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Vanderkruik R, Kobylski LA, Dunk MM, Arakelian MH, Gaw ML, Dineen H, Kanamori M, Freeman MP, Cohen LS. The lived experiences of individuals with postpartum psychosis: A qualitative analysis. J Affect Disord 2024; 348:367-377. [PMID: 38160890 DOI: 10.1016/j.jad.2023.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Postpartum psychosis (PP) is a severe psychiatric illness that occurs in about 1 to 2 per 1000 people in the perinatal period. To date, qualitative research investigating PP has focused on specific topics, such as treatment experiences or the impact of the illness on patients' lives and families. These studies have included small samples of women with histories of PP, often limited to certain geographical areas or treatment centers. Given the heterogeneity in presentations of PP and access to care, larger and geographically diverse samples are needed to broadly understand this complex illness. Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. In addition to the specific aims of MGHP3, which include to better understand the phenomenology and potential genetic underpinnings of PP, this investigation invites participants to qualitatively describe their narratives of postpartum psychosis. This analysis included 130 participants who reported on 133 episodes of PP. Participants' responses to the PP narrative prompt fell under several overarching categories: 1) broad psychosocial experiences surrounding postpartum psychosis, 2) impact on the mother-baby dyad, 3) treatment experiences, and 4) recovery experiences. Our findings shed light on a range of ways in which individuals' lives are impacted by this illness, and point to areas for future research and clinical directions to improve the support and care for individuals with PP and their families.
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Affiliation(s)
- Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychological & Brain Sciences, George Washington University, Washington, DC, United States of America
| | - Madison M Dunk
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hannah Dineen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaux Kanamori
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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Wass N, Chadwick R, Caygill L, O'Mara O. "It kind of strips down your relationship to its defining features……it just kind of shone a light on what was already there": A grounded theory of the impact of postpartum psychosis on the couple's relationship. J Reprod Infant Psychol 2024; 42:281-298. [PMID: 35912867 DOI: 10.1080/02646838.2022.2103793] [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: 12/03/2021] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Postpartum psychosis is a severe mental health illness following childbirth. Studies to date have developed from initial focus on experiences of women to address the role and experiences of partners, and recently to touch on the effect on their relationship. This study aimed to build on this work, by focussing directly on the impact of postpartum psychosis on the couple's relationship, from the perspectives of both the woman and her partner. METHOD A constructivist grounded theory approach was utilised to generate a theory that explained the impact of postpartum psychosis on the couple's relationship. In-depth semi-structured interviews were completed with a sample of eight women and six partners. RESULTS Four stages and five general categories described the processes that the couple experienced, and the impact postpartum psychosis had on their relationship. DISCUSSION The grounded theory adds to current evidence and helps increase understanding of factors that play a role in adjustment and outcomes. New insights were identified, including postpartum psychosis amplifying existing relational patterns; and the mediating role of the pre-existing relationship and couplehood. Clinical implications and areas for further research are considered.
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Affiliation(s)
- Nicola Wass
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Raymond Chadwick
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Lisa Caygill
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Oliver O'Mara
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
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Kobylski LA, Arakelian MH, Freeman MP, Gaw ML, Cohen LS, Vanderkruik R. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health 2024:10.1007/s00737-024-01447-z. [PMID: 38396143 DOI: 10.1007/s00737-024-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. METHODS Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics. RESULTS 139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization. CONCLUSION This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
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Affiliation(s)
- Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA.
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
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O'Brien J, Gregg L, Wittkowski A. A systematic review of clinical psychological guidance for perinatal mental health. BMC Psychiatry 2023; 23:790. [PMID: 37904101 PMCID: PMC10614401 DOI: 10.1186/s12888-023-05173-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input. METHOD Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined. RESULTS From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion. CONCLUSION Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.
