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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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Davies-Kershaw H, Fahmida U, Htet MK, Kulkarni B, Faye B, Yanti D, Shinta D, Zahra NL, Angelin TC, Madhari R, Pullakhandam R, Palika R, Dasi T, Fernandez Rao S, Banjara SK, Selvaraj K, Palepu DP, Yadev D, Diouf S, Lopez-Sall P, Diallo B, Mouissi P, Fall S, Diallo I, Djigal A, Immerzeel TDV, Tairou F, Diop A, Pradeilles R, Strout S, Momo Kadia B, Tata DT, Jobarteh ML, Allen S, Walker A, Webster JP, Haggarty P, Heffernan C, Ferguson E. Anthropometric, biochemical, dietary, morbidity and well-being assessments in women and children in Indonesia, India and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001683. [PMID: 38417920 PMCID: PMC10910654 DOI: 10.1136/bmjpo-2022-001683] [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: 09/22/2022] [Accepted: 03/28/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Child stunting has a complex aetiology, especially in the first 1000 days of life. Nutrition interventions alone have not produced expected impacts in reducing/preventing child stunting, indicating the importance of understanding the complex interplay between environmental, physiological and psychological factors influencing child nutritional status. This study will investigate maternal and child nutrition, health and well-being status and associated factors through the assessment of: (1) anthropometry, (2) biomarkers of nutrition and health status, (3) dietary intakes, (4) fetal growth and development, (5) infant morbidity, (6) infant and young child feeding (IYCF) and (7) perinatal maternal stress, depression and social support. METHODS This study will be conducted in a prospective pregnancy cohort in India, Indonesia and Senegal. Pregnant women will be recruited in the second (Indonesia, Senegal) and third (India) trimester of pregnancy, and the mother and infant dyads followed until the infant is 24 months of age. During pregnancy, anthropometric measures will be taken, venous blood samples will be collected for biochemical assessment of nutrition and health status, dietary intakes will be assessed using a 4-pass-24-hour dietary recall method (MP24HR), fetal ultrasound for assessment of fetal growth. After birth, anthropometry measurements will be taken, venous blood samples will be collected, MP24HR will be conducted, infant morbidity and IYCF practices will be assessed and a sample of breastmilk will be collected for nutrient composition analyses. Perinatal maternal stress, depression, social support and hair cortisol levels (stress) will be measured. The results from this study will be integrated in an interdisciplinary analysis to examine factors influencing infant growth and inform global efforts in reducing child stunting. ETHICS AND DISSEMINATION Ethical approval was granted by the Ethics Committee of the London School of Hygiene and Tropical Medicine (17915/RR/17513); National Institute of Nutrition (ICMR)-Ministry of Health and Family Welfare, Government of India (CR/04/I/2021); Health Research Ethics Committee, University of Indonesia and Cipto Mangunkusumo Hospital (KET-887/UN2.F1/ETIK/PPM.00.02/2019); and the Comité National d'Ethique pour la Recherche en Santé, Senegal (Protocole SEN19/78); the Royal Veterinary College (URN SR2020-0197) and the International Livestock Research Institute Institutional Research Ethics Committee (ILRI-IREC2020-33). Results will be published in peer-reviewed journals and disseminated to policy-makers and participating communities.
