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Haider S, Ott E, Moore A, Rankin K, Campbell R, Mohanty N, Gemkow JW, Caskey R. Linking Inter-professional Newborn and Contraception Care (LINCC) trial: Protocol for a stepped wedge cluster randomized trial to link postpartum contraception care with routine Well-Baby Visits. Contemp Clin Trials 2024; 145:107659. [PMID: 39121991 DOI: 10.1016/j.cct.2024.107659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Pregnancies conceived within 18 months of a prior delivery (termed short inter-pregnancy interval [IPI]) place mothers and infants at high risk for poor health outcomes. Despite this, nearly one third of U.S. women experience a short IPI. OBJECTIVE To address the gap in the current model of postpartum (PP) contraception care by developing and implementing a novel approach to link (co-schedule) PP contraception care with newborn well-baby care to improve access to timely PP contraception. METHODS The LINCC Trial will take place in seven clinical locations across five community health centers within the U.S. PP patients (planned n = 3150) who are attending a Well-Baby Visit between 0 and 6 months will be enrolled. The LINCC Trial aims to leverage the Electronic Health Record to prompt providers to ask PP patients attending a Well-Baby Visit about their PP contraception needs and facilitate co-scheduling of PP contraception care with routine newborn care visits. The study includes a cluster randomized, cross-sectional stepped wedge design to roll out the intervention across the seven sites. The outcomes of the study include receipt of most or moderately effective methods of contraception by two and six months PP; and rate of short IPI pregnancies. Implementation outcomes will be assessed at baseline and 6 months after site enters intervention period. CONCLUSIONS The LINCC Trial seeks to evaluate the effectiveness and feasibility of a linked care model in comparison to usual care.
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Affiliation(s)
- Sadia Haider
- Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, United States.
| | - Emily Ott
- Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, United States
| | - Amy Moore
- The University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, United States
| | - Kristin Rankin
- The University of Illinois at Chicago, 820 S. Wood Street, MC 808, Chicago, IL, 60612, United States
| | - Rebecca Campbell
- The University of Illinois at Chicago, 820 S. Wood Street, MC 808, Chicago, IL, 60612, United States
| | - Nivedita Mohanty
- AllianceChicago, 225 W. Illinois Street, 5(th) Floor, Chicago, IL, 60654, United States
| | - Jena Wallander Gemkow
- AllianceChicago, 225 W. Illinois Street, 5(th) Floor, Chicago, IL, 60654, United States
| | - Rachel Caskey
- The University of Illinois at Chicago, 820 S. Wood Street, MC 808, Chicago, IL, 60612, United States
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Zhang Y, Wang H, Wu S, Xiao Y, Jiang F. Empowering new mothers in China: role of paediatric care in screening and management of postpartum depression. BMJ 2024; 386:e078636. [PMID: 39214561 DOI: 10.1136/bmj-2023-078636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, School of Medicine Shanghai Jiao Tong University Shanghai, China
| | - Haiwa Wang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
- Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Saishuang Wu
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
- Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Yuyin Xiao
- School of Public Health, School of Medicine Shanghai Jiao Tong University Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Dessì A, Pianese G, Mureddu P, Fanos V, Bosco A. From Breastfeeding to Support in Mothers' Feeding Choices: A Key Role in the Prevention of Postpartum Depression? Nutrients 2024; 16:2285. [PMID: 39064728 PMCID: PMC11279849 DOI: 10.3390/nu16142285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10-15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother's emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers' compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother's self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother's emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers' breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP.
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Affiliation(s)
- Angelica Dessì
- Department of Surgical Sciences, University of Cagliari and Neonatal Intensive Care Unit, AOU Cagliari, 09124 Cagliari, Italy; (G.P.); (P.M.); (V.F.); (A.B.)