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Affiliation(s)
- Jayne O'Brien
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Lynsey Gregg
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
| | - Anja Wittkowski
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- The University of Manchester, Manchester Health Alliance Science Centre, Manchester, M13 9PL, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
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Fletcher R, Regan C, May C, White S, St George J. Equipping fathers to support distressed mothers: What do mothers want fathers to know and do? Health Promot J Austr 2023; 34:683-690. [PMID: 37327354 DOI: 10.1002/hpja.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
Abstract
ISSUE ADDRESSED Up to one in five new mothers experience depression or anxiety, and their partners are often the first line of social and practical support. However, many fathers are unprepared for their role as support person. The SMS4dads program (www.sms4dads.com) provides text-based support to new fathers but lacks specific messages addressing maternal mental distress. METHODS A mixed methods process engaged mothers with lived experience of perinatal mental distress to identify message content for co-designing texts in SMS4dads. Participants completed surveys derived from research literature and parenting websites using the theoretical framework of support domains: emotional or affectionate support, informational support, tangible support and positive social interaction. Mothers also indicated the most appropriate timing of support: at the point of identifying the distress (emerging), with ongoing symptoms (persistent) or during recovery (easing). Free text comments from mothers were linked to survey topics to provide examples of wording suitable for text messages to fathers. RESULTS Fifty-five mothers with lived experience completed the surveys. All support items were more often endorsed as helpful rather than not helpful by mothers. Emotional support was thought helpful in the early stages, tangible support was valued with ongoing symptoms and social interaction appreciated as symptoms eased. CONCLUSIONS Mothers experiencing perinatal depression and anxiety require a range of supportive actions by their partners, including household tasks and baby-care, encouragement, listening and managing relationships with family and friends. SO WHAT?: Information provided by distressed mothers can provide guidance to professionals when designing information for fathers/partners. Digital delivery of this co-designed information to fathers across urban and rural areas may enhance the competence of fathers working to support mothers experiencing mental distress in the perinatal period.
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Affiliation(s)
- Richard Fletcher
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Casey Regan
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris May
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Scott White
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jennifer St George
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
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Chevauché M, Corfdir C. [Fathers, patients in mother and baby unit? Thinking about family-based approach in perinatal care]. L'ENCEPHALE 2023; 49:532-534. [PMID: 36907670 DOI: 10.1016/j.encep.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND The perinatal period is a psychic risk for fathers because of multiple overhauls. Fathers' place in perinatal medicine has evolved these last few years but continues to be poorly limited. These psychic difficulties are barely investigated and diagnosed in everyday medical practice. The prevalence of depressive episodes by new fathers was high in the most recent research studies. This thus is a public health problem with consequences on the family system both in the short and the long-term. REVIEW In the mother and baby unit, the father's psychiatric care is often secondary. But with societal modifications, there is the question of impact of separation between the father and the mother and the baby. With the family based approach, care by the father is indispensable for the care of the mother, baby, and the family's as a whole. OBJECTIVE In our mother and baby unit located in Paris, fathers were also hospitalized as patients. Therefore difficulties in the familial dynamic, between each member of the triad and mental health difficulties of fathers were able to be treated. CONCLUSION Following the hospitalization of a few triads with a positive evolution, a reflection process is now in progress.
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Affiliation(s)
- M Chevauché
- Unité d'hospitalisation parents-bébé "La Pomme", pôle de pédopsychiatrie, 75103 Paris, France.
| | - C Corfdir
- Unité d'hospitalisation parents-bébé "La Pomme", pôle de pédopsychiatrie, 75103 Paris, France
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Hodgson S, Painter J, Kilby L, Hirst J. "Crying on the Bus": First Time Fathers' Experiences of Distress on Their Return to Work. Healthcare (Basel) 2023; 11:healthcare11091352. [PMID: 37174894 PMCID: PMC10178037 DOI: 10.3390/healthcare11091352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
There is increasing research interest in the experiences of new fathers taking paternity leave, but less insight into men's experiences of returning to work after the birth of their first baby. For many men in the UK context, this could take place immediately after the birth or after one or two weeks of paternity leave. This paper utilizes data from a UK-based study whilst also drawing on international literature and policy contexts. A constructivist grounded theory method was adopted to generate theory from the data gathered. Twelve new fathers shared their experiences in this study by participating in audio-recorded, semi-structured interviews. This paper focuses on fathers' experiences of negotiating the workplace as part of an overall theoretical framework related to broader transitions to fatherhood and sheds light on the distress, guilt and psychological challenges that the participants experienced when they initially returned to work. Whether fathers did or did not explicitly describe distress at this time, they all described a change in their worker identity, which for some participants led to uncertainty in the workplace. Men returning to work at this time in the postnatal period are vulnerable to experiencing distress. Flexibility and support in the workplace could be protective of their mental health. Finally, policy and practice developments are offered to support men's transitions to fatherhood in the workplace context.
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Affiliation(s)
- Suzanne Hodgson
- Department of Nursing, Manukau Institute of Technology-Te Pūkenga, Manukau, Auckland 2104, New Zealand
| | - Jon Painter
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Laura Kilby
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Julia Hirst
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield S10 2BP, UK
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Roxburgh E, Morant N, Dolman C, Johnson S, Taylor BL. Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study. Community Ment Health J 2023; 59:243-252. [PMID: 35900686 PMCID: PMC9859833 DOI: 10.1007/s10597-022-01002-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
Postpartum psychosis has been found to affect 0.89-2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. Our aim in this study was to understand women's experiences of mental health care and services for psychosis in the postnatal period. Semi-structured interviews were conducted with 12 women who reported being treated for postpartum psychosis. Findings were analysed thematically. Women reported that healthcare professionals across maternity and mental health services often lacked awareness and knowledge of postpartum psychosis and did not always keep them or their partners/families informed, supported, and involved. Women wanted better collaboration between and within services, and more efficient, appropriate, and timely care. They valued inpatient services that could meet their needs, favouring Mother and Baby Units over general psychiatric wards. Early Intervention in Psychosis services and specialist perinatal community mental health teams were also well liked.
