1
|
Jawed M, Pradhan NA, Mistry R, Nazir A, Shekhani S, Ali TS. Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan. PLoS One 2021; 16:e0254212. [PMID: 34234364 PMCID: PMC8263250 DOI: 10.1371/journal.pone.0254212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework.
Collapse
Affiliation(s)
- Makkiya Jawed
- Sehat Kahani Community Innovation Hub, Karachi, Sindh, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Rozina Mistry
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Amirah Nazir
- International Internship Programme, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sualeha Shekhani
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- Center of Biomedical Ethics and Culture, Sindh Institute of Urology & Transplantation, Karachi, Sindh, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Sindh, Pakistan
| |
Collapse
|
2
|
Goedde D, Zidack A, Li YH, Arkava D, Mullette E, Mullowney Y, Brant JM. Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. J Am Psychiatr Nurses Assoc 2021; 27:123-133. [PMID: 31898913 DOI: 10.1177/1078390319897311] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.
Collapse
Affiliation(s)
- Diane Goedde
- Diane Goedde, MSN, APRN, Billings Clinic, Billings, MT, USA
| | - Astri Zidack
- Astri Zidack, EdD, LCPC, CRC, Billings Clinic, Billings, MT, USA
| | - Ya-Huei Li
- Ya-Huei Li, PhD, Billings Clinic, Billings, MT, USA
| | - Diane Arkava
- Diane Arkava, MSW, LCSW, Billings Clinic, Billings, MT, USA
| | | | | | - Jeannine M Brant
- Jeannine M. Brant, PhD, APRN AOCN, FAAN, Billings Clinic, Billings, MT, USA
| |
Collapse
|
3
|
Isobe J, Healey L, Humphreys C. A critical interpretive synthesis of the intersection of domestic violence with parental issues of mental health and substance misuse. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1394-1407. [PMID: 32202363 PMCID: PMC7497205 DOI: 10.1111/hsc.12978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
A critical interpretive synthesis (CIS) methodology was used with the aim of informing practice with children and families when domestic and family violence (DFV) and parental issues relating to alcohol and other drugs (AOD) and mental health (MH) are also present. A CIS is grounded in the literature, but includes questioning of the literature in order to problematise gaps, contradictions and constructions of issues. A review of the literature from 2010 to 2018 was conducted with the structured search strategy identifying 40 relevant research articles. Synthesis and critique of these articles revealed three mutually informative themes through which to understand the literature and how it can inform practice. They were as follows: differences in theoretical approaches and client focus; complexity of system's collaboration; and practices converging on mothers. Taken together, these themes facilitated the development of the synthesising construct: strengthening intersection between DFV, AOD and MH sectors. Attention to practice at multiple levels that responds to the dynamics of gender and the differing impacts of violence was often lacking, particularly in the context of heightened child protection concerns where collaboration between sectors is needed. Both promising and problematic practices relating to gender dynamics and accountability converged on mothers. While there were exceptions, generally, there was an absence of engagement with, and recognition of, the impacts of fathers' patterns of using violence and control on adult and child survivors. Promising practice related to the strengthening of the mother-child relationship and attention to MH and its intersection with domestic violence. Strengthening the intersections between DFV, AOD and MH practices with attention to keeping the perpetrator of violence in view is critical to overcoming the poor practice that can occur when sectors are siloed from each other.
Collapse
Affiliation(s)
- Jasmin Isobe
- Department of Social WorkMelbourne School of Health SciencesUniversity of MelbourneMelbourneVic.Australia
| | - Lucy Healey
- Department of Social WorkMelbourne School of Health SciencesUniversity of MelbourneMelbourneVic.Australia
| | - Cathy Humphreys
- Department of Social WorkMelbourne School of Health SciencesUniversity of MelbourneMelbourneVic.Australia
| |
Collapse
|
4
|
Abstract
Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.
