n = 40) than the comparison group (n = 34). There was an intervention effect approaching significance for anxiety symptoms at 4 months (p = .06), and a significant effect over time (p = .014), but not for depression symptoms. Anxiety and depression symptoms significantly reduced to sub‐clinical levels within the intervention group only. There were fewer depression diagnoses (n = 6) than expected across groups, with no observed intervention effect. No adverse intervention effects were seen. Exploratory analysis of sensory processing sensitivity suggested differential susceptibility to distress and intervention benefits. The NBO was accepted and exerted meaningful effects on relationship quality and distress; and may enhance the infant's interaction experience and maternal emotional adjustment in at‐risk populations.
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Affiliation(s)
- Susan Nicolson
- Department of Psychiatry University of Melbourne Parkville Victoria Australia
- Department of General Practice University of Melbourne Parkville Victoria Australia
- Women's Mental Health Service Royal Women's Hospital Melbourne Victoria Australia
| | | | - Campbell Paul
- Department of Psychiatry University of Melbourne Parkville Victoria Australia
- Women's Mental Health Service Royal Women's Hospital Melbourne Victoria Australia
- Royal Children's Hospital Melbourne Victoria Australia
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Austin MPV, Mule V, Hadzi-Pavlovic D, Reilly N. Screening for anxiety disorders in third trimester pregnancy: a comparison of four brief measures. Arch Womens Ment Health 2022; 25:389-397. [PMID: 34350480 DOI: 10.1007/s00737-021-01166-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
Evidence regarding the accuracy of existing anxiety screeners used in pregnancy is limited. This study compares the psychometric characteristics of the Generalized Anxiety Disorder 2- and 7-item Scales (GAD-2 and GAD-7), the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS-3A) and the two anxiety items of the Antenatal Risk Questionnaire (ANRQ-2A). Nine hundred fifty-four women completed the screening measures and anxiety modules of a diagnostic reference standard (SAGE-SR) in the third trimester. Test performance characteristics of each measure was assessed using Receiver Operator Characteristic (ROC) analysis. We applied four previously recommended criteria to ascertain the value of each measure for widespread clinical use: area under the curve (AUC ≥ 0.8, Youden's index ≥ 0.5, negative predictive value (NPV) ≥ 0.8 and positive likelihood ratio (LR +) ≥ 4.0). Prevalence for any SAGE-SR anxiety disorder was 3%. All measures yielded an acceptable AUC of ≥ 0.8, Youden's index of ≥ 0.5 and NPV of ≥ 0.8. Only the EPDS-3A, at a cut-point ≥ 5, also achieved a LR + of ≥ 4.0 (4.35) but at this cut-point sensitivity was less than 0.75. The ANRQ-2A, at its optimal cut-point of ≥ 6, was the only measure to additionally attain both a sensitivity and specificity of ≥ .75. This study expands the evidence base for brief anxiety screening measures in the maternity setting and provides empirical support for the use of the EPDS-3A and ANRQ-2A in routine screening programmes. Studies assessing the performance of these measures in samples with higher disease prevalence and broader socio-economic status are warranted.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia. .,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia. .,Royal Hospital for Women, Barker St, Sydney, Randwick, NSW, 2031, Australia.
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia.,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia
| | | | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia.,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia.,Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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17
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Warland J, Footner S, Beaufoy G, Stocker J, Agostini A, Dorrian J. Giving sleep position advice in pregnancy: Will we make women anxious? Aust N Z J Obstet Gynaecol 2022; 62:536-541. [PMID: 35312035 PMCID: PMC9544284 DOI: 10.1111/ajo.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background There is now robust evidence that when women settle to sleep on their back in late pregnancy (>28 weeks) they are at increased risk of stillbirth. Therefore, there are several stillbirth prevention programs worldwide that have begun advising pregnant women to adopt a side position when settling to sleep in late pregnancy. However, some hold concerns that giving women information about sleep position and stillbirth risk may make them anxious. Aim This study aimed to determine what influences how ‘safe sleep’ messages are perceived by pregnant women and if there is anxiety associated with receiving this message. Materials and Methods An online survey of 537 Australian women (n = 97 were ‘currently pregnant’). The survey examined participant’s views regarding sleep position messages, type of information source as well as participant characteristics such as general anxiety and their fetal health locus of control (FHLC). Results Our findings suggest that the FHLC may influence how health messaging regarding sleep in pregnancy is perceived and acted upon. We have also shown a subset of pregnant women may feel anxiety associated with the sleep position in pregnancy message. This may not be related to history of anxiety, but rather to their higher ‘internal’ FHLC, ie those who reflect a greater sense of personal agency over fetal health. Conclusions Our findings suggest most women will perceive information about settling into sleep position as informative rather than anxiety provoking. Therefore, maternity care providers should not be overly concerned about provoking anxiety when providing this information.