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Affiliation(s)
- Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Clare Dolman
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Postpartum Psychosis: The Role of Women's Health Care Providers and the Health Care System. Obstet Gynecol Surv 2022; 77:763-777. [PMID: 36477388 DOI: 10.1097/ogx.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Importance The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide. Evidence Acquisition A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references. Results Although it is clear that the triggering event for PPP is childbirth, the processes by which this occurs are not fully understood, which is a critical need for being able to predict, prevent, and manage PPP. There are risk factors that contribute to PPP, and specific groups of women may be at increased risk (eg, women with bipolar disorder). Many questions and challenges remain related to the phenomenology, nosology, prevention, and treatment of PPP. However, there are changes that women's health care providers and systems can take to improve the care of women at risk of and experiencing PPP. Results Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups. Conclusions and Relevance Postpartum psychosis is a rare but serious condition. However, recovery is possible. Women's health care providers and systems can improve the care by better understanding the needs of women and families, offering patient-centered discussions and options for care, particularly those that promote recovery, minimize risk, and limit the interruption of the maternal-infant bond. Improving the prevention and treatment of PPP can have a broad impact for women, children, and families.
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Banerjee D, Arasappa R, Chandra PS, Desai G. "Hear me out": experiences of women with severe mental illness with their healthcare providers in relation to motherhood. Asian J Psychiatr 2021; 55:102505. [PMID: 33310343 DOI: 10.1016/j.ajp.2020.102505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most women with severe mental illness (SMI) are mothers, however little is known about their own experiences of how the health care providers offer support in handling motherhood. This study attempted to assess the barriers, expectations and facilitators in seeking help from mental health care providers in matters of pregnancy and motherhood using a qualitative methodology. METHODS The study used a qualitative design with social constructivist paradigm to obtain data from 30 mothers with SMI who had children less than five years of age. One-to-one in-depth semi-structured interviews were conducted and inductive thematic analysis was used to explore transcripts using Charmaz's grounded theory. RESULTS Main barriers in seeking help from health care providers were perceived stigma, treatment side-effects, misinterpretations of information and health providers not having enough time. On the other hand self-advocacy, early engagement with the health care system, being psychoeducated and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers were early and direct communication and basic guidance regarding child health and parenting issues. CONCLUSION Women who are mothers and also users of mental health services face special challenges in managing their illness and motherhood. Hearing their voices is essential for service provision and ensuring adequate mental health and handling motherhood.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Forde R, Peters S, Wittkowski A. Recovery from postpartum psychosis: a systematic review and metasynthesis of women's and families' experiences. Arch Womens Ment Health 2020; 23:597-612. [PMID: 32020314 PMCID: PMC7497301 DOI: 10.1007/s00737-020-01025-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/26/2020] [Indexed: 01/20/2023]
Abstract
Postpartum psychosis is a serious disorder that can result in adverse consequences for the mother and baby. It is important that we understand the experiences of women, to develop effective interventions during this critical period. The aim of this systematic review was to conduct a metasynthesis of qualitative research exploring women's experiences of postpartum psychosis and factors involved in recovery from the perspective of women and family members. A comprehensive literature search of five databases was conducted and the findings were appraised and synthesised, following a thematic synthesis approach. Fifteen studies, capturing the views of 103 women and 42 family members, met the inclusion criteria. Four main themes incorporating 13 subthemes were identified following synthesis: (1) Experiencing the unspeakable, (2) Loss and disruption, (3) Realigning old self and new self and the integrative theme of (4) Social context. The findings offer new insight into the unique experience of postpartum psychosis and demonstrate that recovery does not follow a linear path. To improve clinical outcomes, a more integrative and individualised approach is needed which incorporates long-term psychological and psychosocial support, and considers the needs of the family. Further areas for staff training, service development and future research are highlighted.