Collapse
Affiliation(s)
- Nancy Byatt
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
| | - Wanlu Xu
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA
| | - Leonard L Levin
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,c Department of Pediatrics , Francis A. Countway Library of Medicine, Harvard Medical School , Boston , MA , USA
| | - Tiffany A Moore Simas
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
| |
Collapse
|
5
|
Vignato J, Connelly CD, Bush RA, Georges JM, Semino-Asaro S, Calero P, Horwitz SM. Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. Issues Ment Health Nurs 2018; 39:840-849. [PMID: 30277842 PMCID: PMC6397067 DOI: 10.1080/01612840.2018.1488313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.
Collapse
Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, 305 College of Nursing Building, 50 Newton Road, Iowa City, IA 52242, USA
| | - Cynthia D. Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Ruth A. Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Jane M. Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Semira Semino-Asaro
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, 8 Floor, New York, NY 10016, USA
| |
Collapse
|
6
|
Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N. A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings. Clin Obstet Gynecol 2018; 61:573-590. [PMID: 29553986 PMCID: PMC6059986 DOI: 10.1097/grf.0000000000000360] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, and sustainability through novel reimbursement mechanisms.
Collapse
Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
- Department of Pediatrics
| | - Michael P. Flynn
- University of Massachusetts Medical School, Worcester, MA
- Department of Obstetrics and Gynecology
| | | | | | - Leonard L. Levin
- University of Massachusetts Medical School, Worcester, MA
- Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA
- Department of Family and Community Medicine
| | - Kathleen Biebel
- University of Massachusetts Medical School, Worcester, MA
- Department of Psychiatry
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
| |
Collapse
|
7
|
Barriers to antenatal psychosocial assessment and depression screening in private hospital settings. Women Birth 2018; 31:292-298. [DOI: 10.1016/j.wombi.2017.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
|
8
|
Adefolarin A, Arulogun O. Perception of Mothers and Selected Informal Maternity Caregivers Regarding Maternal Depression in Two Communities of Ibadan In Nigeria. ARCHIVES OF BASIC AND APPLIED MEDICINE 2018; 6:17-26. [PMID: 30258980 PMCID: PMC6152900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article described the perception of young mothers and selected informal maternity caregivers with no known antecedents of depression residing in two communities in Ibadan, Nigeria about maternal depression. This study is qualitative in design. We purposively selected fifty-one pregnant women and nursing mothers (young mothers) within the communities and the clinics. Thirty-three informal caregivers (Community Birth attendants (CBAs), elderly mothers and men of reproductive age) were also selected. We utilized Focus Group Discussions (FGD), Key Informant Interviews (KIIs), open-ended interviews and document consultation to obtain information about maternal depression. Discussions and interviews were digitally recorded, transcribed verbatim and analyzed using thematic analysis with Nvivo version 15. Common phrases used to describe maternal depression were "severe worrying" and "chronic unhappiness". Young mothers opined that maternal depression was caused by lack of partner support while more of the men and elderly mothers felt spiritual causes were responsible. Symptoms of maternal depression described by the participants included prolonged loss of interest in pleasurable activities and being moody. Common consequences of maternal depression mentioned were premature onset of labour and low birth weight babies. The perceived help-seeking behaviour included special rituals and deliverance. CBAs mentioned referral to a psychiatrist as a last resort. Participants were aware of maternal depression and its symptoms, however, there were misconceptions about the causes which influenced the perceived help-seeking of elderly mothers and men. Health education interventions to dispel these misconceptions should therefore target the mothers and informal caregivers in the study area.
