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Basile-Ibrahim B, Combellick J, Mead TL, Sorensen A, Batten J, Schafer R. The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:480. [PMID: 38673391 PMCID: PMC11049830 DOI: 10.3390/ijerph21040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.
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Affiliation(s)
| | - Joan Combellick
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Thomas L. Mead
- Biomedical Libraries, Dartmouth College, Hanover, NH 03755, USA;
| | - Alee Sorensen
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06510, USA;
| | - Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, NJ 07107, USA;
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
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Craemer KA, Garland CE, Sayah L, Duffecy J, Geller SE, Maki PM. Perinatal mental health in low-income urban and rural patients: The importance of screening for comorbidities. Gen Hosp Psychiatry 2023; 83:130-139. [PMID: 37187032 DOI: 10.1016/j.genhosppsych.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess the rates and feasibility of assessing comorbid mental health disorders and referral rates in low-income urban and rural perinatal patients. METHODS In two urban and one rural clinic serving primarily low-income perinatal patients of color, a computerized adaptive diagnostic tool CAT-MH® was implemented to assess major depressive disorder (MDD), general anxiety disorder (GAD), suicidality (SS), substance use disorder (SUD), and post-traumatic stress disorder (PTSD) at the first obstetric visit and/or 8 weeks postpartum. RESULTS Of a total of 717 screens, 10.7% (n = 77 unique patients) were positive for one or more disorders (6.1% one, 2.5% two, 2.1% three or more). MDD was the most common disorder (9.6%) and was most commonly comorbid with GAD (33% of MDD cases), SUD (23%), or PTSD (23%). For patients with a positive screen, referral to treatment was 35.1% overall, with higher rates in urban (51.6%) versus rural (23.9%) clinics (p = 0.03). CONCLUSION Mental health comorbidities are common in low-income urban and rural populations, but referral rates are low. Promoting mental health in these populations requires comprehensive screening and treatment approaches for psychiatric comorbidities and dedication to increase the availability of mental health prevention and treatment options.
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Affiliation(s)
- Katherine A Craemer
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.
| | - Caitlin E Garland
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Lauren Sayah
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer Duffecy
- Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Stacie E Geller
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Pauline M Maki
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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Musana J, Cohen CR, Kuppermann M, Gerona R, Wanyoro A, Aguilar D, Santos N, Temmerman M, Weiss SJ. Obstetric risk in pregnancy interacts with hair cortisone levels to reduce gestational length. Front Glob Womens Health 2022; 3:878538. [PMID: 35936818 PMCID: PMC9354598 DOI: 10.3389/fgwh.2022.878538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Maternal psychological stress has been linked to preterm birth. However, the differential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the effects of obstetric risks and fetal sex on this relationship among Kenyan pregnant women. Methods The sample included 130 women recruited between 22 to 28 weeks gestation. They completed a clinical and sociodemographic questionnaire together with the Perceived Stress Scale and provided a hair sample for cortisol and cortisone assay. Women underwent an ultrasound to assess weeks of gestation. At delivery, their pregnancy-related health problems were identified using information extracted from medical records to compile each woman's number of pregnancy risks on the Obstetric Medical Risk Index (OMRI). Results Perceived stress and hair cortisol were not significant predictors of gestational length. However, a greater number of obstetric risks on the OMRI was associated with shorter gestational length. This effect was further explained by the interaction between obstetric risk and hair cortisone (B = 0.709, p = 0.02). Hair cortisone levels of mothers who had a shorter gestation were significantly higher in mothers with 2 or more risks on the OMRI but not among mothers with only one or no risks (t = 2.39, p = 0.02). Fetal sex had no relationship to gestational length and also had no moderating effect on the relationship between any stress-related metric and gestational length. Conclusion Cortisone levels may increase in anticipation of shorter gestation as a compensatory response to increased obstetric risk. Elevated cortisone may be a more sensitive marker of risk for early delivery than cortisol or psychological stress, with salience for both the male and female fetus.
