1
|
Fischer AR, Doudell KR, Cundiff JM, Green SRM, Lavender CA, Gunn HE. Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US. Behav Sleep Med 2024; 22:650-673. [PMID: 38600856 DOI: 10.1080/15402002.2024.2339818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. METHODS 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. RESULTS Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. CONCLUSIONS Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.
Collapse
Affiliation(s)
| | - Kelly R Doudell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jenny M Cundiff
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Catherine A Lavender
- College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| |
Collapse
|
2
|
Sayahi M, Nikbina M, Jahangirimehr A, Barati B. Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study. PLoS One 2023; 18:e0294850. [PMID: 38015922 PMCID: PMC10683986 DOI: 10.1371/journal.pone.0294850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran. METHODS This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health). RESULTS A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions. CONCLUSION Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.
Collapse
Affiliation(s)
- Masoumeh Sayahi
- Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Maryam Nikbina
- Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Azam Jahangirimehr
- Department of Public Health, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Barat Barati
- Department of Radiologic Technology, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| |
Collapse
|
3
|
Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
Collapse
Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| |
Collapse
|
4
|
Ahrens KA, Palmsten K, Lipkind HS, Pfeiffer M, Gelsinger C, Ackerman-Banks C. Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions. J Womens Health (Larchmt) 2023; 32:787-800. [PMID: 37192449 PMCID: PMC10354313 DOI: 10.1089/jwh.2022.0367] [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] [Indexed: 05/18/2023] Open
Abstract
Objective: The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. Materials and Methods: This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately. Models were adjusted for maternal demographics and pregnancy characteristics. Results: Of the 123,125 deliveries, the cumulative risk of being diagnosed in the first 24 months postpartum with depression was 28%, anxiety 25%, bipolar disorder 3%, post-traumatic stress disorder 6%, and schizophrenia/psychotic disorder 1%. Women with prenatal depression were at higher risk of having a postpartum mental health diagnosis compared with women without prenatal depression (adjusted hazard ratios [aHRs] ranged from 2.5 [for anxiety] to 4.1 [for postpartum depression]). Risk of having postpartum depression was modestly higher among women with HDP, as was the risk of postpartum bipolar disorder among those with GDM. Findings were generally similar between women living in rural versus urban areas. Conclusions: Effective interventions to prevent, screen, and treat mental health conditions among women with pregnancy complications for an extended time postpartum are warranted.
Collapse
Affiliation(s)
- Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariah Pfeiffer
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Hu Y, Huang S, Xiao M, Fu B, Tang G, Lommel L, Lei J. Barriers and facilitators of psychological help-seeking behaviors for perinatal women with depressive symptoms: A qualitative systematic review based on the Consolidated Framework for Implementation Research. Midwifery 2023; 122:103686. [PMID: 37119670 DOI: 10.1016/j.midw.2023.103686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/22/2023] [Accepted: 04/08/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To identify barriers and facilitators related to psychological help-seeking behaviors of perinatal depression from all related stakeholders (e.g., perinatal women, family members, mental health care providers, and policymakers). DESIGN A literature search of six English-language databases (PubMed, Web of Science, Embase, PsycINFO, the Cochrane Library, CINAHL) and three Chinese-language databases (China National Knowledge Infrastructure, Wan Fang, Chinese Biomedical Literature Databases). Studies published in English or Chinese using qualitative or mixed methods to explore the psychological help-seeking behaviors of women with perinatal depression were included. Data extraction was synthesized for common themes based on the Consolidated Framework for Implementation Research. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise methodologic quality. PARTICIPANTS AND SETTINGS Perinatal women with depression, mental health care providers (e.g., pediatricians/nurses, social workers, nurse-midwives, perinatal psychiatrists, community health workers, and administrators), partners and informal caregivers (e.g., community birth attendants, elderly mothers, and men of reproductive age) based in high, middle and low income countries. FINDINGS Forty-three articles were included in this review and presented according to the Consolidated Framework for Implementation Research domains (in parentheses). The most common barriers to help seeking were stigma (individual characteristics), misconceptions (individual characteristics), cultural beliefs (inner setting), and lack of social support (outer setting). The most common facilitators were providing adequate support (outer setting) and perinatal health care professional training on how to detect, manage and discuss depression; establishing supportive relationships with mental health care providers; and eroding stigma (all three implementation processes). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This systematic review could serve as a reference framework for health authorities to develop diverse strategies for improving the psychological help-seeking behaviors of women with perinatal depression. More high-quality studies focused on the Consolidated Framework for Implementation Research characteristics of available interventions, and implementation processes are needed in future research.
Collapse
Affiliation(s)
- Ying Hu
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Sasa Huang
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Meili Xiao
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Nursing, Hunan Normal University School of Medicine, 371 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Guanxiu Tang
- Department of Geriatrics, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Lisa Lommel
- University of California, San Francisco, 1001 Potrero Ave, San Francisco, San Francisco, California 94110, United States
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| |
Collapse
|
6
|
Adjorlolo S. Seeking and receiving help for mental health services among pregnant women in Ghana. PLoS One 2023; 18:e0280496. [PMID: 36867597 PMCID: PMC9983869 DOI: 10.1371/journal.pone.0280496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/02/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE The heightened vulnerability of women to mental health issues during the period of pregnancy implies that seeking and receiving support for mental health services is a crucial factor in improving the emotional and mental well-being of pregnant women. The current study investigates the prevalence and correlates of seeking and receiving help for mental health services initiated by pregnant women and health professionals during pregnancy. DESIGN Using a cross-sectional design and self-report questionnaires, data were collected from 702 pregnant women in the first, second and third trimesters from four health facilities in the Greater Accra region of Ghana. Data were analyzed using descriptive and inferential statistics. RESULTS It was observed that 18.9% of pregnant women self-initiated help-seeking for mental health services whereas 64.8% reported that health professionals asked about their mental well-being, of which 67.7% were offered mental health support by health professionals. Diagnosis of medical conditions in pregnancy (i.e., hypertension and diabetes), partner abuse, low social support, sleep difficulty and suicidal ideation significantly predicted the initiation of help-seeking for mental health services by pregnant women. Fear of vaginal delivery and COVID-19 concerns predicted the provision of mental health support to pregnant women by health professionals. CONCLUSION The low prevalence of individual-initiated help-seeking implies that health professionals have a high responsibility of supporting pregnant women achieve their mental health needs.