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Borrero L, Dietsch A, Santurri LE, Ewen HH. New Mothers With Postpartum Depression: A Qualitative Exploration of Healthcare Decision-Making. QUALITATIVE HEALTH RESEARCH 2024; 34:217-226. [PMID: 37997365 DOI: 10.1177/10497323231206783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Postpartum depression (PPD) is a significant health issue for many new mothers in the weeks and months following a child's birth. Quantitative data suggest that a mother's PPD negatively impacts healthcare decision-making for the child via routine well-baby visits and pediatric care. However, little is known from a qualitative perspective about the factors that challenge or facilitate these healthcare decisions. The purpose of this descriptive qualitative study was to understand the perceptions of new mothers about factors contributing to their healthcare decision-making, for themselves and for their children, while living with PPD. The researchers used purposive sampling to recruit eight women from clinics, community organizations, and social media support groups who met the study's inclusion criteria. Individual semi-structured interviews were carried out with eight participants about their PPD experiences, motherhood, and healthcare decision-making influences. Transcribed interviews and initial themes were shared with participants to verify researcher interpretations and aid in the analysis process. The researchers analyzed interview data using thematic analysis to cultivate an understanding of the phenomenon by identifying and interpreting patterns in the data. Three primary themes were drawn from the data analysis: (1) Importance of Clinician Trust and Support; (2) Balancing the Health of the Mother and Child; and (3) Other Support Structures That Facilitate Healthcare Decision-Making for the Mother and Baby Dyad. Participant experiences underscored the need for cohesive approaches by clinical providers of pre- and postnatal care. Group model approaches to postnatal care appear to mitigate or reduce the impact of PPD.
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Affiliation(s)
- Lisa Borrero
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Aimee Dietsch
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Laura E Santurri
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Heidi H Ewen
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
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Dlamini LP, Amelia VL, Shongwe MC, Chang PC, Chung MH. Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A systematic review and meta-analysis of cohort studies. Gen Hosp Psychiatry 2023; 85:35-42. [PMID: 37742599 DOI: 10.1016/j.genhosppsych.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/06/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE This meta-analysis aimed at estimating the prevalence of postpartum depression (PPD) at different postpartum timepoints in women with antenatal depression (AD) in the three trimesters. We also examined the association between AD and PPD, and estimated the population attributable fraction of PPD to AD. METHODS This systematic review and meta-analysis identified cohort studies that determined the prevalence of PPD in women who had AD, and those that examined the association between AD and PPD from PubMed, Embase, MEDLINE, CINAHL and PsycINFO. Articles were appraised using the modified Newcastle Ottawa Scale and data were analyzed using Comprehensive Meta-Analysis. RESULTS Eighty-eight (88) cohort studies with a combined sample size of 1,042,448 perinatal women contributed to the meta-analysis. About 37% pregnant women who had AD, later had PPD. Those with AD had four times higher odds of developing PPD (OR: 4.58; 95% CI = 3.52-5.96). The odds of having PPD were higher when AD was observed in the first or third trimester compared to the second trimester. About 12.8% of PPD cases were attributable to AD. CONCLUSION The findings should inform future clinical guidelines on the screening, the frequency of screening, and follow-up care in maternal-mental health.
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Affiliation(s)
| | - Vivi Leona Amelia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan; Universitas Muhammadiyah Purwokerto, Purwokerto, Central Java, Indonesia
| | - Mduduzi Colani Shongwe
- Department of Midwifery, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan.
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Almutairi HA, Alyousef SM, Alhamidi SA, Almoammar DN. Exploring the Healthcare Services' Contribution to Reducing Postpartum Depression. SAGE Open Nurs 2023; 9:23779608231171780. [PMID: 37181734 PMCID: PMC10170593 DOI: 10.1177/23779608231171780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services. Objective The purpose of this study was to explore nurses' perceptions towards health services' contribution to lowering the incidence of PPD. Methods An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method. Results Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses. Conclusion The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.