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Affiliation(s)
- Jane Warland
- UniSA Clinical & Health Sciences University of South Australia Adelaide South Australia Australia
| | - Sarah Footner
- UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
| | - Georgie Beaufoy
- UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
| | - Jade Stocker
- UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
| | - Alex Agostini
- UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
| | - Jillian Dorrian
- UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
- Behaviour‐Brain‐Body Research Centre UniSA Justice and Society University of South Australia Adelaide SAAustralia5001
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O'Rourke P, Jureidini J, Ben-Tovim D. The Maternal Looking Guide: a perinatal clinical tool to support the emerging mother-infant relationship'. J Reprod Infant Psychol 2021:1-18. [PMID: 34672887 DOI: 10.1080/02646838.2021.1991566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study explores maternal looking - the unidirectional looking by a mother at her newborn - as a precursor to mother-infant gaze. METHODS Phase 1 used video as a means of detailed and disciplined observation to examine how mothers look at their newborns (n = 13). Using an iterative design, intensive analysis identified and categorised patterns of looking and looking-related behaviours. This resulted in a typology of looking. Phase 2 subjected the typology to inter-rater reliability testing, with midwives as multiple raters (n = 24), using the typology to rate standardised tapes of mothers and newborns (n = 10). RESULTS Phase 1 generated a one-page clinical tool (Maternal Looking Guide). This tool enables the assessment of mothers' looking behaviour over six constructs and allocation to one of three overall categories of looking: those women who are doing well (comfortable), those who need a referral to an expert perinatal service (worrisome) and those to whom something extra could be offered (uncomfortable). In Phase 2 the Maternal Looking Guide achieved moderate reliability. CONCLUSIONS The Maternal Looking Guide is a practical, moderately reliable, clinical tool that can assist midwives and other perinatal workers identify those mothers who may need extra support at this critical perinatal window of opportunity. .
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Affiliation(s)
- Patricia O'Rourke
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - David Ben-Tovim
- Faculty of Health Sciences, Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
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Barrios YV, Maselko J, Engel SM, Pence BW, Olshan AF, Meltzer-Brody S, Dole N, Thorp JM. The relationship of cumulative psychosocial adversity with antepartum depression and anxiety. Depress Anxiety 2021; 38:1034-1045. [PMID: 34370895 DOI: 10.1002/da.23206] [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: 01/18/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. METHODS This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated. RESULTS Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude. CONCLUSION High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.
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Affiliation(s)
- Yasmin V Barrios
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nancy Dole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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The antenatal risk questionnaire-revised: Development, use and test-retest reliability in a community sample of pregnant women in Australia. J Affect Disord 2021; 293:43-50. [PMID: 34166908 DOI: 10.1016/j.jad.2021.05.081] [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: 09/14/2020] [Revised: 04/05/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Routine psychosocial assessment during pregnancy and the first postnatal year is a public health strategy that prioritises early identification of known risk factors for poor perinatal mental health. We aimed to report on the development and use of the Antenatal Risk Questionnaire-Revised (ANRQ-R), contribute normative data for a community sample of pregnant women and examine its test-retest reliability. METHODS The ANRQ-R was developed in consultation with an expert advisory group. Women completed the ANRQ-R with their midwife at their first antenatal appointment. Test-retest analysis was restricted to women who consented to follow-up and completed a repeat ANRQ-R within four weeks. RESULTS 7183 women completed the ANRQ-R (total score M = 12.05, Mdn=10; range =5-49). There were some statistically significant differences in total score across maternal age group (χ2=69.75, p<.001), country of birth (χ2=144.01, p<.001) and socioeconomic quintiles (χ2=20.13, p<.001), however the effect sizes of all differences were either small or not clinically significant. Test-retest reliability for the ANRQ-R total score was good (N = 1670; ICC=0.77). Item-level test-retest reliabilities were moderate to good (ICC range=0.65-0.80; kappa coefficient range=0.31-0.74). LIMITATIONS The study was conducted at a single site. Although there was significant diversity in terms of maternal age and country of birth, the majority of participants were partnered and resided in socio-economically advantaged areas, limiting the generalisability of results. CONCLUSIONS This study contributes significant normative data for the ANRQ-R and offers valuable insights for clinicians and researchers working with particular sub-groups of the perinatal population. Additional psychometric examination of the ANRQ-R, including its concurrent and predictive validity, is required.
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Amuli K, Decabooter K, Talrich F, Renders A, Beeckman K. Born in Brussels screening tool: the development of a screening tool measuring antenatal psychosocial vulnerability. BMC Public Health 2021; 21:1522. [PMID: 34362316 PMCID: PMC8348826 DOI: 10.1186/s12889-021-11463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal psychosocial vulnerability is a main concern in today's perinatal health care setting. Undetected psychosocially vulnerable pregnant women and their unborn child are at risk for unfavourable health outcomes such as poor birth outcomes or mental state. In order to detect potential risks and prevent worse outcomes, timely and accurate detection of antenatal psychosocial vulnerability is necessary. Therefore, this paper aims to develop a screening tool 'the Born in Brussels Screening Tool (ST)' aimed at detecting antenatal psychosocial vulnerability. METHODS The Born in Brussels ST was developed based on a literature search of existing screening tools measuring antenatal psychosocial vulnerability. Indicators and items (i.e. questions) were evaluated and selected. The assigned points for the answer options were determined based on a survey sent out to caregivers experienced in antenatal (psychosocial) vulnerability. Further refinement of the tool's content and the assigned points was based on expert panels' advice. RESULTS The Born in Brussels ST consists of 22 items that focus on 13 indicators: communication, place of birth, residence status, education, occupational status, partner's occupation, financial situation, housing situation, social support, depression, anxiety, substance use and domestic violence. Based on the 168 caregivers who participated in the survey, assigned points account between 0,5 and 4. Threshold scores of each indicator were associated with adapted care paths. CONCLUSION Generalied and accurate detection of antenatal psychosocial vulnerability is needed. The brief and practical oriented Born in Brussels ST is a first step that can lead to an adequate and adapted care pathway for vulnerable pregnant women.