Collapse
Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health Nursing, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- * E-mail:
| |
Collapse
|
7
|
Geiss C, Chavez MN, Oswald LB, Ketcher D, Reblin M, Bandera EV, Savard J, Zhou ES, Fox RS, Jim HSL, Gonzalez BD. "I Beat Cancer to Feel Sick:" Qualitative Experiences of Sleep Disturbance in Black Breast Cancer Survivors and Recommendations for Culturally Targeted Sleep Interventions. Ann Behav Med 2022; 56:1110-1115. [PMID: 35759312 DOI: 10.1093/abm/kaac035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sleep disturbance is common and distressing among cancer survivors. Black breast cancer survivors (BBCS) suffer disproportionately from sleep disturbance, yet there is limited research on how to address this issue. PURPOSE This study aimed to understand the multifaceted experiences of sleep disturbance among BBCS and how to culturally target a mobile health (mHealth) intervention to improve sleep outcomes in BBCS. METHODS Semi-structured interviews were conducted in a purposive sample of 10 BBCS. Interviews were audio-recorded, transcribed, and coded for key barriers to sleep and potential solutions to incorporate into behavioral interventions using NVivo 12. Inductive applied thematic analysis techniques were employed to identify emergent themes. RESULTS Ten BBCS (mean age = 54, SD = 10) described their experiences of sleep disturbance with themes including: (1) barriers to quality sleep (e.g., cancer worry, personal responsibilities), (2) psychosocial impacts of sleep disturbance (e.g., fatigue, distress), and (3) commonly used strategies to improve sleep. The second section discusses suggestions for developing mHealth interventions to improve sleep for BBCS including: (1) feedback on an existing mHealth intervention and (2) intervention topics suggested by BBCS. CONCLUSIONS Our findings highlight the challenges associated with sleep disturbance in BBCS. Participants report culturally targeted mHealth interventions are needed for BBCS who experience chronic sleep disturbance that affects their overall quality of life. These interventions should address coping with sleep-related issues relevant to many breast cancer survivors and BBCS (e.g., sexual intimacy, fear of cancer recurrence) and should incorporate intervention strategies acceptable to BBCS (e.g., prayer, meditation).
Collapse
Affiliation(s)
- Carley Geiss
- Participant Research, Interventions, and Measurements (PRISM) Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Melody N Chavez
- Participant Research, Interventions, and Measurements (PRISM) Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana Ketcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Elisa V Bandera
- Division of Cancer Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Josée Savard
- School of Psychology, Université Laval, Quebec, Canada.,CHU de Québec-Université Laval Research Center, Université Laval, Quebec, Canada
| | - Eric S Zhou
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rina S Fox
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
8
|
Bellerose M, Rodriguez M, Vivier PM. A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women. Health Serv Res 2022; 57:775-785. [PMID: 35584267 PMCID: PMC9264457 DOI: 10.1111/1475-6773.14008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the qualitative literature on low-income women's perspectives on the barriers to high quality prenatal and postpartum care. DATA SOURCES AND STUDY SETTING We performed searches in PubMed, Web of Science, Embase, SocIndex, and CINAHL for peer-reviewed studies published between 1990 to 2021. STUDY DESIGN Systematic review of qualitative studies with participants who were currently pregnant or had delivered within the past two years and identified as low-income at delivery. DATA COLLECTION / EXTRACTION METHODS Two reviewers independently assessed studies for inclusion, evaluated study quality, and extracted information on study design and themes. PRINCIPLE FINDINGS We identified 34 studies that met inclusion criteria, including 23 focused on prenatal care, 6 on postpartum care, and 5 on both. The most frequently mentioned barriers to prenatal and postpartum care were structural. These included delays in gaining pregnancy-related Medicaid coverage, challenges finding providers who would accept Medicaid, lack of provider continuity, transportation and childcare hurdles, and legal system concerns. Individual-level factors, such as lack of awareness of pregnancy, denial of pregnancy, limited support, conflicting priorities, and indifference to pregnancy also interfered with timely use of prenatal and postpartum care. For those who accessed care, experiences of dismissal, discrimination, and disrespect related to race, insurance status, age, substance use, and language were common. CONCLUSIONS Over a period of 30 years, qualitative studies have identified consistent structural and individual barriers to high-quality prenatal and postpartum care. Medicaid policy changes including expanding presumptive eligibility, increased reimbursement rates for pregnancy services, payment for birth doula support, and extension of postpartum coverage may help overcome these challenges.
Collapse
Affiliation(s)
- Meghan Bellerose
- Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI
| | - Mariela Rodriguez
- Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI
| | - Patrick M Vivier
- Health Services, Policy, and Practice, Brown University School of Public Health, Pediatrics and Emergency Medicine, Warren Alpert Medical School, 121 South Main Street, Providence, RI
| |
Collapse
|
9
|
Savory NA, Hannigan B, Sanders J. Women's experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support. Midwifery 2022; 108:103276. [PMID: 35228115 DOI: 10.1016/j.midw.2022.103276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the experiences of women during pregnancy with mild to moderate mental health problems and describe the barriers to receiving support in relation to their mental health. RESEARCH DESIGN AND PARTICIPANTS This paper reports part of a larger project which recruited women and midwives in one hospital in Wales. Participants completed questionnaires in early pregnancy in an antenatal clinic, and the characteristics of women with and without symptoms of anxiety and depression compared. All women were invited to express interest in a follow up interview in late pregnancy. Women identified to have depression and anxiety in early pregnancy, but not under the care of perinatal mental health services, were eligible for interview. Interviews were conducted with 20 women using a visual timeline to aid discussion and were thematically analysed. FINDINGS In late pregnancy mental health disorders were reported by nine women, of which five were diagnosed during adulthood. EPDS scores found 15 women had symptoms of mild to moderate depression and GAD-7 scores indicating 15 women with mild to moderate anxiety. Three themes were identified: moods and emotions - past, present and future; expectations and control; knowledge and conversations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Due to limited access to specialist perinatal mental health services women relied on support networks and self-care to maintain their mental health. More time and better continuity at antenatal appointments along with improved mental health literacy may increase discussions regarding women's mental health during pregnancy. In addition investment is required to develop strategies and improve access to mental health services for women with mild to moderate mental health problems.
Collapse
Affiliation(s)
- N A Savory
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK.
| | - B Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK
| | - J Sanders
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK
| |
Collapse
|
10
|
Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
Collapse
Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
11
|
Derringer JC, Biddle MJ. Potential directions for farm stress research: A systematic review of educational interventions to reduce psychosocial stress among farm and rural populations. J Rural Health 2021; 38:554-573. [PMID: 34784068 DOI: 10.1111/jrh.12633] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite prevalence of high psychosocial stress and suicide among farm and rural populations, few studies exist that measure effectiveness of stress reduction interventions. PURPOSE To (1) compare studies with educational interventions on psychosocial stress as measured by reliable and valid instruments in farm and rural populations and (2) identify educational strategies utilized among effective interventions. METHODS This systematic review was conducted across 4 electronic databases and Google Scholar to identify research that reported outcomes of stress reduction educational interventions among farm and rural populations. Original research articles published in English between January 1980 and October 2020 were included. Literature was excluded that: (1) used cognitive behavioral therapy, (2) reported outcomes of post-traumatic distress disorders, and (3) examined clinical guidelines or policy change. Extracted data included study characteristics, outcomes, and delivery methodology. FINDINGS Title and abstract screening resulted in 256 manuscripts assessed for inclusion criteria. The final selection of 22 studies were categorized into 2 educational intervention delivery methods: home/community setting or virtual. Fourteen out of 22 studies reported significant stress reduction. Virtual interventions had the most promising impact on psychosocial stress with significant reduction reported in 4 of 6 studies; however, mixed results were found among all delivery methods. CONCLUSIONS Educational interventions may reduce psychosocial stress among farm and rural populations, though important questions remain. We recommend future research should focus on barriers to participation, development of measurement tools, and consistent outcome measurement.
