Barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States

Trauma Informed Care in the Prevention of High-Risk Sexual Behaviors and Unplanned Pregnancy in Adolescents with Mental Health Disorders

Although teen pregnancy and birth rates have declined over the decades, all adolescentpopulations are at risk. Disparities among adolescent pregnancies still exist, including increased risk and rates of unplanned pregnancy among vulnerable adolescents, including those with a mental health diagnosis.Adolescent girls with mental health disorders are notably at higher risk and are three timesmore likely to become pregnant than those without a mental illness. Adolescents who have experienced trauma and have a mental health diagnosis are much more likely to engage in high-risk sexual activity, to not participate in contraceptive use, and to become pregnant than their counterparts.Using Trauma Informed Care (TIC) to assess mental health diagnoses, high-risk sexual behaviors, and risk for unplanned pregnancy among adolescent populations can be an effective approach for primary prevention. There is increased expectation for clinicians to practice TIC and to establish relationships with patients while understanding how mental health diagnoses can impact health behaviors. The focus of this paper is to examine the effects of adolescent unplanned pregnancy, identify the increased risk for adolescents with mental health disorders, and discuss general methods for TIC in clinical practice.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Postpartum Depression: A Metaphorical Analysis

BACKGROUND

The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America is the undiagnosed and untreated mental health of women related to childbirth. Unfamiliar with medical terminology, persons may communicate more effectively by means of metaphors to describe what they are experiencing.

AIMS

To examine the language women used to describe their experiences of postpartum depression with metaphors that can provide a valuable source of insight for psychiatric nurses and other clinicians.

METHODS

Secondary qualitative data analysis of three primary datasets of postpartum depression was conducted. Metaphor identification procedure was the approach used to analyze the texts for metaphorical expressions.

RESULTS

Eleven metaphors were identified that women used to help explain their postpartum depression: being hit by a ton of bricks, being a tightrope walker, living in a nightmare, feeling trapped, being in the middle of the sea, feeling like an alien, being a loner, being a basket case, having cobwebs in the brain, feeling like garbage, and hitting rock bottom.

CONCLUSIONS

These 11 metaphors provide a new voice for women's experiences of postpartum depression. As a result, they provide rich insights for psychiatric nurses and other clinicians to help identify women struggling with postpartum depression.

Family-Centered Primary Care for Teen Parents and Their Children

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

Self-Efficacy and Postpartum Depression Teaching by Perinatal Nurses in a Rural Setting: A Replication Study

Perinatal nurses in rural hospitals can play an important role in providing postpartum depression education to new mothers. Guided by Self-Efficacy Theory, this replication study used a self-report instrument to survey perinatal nurses' self-efficacy in postpartum depression teaching, self-esteem, stigma and attitudes toward seeking help for mental illness. Thirty-eight perinatal nurses employed in a rural hospital participated in the study. The results indicated perinatal nurses' postpartum depression teaching behaviors were associated with: self-efficacy related to postpartum depression teaching; social persuasion by a supervisor; prior mastery of teaching on other postpartum care topics; and vicarious experiences of observing peers teach about postpartum depression. Perinatal nurses with positive attitudes toward receiving psychological help were more likely to provide postpartum depression education.

Resilience in the midst of chaos: Socioecological model applied to women with depressive symptoms and socioeconomic disadvantage

Socioeconomic disadvantage is extremely common among women with depressive symptoms presenting for women's health care. While social stressors related to socioeconomic disadvantage can contribute to depression, health care tends to focus on patients' symptoms in isolation of context. Health care providers may be more effective by addressing issues related to socioeconomic disadvantage. It is imperative to identify common challenges related to socioeconomic disadvantage, as well as sources of resilience. In this qualitative study, we interviewed 20 women's health patients experiencing depressive symptoms and socioeconomic disadvantage about their views of their mental health, the impact of social stressors, and their resources and skills. A Consensual Qualitative Research approach was used to identify domains consisting of challenges and resiliencies. We applied the socioecological model when coding the data and identified cross-cutting themes of chaos and distress, as well as resilience. These findings suggest the importance of incorporating context in the health care of women with depression and socioeconomic disadvantage.