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Affiliation(s)
| | - Seham Mansour Alyousef
- Community and Psychiatric Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Sami Abdulrahman Alhamidi
- Department of Maternal and Child Health, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Danah Nasser Almoammar
- Department of Psychiatric and Mental Health Care, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Woodman J, Simon A, Hauari H, Gilbert R. A scoping review of 'think-family' approaches in healthcare settings. J Public Health (Oxf) 2021; 42:21-37. [PMID: 30668870 DOI: 10.1093/pubmed/fdy210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND 'Think-family' child health approaches treat child and parent/carer health as inter-related. They are promoted within health policy internationally (also called 'family paediatrics' or 'whole-family', 'family-centred' approaches or 'child-centred' approaches within adult services). METHODS We reviewed publications of think-family interventions. We developed a typology of these interventions using thematic analysis of data extracted from the included studies. RESULTS We included 62 studies (60% USA and 18% UK); 45/62 (73%) treated the parent as patient, helping the child by addressing parental mental health, substance and alcohol misuse and/or domestic violence. Our typology details three common mechanisms of change in relevant interventions: screening, health promotion and developing relationships (inter-professional and parent-professional). CONCLUSIONS Policy-makers, practitioners and researchers can use our typology to develop and evaluate think-family approaches within healthcare. Strong relationships between parents and professionals are key in think-family approaches and should be considered in service design. Although helping the child through the parent may be a good place to start for service development, care is needed to ensure parental need does not eclipse child need. Strategies that reach out to the parent behind the child (child as patient) and which work simultaneously with parent and child warrant attention.
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Affiliation(s)
- Jenny Woodman
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Antonia Simon
- UCL-Institute of Education, Social Science Research Unit, 27/8 Woburn Square, London, UK
| | - Hanan Hauari
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Ruth Gilbert
- UCL-GOS- Institute of Child Health, 30 Guilford Street, London, UK
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Sharp M, Huber N, Ward LG, Dolbier C. NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress. J Perinat Neonatal Nurs 2021; 35:57-67. [PMID: 33528188 PMCID: PMC10405171 DOI: 10.1097/jpn.0000000000000543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.
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Affiliation(s)
- Meghan Sharp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island (Drs Sharp and Ward); Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island (Dr Sharp); Department of Psychology, East Carolina University, Greenville, North Carolina (Ms Huber and Dr Dolbier); and Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island (Dr Ward)
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Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review. Gen Hosp Psychiatry 2021; 68:19-24. [PMID: 33271405 DOI: 10.1016/j.genhosppsych.2020.11.011] [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: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To synthesize the literature and develop guidance on supports needed for primary care and perinatal providers in screening, initial management, triage, and bridging treatment for perinatal bipolar disorder. METHODS We conducted a scoping review by searching six electronic databases using keywords related to perinatal bipolar disorder. We summarized descriptive statistics on settings and extracted information on care approaches. We synthesized the literature on indirect care models and extracted data on screening, follow-up, referrals, and management. RESULTS 1169 articles were retrieved. 51 articles were included after review. Most papers were reviews. Fewer addressed care in obstetric (n = 20, 39%), primary care (n = 10, 20%), and pediatric settings (n = 2, 4%). Most papers (n = 30, 59%) discussed using screening instruments for bipolar disorder. Articles were mixed on recommendations for bipolar disorder screening. CONCLUSIONS Varied strategies for structured assessment exist and are influenced by practice setting. There remains uncertainty about optimal strategies for screening and management of perinatal bipolar disorder. We recommend screening for bipolar disorder in the perinatal period in select circumstances (with depression screening, known bipolar disorder risk factors, and prior to starting antidepressants). If specialty mental health care is unavailable, we recommend enhancing usual care through integrated care strategies such as indirect consultation.
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Riffin C, Wolff JL, Pillemer KA. Assessing and Addressing Family Caregivers' Needs and Risks in Primary Care. J Am Geriatr Soc 2020; 69:432-440. [PMID: 33217776 DOI: 10.1111/jgs.16945] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. DESIGN Cross-sectional, national mail-based survey. SETTING American Medical Association Masterfile database. PARTICIPANTS U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62). MEASUREMENTS Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments. RESULTS Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type. CONCLUSIONS Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA
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Abstract
This review highlights proposed pandemic-adjusted modifications in obstetric care, with discussion of risks and benefits based on available evidence. We suggest best practices for balancing community-mitigation efforts with appropriate care of obstetric patients.