Collapse
Affiliation(s)
- Julie C Derringer
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
12
|
Ruybal AL, Siegel JT. Increasing social support for women with postpartum depression through attribution theory guided vignettes and video messages: The understudied role of effort. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2021. [DOI: 10.1016/j.jesp.2021.104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Likelihood of Mental Health and Substance Use Treatment Receipt among Pregnant Women in the USA. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00247-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
14
|
Abstract
Depression pharmacotherapy is the predominant treatment available in the rural United States, yet little is known about the broader contextual factors that rural consumers and providers identify as shaping pharmacotherapy use. Thematic analysis was employed to identify emergent themes from interviews and focus groups about pharmacotherapy adherence, effectiveness, and treatment decisions conducted with Appalachian Kentucky women with depression (N = 37) and diverse healthcare providers who care for this population (N = 21). Pharmacotherapy was seen as inadequate to treat depression in the context of extensive socioeconomic burdens and other health comorbidities. Participants felt that providers over-prescribed pharmacotherapy, a pattern attributed to deficiencies in the rural healthcare system overall. Efforts to improve treatment engagement must acknowledge the significant doubts that rural consumers hold about the potential of pharmacotherapy and should consider the utility of extending broader strategies to address the social conditions shaping vulnerability to depression.
Collapse
Affiliation(s)
- Ryan Jenkins
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA.
| |
Collapse
|
15
|
Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105226. [PMID: 34069073 PMCID: PMC8156805 DOI: 10.3390/ijerph18105226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Abstract
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
Collapse
|
16
|
Wang Q, Song B, Di J, Yang X, Wu A, Lau J, Xin M, Wang L, Mo PKH. Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study. JMIR Ment Health 2021; 8:e24162. [PMID: 33570500 PMCID: PMC7879730 DOI: 10.2196/24162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. OBJECTIVE We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. METHODS A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. RESULTS More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services. CONCLUSIONS Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.
Collapse
Affiliation(s)
- Qian Wang
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Bo Song
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Xue Yang
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anise Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, Macao
| | - Joseph Lau
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Meiqi Xin
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phoenix Kit-Han Mo
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
17
|
Kinser P, Jallo N, Huberty J, Jones E, Thacker L, Moyer S, Laird B, Rider A, Lanni S, Drozd F, Haga S. Study protocol for a multisite randomized controlled trial of an internet and mobile-based intervention for preventing and reducing perinatal depressive symptoms. Res Nurs Health 2021; 44:13-23. [PMID: 33319443 PMCID: PMC7856295 DOI: 10.1002/nur.22092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/02/2020] [Accepted: 11/29/2020] [Indexed: 01/07/2023]
Abstract
Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, nonpharmacologic, and inexpensive self-management approaches, such as via internet and mobile-based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally-funded large-scale randomized controlled study to evaluate "Mamma Mia," a self-guided program with 44 modules that women use throughout pregnancy to 6 months postpartum. The program contains a novel combination of components designed to enable women to enhance self-efficacy, emotional self-regulation, and perceived social support. The overall goal of this three-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in diverse women in the U.S. (n = 1950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) "Mamma Mia" alone, which is self-guided; (2) "Mamma Mia Plus" in which participants engage in the "Mamma Mia" modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well-being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self-Management Theory, the third aim is to evaluate possible mediators (self-efficacy, emotion self-regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self-management approach.
Collapse
Affiliation(s)
| | - Nancy Jallo
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer Huberty
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Evelyn Jones
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leroy Thacker
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sara Moyer
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Breanne Laird
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Amy Rider
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Susan Lanni
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Oslo, Norway
| | - Silje Haga
- Regional Centre for Child and Adolescent Mental Health, Oslo, Norway
| |
Collapse
|
18
|
Selective serotonin reuptake inhibitor use patterns among commercially insured US pregnancies (2005-2014). Arch Womens Ment Health 2021; 24:155-164. [PMID: 32222834 DOI: 10.1007/s00737-020-01027-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022]
Abstract
The goal of this study was to describe patterns of selective serotonin reuptake inhibitor (SSRI) use during pregnancy in a US cohort (2005-2014) of > 1 million commercially insured women using administrative claims. We used international classification of disease (ICD-9) diagnosis and procedure and current procedural terminology codes in the OptumLabs® Data Warehouse to identify deliveries (including losses) among US women aged 15-45 (n = 1,061,023). SSRI dispensings that overlapped with the timing of pregnancy were identified using national drug codes in linked pharmacy claims. Demographic characteristics were imputed based on residential location, census data, and consumer information. We investigated patterns by trimester, agent, and demographic subgroups. A total of 46,087 of women (4.34%) were dispensed SSRIs during the estimated pregnancy period. Sertraline was the most common overall and had the highest initial use after trimester 1, including women who switched from another SSRI, although dispensing for > 1 SSRI during pregnancy was uncommon. Use of vilazodone was rare and had the highest discontinuation after trimester 1, followed by paroxetine. SSRI use was more common among women who were older, White, college-educated, higher income (≥ $100,000), or resided in the Midwest. Paroxetine and dispensings for > 1 SSRI were more common in lower education subgroups. White women had the highest proportion of use in all trimesters of pregnancy, whereas Hispanic women had the lowest. Among commercially insured US women, SSRI use during pregnancy differed by agent and demographics. More research is needed to understand whether these differences are due to symptom reporting, cultural beliefs, and/or physician preferences.
Collapse
|
19
|
Salameh TN, Hall LA, Crawford TN, Staten RR, Hall MT. Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014. J Psychosom Obstet Gynaecol 2020; 41:298-307. [PMID: 31718367 DOI: 10.1080/0167482x.2019.1689949] [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] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.
Collapse
Affiliation(s)
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Ruth R Staten
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| |
Collapse
|
20
|
Borges AM, Goodman LA. Considering poverty in the therapeutic process: experienced therapists’ adaptations. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2019.1589420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Angela M. Borges
- Department of Counseling Psychology, School of Education, Boston College, Chestnut Hill, MA, US
| | - Lisa A. Goodman
- Department of Counseling Psychology, School of Education, Boston College, Chestnut Hill, MA, US
| |
Collapse
|
21
|
Exploring care from extended family through rural women's accounts of perinatal mental illness - a qualitative study with implications for policy and practice. Health Place 2020; 66:102427. [PMID: 32980675 DOI: 10.1016/j.healthplace.2020.102427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
Extended family often have an important role in caring for women experiencing perinatal mental illness; but rural women's perspectives are under-researched. We explored women's experiences of living in rural northern England and receiving care from extended family during periods of perinatal mental illness through 21 qualitative interviews. Key findings were that companionship, practical support - informal childcare and transport, and emotional support were important forms of care - filling gaps in formal service provision. Findings highlight women's needs for support from extended families in rural areas. The rural infrastructure and inequity in formal services can create vulnerability for women.