Efficacy of an Internet-based depression intervention to improve rates of treatment in adolescent mothers

Approximately 400,000 adolescents give birth in the USA annually. Although one-half experience depressive symptoms, less than 25% comply with referrals for depression evaluation and treatment. The current study tested the effectiveness of an Internet-based depression intervention on seeking depression treatment. Based upon the theory of planned behavior (TPB), the intervention included vignettes, questions and answers, and resources. Before the intervention, immediately after the intervention, and 2 weeks later the adolescent mothers (n = 151) answered questions related to TPB variables and depression treatment. Data were compared to adolescent mothers (n = 138) in the control group. Data were collected in community organizations or home visits for the control group. Adolescent mothers in the intervention group answered questions and completed the intervention from a computer of their choice. The adolescents were primarily African American (89.2%), less than high school educated (51.7%), had given birth in last year (97.1%), with a mean age 18.2 years. The intervention led to significant changes in attitude, perceived control, intention to seek mental health treatment, and actually seeking depression treatment. Untreated postpartum depression dramatically impacts a mother's relationship with her child, her functioning at work and school, health care-seeking behaviors, mothering skills, and her development as well as the development of her child. An Internet-based depression intervention is an inexpensive method to increase rates of depression treatment.

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review

Problem statement and significance

Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries?

Methods

A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review.

Results

Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers.

Implications for practice

This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.

Serotonin reuptake inhibitors and breastfeeding: a systematic review

OBJECTIVE

The postnatal period represents a critical phase for mothers because of physiological hormonal changes, the increase of emotional reactions and a greater susceptibility for the onset/recrudescence of psychiatric disorders. Despite the evidence of an increasing utilization of antidepressant drugs during breastfeeding, there is still few reliable information on the neonatal safety of the selective serotonin reuptake inhibitors (SSRIs) and selective noradrenergic reuptake inhibitors (SNRIs) [serotonin reuptake inhibitors (SRIs)] in nursing mothers. The aim of this study is to provide a systematic review on the neonatal safety profile of these drugs during breastfeeding, also assessing the limits of available tools.

METHODS

MEDLINE and PubMed databases were searched without any language restrictions by using the following set of keywords: ((SSRIs OR selective serotonin inhibitor reuptake OR SNRIs OR selective serotonin noradrenaline inhibitor reuptake) AND (breastfeeding OR lactation OR breast milk)). A separate search was also performed for each SSRIs (paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram and escitalopram) and SNRIs (venlafaxine and duloxetine).

RESULTS

Sertraline and paroxetine show a better neonatal safety profile during breastfeeding as compared with other SRIs. Less data are available for fluvoxamine, escitalopram and duloxetine. Few studies followed up infants breastfeed for assessing the neurodevelopmental outcomes.

CONCLUSIONS

Literature review clearly indicates paroxetine and sertraline as the drugs that should be preferred as first line choice in nursing women who need an antidepressant treatment.

Risk factors for depressive symptoms in adolescent pregnancy in a late-teen subsample

Depression in adolescent pregnancy is common but underrecognized and can be associated with negative medical outcomes. This brief report examines the relationship between depressive symptoms and various demographic and obstetrical risk factors, as well as the use of antidepressants in pregnant adolescents of late teenage years. Data were derived from a relatively large sample (506 women) recruited from university-based and community mental health centers in Iowa. A cross-sectional analysis did not reveal significant statistical associations between the risk factors and depressive symptoms (Beck Depression Inventory). Antidepressant use was very low (3.7 %), and adolescents with higher depression scores were more likely to take medications. In conclusion, screening for depression in pregnant adolescents should be universal, regardless of demographic and obstetrical risk factors, and promptly addressed.