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Affiliation(s)
- Kelly Amuli
- Faculty of Medicine and Pharmacy Department of Public Health, Nursing and Midwifery Research Group, Vrije Universiteit Brussel - Campus Jette, Brussel, BE, Belgium. .,Department of Nursing and Midwifery research group (NUMID), Universitair Ziekenhuis Brussel, Laarbeeklaan 101 1090 Brussel, Jette, BE, Belgium.
| | - Kim Decabooter
- Department of Nursing and Midwifery research group (NUMID), Universitair Ziekenhuis Brussel, Laarbeeklaan 101 1090 Brussel, Jette, BE, Belgium
| | - Florence Talrich
- Faculty of Medicine and Pharmacy Department of Public Health, Nursing and Midwifery Research Group, Vrije Universiteit Brussel - Campus Jette, Brussel, BE, Belgium.,Department of Nursing and Midwifery research group (NUMID), Universitair Ziekenhuis Brussel, Laarbeeklaan 101 1090 Brussel, Jette, BE, Belgium
| | - Anne Renders
- Department of Nursing and Midwifery research group (NUMID), Universitair Ziekenhuis Brussel, Laarbeeklaan 101 1090 Brussel, Jette, BE, Belgium
| | - Katrien Beeckman
- Faculty of Medicine and Pharmacy Department of Public Health, Nursing and Midwifery Research Group, Vrije Universiteit Brussel - Campus Jette, Brussel, BE, Belgium.,Department of Nursing and Midwifery research group (NUMID), Universitair Ziekenhuis Brussel, Laarbeeklaan 101 1090 Brussel, Jette, BE, Belgium.,Verpleeg- en vroedkunde, Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Universiteit Antwerpen, Antwerp, Belgium
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Stoodley C, McKellar L, Ziaian T, Steen M, Gwilt I, Fereday J. Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e29770. [PMID: 34110301 PMCID: PMC8241434 DOI: 10.2196/29770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period.
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Affiliation(s)
- Cathy Stoodley
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Lois McKellar
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Tahereh Ziaian
- UniSA: Justice & Society, Magill Campus, University of South Australia, Adelaide, Australia
| | - Mary Steen
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Ian Gwilt
- UniSA: Creative, City West Campus, University of South Australia, Adelaide, Australia
| | - Jenny Fereday
- Women's and Children's Health Network, Adelaide, Australia
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Chambers GM, Botha W, Reilly N, Black E, Kingston D, Austin MP. The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study. Women Birth 2021; 35:e133-e141. [PMID: 34099393 DOI: 10.1016/j.wombi.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Although perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain. AIM To compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA). METHODS Women attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an 'at-risk' flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the 'at-risk' flag for PIPA than for Usual-Care. Each model's performance was evaluated using the midwife's agreement with the 'at-risk' flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach. FINDINGS Both models performed well at identifying 'at-risk' women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying 'at-risk' women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted. DISCUSSION Overall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as 'at-risk' and 'not at-risk' of perinatal psychosocial morbidity.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Willings Botha
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia; Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia.
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Reilly N, Hadzi-Pavlovic D, Loxton D, Black E, Mule V, Austin MP. Supporting routine psychosocial assessment in the perinatal period: The concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised. Women Birth 2021; 35:e118-e124. [PMID: 33896760 DOI: 10.1016/j.wombi.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/07/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Australian clinical practice guidelines support comprehensive psychosocial assessment as a routine component of maternity care. AIM To examine the concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised (ANRQ-R) when used across the perinatal period. METHODS Women completed the ANRQ-R and a diagnostic reference standard (SAGE-SR) in the second and third trimesters and at 3-months postpartum. ANRQ-R test performance for cut-off scores at each time-point was assessed using Receiver Operator Characteristic (ROC) analysis. FINDINGS Overall sample sizes were N=1166 (second trimester), N=957 (third trimester) and N=796 (3-month postpartum). 6.5%, 5.6% and 6.2% of women met SAGE-SR criteria for any depressive or anxiety disorder at these time-points ('cases'), respectively. ROC analysis yielded acceptable areas under the curve (AUC) when the ANRQ-R was used to detect current (AUC=0.789-0.798) or predict future (AUC=0.705-0.789) depression or anxiety. Using an example cut-off score of 18 or more, the ANRQ-R correctly classified 72-76% of concurrent 'cases' and 'non-cases' (sensitivity=0.70-0.74, specificity=0.72-0.76) and correctly predicted 74-78% of postnatal 'cases' and 'non-cases' (sensitivity=0.52-0.72, specificity=0.75-0.79). Completion of the ANRQ-R earlier in pregnancy yielded greater positive likelihood ratios for predicting depression or anxiety at 3-months postpartum (cut-off ≥18: second trimester=3.8; third trimester=2.2). CONCLUSION The ANRQ-R is a structured psychosocial assessment questionnaire that can be scored to provide an overall measure of psychosocial risk. Cut-off scores need not be uniform across settings. Such decisions should be guided by factors including diagnostic prevalence rates, local needs and resource availability.