Collapse
|
22
|
Salameh TN, Hall LA, Crawford TN, Staten RR, Hall MT. Racial/ethnic differences in mental health treatment among a national sample of pregnant women with mental health and/or substance use disorders in the United States. J Psychosom Res 2019; 121:74-80. [PMID: 30928211 DOI: 10.1016/j.jpsychores.2019.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine racial/ethnic differences in the receipt of mental health treatment among pregnant women with mental health (i.e., depression and serious psychological distress) and/or substance use disorders. METHOD Secondary analysis of data from the National Survey on Drug Use and Health was conducted. The sample consisted of 1232 pregnant women with mental health/substance use disorders. RESULTS Black/African American (Adjusted Odds Ratio [AOR]: 0.36, 95% Confidence Interval [CI]: 0.17-0.75), other non-Hispanic (AOR: 0.24, 95% CI: 0.11-0.52), and Hispanic (AOR: 0.42, 95% CI: 0.22-0.81) pregnant women had significantly lower odds of mental health treatment receipt compared to Whites, even when controlling for age, education, marital status, number of children, employment status, income, health insurance, county urbanicity, self-rated health status, type of mental health condition, and time. There were no racial/ethnic differences by mental health and/or substance use disorders. Among pregnant women who perceived unmet mental health treatment need (N = 299), a greater proportion of White compared to Non-White pregnant women perceived cost as an obstacle to access treatment (62.1% vs. 35.6%, p = .001); however, the two groups did not differ in other perceived barriers to mental health treatment (i.e., opposition to treatment, stigma, time/transportation limitation, and not knowing where to go). CONCLUSIONS Strategies are needed to increase access to mental health treatment among racial/ethnic minority women who are pregnant and have mental health/substance use disorders. Further studies are required to understand racial/ethnic differences in the perceived barriers to mental health treatment.
Collapse
Affiliation(s)
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Ruth R Staten
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| |
Collapse
|
23
|
Cluxton-Keller F, Buteau J, Williams M, Stolte P, Monroe-Cassel M, Bruce ML. Engaging rural young mothers in a technology-based intervention for depression. CHILD & YOUTH SERVICES 2019; 40:158-183. [PMID: 31274940 PMCID: PMC6608730 DOI: 10.1080/0145935x.2018.1561264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Peripartum depression is prevalent among young mothers (ages 25 and younger), and low family support can exacerbate depressive symptoms. The current study explores an innovative method for engaging young mothers in a family-based intervention to help reduce peripartum depressive symptoms. This descriptive study includes details on the baseline characteristics of participants, integrative support teams, and a service delivery method to engage families living rural communities. In conclusion, engaging depressed young mothers living in rural communities requires a multifaceted approach. Our approach has demonstrated promise in engaging this hard-to-reach population. Implications for clinical practice and future research are addressed.
Collapse
Affiliation(s)
- Fallon Cluxton-Keller
- Department of Psychiatry, Dartmouth College, Geisel School of Medicine, Lebanon, NH, USA
| | | | | | | | | | - Martha L. Bruce
- Department of Psychiatry, Dartmouth College, Geisel School of Medicine, Lebanon, NH, USA
| |
Collapse
|
24
|
Logsdon MC, Morrison D, Myers JA, Capps J, Masterson KM. Intention to Seek Depression Treatment in Latina Immigrant Mothers. Issues Ment Health Nurs 2018; 39:962-966. [PMID: 30252541 DOI: 10.1080/01612840.2018.1479905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Postpartum depression in Latina immigrant mothers can lead to adverse outcomes in both mothers and babies, yet depression treatment remains suboptimal. AIMS The aims were to determine predictors of intention to seek depression treatment and to determine if intention to seek depression treatment differed in those with significant symptoms of depression. METHODS Based upon the theory of planned behavior (TPB), a cross-sectional study design was used. A convenience sample of Latina immigrant mothers (n = 50) were interviewed in Spanish. Certified translation services were used to translate study instruments to Spanish. Descriptive analysis and multivariable logistic regression techniques were used for data analysis. RESULTS While increases in attitudes were associated with intention to seek depression treatment, increased social support and perceived control were associated with a decrease in intention to seek treatment. CONCLUSIONS The differing role of social support in Latina immigrant mothers should be explored.
Collapse
Affiliation(s)
- M Cynthia Logsdon
- a School of Nursing , University of Louisville , Louisville , Kentucky , USA
| | - David Morrison
- b University of Louisville Hospital , Louisville , Kentucky , USA
| | - John A Myers
- c Department of Pediatrics, School of Medicine , University of Louisville , Louisville , Kentucky , USA
| | - Josh Capps
- a School of Nursing , University of Louisville , Louisville , Kentucky , USA
| | - Katlin M Masterson
- a School of Nursing , University of Louisville , Louisville , Kentucky , USA
| |
Collapse
|
25
|
Kim Y, Dee V. Self-Care for Health in Rural Hispanic Women at Risk for Postpartum Depression. Matern Child Health J 2018; 21:77-84. [PMID: 27435729 DOI: 10.1007/s10995-016-2096-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine factors that affect self-care of rural Hispanic women at risk for postpartum depression (PPD). METHODS This study was a descriptive cross-sectional design based on the key concepts of Orem's Self-care Deficit Nursing theory. Data were collected from 223 Hispanic postpartum women residing in Mecca, North Shore, and Thermal in California by an interviewer-administered survey. Four instruments were utilized: Edinburgh Postnatal Depression Scale (EPDS) for PPD, Multidimensional Scale of Perceived Social Support for social support, Duke University Religion Index (DUREL) for spirituality, and Self Rated Abilities for Health Practices for self-care. RESULTS The prevalence of women at risk for PPD was about 43 %. Social support, spirituality, and self-care ability were significantly correlated in women with PPD. Social support was a strong factor in predicting self-care ability for 'Nutrition', 'Psychological well-being', 'Exercise', and 'Responsible Health Practices' in the rural Hispanic women at risk for PPD. CONCLUSIONS The study findings can enable nurses and healthcare professionals to develop effective tailored interventions to assist rural Hispanic women's abilities to perform self-care for health, and in particular, during the postpartum period.