The role of maternal self-care in new motherhood

OBJECTIVE

To examine the following: (1) women's perceptions regarding the role of maternal self-care, (2) specific applications of self-care in new motherhood and (3) barriers to practising effective self-care.

DESIGN

three focus groups were conducted in order to study women's perspectives regarding the key components of new motherhood.

SETTING

Recruitment took place in Allegheny County, surrounding Pittsburgh. The focus groups were held at the University of Pittsburgh's Medical School.

PARTICIPANTS

Thirty-one adult women who had given birth in the year prior to enrollment participated in the study.

METHODS

The focus group conversations were recorded and transcribed for purposes of qualitative analysis. Conversation related to maternal self-care, which was identified as a component of new motherhood, was grouped into one of three categories: (1) women's valuations of self-care, (2) effective applications of self-care and (3) barriers to good self-care practice.

FINDINGS

Two ideologies regarding the role of self-care emerged. In one conception of effective mothering, self-care was of primary importance. On the contrary, some women associated a sometimes extreme form of self-sacrifice with new motherhood. Effective applications of self-care included taking time to exercise, allowing the infant's father to care for the child for a period of time and going out to restaurants. Barriers to good self-care practice were time, other limited resources such as money and social support and difficulty accepting help and setting boundaries.

KEY CONCLUSIONS

Additional focus groups should be conducted with the purpose of studying maternal self-care exclusively. This work is an important first step in identifying ways to help new mothers better care for themselves.

Testing of a prototype Web based intervention for adolescent mothers on postpartum depression

PURPOSE

This article describes testing of a prototype Web site for adolescent mothers with postpartum depression; providing proof of concept.

METHODS

Participants (N=138) were recruited from a public school-based program for adolescent parents and completed the Mental Health Acceptability Scale, Stigma Scale for Receiving Psychological Help, and Attitudes Towards Seeking Professional Psychological Help Scale before, and after, the Web site intervention. They also provided feedback on the usability of the Web site.

RESULTS

Attitudes related to depression and treatment (ATSPPH) improved after viewing the Web site (p=.023). Feedback on the Web site indicated that it was easy to use (77%), reflecting highly acceptable score for product usability.

CONCLUSIONS

The data provide the foundation for the launch of the Web site from prototype to product and more comprehensive testing. The creation and testing of informational text messages will be added to the Web site to increase the interactivity and dose of the intervention.

Self-efficacy and postpartum teaching: a replication study

Postpartum depression (PPD) occurs in 13% of new mothers internationally, but many do not receive treatment. In the Western world, hospital-based perinatal nurses have extended contact with new mothers and are in a unique position to teach them to recognize symptoms of and seek treatment for PPD. In this replication study framed by self-efficacy theory, teaching new mothers about PPD was predicted by a nurse's self-efficacy related to PPD teaching, expectations for teaching from supervisor, PPD continuing education, teaching experience on other topics, and experience with observing other nurses teaching patients about PPD. The results of the study demonstrate the importance of the climate created by the nursing supervisor in which teaching about PPD is expected and facilitators of effective patient teaching are available.

Adapting and testing telephone-based depression care management intervention for adolescent mothers

This phase 1 clinical trial combined qualitative and quantitative methods to modify a collaborative care, telephone-based, depression care management intervention for adolescent mothers and to determine the acceptability, feasibility, and initial efficacy of the intervention in a sample of adolescent mothers (n = 97) who were recruited from a Teen Parent Program. Outcomes included measures of depressive symptoms, functioning, and use of mental health services. Acceptability of the intervention was demonstrated, but feasibility issues related to the complex life challenges confronting the adolescent mother. Although only four adolescent mothers received mental health treatment, there was a trend for improved depressive symptoms over time. Results of the study provide data for the need of further refinement of the intervention before a large clinical trial is conducted for adolescent mothers with symptoms of depression.

Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.