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Bhat A, Miller ES, Wendt A, Ratzliff A. Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap? Womens Health Issues 2020; 30:405-408. [DOI: 10.1016/j.whi.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
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Martínez P, Magaña I, Vöhringer PA, Guajardo V, Rojas G. Development and validation of a three‐item version of the Edinburgh Postnatal Depression Scale. J Clin Psychol 2020; 76:2198-2211. [DOI: 10.1002/jclp.23041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Pablo Martínez
- Escuela de Psicología, Facultad de Humanidades Universidad de Santiago de Chile Santiago Chile
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay Santiago Chile
| | - Irene Magaña
- Escuela de Psicología, Facultad de Humanidades Universidad de Santiago de Chile Santiago Chile
- Centro de Estudios Migratorios (CEM) Universidad de Santiago de Chile Santiago Chile
| | - Paul A. Vöhringer
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Department of Psychiatry Tufts Medical Center Boston MA USA
- Tufts University School of Medicine Boston Massachusetts USA
| | - Viviana Guajardo
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Servicio de Psiquiatría Hospital El Pino Santiago Chile
| | - Graciela Rojas
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay Santiago Chile
- Millennium Nucleus of Social Development Santiago Chile
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Goff SL, Moran MJ, Szegda K, Fioroni T, DeBanate MA, Byatt N. Development and pilot testing of an adaptable protocol to address postpartum depression in pediatric practices serving lower-income and racial/ethnic minority families: contextual considerations. Implement Sci Commun 2020; 1:66. [PMID: 32885220 PMCID: PMC7427956 DOI: 10.1186/s43058-020-00049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/12/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) affects approximately 25% of women in lower-income and racial/ethnic minority populations in the USA. Evidence-based interventions for PPD screening and treatment exist, but many women with PPD are not identified or are inadequately treated. To address this gap, the American Academy of Pediatrics recommends screening for PPD at routine preventive visits in the first 6 months of postpartum, but less than half of pediatricians do so. Small PPD screening studies have been conducted in pediatric practices serving average-risk women, but less is known about practices serving families with lower-income and/or racial/ethnic minority status (safety-net practices). Study objectives were (1) to develop and pilot test an adaptable PPD screening protocol in safety-net practices and (2) to test strategies for implementing the protocol. METHODS The Consolidated Framework for Implementation Research was used for this two-phase pilot study. Phase I focus groups with pediatric providers and staff in four safety-net practices informed phase II development and implementation of a PPD screening and referral protocol. Feasibility measures included the percentage of eligible women screened and documentation of follow-up plans in the electronic health record at 1-, 2-, 4-, and 6-month preventive visits over 3 months. Implementation strategies were assessed for acceptability, appropriateness, and feasibility. RESULTS Focus group participants felt that (1) addressing PPD in the pediatric setting is important, (2) all clinical team members should be engaged in screening, (3) workflows and competing interests may present barriers, and (4) commonly used screening tools/approaches may not adequately detect depression in the population studied. During protocol implementation, screening rates increased from 75 to 85% for 324 eligible preventive visits and documentation of follow-up plans increased from 66 to 87%. Only 6.5% of women screened positive (EPDS ≥ 10). Minor adaptations to implementation strategies were recommended to improve acceptability, appropriateness, and feasibility. CONCLUSIONS Although developing and implementing an adaptable protocol for PPD screening in safety-net pediatric practices using external facilitation and a bundle of implementation strategies appear feasible, low positive screen rates suggest adaptations to account for intersecting patient, practice, and external policy contexts are needed to improve PPD screening effectiveness in these practices.