Collapse
Affiliation(s)
- A.O. Adefolarin
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan
- Department of Psychiatry, College of Medicine, University of Ibadan
| | - O.S. Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan
| |
Collapse
|
9
|
Bonnell S, Griggs A, Avila G, Mack J, Bush RA, Vignato J, Connelly CD. Community Health Workers and Use of mHealth: Improving Identification of Pregnancy Complications and Access to Care in the Dominican Republic. Health Promot Pract 2017; 19:331-340. [PMID: 28578606 DOI: 10.1177/1524839917708795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the feasibility and acceptability of using mobile health technology by community health workers (CHWs) in San Juan Province, Dominican Republic, to improve identification of pregnancy complications and access to care for pregnant women. Although most women in the Dominican Republic receive four antenatal care visits, poor women and adolescents in remote areas are more likely to have only one initial prenatal visit to verify the pregnancy. This community-based research began when community leaders raised concern about the numbers of their mothers who died in childbirth annually; San Juan's maternal mortality rate is 144/100,000 compared to the Caribbean rate of 85/100,000. Eight CHWs in three communities were taught to provide third-trimester antenatal assessment, upload the data on a mobile phone application, send the data to the local physician who monitored data for "red flags," and call directly if a mother had an urgent problem. Fifty-two pregnant women enrolled, 38 were followed to delivery, 95 antenatal care postintake were provided, 2 urgent complications required CHW home management of mothers, and there were 0 deaths. Stakeholders endorsed acceptability of intervention. Preliminary data suggest CHWs using mobile health technology is feasible, linking underserved and formal health care systems with provision of primary care in mothers' homes.
Collapse
Affiliation(s)
| | - Anne Griggs
- 1 University of San Diego, San Diego, CA, USA
| | | | | | - Ruth A Bush
- 1 University of San Diego, San Diego, CA, USA
| | | | | |
Collapse
|
10
|
Weinreb L, Upshur CC, Fletcher-Blake D, Reed G, Frisard C. Managing Depression Among Homeless Mothers: Pilot Testing an Adapted Collaborative Care Intervention. Prim Care Companion CNS Disord 2016; 18:15m01907. [PMID: 27486545 DOI: 10.4088/pcc.15m01907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/29/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Although depression is common among homeless mothers, little progress has been made in testing treatment strategies for this group. We describe pilot test results of an adapted collaborative care model for homeless mothers with depression. METHOD We conducted a pilot intervention study of mothers screening positive for depression in 2 randomly selected shelter-based primary care clinics in New York over 18 months in 2010-2012. Study participants completed a psychosocial, health, and mental health assessment at baseline, 3 months, and 6 months. RESULTS One-third of women screened positive for depression (123 of 328 women). Sixty-seven women (63.2% of the eligible sample) enrolled in the intervention. At 6 months, compared to usual-care women, intervention group women were more likely to be receiving depression treatment (40.0% vs 5.9%, P = .01) and antidepressant medication (73.3% vs 5.9%, P = .001, respectively) and had more primary care physician and care manager visits at both 3 months (74.3% vs 53.3%, P = .009 and 91.4% vs 26.7%, P < .001, respectively) and 6 months (46.7% vs 23.5%, P = .003 and 70% vs 17.7%, P = .001, respectively). More women in the intervention group compared to usual-care women reported ≥ 50% improvement in depression symptoms at 6 months (30% vs 5.9%, P = .07). CONCLUSIONS This pilot study found that implementing an adapted collaborative care intervention was feasible in a shelter-based primary care clinic and had promising results that require further testing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02723058.
Collapse
Affiliation(s)
- Linda Weinreb
- Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
| | - Carole C Upshur
- Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
| | | | - George Reed
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Christine Frisard
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| |
Collapse
|
11
|
van der Waerden J, Galéra C, Saurel-Cubizolles MJ, Sutter-Dallay AL, Melchior M. Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France. Psychol Med 2015; 45:1999-2012. [PMID: 25678201 DOI: 10.1017/s003329171500015x] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors. METHOD Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership. RESULTS Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy. CONCLUSIONS Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.