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Affiliation(s)
- Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Umi Fahmida
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Min Kyaw Htet
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Bharati Kulkarni
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Babacar Faye
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Dwi Yanti
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Dewi Shinta
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Nur L Zahra
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Tiffany C Angelin
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Radhika Madhari
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Raghu Pullakhandam
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Ravindranadh Palika
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Teena Dasi
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Sylvia Fernandez Rao
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Santosh Kumar Banjara
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Kiruthika Selvaraj
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Dharani Pratyusha Palepu
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Dinesh Yadev
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Saliou Diouf
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Philomene Lopez-Sall
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Babacar Diallo
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Princillia Mouissi
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Sally Fall
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Ibrahima Diallo
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Aicha Djigal
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | | | - Fassia Tairou
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Assana Diop
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- UMR, MOISA, Montpellier, France
| | - Sara Strout
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darius Tetsa Tata
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Modou Lamin Jobarteh
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Alan Walker
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, University of London, London, UK
| | - Paul Haggarty
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Claire Heffernan
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Fitzgerald L, McNab S, Njau P, Chandra P, Koyiet P, Levine R, Hardtman P, Stalls S. Beyond survival: Prioritizing the unmet mental health needs of pregnant and postpartum women and their caregivers. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002782. [PMID: 38315641 PMCID: PMC10843059 DOI: 10.1371/journal.pgph.0002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Laura Fitzgerald
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
| | - Shanon McNab
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
| | | | - Prabha Chandra
- Department of Psychiatry, the National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Phiona Koyiet
- Global Technical Resource Team: Disaster Management, World Vision International, Nairobi, Kenya
| | - Rebecca Levine
- Global Health Practice, Palladium, Washington, District of Columbia, United States of America
| | - Pandora Hardtman
- Technical Leadership Office, Jhpiego, Baltimore, Maryland, United States of America
| | - Suzanne Stalls
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
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Arikan G, Kumru A. A person-based approach to emotion socialization in toddlerhood: Individual differences in maternal emotion regulation, mental-health and parental sense of competence. Sci Rep 2023; 13:13606. [PMID: 37604851 PMCID: PMC10442338 DOI: 10.1038/s41598-023-40850-x] [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: 10/05/2022] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Mothers adopt various emotion socialization strategies and sometimes exhibit contradictory responses. Thus, it is essential to understand how mothers differentiate in their use of emotion socialization strategies, and whether a set of emotion socialization responses is associated with individual differences in emotion regulation, mental health, and parental sense of competence during toddlerhood. Therefore, we used a person-centred approach to identify mothers' emotion socialization responses and then compared mothers based on the aforementioned characteristics. The mothers (N = 680) with toddlers (M = 23.56 months) responded to the Coping with Toddlers' Negative Emotions Scale, the Emotion Regulation Questionnaire, the Brief Symptom Inventory, and the Parental Sense of Competence Scale. The 3-profile-solution revealed: Unspecified (moderate scores in all emotion socialization strategies), supportive (high scores in supportive emotion socialization strategies) and mixture profiles (high in all emotion socialization strategies). The supportive and mixture profiles scored highly in cognitive reappraisal. Unspecified and mixture profiles did not vary in expressive suppression and mental health symptoms, but they scored lower than supportive profile mothers. In the parental sense of competence, the supportive profile scored higher than the mixture profile. The results showed mothers mainly using supportive emotion socialization strategies can demonstrate adequate emotion regulation and benefit from psychological well-being that potentially boosts parenting competence.
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Affiliation(s)
- Gizem Arikan
- Department of Psychology, Ozyegin University, 34794, Istanbul, Turkey.
| | - Asiye Kumru
- Department of Psychology, Ozyegin University, 34794, Istanbul, Turkey
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Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
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6
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Lasater ME, Beebe M, Warren NE, Winch PJ, Soucko F, Keita M, Doumbia S, Murray SM. Reliability and validity of a perinatal depression screening instrument in rural Mali. SSM - MENTAL HEALTH 2022; 2:100059. [PMID: 36644110 PMCID: PMC9835090 DOI: 10.1016/j.ssmmh.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. Methods We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. Results The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. Conclusions Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.
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Affiliation(s)
- Molly E. Lasater
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA,Corresponding author. 615 N. Wolfe St, Baltimore, MD, USA, 21205. (M.E. Lasater)
| | - Madeleine Beebe
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Nicole E. Warren
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Peter J. Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Fatoumata Soucko
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Mariam Keita
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Seydou Doumbia
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Matthey S, Robinson J, Della Vedova AM. Women's interpretation, understanding and attribution of the anhedonia question in the PHQ-4 and modified-Whooley questions in the antenatal period. J Reprod Infant Psychol 2021:1-16. [PMID: 34846957 DOI: 10.1080/02646838.2021.2000592] [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: 10/19/2022]
Abstract
OBJECTIVES To report on the rates of misinterpretation, confusion, and attribution of the anhedonia question in the PHQ-4 and Whooley questions by pregnant women. BACKGROUND The NICE Perinatal Mental Health guidelines recommend the use of the anhedonia question for depression screening, yet evidence suggests it may be misinterpreted or not be related to mood. METHOD Women attending a public hospital's antenatal clinic, communicating in English as their language of choice, completed either the PHQ-4 or the Whooley questions. Following comments to general evaluation questions in the first sample, women were asked a targeted anhedonia interpretation question, an anhedonia attribution question, and an ease of understanding question (PHQ-4: N = 37-119; Whooley: N = 31-100). RESULTS Across the PHQ-4 and Whooley formats around 15% of participants completely misinterpreted the anhedonia question, with a further 17% finding it difficult to understand. Around two-thirds of those experiencing the symptom said it was due to normal symptoms of pregnancy, and not related to their mood. In the PHQ-4 format, which included all three questions, 48% of the women had one or more of these issues. While CALD women appear to have greater difficulty understanding the question, there were no meaningful associations with whether English was spoken at home. CONCLUSION Almost half of the women incorrectly interpreted the anhedonia question, or said that it was confusing, or that it did not reflect low mood. These data indicate that the anhedonia question should not be used in screening women in the antenatal period, whether in the PHQ-4 or Whooley formats.