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Affiliation(s)
- Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW, Australia; Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia; School of Psychiatry, UNSW Medicine, NSW, Australia.
| | | | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, NSW, Australia; Australian Longitudinal Study on Women's Health, University of Newcastle, NSW, Australia
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW and Discipline of Addiction Medicine, University of Sydney, NSW, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia; School of Psychiatry, UNSW Medicine, NSW, Australia; Royal Hospital for Women, NSW, Australia
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Austin MPV, Reilly N, Mule V, Kingston D, Black E, Hadzi-Pavlovic D. Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment. Women Birth 2021; 35:e125-e132. [PMID: 33895108 DOI: 10.1016/j.wombi.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician. AIMS To assess the impact of psychosocial risk, current symptoms and mode of assessment on women's honesty of disclosure at psychosocial assessment. METHODS Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were 'always honest' and 'not always honest'. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk. FINDINGS 10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18-2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16-2.62, p<0.05; aOR=2.08, 95%CI: 1.11-3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest. DISCUSSION A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback. CONCLUSION Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Royal Hospital for Women, Sydney, Barker St, Randwick, NSW 2031, Australia.
| | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
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Bright KS, Wajid A, McNeil DA, Stuart S, Kingston D. Profiles of women participating in an internet-based prenatal mental health platform (HOPE – Healthy Outcomes of Prenatal and Postnatal Experiences). JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Why do some pregnant women not fully disclose at comprehensive psychosocial assessment with their midwife? Women Birth 2021; 35:80-86. [PMID: 33781709 DOI: 10.1016/j.wombi.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022]
Abstract
PROBLEM While comprehensive psychosocial assessment is recommended as part of routine maternity care, unless women engage and disclose, psychosocial risk will not be identified or referred in a timely manner. We need to better understand and where possible overcome the barriers to disclosure if we are to reduce mental health morbidity and complex psychosocial adversity. AIMS To assess pregnant women's attitude to, and reasons for non-disclosure at, comprehensive psychosocial assessment with their midwife. METHODS Data from 1796 pregnant women were analysed using a mixed method approach. After ascertaining women's comfort with, attitude to, and non-disclosure at psychosocial screening, thematic analysis was used to understand the reasons underpinning non-disclosure. FINDINGS 99% of participants were comfortable with the assessment, however 11.1% (N = 193) reported some level of nondisclosure. Key themes for non-disclosure included (1) Normalising and negative self-perception, (2) Fear of negative perceptions from others, (3) Lack of trust of midwife, (4) Differing expectation of appointment and (5) Mode of assessment and time issues. DISCUSSION Factors associated with high comfort and disclosure levels in this sample include an experienced and skilled midwifery workforce at the study site and a relatively advantaged and mental health literate sample. Proper implementation of psychosocial assessment policy; setting clear expectations for women and, for more vulnerable women, extending assessment time, modifying mode of assessment, and offering continuity of midwifery care will help build rapport, improve disclosure, and increase the chance of early identification and intervention. CONCLUSIONS This study informs approaches to improving comprehensive psychosocial assessment in the maternity setting.
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Reilly N, Austin MP. Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study. J Med Internet Res 2021; 23:e18517. [PMID: 33769302 PMCID: PMC8088843 DOI: 10.2196/18517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women's awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers. OBJECTIVE The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined. METHODS Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later. RESULTS A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help. CONCLUSIONS Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.
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Affiliation(s)
- Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.,Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital & School of Psychiatry, University of New South Wales, Burwood, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital & School of Psychiatry, University of New South Wales, Burwood, Australia.,Royal Hospital for Women, Randwick, Australia
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Dowse E, Chan S, Ebert L, Wynne O, Thomas S, Jones D, Fealy S, Evans TJ, Oldmeadow C. Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis. Matern Child Health J 2021; 24:718-726. [PMID: 32303935 DOI: 10.1007/s10995-020-02906-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes. METHODS A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay. RESULTS Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay. CONCLUSIONS Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.
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Affiliation(s)
- Eileen Dowse
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia. .,University of Newcastle Priority Research Centre for Reproductive Science: Mothers and Babies, Callaghan, Australia.
| | - Sally Chan
- University of Newcastle Priority Research Centre for Brain & Mental Health, Callaghan, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, Australia.,University of Newcastle, UON Singapore Operation, Singapore, Singapore
| | - Lyn Ebert
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Reproductive Science: Mothers and Babies, Callaghan, Australia
| | - Olivia Wynne
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Susan Thomas
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Donovan Jones
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Brain & Mental Health, Callaghan, Australia.,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Port Macquarie Campus, 7 Major Innes Road, Port Macquarie, NSW, 2444, Australia
| | - Shanna Fealy
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Port Macquarie Campus, 7 Major Innes Road, Port Macquarie, NSW, 2444, Australia
| | - Tiffany-Jane Evans
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Christopher Oldmeadow
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Pietikäinen JT, Härkänen T, Polo-Kantola P, Karlsson H, Paunio T, Karlsson L, Paavonen EJ. Estimating the cumulative risk of postnatal depressive symptoms: the role of insomnia symptoms across pregnancy. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2251-2261. [PMID: 33961078 PMCID: PMC8558280 DOI: 10.1007/s00127-021-02101-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Insomnia symptoms during late pregnancy are a known risk for postnatal depressive symptoms (PDS). However, the cumulative effect of various risk factors throughout pregnancy has not been explored. Our aim was to test how various insomnia symptoms (sleep latency, duration, quality, frequent night awakenings, early morning awakenings) and other risk factors (e.g., history of depression, symptoms of depression and anxiety, as well as sociodemographic factors) in early, mid-, and late pregnancy predict PDS. METHODS Using data from the FinnBrain Birth Cohort Study and logistic regression analyses, we investigated the associations of distinct insomnia symptoms at gw 14, 24, and 34 with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 11) 3 months postnatally. We also calculated separate and combined predictive models of PDS for each pregnancy time point and reported the odds ratios for each risk group. RESULTS Of the 2224 women included in the study, 7.1% scored EPDS ≥ 11 3 months postnatally. Our predictive models indicated that sleep latency of ≥ 20 min, anxiety in early pregnancy, and insufficient sleep during late pregnancy predicted the risk of PDS. Furthermore, we found highly elevated odds ratios in early, mid-, and late pregnancy for women with multiple PDS risk factors. CONCLUSION Screening of long sleep latency and anxiety during early pregnancy, in addition to depression screening, could be advisable. Odds ratios of risk factor combinations demonstrate the magnitude of cumulating risk of PDS when multiple risk factors are present.