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Affiliation(s)
- R Forde
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Forde R, Peters S, Wittkowski A. Psychological interventions for managing postpartum psychosis: a qualitative analysis of women's and family members' experiences and preferences. BMC Psychiatry 2019; 19:411. [PMID: 31856785 PMCID: PMC6923990 DOI: 10.1186/s12888-019-2378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members. METHODS Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis. RESULTS Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women's psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies. CONCLUSION The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
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Affiliation(s)
- R Forde
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Fletcher R, StGeorge J, Newman L, Wroe J. Male callers to an Australian perinatal depression and anxiety help line—Understanding issues and concerns. Infant Ment Health J 2019; 41:145-157. [DOI: 10.1002/imhj.21829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Richard Fletcher
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
| | - Jennifer StGeorge
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
| | - Louise Newman
- The Royal Women's Hospital Locked Bag 300, Cnr Grattan Street & Flemington Road Parkville Victoria 3052 Australia
| | - Jaime Wroe
- Family Action CentreFaculty of Health and MedicineUniversity of Newcastle New South Wales Callaghan 2308 Australia
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14
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Davies EL, Pelentsov LJ, Hooper KJ, Gordon AL, Esterman AJ. Needs of Individuals Recovering from a First-Episode of Mental Illness: A Qualitative Descriptive Analysis of Focus Group Discussions. Issues Ment Health Nurs 2019; 40:737-746. [PMID: 31241376 DOI: 10.1080/01612840.2019.1609637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A broad array of needs often arise for individuals when significant physical or mental illness occurs. The aim of this study was to investigate the needs experienced by individuals recovering from a first-episode of mental illness, to explore how these needs have been assessed and to gauge the acceptability of participating in formal, systematic needs assessments in the future. Fifteen individuals who had presented to a tertiary mental health service within the previous 3 years, and who were considered to be recovering from a first-episode of mental illness discussed their current and previous needs in small focus groups. A qualitative descriptive methodology was adopted to analyse data. Three themes incorporating the broad range of inter-related and often complex needs were identified as being: the need for safety, stability and security; the need to be understood and to understand and; the need for support networks and services. Participants reported a lack of involvement in discussions with mental health clinicians regarding their needs, and were in favour of participating in formal, systematic needs assessments in the future.
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Affiliation(s)
- Ellen L Davies
- School of Nursing and Midwifery, University of South Australia , Adelaide , South Australia , Australia
| | - Lemuel J Pelentsov
- School of Nursing and Midwifery, University of South Australia , Adelaide , South Australia , Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network , Oaklands Park , South Australia , Australia
| | - Andrea L Gordon
- Australian Centre for Child Protection, University of South Australia , Adelaide , South Australia , Australia
| | - Adrian J Esterman
- School of Nursing and Midwifery, University of South Australia , Adelaide , South Australia , Australia.,The Australian Institute for Tropical Health and Medicine, James Cook University , Cairns , Queensland , Australia
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15
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Sihre HK, Gill P, Lindenmeyer A, McGuiness M, Berrisford G, Jankovic J, Patel M, Lewin J, Fazil Q. Understanding the lived experiences of severe postnatal psychiatric illnesses in English speaking South Asian women, living in the UK: a qualitative study protocol. BMJ Open 2019; 9:e025928. [PMID: 31375603 PMCID: PMC6688680 DOI: 10.1136/bmjopen-2018-025928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The South Asian population is the UK's largest and fastest growing minority ethnic group. There is evidence to suggest the lay understanding of postnatal psychiatric illnesses of this group may fall outside the purview of Western biomedical perspectives. Alternative explanations include psychosocial, cultural and spiritual factors. Approaching psychiatric illnesses through a social perspective includes gaining insight to the patient's subjective experiences and understandings via qualitative inquiry. The objectives of this qualitative study are to explore South Asian women's narrative of living with a severe postnatal psychiatric illness and experiences of Perinatal Mental Health Services, care and support. METHODS AND ANALYSIS Data collection is ongoing and will continue until 31 December 2018. Participants will be identified and recruited from Perinatal Mental Health Services in Birmingham and London. Eligible participants will be English speaking South Asian females aged 18 years or above with the capacity to give written informed consent. Participants are clinically diagnosed with a severe postnatal psychiatric illness. This qualitative study uses individual in-depth face-to-face interviews that aim to last 1 hour. Interviews will be audio recorded with participants' permission. Interview audio recordings will be transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). The primary goal of IPA is for the researcher to closely study and interpret how individuals make sense of their life experiences in a particular context by drawing on the fundamental principles of phenomenology, hermeneutics and idiography. ETHICS AND DISSEMINATION The University of Birmingham, the South Birmingham Research Ethics Committee and the Health Research Authority have approved this study (approvals date: 18-12-2017 ref: 17/WM/0350). Local capability and capacity have been confirmed from Trust Research and Development departments. The researchers plan to publish the results from this study in journals and present findings at academic conferences.