Collapse
Affiliation(s)
- J van der Waerden
- Department of Social Epidemiology,INSERM UMR-S 1136,Pierre Louis Institute of Epidemiology and Public Health,F-75013 Paris,France
| | - C Galéra
- Department of Child and Adolescent Psychiatry,Charles Perrens Hospital,F-33000 Bordeaux,France
| | | | | | - M Melchior
- Department of Social Epidemiology,INSERM UMR-S 1136,Pierre Louis Institute of Epidemiology and Public Health,F-75013 Paris,France
| |
Collapse
|
12
|
Poleshuck E, Wittink M, Crean H, Gellasch T, Sandler M, Bell E, Juskiewicz I, Cerulli C. Using patient engagement in the design and rationale of a trial for women with depression in obstetrics and gynecology practices. Contemp Clin Trials 2015; 43:83-92. [PMID: 25937505 DOI: 10.1016/j.cct.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Significant health disparities exist among socioeconomically disadvantaged women, who experience elevated rates of depression and increased risk for poor depression treatment engagement and outcomes. We aimed to use stakeholder input to develop innovative methods for a comparative effectiveness trial to address the needs of socioeconomically disadvantaged women with depression in women's health practices. METHODS Using a community advisory board, focus groups, and individual patient input, we determined the feasibility and acceptability of an electronic psychosocial screening and referral tool; developed and finalized a prioritization tool for women with depression; and piloted the prioritization tool. Two intervention approaches, enhanced screening and referral using an electronic psychosocial screening, and mentoring using the prioritization tool, were developed as intervention options for socioeconomically disadvantaged women attending women's health practices. We describe the developmental steps and the final design for the comparative effectiveness trial evaluating both intervention approaches. CONCLUSIONS Stakeholder input allowed us to develop an acceptable clinical trial of two patient-centered interventions with patient-driven outcomes.
Collapse
Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Department of Obstetrics and Gynecology, University of Rochester, 401 Elmwood Ave, Rochester, NY 14642, USA.
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Hugh Crean
- School of Nursing, University of Rochester, 255 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Tara Gellasch
- Newark Wayne, Rochester Regional Health System, 1200 Driving Park Avenue, Newark, NY 14513, USA
| | - Mardy Sandler
- Division of Social Work, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Elaine Bell
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Iwona Juskiewicz
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| |
Collapse
|
13
|
DeRose LM, Shiyko M, Levey S, Helm J, Hastings PD. Early Maternal Depression and Social Skills in Adolescence: A Marginal Structural Modeling Approach. SOCIAL DEVELOPMENT 2014. [DOI: 10.1111/sode.12073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Connelly CD, Hazen AL, Baker-Ericzén MJ, Landsverk J, Horwitz SM. Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women. J Womens Health (Larchmt) 2013; 22:844-52. [PMID: 23931153 DOI: 10.1089/jwh.2012.4121] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. METHOD Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. RESULTS A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. CONCLUSION In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.
Collapse
Affiliation(s)
- Cynthia D Connelly
- 1 University of San Diego Hahn School of Nursing and Health Science , San Diego, California
| | | | | | | | | |
Collapse
|
15
|
Hayden M, Connelly CD, Baker-Ericzen MJ, Hazen AL, McCue Horwitz S. Exploring perceptions and experiences of maternal depression in Latinas: a qualitative study. Issues Ment Health Nurs 2013; 34:180-4. [PMID: 23477438 DOI: 10.3109/01612840.2012.701708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Understanding how depression is conceptualized is key to designing effective screening and treatment procedures. Of particular concern is maternal depression in Latinas, given the high Latina birthrate. We conducted two focus groups of pregnant Latinas to elicit their perceptions of and experiences with maternal depression. Women reported familiarity with the concept of maternal depression and that their experiences with depression were linked to social support from family and friends. Women also indicated that they felt responsible for coping and recovering from depression independently. How experiences with depression interact with traditional Latino idioms of distress, needs further investigation.