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Affiliation(s)
- Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Amherst, MA 01003 USA
- Institute for Healthcare Delivery and Population Sciences, University of Massachusetts Medical School-Baystate, 3601 Main St., Springfield, MA 01199 USA
| | - Michael J. Moran
- Institute for Healthcare Delivery and Population Sciences, University of Massachusetts Medical School-Baystate, 3601 Main St., Springfield, MA 01199 USA
| | - Kathleen Szegda
- Public Health Institute of Western Massachusetts, 127 State St. 4th Fl., Springfield, MA 01103 USA
| | - Tina Fioroni
- Codman Square Health Center, 637 Washington St., Dorchester, MA 02124 USA
| | - Mary Ann DeBanate
- Public Health Institute of Western Massachusetts, 127 State St. 4th Fl., Springfield, MA 01103 USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School-Worcester, 55 Lake Avenue N, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Worcester, 55 Lake Avenue N, Worcester, MA 01655 USA
- Massachusetts Child Psychiatry Access Program for Moms, 25 Staniford Street, Boston, MA 02114 USA
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Riffin C, Wolff JL, Estill M, Prabhu S, Pillemer KA. Caregiver Needs Assessment in Primary Care: Views of Clinicians, Staff, Patients, and Caregivers. J Am Geriatr Soc 2020; 68:1262-1270. [PMID: 32167573 PMCID: PMC7325837 DOI: 10.1111/jgs.16401] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care. DESIGN Qualitative study consisting of in-depth semi-structured interviews. SETTING Four primary care practices located in urban and rural settings. PARTICIPANTS Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling. MEASUREMENTS Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio-recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis. RESULTS Participating clinicians had been in practice for an average of 12.8 years (range = 1-36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregivers' needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician-caregiver communication, and validate caregivers' efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self-administered assessment tools and post-screen discussions with practice staff. CONCLUSION Identification of caregivers' needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262-1270, 2020.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Estill
- Department of Internal Medicine, The Guthrie Clinic, Ithaca, New York, USA
| | - Sheela Prabhu
- Department of Internal Medicine, The Guthrie Clinic, Sayre, Pennsylvania, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA
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Haider S, Stoffel C, Rankin K, Uesugi K, Handler A, Caskey R. A Novel Approach to Postpartum Contraception Provision Combined with Infant Care: A Randomized, Controlled Trial. Womens Health Issues 2020; 30:83-92. [PMID: 31964564 PMCID: PMC8696743 DOI: 10.1016/j.whi.2019.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 11/05/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5 months postpartum compared with usual care in a randomized, controlled trial. METHODS Women with infants aged 4.5 months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed. RESULTS Between January 2015 and January 2017, 446 women were randomized. LARC use at 5 months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5 months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07). CONCLUSIONS Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.
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Affiliation(s)
- Sadia Haider
- The University of Illinois at Chicago, Chicago, Illinois.
| | | | - Kristin Rankin
- The University of Illinois at Chicago, Chicago, Illinois
| | - Keriann Uesugi
- The University of Illinois at Chicago, Chicago, Illinois
| | - Arden Handler
- The University of Illinois at Chicago, Chicago, Illinois
| | - Rachel Caskey
- The University of Illinois at Chicago, Chicago, Illinois
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17
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Morgenlander MA, Tyrrell H, Garfunkel LC, Serwint JR, Steiner MJ, Schilling S. Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic. Acad Pediatr 2019; 19:868-874. [PMID: 30862512 DOI: 10.1016/j.acap.2019.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/12/2019] [Accepted: 02/24/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Describe current practices in systematic screening for social determinants of health (SDH) in pediatric resident clinics enrolled in the Continuity Research Network (CORNET). METHODS CORNET clinic directors were surveyed on demographics, barriers to screening, and screening practices for 15 SDH, including the screen source, timing of screening, process of administering the screen, and personnel involved in screening. Incidence rate ratios were tabulated to investigate relationships among screening practices and clinic staff composition. RESULTS Clinic response rate was 41% (65/158). Clinics reported screening for between 0 and 15 SDH (median, 7). Maternal depression (86%), child educational problems (84%), and food insecurity (71%) were the items most commonly screened. Immigration status (17%), parental health literacy (19%), and parental incarceration (21%) were least commonly screened. Within 3 years, clinics plan to screen for 25% of SDH not currently being screened. Barriers to screening included lack of time (63%), resources (50%), and training (46%). CONCLUSIONS Screening for SDH in our study population of CORNET clinics is common but has not been universally implemented. Screening practices are variable and reflect the complex nature of screening, including the heterogeneity of the patient populations, the clinic staff composition, and the SDH encountered.