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Affiliation(s)
- Joseph Musana
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
- *Correspondence: Joseph Musana
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Roy Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anthony Wanyoro
- Department of Obstetrics and Gynaecology, Kenyatta University, Nairobi, Kenya
| | - David Aguilar
- Clinical Toxicology and Environmental Biomonitoring Lab, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole Santos
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
| | - Sandra J. Weiss
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
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Parameswaran UD, Pentecost R, Williams M, Smid M, Latendresse G. Experiences with use of technology and telehealth among women with perinatal depression. BMC Pregnancy Childbirth 2022; 22:571. [PMID: 35850663 PMCID: PMC9289084 DOI: 10.1186/s12884-022-04889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background Perinatal depression (PD) affects 10–20% of childbearing women. Telehealth is increasingly utilized for mental health services to increase access to care and overcome COVID-19 pandemic barriers. Women’s perspectives on telehealth services for PD is unknown, however. This study’s primary objective was to obtain the perspectives of women who participated in an 8-week group videoconference intervention for PD symptoms, including how technology impacted their experience. Methods We utilized theoretical sampling and included perinatal women who had completed the 8-week mindfulness-based cognitive-behavioral intervention group. Semi-structured focus groups with four to six women were conducted on a videoconference platform. Primary analysis used grounded theory and a secondary analysis used qualitative description and was conducted by two coding teams. The teams collaborated on the final themes across the analyses. Results Three groups, with a total of 17 participants were conducted. Composition consisted of seven postpartum and ten pregnant women from the 47 total participants. Identified core themes regarding their experiences of the videoconference intervention were: positive experiences, negative experiences, suggestions and ideas, and screening and communication. Conclusion This study provides growing evidence informed by perinatal women of positive experiences with engagement in a videoconference intervention for PD. Telehealth may be a reasonable and acceptable platform to increase access and retention for mental health services in childbearing women. Further, this pilot work showcases videoconferencing delivery for a wide range of effective and affordable mental health services in low-resource communities.
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Affiliation(s)
- Uma D Parameswaran
- Department of Psychology, University of Utah, Salt Lake City, USA. .,Department of Applied Psychology, New York University, New York, USA.
| | | | | | - Marcela Smid
- Maternal Fetal Medicine, University of Utah Hospital, Salt Lake City, USA
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Johnson JE, Price AB, Sikorskii A, Key KD, Taylor B, Lamphere S, Huff C, Cinader M, Zlotnick C. Protocol for the Healing After Loss (HeAL) Study: a randomised controlled trial of interpersonal psychotherapy (IPT) for major depression following perinatal loss. BMJ Open 2022; 12:e057747. [PMID: 35440458 PMCID: PMC9020310 DOI: 10.1136/bmjopen-2021-057747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This protocol describes a study testing the efficacy of interpersonal psychotherapy (IPT) for major depressive disorder following perinatal loss (early and late fetal death and early neonatal death). Perinatal loss is associated with elevated risk of major depressive disorder and post-traumatic stress disorder (PTSD). Perinatal loss conveys specific treatment needs. The trial will be the first fully powered randomised trial of treatment for any psychiatric disorder following perinatal loss. METHODS AND ANALYSIS A sample of 274 women in Flint and Detroit areas in Michigan who experience a major depressive episode following a perinatal loss will be randomised to group IPT for perinatal loss or to group coping with depression. We anticipate that 50% of the sample will have co-occurring PTSD. Assessments occur at baseline, mid-treatment (8 weeks), post-treatment (16 weeks) and follow-up (28 weeks). Clinical outcomes include time to recovery from major depressive episode (primary), depressive symptoms, PTSD symptoms and time to recovery from PTSD. Additional outcomes include social support, social role functioning (including parental functioning for those with living children), well-being, grief (including complicated grief and fault beliefs) and fear of subsequent pregnancies. Social support and grief are hypothesised mediators of IPT effects on time to recovery from major depressive episode. ETHICS AND DISSEMINATION The trial was approved by Michigan State University's Biomedical Institutional Review Board. It has a data and safety monitoring board and has been submitted to the community-based organisation partners community ethics review board. Written operating procedures outline methods for protecting confidentiality, monitoring and recording adverse events, and safeguarding participants. We will share study results with research and clinical communities, community organisations through which we recruited, and will offer results to study participants. Deidentified datasets will be available through the National Institute of Mental Health Data Archive and to qualified investigators on request. TRIAL REGISTRATION NUMBER NCT04629599.