Collapse
|
16
|
Matthey S, Ross-Hamid C. Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord 2012; 141:213-21. [PMID: 22695259 DOI: 10.1016/j.jad.2012.02.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/03/2012] [Accepted: 02/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Edinburgh Depression Scale (EDS/EPDS) is routinely used in many clinical services to screen for probable distress in antenatal and postnatal women. Typically a single administration of this scale results in a referral to a specialist mental health service if the woman scores above the service's cut-off score on the measure - that is, scores 'high'. A few postnatal studies have shown, however, that many women when re-tested just a few weeks later no longer score 'high'. This study explored this phenomenon in a sample of pregnant women, using both the EDS and an anxiety self-report measure (Hospital Anxiety and Depression Scale - Anxiety subscale: HADS-A). METHOD 164 English-speaking pregnant women attending a local public hospital's antenatal clinic for their first appointment participated. At this appointment they completed the EDS and the HADS-A, and predicted how they might be feeling in about two-week time. Approximately two weeks later they were interviewed by phone and again completed the EDS and the HADS-A, and answered questions about possible mood changes. RESULTS Regardless of which of several cut-off scores on the EDS or HADS-A was used to define 'high' scorers, approximately 50% (±6%) of women scoring high at their first appointment on either measure no longer scored 'high' two weeks later. Common reasons given for their mood improvement included reduced morning sickness, reassuring results from routine tests (e.g., ultrasounds), fear of miscarriage subsiding, and a sense of reassurance following their hospital visit. Many of the women were accurate in predicting at their first appointment that they would be feeling better within a few weeks. LIMITATIONS The administration procedure for completion of the measures on the two occasions was different. Women initially completed the measures by hand, and on the second occasion over the phone. CONCLUSION Half the women screened as having emotional distress - that is, scoring 'high' on self-report mood measures (i.e., EDS and HADS-A) - during their first hospital visit in pregnancy are likely to have transient distress for predictable reasons. Referring women to specialist mental health services based upon just one administration of these measures will therefore result in a large number of unnecessary referrals, thus possibly overstretching the resources available. We therefore believe that when women score high on a self-report mood measure, enquiring as to why this is the case, and about whether the woman expects to feel differently in a few weeks time, together with a second administration of the measures in a few weeks is a better practice, unless there are good clinical reasons to do otherwise. In addition, studies reporting prevalence rates of perinatal distress should not simply use a one-off administration of a self-report mood scale to state the probable rate of disorders or distress.
Collapse
Affiliation(s)
- Stephen Matthey
- Infant, Child and Adolescent Mental Health Service, South Western Sydney Local Health District, Australia.
| | | |
Collapse
|
17
|
Baker-Ericzén MJ, Connelly CD, Hazen AL, Dueñas C, Landsverk JA, Horwitz SM. A collaborative care telemedicine intervention to overcome treatment barriers for Latina women with depression during the perinatal period. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2012; 30:224-40. [PMID: 22709321 PMCID: PMC3780578 DOI: 10.1037/a0028750] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Maternal depression is highly prevalent (10-20%) during the perinatal period, with rates as high as 35% to 40% for Latinas. However, few Latinas are either identified or treated during the perinatal period. The Perinatal Mental Health (PMH) model was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, collaborative care intervention for addressing depression among Mexican American mothers. It attends to sociocultural and socioeconomic dimensions and is delivered by trained mental health advisors in obstetric care settings. This article describes the feasibility and acceptability of using the PMH. Participants (N = 79) were selected from a 1st-year ongoing randomized trial in community obstetric clinics. The intervention seems feasible and acceptable; low-income Latinas, identified as depressed during the perinatal period, reported having access to a range of appropriate community services and high satisfaction.
Collapse
Affiliation(s)
- Mary J Baker-Ericzén
- Child and Adolescent Services Research Center, Rady Children's Hospital San Diego, San Diego, CA 92123, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Mendes AV, Loureiro SR, Crippa JA, de Meneses Gaya C, García-Esteve L, Martín-Santos R. Mothers with depression, school-age children with depression? A systematic review. Perspect Psychiatr Care 2012; 48:138-48. [PMID: 22724399 DOI: 10.1111/j.1744-6163.2011.00318.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To carry out a systematic review of the association between maternal and school-age children depression and covariate factors. DESIGN AND METHODS The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004-2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used. FINDINGS Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis. PRACTICE IMPLICATIONS Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression.
Collapse
Affiliation(s)
- Ana Vilela Mendes
- Department of Neurosciences and Behavior, Division of Psychiatry, Ribeirão Preto School of Medicine, University of São Paulo (FMRP-USP), Brazil.
| | | | | | | | | | | |
Collapse
|
19
|
Loprinzi PD, Fitzgerald EM, Cardinal BJ. Physical Activity and Depression Symptoms among Pregnant Women from the National Health and Nutrition Examination Survey 2005–2006. J Obstet Gynecol Neonatal Nurs 2012; 41:227-235. [DOI: 10.1111/j.1552-6909.2012.01340.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|