Collapse
Affiliation(s)
- Younglee Kim
- California State University San Bernardino, 5500 University Pkwy, San Bernardino, CA, 92407, USA.
| | - Vivien Dee
- Nursing Program, Azusa Pacific University, 901 E Alosta Ave, Azusa, CA, 91702, USA
| |
Collapse
|
26
|
Zimmerman MS. Assessing the Reproductive Health-Related Information-Seeking Behavior of Low-Income Women: Describing a Two-Step Information-Seeking Process. JOURNAL OF HEALTH COMMUNICATION 2017; 23:72-79. [PMID: 29265926 DOI: 10.1080/10810730.2017.1411996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper explores the reproductive health-related information seeking of low-income women that has been found to be affected by digital divide disparities. A survey conducted with 70 low-income women explores what information sources women use for reproductive health-related information seeking, what process they go through to find information, and if they are using sources that they trust. The findings of this study detail a two-step information-seeking process that typically includes a preference for personal, informal sources. Women of this income group often rely upon sources that they do not consider credible. While there have been many studies on the end effects of a lack of accurate and accessible reproductive health information, little research has been conducted to examine the reproductive healthcare information-seeking patterns of women who live in poverty.
Collapse
Affiliation(s)
- Margaret S Zimmerman
- a Department of Library and Information Science , University of Iowa , Iowa City , IA , USA
| |
Collapse
|
27
|
Malouf R, Henderson J, Redshaw M. Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey. BMJ Open 2017; 7:e016757. [PMID: 28729324 PMCID: PMC5642776 DOI: 10.1136/bmjopen-2017-016757] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities. DESIGN Secondary analysis was conducted on data from a 2015 national survey of women's experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women. SETTING Survey data were collected on women's experience of primary and secondary care in all trusts providing maternity care in England. PARTICIPANTS Women who had given birth 3 months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth. RESULTS Overall, 20 094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding. CONCLUSION While access to care was generally satisfactory for disabled women, women's emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women's sense of control to build trusting relationships with healthcare providers.
Collapse
Affiliation(s)
- Reem Malouf
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| |
Collapse
|
28
|
Arrieta J, Aguerrebere M, Raviola G, Flores H, Elliott P, Espinosa A, Reyes A, Ortiz-Panozo E, Rodriguez-Gutierrez EG, Mukherjee J, Palazuelos D, Franke MF. Validity and Utility of the Patient Health Questionnaire (PHQ)-2 and PHQ-9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross-Sectional Study. J Clin Psychol 2017; 73:1076-1090. [PMID: 28195649 PMCID: PMC5573982 DOI: 10.1002/jclp.22390] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/19/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depressive disorders are frequently under diagnosed in resource-limited settings because of lack of access to mental health care or the inability of healthcare providers to recognize them. The Patient Health Questionnaire (PHQ)-2 and the PHQ-9 have been widely used for screening and diagnosis of depression in primary care settings; however, the validity of their use in rural, Spanish-speaking populations is unknown. METHOD We used a cross-sectional design to assess the psychometric properties of the PHQ-9 for depression diagnosis and estimated the sensitivity and specificity of the PHQ-2 for depression screening. Data were collected from 223 adults in a rural community of Chiapas, Mexico, using the PHQ-2, the PHQ-9, and the World Health Organization Quality of Life BREF Scale (WHOQOL- BREF). RESULTS Confirmatory factor analysis suggested that the 1-factor structure fit reasonably well. The internal consistency of the PHQ-9 was good (Cronbach's alpha > = 0.8) overall and for subgroups defined by gender, literacy, and age. The PHQ-9 demonstrated good predictive validity: Participants with a PHQ-9 diagnosis of depression had lower quality of life scores on the overall WHOQOL-BREF Scale and each of its domains. Using the PHQ-9 results as a gold standard, the optimal PHQ-2 cutoff score for screening of depression was 3 (sensitivity 80.00%, specificity 86.88%, area under receiver operating characteristic curve = 0.89; 95% confidence interval [0.84, 0.94]). CONCLUSION The PHQ-2 and PHQ-9 demonstrated good psychometric properties, suggesting their potential benefit as tools for depression screening and diagnosis in rural, Spanish-speaking populations.
Collapse
Affiliation(s)
- Jafet Arrieta
- Harvard T.H. Chan School of Public Health.,Harvard Medical School.,Partners In Health/Compañeros En Salud
| | | | | | - Hugo Flores
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | - Patrick Elliott
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | | | | | | | | | - Joia Mukherjee
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | - Daniel Palazuelos
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | | |
Collapse
|
29
|
Jesse DE, Bian H, Banks EC, Gaynes BN, Hollon SD, Newton ER. Role of Mediators in Reducing Antepartum Depressive Symptoms in Rural Low-Income Women Receiving a Culturally Tailored Cognitive Behavioral Intervention. Issues Ment Health Nurs 2016; 37:811-819. [PMID: 27740883 PMCID: PMC5198893 DOI: 10.1080/01612840.2016.1229821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although cognitive behavioral interventions (CBIs) have demonstrated effectiveness for reducing depressive symptoms in the general population, the mechanism for reducing antepartum depressive symptoms (APDS) in rural low-income and minority women is unknown. This study tested the hypothesis that reducing stress and negative thinking, enhancing self-esteem, and increasing social-support will mediate the effect of a CBI on reducing APDS in rural low-income and minority women. Our findings show that CBI may work through reducing stress and negative thinking and enhancing self-esteem, but not social support. The findings also suggest that mental health care providers should emphasize these activities to reduce antepartum depressive symptoms.
Collapse
Affiliation(s)
- D Elizabeth Jesse
- a East Carolina University, College of Nursing , Greenville , North Carolina , USA
| | - Hui Bian
- b East Carolina University, Office for Faculty Excellence , Greenville , North Carolina , USA
| | - Elizabeth C Banks
- c East Carolina University, Family Medicine , Greenville , North Carolina , USA
| | - Bradley N Gaynes
- d University of North Carolina Chapel Hill , Department of Psychiatry, Research Training and Education , Chapel Hill , North Carolina , USA
| | - Steve D Hollon
- e Vanderbilt University, College of Arts and Science , Nashville , Tennessee , USA
| | - Edward R Newton
- f Brody School of Medicine, Obstetrics & Gynecology , Greenville , North Carolina , USA
| |
Collapse
|
30
|
Keller AO, Valdez CR, Schwei RJ, Jacobs EA. Disclosure of Depression in Primary Care: A Qualitative Study of Women's Perceptions. Womens Health Issues 2016; 26:529-36. [PMID: 27531601 DOI: 10.1016/j.whi.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women. METHODS Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis. FINDINGS Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure. CONCLUSIONS Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy.