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Affiliation(s)
| | | | - Lynn C Garfunkel
- Department of Pediatrics (LC Garfunkel), University of Rochester School of Medicine and Rochester Regional Health, Rochester, NY
| | - Janet R Serwint
- Department of Pediatrics (JR Serwint), The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Michael J Steiner
- Department of Pediatrics (MJ Steiner and S Schilling), University of North Carolina at Chapel Hill
| | - Samantha Schilling
- Department of Pediatrics (MJ Steiner and S Schilling), University of North Carolina at Chapel Hill
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18
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Consolidation of Guidelines of Postpartum Care Recommendations to Address Maternal Morbidity and Mortality. Nurs Womens Health 2019; 23:508-517. [PMID: 31668997 DOI: 10.1016/j.nwh.2019.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/30/2019] [Accepted: 09/01/2019] [Indexed: 11/21/2022]
Abstract
Rates of maternal morbidity and mortality in the United States represent an urgent crisis. The purpose of this article is to consolidate current postpartum care guidelines to provide a comprehensive approach to care in the postpartum period. We include a critical examination of the reasons for some women's lack of attendance at postpartum visits, the current state of postpartum care, and the unmet needs of women. We review several postpartum care programs and suggest possible solutions for the postpartum period, including clinical implications for continuity of care for women with comorbidities including gestational diabetes, hypertension, and depression.
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19
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Kallem S, Matone M, Boyd RC, Guevara JP. Mothers' Mental Health Care Use After Screening for Postpartum Depression at Well-Child Visits. Acad Pediatr 2019; 19:652-658. [PMID: 30496869 DOI: 10.1016/j.acap.2018.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/05/2018] [Accepted: 11/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown whether pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine 1) mental health care use among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care use. METHODS Retrospective cohort design of mothers attending their infants' 2-month well child visit at 1 of 5 urban primary care practices between 2011 and 2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care use within 6 months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use. RESULTS In total, 3052 mothers met study criteria, 1986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD, of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least 1 Medicaid claim for depression within 6 months of screening. In multivariate modeling, mothers with a history of depression in the previous year (odds ratio = 3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen. CONCLUSIONS Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services after PPD screening are needed.
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Affiliation(s)
- Stacey Kallem
- PolicyLab, Children's Hospital of Philadelphia (S Kallem, M Matone, RC Boyd, and JP Guevara); Leonard Davis Institute of Health Economics, University of Pennsylvania (S Kallem, JP Guevara), Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (S Kallem, M Matone, JP Guevara), Philadelphia.
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia (S Kallem, M Matone, RC Boyd, and JP Guevara); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (S Kallem, M Matone, JP Guevara), Philadelphia
| | - Rhonda C Boyd
- PolicyLab, Children's Hospital of Philadelphia (S Kallem, M Matone, RC Boyd, and JP Guevara); Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia (RC Boyd)
| | - James P Guevara
- PolicyLab, Children's Hospital of Philadelphia (S Kallem, M Matone, RC Boyd, and JP Guevara); Leonard Davis Institute of Health Economics, University of Pennsylvania (S Kallem, JP Guevara), Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (S Kallem, M Matone, JP Guevara), Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania (JP Guevara), Philadelphia, Pa
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20
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Russomagno S, Waldrop J. Improving Postpartum Depression Screening and Referral in Pediatric Primary Care. J Pediatr Health Care 2019; 33:e19-e27. [PMID: 31227124 DOI: 10.1016/j.pedhc.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Postpartum depression (PPD) affects up to 20% of American mothers and, if left untreated, can have serious, lifelong effects on women and their children. The American Academy of Pediatrics recommends that pediatric practices screen for PPD at the 1-, 2-, 4-, and 6-month well-child checks; however, few pediatric practices oblige. METHODS This project standardized the PPD screening schedule and developed a novel referral algorithm that was concurrently implemented in a rural primary care pediatric practice. RESULTS The project significantly increased the clinic's screening rate from 33% to 80% (p < .001) and improved referral rates from 66% to 79%. DISCUSSION By standardizing PPD screening and implementing a referral algorithm in the ambulatory pediatric setting, more PPD cases can be identified, further evaluated, and, hopefully, treated to improve maternal and infant health outcomes.
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Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers' Experiences. Acad Pediatr 2019; 19:934-941. [PMID: 31425791 PMCID: PMC6907070 DOI: 10.1016/j.acap.2019.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. METHODS Semistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. RESULTS Twenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. CONCLUSIONS Postpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.