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Affiliation(s)
- Harpreet Kaur Sihre
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Social Science and Systems in Health, University of Warwick, Warwick, UK
| | - Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mary McGuiness
- Perinatal Mental Health services, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Giles Berrisford
- Perinatal Mental Health services, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Jelena Jankovic
- Perinatal Mental Health services, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Minaxi Patel
- Coombe Wood Perinatal Service, Central and North West London Foundation Trust, London, UK
| | - Jona Lewin
- Coombe Wood Perinatal Service, Central and North West London Foundation Trust, London, UK
| | - Qulsom Fazil
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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16
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Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e389-e405. [PMID: 30900371 DOI: 10.1111/hsc.12740] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Nursing and Midwifery Research Centre, Newcastle, Australia
- University of Newcastle, Faculty of Health and Medicine, Newcastle, Australia
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17
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Holford N, Channon S, Heron J, Jones I. The impact of postpartum psychosis on partners. BMC Pregnancy Childbirth 2018; 18:414. [PMID: 30352559 PMCID: PMC6199718 DOI: 10.1186/s12884-018-2055-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum Psychosis is a severe mental health condition following childbirth, with a psychosis and associated mood disturbance. Research to date has primarily focused on mothers’ experiences, and on identifying risk factors, aetiology, and intervention efficacy. Within both research and clinical communities, there has been little acknowledgement of partners’ experiences of Postpartum Psychosis, nor the important support role that partners can provide. The aim of this study was to consider the lived experiences of partners of women who have had Postpartum Psychosis, and the impact that it has had on their lives and relationships. Methods Participants (N = 8) were partners recruited through the charity Action on Postpartum Psychosis. Partners completed an in-depth, semi-structured interview regarding their experiences of Postpartum Psychosis. Interpretative Phenomenological Analysis was used to analyse the interview transcripts. Results Seven superordinate themes emerged from the interview data: loss; powerlessness; united vs. individual coping; hypothesising and hindsight; barriers to accessing care and unmet needs; managing multiple roles; and positive changes from Postpartum Psychosis. Conclusions These findings provide a rich illustration of the experiences of partners, including some previously unidentified findings relating to partner hypervigilance to signs of relapse and positive changes in their attitudes and relationships. Areas where support could be provided for partners are also highlighted. Electronic supplementary material The online version of this article (10.1186/s12884-018-2055-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nia Holford
- South Wales Clinical Psychology Doctorate Programme, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Jessica Heron
- Action on Postpartum Psychosis, Department of Psychiatry, The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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18
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Davies EL, Gordon AL, Pelentsov LJ, Hooper KJ, Esterman AJ. Needs of individuals recovering from a first episode of mental illness: A scoping review. Int J Ment Health Nurs 2018; 27:1326-1343. [PMID: 29975442 DOI: 10.1111/inm.12518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 01/29/2023]
Abstract
Central to the role of mental health clinicians is the assessment of needs. A number of assessment tools have been used to evaluate the needs of individuals diagnosed with a mental illness. These tools have largely been developed for people with a severe and persistent mental illness and may not be suitable for individuals who are recovering from a first episode of mental illness. The aims of this review were therefore to identify the needs experienced by individuals recovering from a first episode of mental illness; determine what tools have been used to evaluate these needs; and explore whether existing tools adequately reflect the needs described in the literature. Twenty-one articles were included, comprising articles which identified needs (n = 10), needs assessment tools (n = 1), or articles which identified both needs and a needs assessment tool (n = 10). Results indicate that individuals who have been admitted to a specialized mental health unit and are recovering from a first episode of mental illness may experience an extensive range of needs, spanning emotional, psychological, social, informational, functional, practical, and relationship needs. Four established needs assessment tools were found to have been used to evaluate these needs; however, these do not appear to represent all needs discovered in this review, were mostly developed for populations with a long-term mental illness, and may not be suitable for assessing the needs of individuals recovering from a first episode of mental illness following a presentation to a specialized mental health unit.