Collapse
Affiliation(s)
- Abiola O Keller
- Department of Physician Assistant Studies, Marquette University, Milwaukee, Wisconsin.
| | - Carmen R Valdez
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rebecca J Schwei
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elizabeth A Jacobs
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
31
|
Snell-Rood C, Hauenstein E, Leukefeld C, Feltner F, Marcum A, Schoenberg N. Mental health treatment seeking patterns and preferences of Appalachian women with depression. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2016; 87:233-241. [PMID: 27322157 DOI: 10.1037/ort0000193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia-a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants' perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality-not merely access-limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women's self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study's findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation. (PsycINFO Database Record
Collapse
Affiliation(s)
- Claire Snell-Rood
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Amber Marcum
- Department of Psychology, University of Kentucky
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine
| |
Collapse
|
32
|
Abstract
Despite improvements in service delivery and patient management, low birth weight among infants has been a persistent challenge in South Africa. The study aimed to explore the relationship between depression before pregnancy and the low birth weight (LBW) of infants in post-apartheid South Africa. This study utilized data from Waves 1 and 2 of the South African National Income Dynamics Study, the main outcome being a dichotomous measure of child LBW (<2500 g) drawn from the Wave 2 child questionnaire. Depressive symptoms of non-pregnant women was the main predictor drawn from the Wave 1 adult questionnaire. Depressive symptoms were screened using the 10-item four-point Likert version of the Center for Epidemiologic Studies Depression Scale (CES-D) instrument. A total score of 10 or greater on the CES-D indicates a positive screen for depressive symptoms. An adjusted logistic regression model was used to examine the relationship between women's depression before pregnancy and infant LBW. A sample size of 651 women in Wave 1 was linked to 672 newborns in Wave 2. The results of the adjusted logistic regression model indicated depressive symptoms (CES-D ≥ 10) prior to pregnancy were associated with infant LBW (adjusted OR 2.84, 95 % CI 1.08-7.46). Another significant covariate in the model was multiple childbirths. Our finding indicates that women's depressive symptoms prior to pregnancy are associated with the low birth weight of newborns and suggests that this association may not be limited to depression present during the ante-natal phase.
Collapse
|
33
|
Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
Collapse
|
34
|
Lau R, McCauley K, Barnfield J, Moss C, Cross W. Attitudes of midwives and maternal child health nurses towards suicide: A cross-sectional study. Int J Ment Health Nurs 2015; 24:561-8. [PMID: 26350295 DOI: 10.1111/inm.12162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.
Collapse
Affiliation(s)
- Rosalind Lau
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Kay McCauley
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Jakqui Barnfield
- Department of Mental Health, Monash Health, Melbourne, Victoria, Australia
| | - Cheryle Moss
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
35
|
Kinser P, Masho S. "Yoga Was My Saving Grace": The Experience of Women Who Practice Prenatal Yoga. J Am Psychiatr Nurses Assoc 2015; 21:319-26. [PMID: 26511433 DOI: 10.1177/1078390315610554] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately 20% of women in the United States practice prenatal yoga, but there is a paucity of information about the experience of these women. OBJECTIVE This study examines women's experiences participating in community-based prenatal yoga. METHOD A qualitative descriptive exploratory design used focus groups with a convenience sample of pregnant and postpartum women (n = 14) who engaged in prenatal yoga within the previous 6 months. Content analysis was employed to identify key themes and subthemes. RESULTS Three themes arose: (a) stress and depressive symptoms commonly instigate women's interest in prenatal yoga, (b) prenatal yoga is perceived to be psychologically and physically beneficial, and (c) prenatal yoga is perceived as more beneficial than other group classes. CONCLUSIONS Pregnant women with stress and depressive symptoms may be drawn to prenatal yoga for the psychological and physical benefits. It is imperative that health care providers and researchers focus on these needs, particularly when designing prevention and intervention strategies with this population.
Collapse
Affiliation(s)
- Patricia Kinser
- Patricia Kinser, PhD, WHNP-BC, RN, Virginia Commonwealth University, Richmond, VA, USA
| | - Saba Masho
- Saba Masho, MD, MPH, DrPH, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
36
|
Jesse DE, Gaynes BN, Feldhousen EB, Newton ER, Bunch S, Hollon SD. Performance of a Culturally Tailored Cognitive-Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial. J Midwifery Womens Health 2015; 60:578-92. [PMID: 26261095 DOI: 10.1111/jmwh.12308] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cognitive-behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week, culturally tailored, cognitive-behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression. METHODS A total of 146 pregnant women were stratified by high risk for antepartum depression (Edinburgh Postnatal Depression Scale [EPDS] score of 10 or higher) or by low-moderate risk (EPDS score of 4-9) and randomized to a cognitive-behavioral intervention or treatment as usual. Differences in mean change of EPDS and Beck Depression Inventory (BDI)-II scores for low-moderate and high-risk women in the cognitive-behavioral intervention and treatment as usual for the full sample were assessed from baseline (T1), posttreatment (T2), and one-month follow-up (T3), and for African American women in the subsample. RESULTS Both the cognitive-behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high risk for depression (n = 62), there was no significant treatment effect from T1 to T2 or T3 for the EPDS. However, in low-moderate risk women, there was a significantly greater mean change in the BDI-II scores from significant decrease in the BDI-II scores from T1 to T2 (4.92 vs 0.59, P = .018) and T1 to T3 (5.67 vs 1.51, P = .04). Also, the cognitive-behavioral intervention significantly reduced EPDS scores for African American women at high risk (n = 43) from T1 to T2 (5.59 vs 2.18, P = .02) and from T1 to T3 (6.32 vs 3.14, P = .04). DISCUSSION A cognitive-behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment as usual, the cognitive-behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement.
Collapse
|
37
|
Hill SK, Cantrell P, Edwards J, Dalton W. Factors Influencing Mental Health Screening and Treatment Among Women in a Rural South Central Appalachian Primary Care Clinic. J Rural Health 2015; 32:82-91. [PMID: 26249659 DOI: 10.1111/jrh.12134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Some of the most significant mental health concerns among US adults are depression, anxiety, substance abuse, and intimate partner violence. These concerns represent an ever-growing portion of the primary care population, especially in rural areas. However, few studies have examined factors influencing screening and treatment of these concerns by primary care providers, particularly in Appalachia. This study explores barriers and facilitators to mental health screening and treatment among women at a rural, primary care clinic in Appalachia. METHODS Eighteen patients and 4 providers were interviewed face-to-face. Thematic analysis was used to identify emergent themes. FINDINGS Patients identified 3 barriers (stigma, lack of support, and lack of education) and 2 facilitators (integrated care and positive experiences with providers). Providers identified 4 barriers (operational barriers, mental health competence, predicted patient reactions, and patient attitudes) and 3 facilitators (clinic characteristics, provider characteristics, and patient and provider education). Generally, patients focused more on individual and social factors influencing mental health service use, while providers were more aware of training gaps, logistical factors at the clinic, and systemic issues within the larger health care system. Both participant types emphasized specific interpersonal qualities and the importance of integrated services. CONCLUSIONS Screening and treatment may be influenced by the availability and advertisement of integrated services, institutional support, strong patient-provider relationships, and provider training and experience. For rural south central Appalachia women, limited mental health resources may make these factors even more salient.