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Abstract
This study estimates the prevalence of paternal depression using the Child Health Improvement Through Computer Automation system in fathers attending well-child care visits.
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Affiliation(s)
- Erika R. Cheng
- Division of Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Stephen M. Downs
- Division of Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Aaron E. Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis
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23
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Kimmel MC, Platt RE, Steinberg DN, Cluxton-Keller F, Osborne LM, Carter T, Payne JL, Solomon BS. Integrating Maternal Mental Health Care in the Pediatric Medical Home: Treatment Engagement and Child Outcomes. Clin Pediatr (Phila) 2017; 56:1148-1156. [PMID: 27872354 DOI: 10.1177/0009922816679510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal depression is associated with an array of poor child health outcomes, and low-income women face many barriers to accessing treatment. In this pilot study, we assessed treatment engagement in a maternal mental health clinic staffed by a case manager and psychiatrist in an urban pediatric practice. We also examined factors associated with engagement as well as child health outcomes and health care use. Nearly half of the women enrolled attended at least 4 sessions with a psychiatrist in 6 months. Text messaging with the case manager was associated with a greater compliance with psychiatrist sessions. Comparing index children with their siblings prior to enrollment, a higher percentage had immunizations up to date at 1 year of age (82% vs 43%, P = .01), and well-child visit compliance trended toward significance (65% vs 35%, P = .06). The pediatric setting holds promise as an innovative venue to deliver maternal mental health care.
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Affiliation(s)
- Mary C Kimmel
- 1 Johns Hopkins School of Medicine, Baltimore, MD, USA.,2 University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Fallon Cluxton-Keller
- 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,5 Geisel School of Medicine, Hanover, NH, USA
| | | | - Tracy Carter
- 1 Johns Hopkins School of Medicine, Baltimore, MD, USA
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24
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Olin SCS, McCord M, Stein REK, Kerker BD, Weiss D, Hoagwood KE, Horwitz SM. Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings. J Womens Health (Larchmt) 2017; 26:966-975. [PMID: 28409703 DOI: 10.1089/jwh.2016.6089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.
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Affiliation(s)
- Su-Chin Serene Olin
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Mary McCord
- 2 Department of Pediatrics, New York University School of Medicine , New York, New York.,3 Department of Pediatrics, Gouverneur Health Services , New York, New York
| | - Ruth E K Stein
- 4 Albert Einstein College of Medicine/Children's Hospital at Montefiore , New York, New York
| | - Bonnie D Kerker
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Dara Weiss
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Kimberly E Hoagwood
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Sarah M Horwitz
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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Serim Demirgoren B, Ozbek A, Ormen M, Kavurma C, Ozer E, Aydın A. Do mothers with high sodium levels in their breast milk have high depression and anxiety scores? J Int Med Res 2017; 45:843-848. [PMID: 28351282 PMCID: PMC5536667 DOI: 10.1177/0300060517700013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to assess the possible association of high breast milk sodium levels with postpartum depression and anxiety. Methods A total of 150 mothers and their healthy, exclusively breastfed newborns aged 8 to 15 days were recruited. Mothers were asked to complete scales for evaluation of postnatal depression and anxiety following an interview for consent and sociodemographic data collection. Breast milk samples were obtained to measure sodium and potassium (K) levels. Results Forty-nine mothers had higher than expected breast milk Na concentrations and a high Na/K ratio. These mothers scored significantly higher on the scales of postnatal depression and state anxiety ( P = 0.018 and P = 0.048, respectively). Conclusions This study shows that compared to normal breast milk Na levels and Na/K ratio, high breast milk Na and high Na/K ratio, with possible serious consequences in infants, are associated with maternal depressive and anxious symptoms in the postpartum period.
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Affiliation(s)
- Burcu Serim Demirgoren
- 1 MD, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Ozbek
- 1 MD, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Ormen
- 2 MD, Department of Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Canem Kavurma
- 3 MD, Department of Child and Adolescent Psychiatry, Manisa Mental Health Hospital, Manisa, Turkey
| | - Esra Ozer
- 4 MD, Department of Paediatrics, Tepecik State Hospital, Izmir, Turkey
| | - Adem Aydın
- 5 MD, Department of Paediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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