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Affiliation(s)
- Ellen L Davies
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Andrea L Gordon
- School of Pharmacy and Biosciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lemuel J Pelentsov
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Adrian J Esterman
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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19
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Roberts L, Berrisford G, Heron J, Jones L, Jones I, Dolman C, Lane DA. Qualitative exploration of the effect of a television soap opera storyline on women with experience of postpartum psychosis. BJPsych Open 2018; 4:75-82. [PMID: 29971150 PMCID: PMC6020274 DOI: 10.1192/bjo.2018.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/05/2018] [Accepted: 01/29/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postpartum psychosis has recently been the focus of an in-depth storyline on a British television soap opera watched by millions of viewers. AIMS This research explored how the storyline and concomitant increase in public awareness of postpartum psychosis have been received by women who have recovered from the condition. METHOD Nine semistructured, one-to-one interviews were conducted with women who had experienced postpartum psychosis. Thematic analysis consistent with Braun and Clarke's six-step approach was used to generate themes from the data. RESULTS Public exposure provided by the postpartum psychosis portrayal was deemed highly valuable, and its mixed reception encompassed potentially therapeutic benefits in addition to harms. CONCLUSIONS Public awareness of postpartum psychosis strongly affects women who have experienced postpartum psychosis. This research highlights the complexity of using television drama for public education and may enable mental health organisations to better focus future practices of raising postpartum psychosis awareness. DECLARATION OF INTEREST GB is chair of action on Postpartum Psychosis. JH is director of action on Postpartum Psychosis. IJ is a trustee of action on Postpartum Psychosis and was a consultant to the BBC (television company) on the EastEnders storyline. CD is a trustee of action on Postpartum Psychosis, a trustee of BIPOLAR UK, vice chair of the Maternal Mental Health Alliance, and was a consultant to the BBC (television company) on the EastEnders storyline.
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Affiliation(s)
| | - Giles Berrisford
- Birmingham and Solihull Mental Health NHS Foundation
Trust, Barberry National Centre for Mental Health,
UK
| | - Jessica Heron
- Institute of Clinical Sciences, University of
Birmingham, Barberry National Centre for Mental Health,
UK
| | - Lisa Jones
- Department of Psychological Medicine,
University of Worcester, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neurosciences,
Cardiff University, UK
| | - Clare Dolman
- Section of Women's Mental Health, Institute
of Psychiatry, Psychology and Neuroscience, King's College,
London, UK
| | - Deirdre A. Lane
- University of Birmingham Institute of Cardiovascular
Sciences, City Hospital,
Birmingham, UK
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20
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Coates D, Saleeba C, Howe D. Profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e154-e163. [PMID: 28868664 DOI: 10.1111/hsc.12489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery.
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Affiliation(s)
- Dominiek Coates
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
| | - Christine Saleeba
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
| | - Deborah Howe
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
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21
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Lever Taylor B, Billings J, Morant N, Johnson S. How do women's partners view perinatal mental health services? A qualitative meta-synthesis. Clin Psychol Psychother 2017; 25:112-129. [PMID: 28857366 DOI: 10.1002/cpp.2133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Perinatal mental health difficulties are prevalent among women and can adversely affect their partners too. There is also increasing recognition that a woman's partner can play a vital role in relation to her perinatal mental health and should be supported and involved in decisions about her care. Yet it is unclear how services are experienced by the partners of women with perinatal mental health difficulties. This study aimed to synthesize qualitative evidence of partners' views of perinatal mental health care. METHODS A systematic search of 5 electronic databases identified 20 studies that met the inclusion criteria. The findings of these studies were synthesized using an approach based on meta-ethnography. RESULTS Six themes were identified, namely, the marginalization and neglect of women's partners, an unmet need for information, partners' ambivalence about involvement and support, practical barriers to involvement, views about support for women's partners, and the impact on partners of the care women received. CONCLUSIONS Given the importance of women's partners in relation to perinatal mental health as well as to women's engagement with support and treatment outcomes, greater consideration should be given to their needs to ensure they feel well informed and involved in perinatal mental health care, rather than marginalized. However, professionals also need to challenge the barriers to involvement and support that women's partners face and consider the ways in which services may reinforce these barriers.
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Affiliation(s)
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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22
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Latendresse G, Elmore C, Deneris A. Selective Serotonin Reuptake Inhibitors as First-Line Antidepressant Therapy for Perinatal Depression. J Midwifery Womens Health 2017; 62:317-328. [PMID: 28485526 DOI: 10.1111/jmwh.12607] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/22/2016] [Accepted: 01/06/2017] [Indexed: 01/22/2023]
Abstract
One in 7 women experience depression during the prenatal and/or postpartum period. Nonpharmacologic approaches are known to be as effective as pharmacologic therapies for mild to moderate depression. However, for women who suffer from moderate to severe depression, antidepressant therapy may be the best option, in combination with nonpharmacologic approaches. Considering the substantial negative impact of untreated perinatal depression, providers of prenatal care need to be prepared to diagnose depression, prescribe first-line antidepressants, and refer to other professionals. The purpose of this article is to assist providers to select the safest, most effective selective serotonin reuptake inhibitor (SSRI) as the first-line antidepressant during pregnancy and lactation. Information about side effects, adverse effects, contraindications, and clinical considerations associated with the use of SSRIs is provided. A brief discussion of nonpharmacologic therapies is provided but is not the focus of this article.