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Affiliation(s)
- Johanna T. Pietikäinen
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland ,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku University, Turku, Finland ,Department of Pulmonary Diseases and Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Hasse Karlsson
- Department of Clinical Medicine, The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland ,Department of Psychiatry and SleepWell Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Linnea Karlsson
- Department of Clinical Medicine, The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - E. Juulia Paavonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland ,Department of Child Psychiatry, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Risk and resilience: a mixed methods investigation of Aboriginal Australian women's perinatal mental health screening assessments. Soc Psychiatry Psychiatr Epidemiol 2021; 56:547-557. [PMID: 33226453 PMCID: PMC8053144 DOI: 10.1007/s00127-020-01986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women's Kimberley Mum's Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. METHODS We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into 'risk' and 'protective' factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. RESULTS Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11-33% high vs 61-100% no risk) and more commonly had risk factors (22-67% high vs 6-28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. CONCLUSION Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.
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Creating a Multisite Perinatal Psychiatry Databank: Purpose and Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249352. [PMID: 33327576 PMCID: PMC7765035 DOI: 10.3390/ijerph17249352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among six perinatal mental health services in Quebec, Canada, to create an electronic databank that captures longitudinal patient data over the course of the perinatal period. The collaborating sites met to identify research interests and to select a standardized set of variables to be collected during clinical appointments. Procedures were implemented for creating a databank that serves both research and clinical purposes. The resulting databank allows pregnant and postpartum patients to complete self-report questionnaires on medical and psychosocial variables during their intake appointment in conjunction with their clinicians who fill in relevant medical information. All participants are followed until 6 months postpartum. The databank represents an opportunity to examine illness trajectories and to study rare mental disorders and the relationship between biological and psychosocial variables.
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Chamberlain C, Gee G, Gartland D, Mensah FK, Mares S, Clark Y, Ralph N, Atkinson C, Hirvonen T, McLachlan H, Edwards T, Herrman H, Brown SJ, Nicholson AJM. Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: 'Its Important, but How These Discussions Are Held Is Critical'. Front Psychol 2020; 11:2014. [PMID: 33041880 PMCID: PMC7522325 DOI: 10.3389/fpsyg.2020.02014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing ‘complex trauma.’ Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents. Setting and Methods A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored. Main Findings The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding ‘qualities’ (e.g., caring), rather than specific ‘attributes’ (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion. Conclusion Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social Equity, Perth, WA, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona K Mensah
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Naomi Ralph
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | | | - Tanja Hirvonen
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Tahnia Edwards
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie J Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - And Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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Slavin V, Creedy DK, Gamble J. Single Item Measure of Social Supports: Evaluation of construct validity during pregnancy. J Affect Disord 2020; 272:91-97. [PMID: 32379626 DOI: 10.1016/j.jad.2020.03.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/02/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lack of social support during pregnancy is associated with psychosocial vulnerability. The Single Item Measure of Social Supports (SIMSS) is included in a core outcome set to facilitate case-adjustment based on social support. Validity of the SIMSS has not been evaluated in childbearing women. We aimed to evaluate the construct validity of the SIMSS during pregnancy. Secondary aim was to evaluate an alternative short-measure of social support. METHODS Recruited women (n = 309) attending antenatal care were invited to complete the SIMSS, Multidimensional Scale of Perceived Social Support (MSPSS), Antenatal Risk Questionnaire (ANRQ), and Edinburgh Postnatal Depression Scale (EPDS). Convergent validity of SIMSS with MSPSS and hypothesis testing for psychosocial risk and depressive symptoms were conducted. RESULTS Correlations were moderate between the SIMSS and MSPSS (rs = .35), but weak between the SIMSS and EPDS (rs = -.18); and SIMSS and ANRQ (rs = -.22). In contrast, correlations were moderate between the MSPSS and EPDS (rs = -.39) and ANRQ (rs = -.45). A shortened 3-item version of the MSPSS showed good psychometric properties and internal consistency reliability (a = .86). LIMITATIONS Findings relate to one Australian birthing sample during pregnancy. Replication of this study in larger, diverse maternity populations, including postpartum is recommended. CONCLUSIONS The SIMSS is a poor measure of social support during pregnancy with poor predictive ability to detect maternal vulnerability including depression and psychosocial risk. A revised 3-item version of the MSPSS was found to be a valid and reliable measure of social support.