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Affiliation(s)
- Stephen Matthey
- Infant Child and Adolescent Mental Health Service, South Western Sydney Local Health District, Sydney, Australia.,School of Psychiatry, UNSW, Sydney, Australia
| | - Joanne Robinson
- Infant Child and Adolescent Mental Health Service, South Western Sydney Local Health District, Sydney, Australia
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Vanderkruik R, Raffi E, Freeman MP, Wales R, Cohen L. Perinatal depression screening using smartphone technology: Exploring uptake, engagement and future directions for the MGH Perinatal Depression Scale (MGHPDS). PLoS One 2021; 16:e0257065. [PMID: 34587183 PMCID: PMC8480830 DOI: 10.1371/journal.pone.0257065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Women may experience new-onset or worsening depressive disorders during pregnancy and the postpartum. If untreated, there may be detrimental consequences to the health and wellbeing of the woman and to her baby. There is a need for improved tools and approaches that can be easily and broadly implemented to effectively detect depression during the perinatal period. Early identification of depression during pregnancy is an important first step towards connecting women to treatment and preventing continued depression into the postpartum or beyond. This report provides preliminary findings from a pilot study of a digital screening app for perinatal depression expiring potential for app reach, engagement, and user demographics and mental health symptoms. With mainly passive recruitment efforts, we collected cross-sectional mental health data on over 700 women during the perinatal period, including women across over 30 countries. We report on mean depression scores among women during pregnancy and the postpartum as well as on constructs that are commonly comorbid with depression, including anxiety, sleep dysregulation, and perceived stress. Over half of the women during pregnancy and over 70% of women in the postpartum had a depression score indicative of clinical depression. Future research directions for this work and potential for public health impact are discussed, including longitudinal data collection and analyses of symptomology over time and embedding evidence-based digital therapeutics into the app as a means to increase access to mental health services.
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Affiliation(s)
- Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
| | - Edwin Raffi
- Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Marlene P. Freeman
- Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rebecca Wales
- Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lee Cohen
- Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, United States of America
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Kim ET, Ali M, Adam H, Abubakr-Bibilazu S, Gallis JA, Lillie M, Hembling J, McEwan E, Baumgartner JN. The Effects of Antenatal Depression and Women's Perception of Having Poor Health on Maternal Health Service Utilization in Northern Ghana. Matern Child Health J 2021; 25:1697-1706. [PMID: 34405361 DOI: 10.1007/s10995-021-03216-1] [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] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the effects of antenatal depression and women's perceived health during the antenatal period on maternal health service utilization in rural northern Ghana; including how the effect of antenatal depression on service use might be modified by women's perceived health. METHODS Probable antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9). Linear regression was used for the outcome of number of antenatal care (ANC) visits, and logistic regression was used for the outcomes of facility delivery, postnatal care (PNC) within 7 days and completion of continuum of care. Continuum of care was defined as having had four or more ANC visits, delivered at a health facility and had PNC visit within 7 days. RESULTS Antenatal depression had very small or no association with maternal health service utilization. Women with self-perceived fair or poor health were significantly less likely to use PNC within 7 days and less likely to complete the continuum of care. As for effect modification, we found that for women with probable moderate or severe antenatal depression (a score of 10 or greater), those with perceived fair or poor health used fewer ANC visits and were less likely to use PNC within 7 days than those with perceived excellent, very good or good health. CONCLUSIONS Women experiencing moderate or severe antenatal depression and/or who self-perceive as having poor health should be identified and targeted for additional support to access and utilize maternal health services.