Collapse
Affiliation(s)
- Sarah K Hill
- Clinical Psychology Department, East Tennessee State University, Johnson City, Tennessee
| | - Peggy Cantrell
- Clinical Psychology Department, East Tennessee State University, Johnson City, Tennessee
| | - Joellen Edwards
- Center for Nursing Research, East Tennessee State University, Johnson City, Tennessee
| | - Will Dalton
- Clinical Psychology Department, East Tennessee State University, Johnson City, Tennessee
| |
Collapse
|
38
|
Kinser P, Masho S. "I just start crying for no reason": the experience of stress and depression in pregnant, urban, African-American adolescents and their perception of yoga as a management strategy. Womens Health Issues 2015; 25:142-8. [PMID: 25648492 DOI: 10.1016/j.whi.2014.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE Perinatal health disparities are of particular concern with pregnant, urban, African-American (AA) adolescents, who have high rates of stress and depression during pregnancy, higher rates of adverse pregnancy and neonatal outcomes, and many barriers to effective treatment. The purpose of this study was to explore pregnant, urban, AA teenagers' experience of stress and depression and examine their perceptions of adjunctive nonpharmacologic management strategies, such as yoga. METHODS This community-based, qualitative study used nontherapeutic focus groups to allow for exploration of attitudes, concerns, beliefs, and values regarding stress and depression in pregnancy and nonpharmacologic management approaches, such as mind-body therapies and other prenatal activities. FINDINGS The sample consisted of pregnant, AA, low-income adolescents (n=17) who resided in a large urban area in the United States. The themes that arose in the focus group discussions were that 1) stress and depression symptoms are pervasive in daily life, 2) participants felt a generalized sense of isolation, 3) stress/depression management techniques should be group based, interactive, and focused on the specific needs of teenagers, and 4) yoga is an appealing stress management technique to this population. CONCLUSIONS Findings from this study suggest that pregnant, urban, adolescents are highly stressed; they interpret depression-like symptoms to be signs of stress; they desire group-based, interactive activities; and they are interested in yoga classes for stress/depression management and relationship building. It is imperative that health care providers and researchers focus on these needs, particularly when designing prevention and intervention strategies.
Collapse
Affiliation(s)
- Patricia Kinser
- Department of Family and Community Health, Virginia Commonwealth University School of Nursing, Richmond, Virginia.
| | - Saba Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Obstetrics and Gynecology & Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
39
|
Raymond NC, Pratt RJ, Godecker A, Harrison PA, Kim H, Kuendig J, O’Brien JM. Addressing perinatal depression in a group of underserved urban women: a focus group study. BMC Pregnancy Childbirth 2014; 14:336. [PMID: 25261279 PMCID: PMC4190388 DOI: 10.1186/1471-2393-14-336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 09/18/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Perinatal mental health problems are common complications of pregnancy that can go undetected and untreated. Research indicated that mental health complications are more prevalent in women from disadvantaged communities, yet women from these communities often experience barriers to accessing treatments and interventions. Untreated depression during pregnancy can lead to poor self-care, increased substance abuse, poor obstetrical outcomes, developmental delay in children, and increased risk of postpartum depression. In this study we investigated the perceived perinatal mental health needs of our participants and they wanted to address their perceived needs. METHODS In this qualitative study, we invited women who resided in an underserved, urban community who were pregnant or who delivered within the past year to participate in focus groups. RESULTS Thirty-seven women participated in seven focus groups. Thirteen themes emerged which were described in relation to mental health needs, help currently accessed and the type of support wanted. The themes included the various mental health needs including dealing with changing moods, depression, feelings of isolation, worrying and a sense of being burdened. Women described using a limited range of supports and help. Participants expressed a preference for mental health support that was empowerment focused in its orientation, including peer support. Women also described the compounding effect that social and economic stresses had on their mental health. CONCLUSIONS Participants wanted access to a greater range of supports for mental health than were currently available to them, including peer support, and wanted assistance in addressing social and economic needs. These findings offer a challenge to further broaden the types of services offered to women, and demonstrate that those services need to be responsive to the challenging contexts of women's lives. Integrating women's views and experiences into the development of services may help to overcome barriers to care.
Collapse
Affiliation(s)
- Nancy C Raymond
- />Deborah E Powell Center for Women’s Health, Departments of Psychiatry and Family Medicine and Community Health, Medical School, University of Minnesota Medical School, MMC 293 Mayo, 420 Delaware Street SE, Minneapolis, MN 55454 USA
| | - Rebekah J Pratt
- />Family Med/Community Health, MMC 381 Mayo, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Amy Godecker
- />Carbone Cancer Center, University of Wisconsin-Madison, 370 WARF Building, 610 Walnut Street, Madison, WI 53726 USA
| | - Patricia A Harrison
- />Minneapolis Health Department, Director of Research and Program Development, 250 4th St. S., Room 510, Minneapolis, MN 55415-1384 USA
| | - Helen Kim
- />Hennepin Women’s Mental Health Program, 914 South 8th Street, Suite S-110, Minneapolis, MN 55404 USA
| | - Jesse Kuendig
- />Hennepin Women’s Mental Health Program, 914 South 8th Street, Suite S-110, Minneapolis, MN 55404 USA
| | - Jennifer M O’Brien
- />Deborah E Powell Center for Women’s Health, Departments of Psychiatry and Family Medicine and Community Health, Medical School, University of Minnesota Medical School, MMC 293 Mayo, 420 Delaware Street SE, Minneapolis, MN 55454 USA
| |
Collapse
|
40
|
Molewyk Doornbos M, Zandee GL, DeGroot J. Attending to Communication and Patterns of Interaction: Culturally Sensitive Mental Health Care for Groups of Urban, Ethnically Diverse, Impoverished, and Underserved Women. J Am Psychiatr Nurses Assoc 2014; 20:239-249. [PMID: 25080464 DOI: 10.1177/1078390314543688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. OBJECTIVE Using Leininger's theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. DESIGN Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. RESULTS The women's communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. CONCLUSIONS The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care.
Collapse
Affiliation(s)
| | | | - Joleen DeGroot
- Joleen DeGroot, BSN, RN, Spectrum Health, Grand Rapids, MI, USA
| |
Collapse
|
41
|
Jesse DE, Kim H, Herndon C. Social support and self-esteem as mediators between stress and antepartum depressive symptoms in rural pregnant women. Res Nurs Health 2014; 37:241-52. [PMID: 24797585 DOI: 10.1002/nur.21600] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/11/2022]
Abstract
The purpose of this secondary analysis was to determine whether satisfaction with social support and self-esteem mediated the relationship between antepartum stress and depressive symptoms in women attending prenatal clinics in a rural Southeastern community (N = 318). Path analysis with linear regression indicated that the relationship between antepartum stress and depressive symptoms was partially mediated by higher levels of the internal resources of satisfaction with social support and self-esteem. Self-esteem had a greater influence on the relationship between antepartum stress and depressive symptoms than did satisfaction with social support. These findings suggest further study to determine whether developing culturally tailored interventions that emphasize stress reduction activities in addition to enhancing self-esteem and increasing satisfaction with social support can decrease the burden of antepartum depressive symptoms in rural low-income women.