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Affiliation(s)
- Valerie Slavin
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia; Women, Newborn & Children's Services, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld, 4215, Australia..
| | - Debra K Creedy
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
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Çankaya S. The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study. Arch Psychiatr Nurs 2020; 34:176-183. [PMID: 32513469 DOI: 10.1016/j.apnu.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6-8 weeks. METHODS This study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6-8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale. RESULTS Forty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ2 = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms. CONCLUSIONS Psychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.
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Affiliation(s)
- Seyhan Çankaya
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey.
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Elliott AE, Elliott PC, Cook R. Postpartum maternal distress: a multidimensional illness requiring a multilevel, multidiscipline response. Aust J Prim Health 2020; 26:222-226. [PMID: 32340663 DOI: 10.1071/py19180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/11/2020] [Indexed: 11/23/2022]
Abstract
Australia's federal, state, territory and local governments all have responsibilities, often overlapping, for policy and delivery of primary mental health care to postpartum women. Identification and treatment of postpartum distress is carried out by a broad range of professionals from diverse disciplines. Although there is evidence to show that anxiety and stress are important aspects of postpartum distress, substantially greater emphasis has been given to identification and treatment of depression. In addition, relatively little attention has been given to incorporating positive and negative social experiences in healthcare policy and practice. This study aimed to extend the postpartum literature by: (1) comparing the levels of depression, anxiety and stress (i.e. distress indicators) in a non-clinical sample of postpartum mothers to those in the general non-clinical population; (2) comparing the prevalence of anxiety and stress to that of depression in postpartum mothers; and (3) examining the consequences of negative social exchange, alongside perceived social support, on postpartum distress indicators. A self-report survey was completed by 242 postpartum women assessing levels of perceived social support, frequency of negative social exchange and distress indicators. Postpartum mothers were found to have significantly higher depression, anxiety and stress than the general population, and had anxiety and stress levels that were similar in severity to depression. In addition, both negative social exchanges and perceived social support were found to be important for postpartum depression, anxiety and stress. These findings suggest that Australia's primary postpartum mental health care policy and practice guidelines, delivered through a broad range of professionals, may benefit from giving anxiety and stress equal weight to depression and by embracing the important effects, for good and for ill, of positive and negative social interactions.
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Affiliation(s)
- Angela E Elliott
- School of Health Sciences, Swinburne University of Technology, PO Box 218, H29, Hawthorn, Vic. 3122, Australia
| | - Peter C Elliott
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Level 3, 161 Barry Street, Carlton, Vic. 3053, Australia; and Corresponding author. ,
| | - Roger Cook
- School of Health Sciences, Swinburne University of Technology, PO Box 218, H29, Hawthorn, Vic. 3122, Australia
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Mohammed H, Roberts CT, Grzeskowiak LE, Giles L, Leemaqz S, Dalton J, Dekker G, Marshall HS. Psychosocial determinants of pertussis and influenza vaccine uptake in pregnant women: A prospective study. Vaccine 2020; 38:3358-3368. [DOI: 10.1016/j.vaccine.2020.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/24/2022]
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Solomonova E, MacKinnon AL, Gold I, Robins S, Wunderlich S, Feeley N, Hayton B, Libman E, Zelkowitz P. Disordered sleep is related to delusional ideation and depression during the perinatal period. Sleep Health 2020; 6:179-184. [DOI: 10.1016/j.sleh.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
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40
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Palumbo G, Mirabella F, Gigantesco A. Positive screening and risk factors for postpartum depression. Eur Psychiatry 2020; 42:77-85. [DOI: 10.1016/j.eurpsy.2016.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 11/15/2016] [Accepted: 11/19/2016] [Indexed: 11/29/2022] Open
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Pullon S, Ballantyne A, Macdonald L, Barthow C, Wickens K, Crane J. Daily decision-making about food during pregnancy: a New Zealand study. Health Promot Int 2020; 34:469-478. [PMID: 29342272 DOI: 10.1093/heapro/dax098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pregnancy has always been a life-changing event for women and their families, but societal concern about pregnancy and motherhood has become intense in the digital age. The role of health promotion agencies and others supplying health-related resources about lifestyle behaviours is both important and in need of scrutiny. Ever increasing advice for pregnant women, their families and health professionals, abounds. This study of decision making during pregnancy investigated how women made everyday decisions during pregnancy about food and drink, as well as dietary supplements and medications, alcohol and recreational drugs. This qualitative interview study was a side-arm to a double-blind randomized, placebo-controlled trial conducted with pregnant women in Wellington New Zealand, 2013-2016. Data from interviews with 20 women were analysed using inductive thematic analysis. In relation to decision-making about lifestyle behaviours, five themes emerged-Information about food; Wanted and unwanted advice; Worry, anxiety and indecision; Making daily decisions about food; Changes in decision making over time. Participating women talked more about food selection and restriction advice than any other lifestyle topic. Analysis demonstrated concern about information accuracy and overload from multiple, diverse sources. Women described learning how to assess resource credibility, how to develop decision-making skills, and who to trust. The study raises important questions about how the health information environment, despite best intentions, can be confusing or potentially harmful. The study underlines the continued importance of the role health professionals have in not only interpreting information to discuss individualized advice, but also in empowering pregnant women to develop lifestyle-related decision-making skills.