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23
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Plunkett C, Peters S, Wieck A, Wittkowski A. A qualitative investigation in the role of the baby in recovery from postpartum psychosis. Clin Psychol Psychother 2017; 24:1099-1108. [PMID: 28138996 DOI: 10.1002/cpp.2074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/06/2016] [Accepted: 12/29/2016] [Indexed: 11/07/2022]
Abstract
Psychosis after childbirth is a rare but severe type of mental health difficulty experienced by perinatal women. Research has explored mothers' experiences of onset and recovery from psychosis after childbirth. This study explored the role of the baby in 12 mothers' experiences of recovery. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery from psychosis after childbirth. Findings revealed that the baby was central to recovery, experienced by mothers as both helpful and unhelpful. The baby interacted with the mother, increasing self-efficacy, and reducing emotional distress. Findings also showed that the baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self-care. The findings of the study add to the existing evidence based on recovery from psychosis after childbirth. The research and clinical implications of these findings are discussed with reference to the existing literature. KEY PRACTITIONER MESSAGE The baby has an important role in recovery from psychosis after childbirth. The baby can be perceived by mothers to both hinder and help their recovery. Interacting with the baby can be helpful for the mothers' recovery by improving their self-efficacy and reducing emotional distress. Specialist interventions offered by a mother and baby unit can provide practical support that facilitates mother-baby interactions, which helps move women forward in the recovery process.
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Affiliation(s)
| | - Sarah Peters
- School of Health Sciences, University of Manchester, UK
| | | | - Anja Wittkowski
- School of Health Sciences, University of Manchester, UK.,Manchester Mental Health and Social Care Trust, UK
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24
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McKeever A, Alderman S, Luff S, DeJesus B. Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness. Nurs Womens Health 2016; 20:484-499. [PMID: 27719778 DOI: 10.1016/j.nwh.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/09/2016] [Indexed: 06/06/2023]
Abstract
Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.
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25
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Boddy R, Gordon C, MacCallum F, McGuinness M. Men's experiences of having a partner who requires Mother and Baby Unit admission for first episode postpartum psychosis. J Adv Nurs 2016; 73:399-409. [PMID: 27533096 DOI: 10.1111/jan.13110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to explore the experiences of men during their partner's admission to a Mother and Baby Unit for first episode postpartum psychosis. BACKGROUND Postpartum psychosis can be life-changing for women, however little is known about the impact on their partners or their partners' needs. DESIGN An Interpretative Phenomenological Analysis approach was used to analyse interview transcripts. METHODS Semi-structured interviews were conducted with seven participants. Interviews were conducted in 2014-2015. FINDINGS Two main themes were identified: 'What the f*** is going on?' and 'Time to figure out how your family works'. Partners experienced shock and confusion during postpartum psychosis onset. Most felt hospital admission was beneficial, although there were barriers to accessing help and involvement in their partner's care. A process of understanding changes to roles, relationships and family identity was described. Loss was a common experience, with a potentially lasting impact. CONCLUSIONS Men reported a range of challenging and positive experiences associated with their partner's postpartum psychosis. Improvements are needed in awareness of postpartum psychosis, access to appropriate services and support of partners.
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Affiliation(s)
- Rebecca Boddy
- School of Psychological, Social and Behavioural Sciences, Coventry University, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - Carolyn Gordon
- School of Psychological, Social and Behavioural Sciences, Coventry University, UK
| | - Fiona MacCallum
- Department of Psychology, University of Warwick, Coventry, UK
| | - Mary McGuinness
- Birmingham and Solihull Mental Health NHS Foundation Trust, Perinatal Mental Health Service, UK
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26
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Grant A, Reupert A. The Impact of Organizational Factors and Government Policy on Psychiatric Nurses' Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland. JOURNAL OF FAMILY NURSING 2016; 22:199-223. [PMID: 27090512 DOI: 10.1177/1074840716643770] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services.