Collapse
Affiliation(s)
- D Elizabeth Jesse
- Associate Professor, East Carolina University College of Nursing, 3160 Health Sciences Building, Greenville, NC 27858; Brody School of Medicine, Greenville, NC
| | | | | |
Collapse
|
42
|
Jarosinski JM, Pollard DL. Postpartum depression: perceptions of a diverse sample of low-income women. Issues Ment Health Nurs 2014; 35:189-97. [PMID: 24597584 DOI: 10.3109/01612840.2013.848960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred.
Collapse
|
43
|
Gaebel W, Muijen M, Baumann A, Bhugra D, Wasserman D, van der Gaag R, Heun R, Zielasek J. EPA Guidance on Building Trust in Mental Health Services. Eur Psychiatry 2014; 29:83-100. [DOI: 10.1016/j.eurpsy.2014.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 01/26/2023] Open
Abstract
AbstractPurposeTo advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system.MethodsWe performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process.ResultsWe developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization.DiscussionTrust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust.ConclusionEvidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization.
Collapse
|
44
|
Peters RM, Benkert R, Templin TN, Cassidy-Bushrow AE. Measuring African American Women's Trust in Provider During Pregnancy. Res Nurs Health 2014; 37:144-54. [DOI: 10.1002/nur.21581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Rosalind M. Peters
- College of Nursing; Wayne State University; 5557 Cass Avenue-Room 358 Detroit MI 48202
| | - Ramona Benkert
- College of Nursing; Wayne State University; 5557 Cass Avenue-Room 358 Detroit MI 48202
| | - Thomas N. Templin
- College of Nursing; Wayne State University; 5557 Cass Avenue-Room 358 Detroit MI 48202
| | | |
Collapse
|
45
|
Gonyea JLJ, Wright DW, Earl-Kulkosky T. Navigating dual relationships in rural communities. JOURNAL OF MARITAL AND FAMILY THERAPY 2014; 40:125-136. [PMID: 25059416 DOI: 10.1111/j.1752-0606.2012.00335.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The literature examining dual relationships in rural communities is limited, and existing ethical guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists' perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relationships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relationship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with established ethical decision-making models, and implications for the ethical guidelines and appropriate ethical training are suggested.
Collapse
|
46
|
Abstract
Women with postpartum depression may suffer in silence due to the stigma of depression and failed motherhood. It is important to consider how mothers are able to talk about postpartum depression and what strategies they use. Foucault's idea that confession is a widespread technique for producing truth in Western societies was tested through discourse analysis of posts on an Internet forum for women with postpartum depression. The Internet forum showed women's use of confessionary language and self-judgments as well as their sense of disconnected mothering, shame, and disembodiment. Discourses of depression included the good mother, biomedical illness, and social dysfunction. Findings have implications for creating safe spaces for helping mothers with postpartum depression.
Collapse
|
47
|
Almeida CP, Cunha FF, Pires EP, Sá E. Common mental disorders in pregnancy in the context of interpartner violence. J Psychiatr Ment Health Nurs 2013; 20:419-25. [PMID: 22672493 DOI: 10.1111/j.1365-2850.2012.01937.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnancy is generally described as a period with a high incidence of common mental disorders (CMD) in the life cycle of many women who incur the risk of developing mental problems including depression, post-traumatic stress and drug abuse. Our objective with this study was to gauge how the presence of violence in Portuguese pregnant women affected their psychopathology. One hundred and eighty-four pregnant outpatients of the Obstetrics and Gynaecology Department of the Hospital Pedro Hispano in Matosinhos, Oporto, Portugal with an average age of 29 and in their last 3 months of pregnancy were the subjects of this study. These participants were divided into two groups: one of abused women (n= 107) and another of non-abused women (n= 77). In order to be able to compare them, both groups were assessed with the Conflict Tactic Scale 2, the Brief Symptom Inventory and the Inventory of the Clinical Evaluation of Depression. It was observed that pregnant women who had suffered violence during pregnancy exhibited some form of CMD during pregnancy. Another important finding was the evidence of the negative impacts that domestic violence had on the mental health of women.
Collapse
Affiliation(s)
- C P Almeida
- Psychology Department, WeDoCare - Private Practice, Porto, Portugal.
| | | | | | | |
Collapse
|
48
|
Henshaw E, Sabourin B, Warning M. Treatment-seeking behaviors and attitudes survey among women at risk for perinatal depression or anxiety. J Obstet Gynecol Neonatal Nurs 2013; 42:168-77. [PMID: 23374137 DOI: 10.1111/1552-6909.12014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify treatment preferences, help-seeking steps, and responses from social support persons among women at risk for perinatal depression or anxiety. DESIGN Prospective descriptive survey of women at risk for depression or anxiety. SETTING Private hospital in central Ohio. PARTICIPANTS From an original sample of 220 women recruited between the third trimester of pregnancy and 2 months postpartum, we selected 36 women reporting clinically significant levels of depressive or anxious symptoms to complete a telephone survey. An additional 17 family members were surveyed as identified social support persons. METHODS Two telephone interviews including survey and open-ended responses were administered to participants approximately 6 weeks apart. Social support persons also received survey interviews assessing their opinions about the participants' mood changes. RESULTS More participants reported consulting friends and family about symptoms (83%) than consulting health care professionals (50%). However, most participants and their social support persons disagreed about the primary illness cause (66%). Approximately two thirds of participants recalled receipt of depression screening and feedback, but far fewer received referral or treatment via pharmacotherapy (36.1%) or psychotherapy (16.7%). CONCLUSION Findings suggest screening and referral can be enhanced through expanding perinatal mental health education to target social support persons as they are often consulted by women when determining whether depression exists or should be treated. Further, a more active, personalized referral processes should be used routinely in addition to screening and education to facilitate appropriate treatment.
Collapse
Affiliation(s)
- Erin Henshaw
- Denison University, Psychology Department, Granville, OH 43023, USA.
| | | | | |
Collapse
|
49
|
Price SK, Cohen-Filipic K. Daily life or diagnosis? Dual perspectives on perinatal depression within maternal and child health home visiting. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:554-65. [PMID: 23944165 PMCID: PMC3744772 DOI: 10.1080/19371918.2011.592087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study describes a qualitative inquiry-informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child health home visiting programs.
Collapse
Affiliation(s)
- Sarah Kye Price
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA.
| | | |
Collapse
|
50
|
Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D, Pbert L. Patient's views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals? Gen Hosp Psychiatry 2013; 35:598-604. [PMID: 23969144 PMCID: PMC4107904 DOI: 10.1016/j.genhosppsych.2013.07.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The objectives were to examine patients' perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals. METHOD Four 90-min focus groups were conducted with women 3-36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach. RESULTS Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals. CONCLUSIONS Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals' perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
Collapse
Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 01655.
| | - Kathleen Biebel
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | | | | | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|