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Affiliation(s)
- Susan Pullon
- Department of Primary Health Care and General Practice
| | | | | | - Christine Barthow
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kristin Wickens
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, Wellington, New Zealand
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Bright KS, Mughal MK, Wajid A, Lane-Smith M, Murray L, Roy N, Van Zanten SV, Mcneil DA, Stuart S, Kingston D. Internet-based interpersonal psychotherapy for stress, anxiety, and depression in prenatal women: study protocol for a pilot randomized controlled trial. Trials 2019; 20:814. [PMID: 31888712 PMCID: PMC6938015 DOI: 10.1186/s13063-019-3897-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological distress, defined as depression, anxiety and perceived stress, during pregnancy is common, with 15-25% of women experiencing clinically significant levels of such distress. Despite the far-reaching impact of prenatal psychological distress on mothers and their children, and that women are receptive to screening, few providers routinely screen for prenatal psychological distress and less than one in five women will receive the mental health care that they require. There is a lack of certainty regarding the most effective treatments for prenatal psychological distress. No online interpersonal psychotherapy (IPT) trials have been conducted that focus on improving psychological distress in prenatal women. The purpose of this pilot randomized controlled trial is to evaluate the perspectives of pregnant women on the feasibility and acceptability of online IPT (e-IPT) delivered during pregnancy. METHODS A pilot randomized controlled trial design with repeated measures will evaluate the feasibility and acceptability of e-IPT for pregnant women compared to routine prenatal care. Qualitative interviews with 15-30 individuals in the intervention group will provide further data on the feasibility and acceptability of the intervention. Assessment of feasibility will include the ease of accessing and completing the intervention. Women will also be asked about what barriers there were to starting and completing the e-IPT. Assessment of acceptability will inquire about the perception of women regarding the intervention and its various features. A sample size of 160 consenting pregnant women aged 18 years and older will be enrolled and randomized into the experimental (e-IPT) or control (routine care) condition. The secondary outcome measures include: depression, anxiety and stress symptoms; self-efficacy; self-mastery; self-esteem; relationship quality (spouse, immediate family members); coping; and resilience. All participants will complete the aforementioned measures at baseline during pregnancy (T1), 3 months postrandomization (T2), at 8 months of pregnancy (T3), and 3 months postpartum (T4). DISCUSSION The results of this pilot randomized controlled trial will provide data on the feasibility and acceptability of the intervention and identify necessary adaptations. This study will allow for optimization of full trial processes and inform the evaluation strategy, including sample size calculations for the full randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT01901796. Registered on 18 December 2014.
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Affiliation(s)
- Katherine S. Bright
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Marie Lane-Smith
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Lindsay Murray
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Nicola Roy
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | | | - Deborah A. Mcneil
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
- Alberta Health Services, Scientific Director, Maternal Newborn Child and Youth Strategic Clinical Network, Southport Atrium #2237, 10101 Southport Road, S.W., Calgary, AB T2W 3N2 Canada
| | - Scott Stuart
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
- Interpersonal Psychotherapy (IPT) Institute, PO Box 5925, Coralville, Iowa 52241 USA
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
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'Having a Quiet Word': Yarning with Aboriginal Women in the Pilbara Region of Western Australia about Mental Health and Mental Health Screening during the Perinatal Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214253. [PMID: 31683908 PMCID: PMC6862568 DOI: 10.3390/ijerph16214253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.
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Reilly N, Brake E, Briggs N, Austin MP. Trajectories of clinical and parenting outcomes following admission to an inpatient mother-baby unit. BMC Psychiatry 2019; 19:336. [PMID: 31675945 PMCID: PMC6825337 DOI: 10.1186/s12888-019-2331-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to examine trajectories of clinical and parenting outcomes following admission to a mother-baby unit (MBU), and to explore factors associated with these trajectories. METHODS Women admitted to an MBU completed the Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS-21), Karitane Parenting Confidence Scale (KPCS) and Maternal Postnatal Attachment Scale (MPAS) at admission, discharge and 3 months following discharge. Questions assessing psychosocial risk and adult attachment style were also completed at admission, and information relating to service engagement in the time since discharge was collected at follow-up. Additional clinical and demographic information was extracted from the patient medical record. RESULTS Seventy-five women participated in the study. Overall, significant improvements in mean scores on measures of anxiety and parenting confidence were maintained 3-months following discharge. However, the majority of women (93.3%) followed trajectories that were characterised by deterioration in self-reported mother-infant attachment following discharge. 62.9 and 34.6% of women followed trajectories of increased symptoms of depression and stress between discharge and follow-up, respectively. Across measures, the least optimal trajectories, or least optimal scores, at follow-up were associated with less secure maternal attachment style (associated with more anxiety symptoms, poorer parenting confidence and maternal-infant attachment), older maternal age (more depressive symptoms) and increased psychosocial risk (more anxiety symptoms). CONCLUSIONS The findings of this study highlight the clinical implications of anxious attachment style for the mental health and parenting outcomes of women admitted to an MBU and the importance of incorporating mother-infant therapy as part of an ongoing management plan. Comprehensive discharge planning and transitional care to help ensure women discharged from an MBU are best supported in the longer term is recommended.