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Affiliation(s)
- Anne Grant
- Queen's University Belfast, Northern Ireland
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27
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Watkinson M, Murray C, Simpson J. Maternal experiences of embodied emotional sensations during breast feeding: An Interpretative Phenomenological Analysis. Midwifery 2016; 36:53-60. [PMID: 27106944 DOI: 10.1016/j.midw.2016.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE the purpose of this study was to explore mothers׳ experiences of embodied emotional sensations during breast feeding and to understand the meaning and consequences that such experiences may have on mothers' sense of self and the relationships they form with their children. DESIGN a qualitative design was applied to this study as it was judged as the most appropriate approach to this novel field of enquiry. SETTING the study was conducted in United Kingdom using a sample of mothers drawn from five different countries from Europe, America and Australia. PARTICIPANTS the sample consisted of 11 mothers who reported experiencing or having experienced negative embodied emotional sensations associated with breast feeding in the past five years. MEASUREMENTS semi-structured interviews were conducted with the mothers and interviews were transcribed to enable the process of data analysis. Interpretative Phenomenological Analysis (IPA; Smith et al., 2009a, 2009b) was chosen as a method of data analysis, enabling in depth understanding and interpretation of the meaning of mothers' experiences. IPA was chosen due to its idiographic commitment and particular interest in sense-making, phenomenology and hermeneutics. FINDINGS three themes were generated reflecting the multifaceted nature of breast feeding experiences (i) 'Breast feeding: An unexpected trigger of intense embodied emotional sensations incongruent with view of self', (ii) 'Fulfilling maternal expectations and maintaining closeness with the child', (iii) 'Making sense of embodied emotional sensations essential to acceptance and coping'. CONCLUSIONS breast feeding has the potential to trigger a range of conflicting cognitions and emotions in mothers that may impact on how mothers view themselves and relate to their children. IMPLICATIONS FOR PRACTICE increasing awareness about emotional breast feeding experiences and recognising the multifaceted, individual nature of difficulties around breast feeding enables professionals to offer mothers person-centred care and avoid making clinical decisions and recommendations based on inaccurate knowledge.
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Affiliation(s)
- Marcelina Watkinson
- Division of Health Research, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom.
| | - Craig Murray
- Division of Health Research, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom.
| | - Jane Simpson
- Division of Health Research, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom.
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Wyatt C, Murray C, Davies J, Jomeen J. Postpartum psychosis and relationships: their mutual influence from the perspective of women and significant others. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1027181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hamelin-Brabant L, de Montigny F, Roch G, Deshaies MH, Mbourou-Azizah G, Borgès Da Silva R, Comeau Y, Fournier C. Vulnérabilité périnatale et soutien social en période postnatale : une revue de la littérature. SANTE PUBLIQUE 2015. [DOI: 10.3917/spub.151.0027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Posmontier B, Fisher KM. A narratology of postpartum psychosis in an Orthodox Jewish woman. Perspect Psychiatr Care 2014; 50:167-77. [PMID: 25040213 DOI: 10.1111/ppc.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 06/19/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to understand the experience of postpartum psychosis in an Orthodox Jewish woman. DESIGN AND METHODS A case-based narratology using an unstructured interview was conducted to facilitate the telling of her story. FINDINGS While the nurses were unable to recognize her symptoms in the hospital, her family members were also unable to recognize escalating symptoms once she returned home, until she became a danger to herself. PRACTICE IMPLICATIONS Better recognition of symptoms, empathetic connections, cultural appreciation of faith-based rituals and their effect on patient isolation, and education of families and nursing staff may be vital components to successful recovery from postpartum psychosis.
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Barkin JL, Bloch JR, Hawkins KC, Thomas TS. Barriers to Optimal Social Support in the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2014; 43:445-54. [DOI: 10.1111/1552-6909.12463] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Glover L, Jomeen J, Urquhart T, Martin CR. Puerperal psychosis – a qualitative study of women’s experiences. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.883597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | - Tracy Urquhart
- Lincolnshire Partnership NHS Foundation Trust, Grimsby, UK
| | - Colin R. Martin
- Buckinghamshire New University, UK
- West London Mental Health NHS Trust, UK
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Abstract
PURPOSE OF REVIEW Despite an increasing awareness of support needs of families affected by parental mental illness, there is a lack of adequate mental healthcare provision for parents. As contemporary mental health services are both user-focused and evidence based, the present review focuses on knowledge regarding the subjective perspective on parenting issues among affected parents and the evidence base for parenting programs. RECENT FINDINGS There has been a shift in the research focus from adverse effects of parental mental illness on children toward inclusion and the subjective perspective in affected mothers and, more recently, fathers with mental health problems. Parents report on role conflicts, parenting difficulties, and stigma. Despite a broad spectrum of parental needs, many parents are reluctant to use services. There is an increasing evidence base for intervention programs. SUMMARY Adequate care for parents affected by mental illness requires sensitivity for parents' subjective perspective, interagency collaboration, standard intake practice, high level of professional knowledge and skills, provision of family-friendly environments, evidence-based parenting programs comprising both individual and group approaches and peer support. There is a lack of research on other parenting needs such as desire for children, coping with custody loss, and childlessness related to mental illness.
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Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health 2013; 16:173-96. [PMID: 23525788 DOI: 10.1007/s00737-013-0336-0] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
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.
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