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Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Mohammed Ali
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Haliq Adam
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Safiyatu Abubakr-Bibilazu
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - John A Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Rd, Suite 1102 Hock Plaza, Durham, NC, 27710, USA
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - John Hembling
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Elena McEwan
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, Chapel Hill, NC, 27599, USA
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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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Boisits S, Abrahams Z, Schneider M, Honikman S, Kaminer D, Lund C. Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study. Int J Ment Health Syst 2021; 15:23. [PMID: 33722252 PMCID: PMC7958439 DOI: 10.1186/s13033-021-00443-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. METHODS We conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material. RESULTS The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. CONCLUSION Input from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
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Affiliation(s)
- Sonet Boisits
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Zulfa Abrahams
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crisping Park, London, SE5 8AF, UK
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Mohsin S, Atif N, Rabbani W, Tariq A, Khan SA, Tariq M, Sikander S. Cultural Adaptation of Community Informant Tool for Detection of Maternal Depression in Rural Pakistan. Front Psychiatry 2021; 12:598857. [PMID: 33868040 PMCID: PMC8047053 DOI: 10.3389/fpsyt.2021.598857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/02/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Evidence indicates that mental health issues like depression, epilepsy, and substance misuse can be detected with reasonable accuracy in resource-poor settings. The Community Informant Detection Tool (CIDT) is one such approach used for detecting mental health problems, including depression. We adapted this community informant approach for detecting maternal depression in Pakistan. Methods: Adaptation of Community Informant Detection Tool for Maternal Depression (CIDT-MD) involved five steps. First, a scoping review of the literature was conducted to select an appropriate tool for adaptation. Second, in-depth interviews were conducted to explore the idioms of depression and distress, perceived causes, and the effects of maternal depression among currently depressed and recovered mothers (n = 11), mothers in law (n = 6), and Primary Care Providers (Primary Care Physicians and Lady Health Supervisors) (n = 6). Third, case vignettes and illustrations were created with input from a panel of mental health experts, incorporating the idioms of depression and distress used, causes, and effects for each symptom described. Fourth, to assess the comprehensibility of the illustrations and level of understanding, Focus Group Discussions (n = 4) were done with purposely selected community health workers (Lady Health Workers and Lay Peers, n = 28) trained in delivering maternal depression intervention. The final step was reflection and inputs by a panel of mental health experts on all steps to finalize the content of the tool. Results: Context-specific cultural adaptation in the presentation and format of CIDT-MD was conducted successfully. Lady Health Workers (LHW) and Lay Peers (LP) were found to be the most appropriate persons to use the tool and function as the informants. The adapted tool with all its vignettes and illustrations was found to be easily understandable, comprehensible, and culturally appropriate, meaningful, and contextually relevant by the community health workers and peers working in the relevant settings. They easily relate to and identify potentially depressed such women lining up with the tool. Lastly, the coding of the tool was found easy to follow as well. Conclusion: The Community Informant Detection Tool for Maternal Depression (CIDT-MD) is a culturally acceptable, easy to use, and comprehensible tool for detecting maternal depression in community settings of Pakistan. The community informants found the content and approach highly relevant to the local needs.
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Affiliation(s)
- Shamaila Mohsin
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Waqas Rabbani
- Department of Behavioural Sciences, Shifa College of Medicine, Islamabad, Pakistan
| | - Ahmaren Tariq
- Human Development Research Foundation, Islamabad, Pakistan
| | - Shahzad Ali Khan
- Global Health Department, Health Services Academy, Islamabad, Pakistan
| | | | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan.,Global Health Department, Health Services Academy, Islamabad, Pakistan.,Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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Abstract
In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a thematic issue traces the recent shifts in the GMH agenda and discusses the changing construct of "mental health" as GMH moves away from a categorical biomedical model toward dimensional and transdiagnostic approaches and embraces digital technologies. We highlight persistent and emerging lines of inquiry and advocate for meaningful interdisciplinary engagement. Taken together, the articles in this special issue of Transcultural Psychiatry provide a snapshot of current interdisciplinary work in GMH that considers the socio-cultural and historical dimensions of mental health important and proposes reflexive development of interventions and implementation strategies.
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Affiliation(s)
- Dörte Bemme
- University of North Carolina at Chapel Hill, USA.,Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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