Mental health nurses’ attitudes towards severe perinatal mental illness

A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness

There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.

Feasibility of training primary healthcare workers to identify antenatal depression

Identifying women with depressive symptoms is the first step to reducing the risk of the short-term and long-term consequences of antenatal depression. Task shifting by training primary healthcare workers may help to reduce the burden in low-resource settings. Twenty health workers in a primary healthcare center in urban Bengaluru were trained to screen and identify antenatal depression. The training had two components: knowledge-based, using the depression module in the Mental Health Gap Action Program; and skills-based hands-on training, using the Patient Health Questionnaire-9. Knowledge about antenatal depression in the health workers improved by three units after training (p < 0.001). Their perceived skills and self-efficacy also improved by one unit each (p = 0.032 and p = 0.036, respectively). Following the training, 25% of the pregnant women who underwent screening by health workers reported depressive symptoms, as compared to no positive screening before training. Training was found to improve the knowledge, perceived skills and self-efficacy of nurses, junior health assistants and Accredited Social Health Activists (ASHAs), and was found to increase the screening rate of depression in an antenatal clinic in urban India. Incorporating screening for depressive symptoms into regular antenatal care is feasible in low-resource settings.

Mental health professionals' experiences of working with parents with psychosis and their families: a qualitative study

Background

Healthcare service users who are parents with psychosis form part of the caseload of most community mental health teams. Mental health professionals can experience uncertainty about how to work with and ask about the children of these parents, and often report difficulties when collaborating with other agencies. This study focused on professionals’ experiences of working with parents with psychosis and their families to gain an understanding of these parents’ needs from a service-level perspective, and to identify barriers that professionals may experience in meeting those needs.

Methods

Qualitative focus groups were conducted with four to eight mental health professionals per group. Data were analysed using reflexive thematic analysis. JR familiarised herself with the transcripts and then coded each salient unit within the text. Themes were then identified and discussed amongst all authors until there was agreement.

Results

We developed two overarching themes: 1) Diversity of need in parents with psychosis and 2) Role boundaries. The first explored mental health professionals’ perceived range of experiences that parents with psychosis and their families have, and the range of potential effects of parental psychosis on a child. The second theme described how some mental health professionals emphasised the importance of supporting service users in terms of their parenting status and others felt it was more critical to treat the person’s symptomatic expression. This theme also included issues with communication both with their service users and with other agencies.

Conclusions

Mental health professionals identified that the needs of parents with psychosis were diverse and reflected significant variation in the experiences of service users. Mental health professionals across different types of team (early intervention and community mental health) expressed contrasting viewpoints about how achievable it was to respond to a service user’s parenting status in an adult mental health setting. Future research should aim to determine where training is needed to enhance mental health professionals’ ability to work holistically with families in an adult mental health setting, and how to enhance collaboration with other agencies.

Approaches to health-care provider education and professional development in perinatal depression: a systematic review

Background

Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression.

Methods

A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis.

Results

Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes.

Conclusions

This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers.

Trial registration

A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701), June 21, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1431-4) contains supplementary material, which is available to authorized users.

Working together for women’s empowerment: Strategies for interdisciplinary collaboration in perinatal care

Women’s experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.

A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos?

BACKGROUND

Women at risk of poor perinatal mental health benefit from coordinated approaches to care. Perinatal and infant mental health (PIMH) services have been established to support women with social and emotional needs. This paper examines the nature and extent of collaboration within two PIMH services in Australia.

METHODS

A convergent, embedded, mixed methods design was used. Two hundred and forty four medical records were reviewed, 13 professionals (six PIMH clinicians, two PIMH service managers, and five key stakeholders) and 11 women service-users participated in semi-structured interviews.

RESULTS

Three broad themes were drawn from the data, Theme 1: We don't sit in silos … but they do, Theme 2: We need to enhance communication, and Theme 3: Collaboration is hard work. Perinatal and infant mental health clinicians believe they work collaboratively with other service providers. Key stakeholders and documentation in the medical records reveal that collaboration is nominal.

CONCLUSIONS

Professionals believe that collaboration is essential for women with complex needs. Perinatal and infant mental health clinicians are skilled at building relationships with women, however further support is needed to build trusting relationships with other service providers. Women service-users also need to be involved in the collaborative process to become equal partners in their care.

Therapeutic interventions in perinatal and infant mental health services: a mixed methods inquiry

Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.

Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness

The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven databases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes included the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.

Collaboration and integrated services for perinatal mental health: an integrative review

BACKGROUND

  An integrative review was undertaken to synthesise the research related to professionals' perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems.

METHOD

  A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review.

RESULTS

  The overarching theme identified in the review related to the process of 'making it happen'. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways.

CONCLUSION

  Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.

Using the repertory grid technique to examine nursing staff's construal of mothers with mental health problems

BACKGROUND

This study explored the attitudes of psychiatric nursing staff towards mothers with mental health difficulties. Working with mothers experiencing mental health problems can evoke negative reactions in staff that activate value-laden beliefs regarding the capacity of these women to care for their infants, which could diminish the provision of optimal care and treatment for patients.

METHOD

Ten psychiatric nursing staff working in a specialist mother and baby unit in the North of England were interviewed about their views of various types of client by using the repertory grid technique.

FINDINGS

A total of 86 constructs that clustered under 21 headings were elicited. All staff made critical judgements about some clients. Staff often described the context in which these perceptions were reached such as the behaviour of clients and the quality of the nurse-client relationship.

CONCLUSIONS

Clients with a personality disorder and those who were thought to be 'bad' mothers were construed as being furthest from the self and more negatively than clients with depression or psychosis. Further training is indicated for staff working with mothers displaying challenging interactional styles; however, training packages must consider the individuality of perception and experience present within staff groups.