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Affiliation(s)
- Nicole Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134, Australia.
| | - Elloise Brake
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
| | - Nancy Briggs
- 0000 0004 4902 0432grid.1005.4Stats Central, Mark Wainwright Analytical Centre, Biological Sciences South Building, UNSW, Sydney, 2052 Australia
| | - Marie-Paule Austin
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
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Reilly N, Brake E, Kalra H, Austin MP. Insights into implementation of routine depression screening and psychosocial assessment in a private hospital setting: A qualitative study. Aust N Z J Obstet Gynaecol 2019; 60:419-424. [PMID: 31650543 DOI: 10.1111/ajo.13083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/06/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies continue to show that women who give birth in the private maternity sector are less likely to receive depression screening and psychosocial assessment as a routine component of maternity care. However, examples of successfully implemented routine psychosocial assessment programs are beginning to emerge, and there is great value in better understanding the factors that can contribute to the successful delivery of emotional health care in this context. AIM The aim of this study was to identify factors that facilitated successful implementation of antenatal psychosocial assessment in a private hospital setting. METHODS This study employed a qualitative research design. Semi-structured interviews were used to explore the views and experiences of health professionals involved in implementation of the program at the participating site. RESULTS Nine health professionals participated in the study (three midwives, three obstetricians, two managers and one mental health worker). Factors that facilitated successful implementation of the program were reflected in five key themes: (i) multidisciplinary support for the program; (ii) training and clinical supervision; (iii) allocation of sufficient resources; (iv) availability of local referral pathways; and (v) normalisation of the process. CONCLUSION This study shows that barriers to implementation of perinatal depression screening and psychosocial assessment are surmountable and will provide confidence to other services, that routine 'mental health assessment' as required under updated Medical Benefits Scheme items for obstetric services, can be successfully implemented and sustained in private hospital settings.
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Affiliation(s)
- Nicole Reilly
- Research Centre for Generational Health and Ageing, School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Elloise Brake
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Harish Kalra
- Raphael Services, St John of God Health Care Social Outreach, Ballarat, Australia.,University of Notre Dame, Ballarat, Australia
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia.,Royal Hospital for Women, Randwick, Australia
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van Heyningen T, Myer L, Tomlinson M, Field S, Honikman S. The development of an ultra-short, maternal mental health screening tool in South Africa. Glob Ment Health (Camb) 2019; 6:e24. [PMID: 31662879 PMCID: PMC6796322 DOI: 10.1017/gmh.2019.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation. METHODS A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis. RESULTS The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78-0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%. CONCLUSION This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.
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Affiliation(s)
- T. van Heyningen
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L. Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - M. Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - S. Field
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S. Honikman
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Fletcher R, StGeorge J, Newman L, Wroe J. Male callers to an Australian perinatal depression and anxiety help line—Understanding issues and concerns. Infant Ment Health J 2019; 41:145-157. [DOI: 10.1002/imhj.21829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Richard Fletcher
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
| | - Jennifer StGeorge
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
| | - Louise Newman
- The Royal Women's Hospital Locked Bag 300, Cnr Grattan Street & Flemington Road Parkville Victoria 3052 Australia
| | - Jaime Wroe
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
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Čėsnaitė G, Domža G, Ramašauskaitė D, Volochovič J, Bužinskienė D. Factors affecting the maternal-foetal relationship. Acta Med Litu 2019; 26:118-124. [PMID: 31632186 DOI: 10.6001/actamedica.v26i2.4032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Mother's attachment to her unborn child has a strong impact on a pregnant woman's attitude towards her health, postnatal attachment, and the child's physical and emotional growth. The purpose of our study was to identify the factors that impact the maternal-foetal relationship. Materials and methods The study was conducted at the Centre of Obstetrics and Gynaecology of the tertiary-level Vilnius University Hospital Santaros Klinikos in Vilnius, Lithuania. An original questionnaire of nine parts was developed that the questionnaire included information on demographical data, gynaecological and obstetrical history, a relationship assessment scale, the index of happiness, an antenatal depression risk questionnaire, and the Maternal-Antenatal Attachment Scale. Results The study included 388 pregnant women. It was found that the level of education, obstetrical issues during pregnancy, and the risk of postnatal depression negatively impacted the maternal-foetal relationship (p < 0.05). Mothers who were elder in family birth order, also those whose pregnancy was of a longer duration, who had a better-quality romantic relationship with partner, and whose socioeconomic fulfilment was higher were all found to have a better quality of maternal-foetal bonding (p < 0.05). Conclusions The early recognition of low attachment and right application of various means of psychologic intervention might improve the quality of pregnancy, maternity, and childhood.
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Affiliation(s)
- Gerda Čėsnaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintautas Domža
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Diana Ramašauskaitė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Jelena Volochovič
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Diana Bužinskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
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Judd F, Lorimer S, Thomson RH, Hay A. Screening for depression with the Edinburgh Postnatal Depression Scale and finding borderline personality disorder. Aust N Z J Psychiatry 2019; 53:424-432. [PMID: 30309241 DOI: 10.1177/0004867418804067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the 'cut-off' on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. METHOD Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity 'booking-in' visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. RESULTS A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. CONCLUSION Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.
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Affiliation(s)
- Fiona Judd
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia.,2 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,3 Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Lorimer
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| | - Richard H Thomson
- 4 Monash Alfred Psychiatry Research Centre and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Angela Hay
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
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Felder JN. Implementing the USPSTF Recommendations on Prevention of Perinatal Depression-Opportunities and Challenges. JAMA Intern Med 2019; 179:467-468. [PMID: 30747945 PMCID: PMC6684472 DOI: 10.1001/jamainternmed.2018.7729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Medicine, University of California, San Francisco.,Department of Psychiatry, University of California, San Francisco
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