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Affiliation(s)
- Jennifer E Johnson
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, Flint, Michigan, USA
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Ann B Price
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Kent D Key
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Brandon Taylor
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Susan Lamphere
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Christine Huff
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Morgan Cinader
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Caron Zlotnick
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
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Porter AC, Hunter S, Noonan K, Hoffman MC. A Mindfulness Application for Reducing Prenatal Stress. J Midwifery Womens Health 2022; 67:442-447. [PMID: 35403807 PMCID: PMC9540335 DOI: 10.1111/jmwh.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Up to 40% of patients report depression or anxiety symptoms in pregnancy; feelings of increased stress are nearly universal. Antepartum stress is linked to adverse outcomes including preterm birth, low birthweight, postpartum depression, and maternal self harm. Unfortunately, limited treatment options exist, and patients are often hesitant to initiate medications prenatally. Thus, the development of efficacious nonpharmacologic interventions is crucial. This pilot study investigated the feasibility and impact of an application (app)-based mindfulness practice, begun in the first trimester, on maternal stress and pregnancy outcomes. METHODS The study enrolled patients prior to 15 weeks' gestation and followed them prospectively through birth. Patients were provided with a free subscription to Expectful, a commercially available prenatal mindfulness app, and asked to complete daily meditations. Patients completed the Perceived Stress Scale (PSS) self-assessment at 15 weeks and 28 weeks. PSS scores and pregnancy outcomes were compared with a historical control group of pregnant people who did not use the app. RESULTS Of 68 patients approached, 59 consented to enrollment. Of these, 21 used the app, with an average use of 170 minutes (range, 1.3-1315 min). The average PSS score was significantly lower in the app group at 28 weeks. Additionally, the change in PSS score for app users was greater compared with that of the historical control between enrollment and 28 weeks (-6.3 vs -0.95, P = .0008). Pregnancy outcomes were similar for app users and the historical control. DISCUSSION Our recruitment rate suggests pregnant patients are eager for a nonmedication intervention to decrease stress. However, adherence after enrollment was limited. For a subset of motivated patients, an app-based mindfulness practice significantly reduced perceived stress between the second and third trimesters compared with non-app users. Prenatal mindfulness apps represent an important low-intervention, low-cost, highly accessible tool for managing perinatal mood and stress.
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Affiliation(s)
- Anne C Porter
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sharon Hunter
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Kate Noonan
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Can the Healthy Start Risk Screen Predict Perinatal Depressive Symptoms among High-Risk Women? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020180. [PMID: 35204899 PMCID: PMC8870092 DOI: 10.3390/children9020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Early detection of depression in at-risk populations is critical for ensuring better maternal and child health outcomes. This study assessed whether Healthy Start Prenatal Risk Screening (HSPRS) could predict depressive symptoms in women enrolled in a Healthy Start (HS) program in under-resourced, high-risk communities of Hillsborough County. METHODS Data from HS participants were included for those who were evaluated using the HSPRS and the Edinburgh Postnatal Depression Scale (EPDS). A correlation analysis determined if the HSPRS score was associated with a positive EPDS screen, and HSPRS questions related to the participants psychosocial environment were assessed individually to determine their predictive potential. The crude odds ratio (OR) and adjusted OR (controlling for sociodemographic covariates) were calculated for each question of interest. RESULTS A total of 736 women were included, with 122 (16.5%) scoring 14 or greater on the EPDS, indicating probable depression risk. There were significant differences between women at risk for depression compared to those not at risk regarding maternal age (p-value = 0.03) and marital status (p-value = 0.01). There were no significant differences in education, ethnicity, or race. The total HSPRS score had a weak yet significant correlation with the EPDS score (r = 0.14, p-value = 0.0001), and seven individual HSPRS questions were significantly associated with risk for perinatal depression. Conclusions for Practice: By focusing on responses to key HSPRS questions rather than the overall score, women may receive access to much needed services more quickly, thereby reducing the risk for poorer maternal and developmental outcomes. SIGNIFICANCE A young maternal age and single marital status have been identified as risk factors for perinatal depression. Additionally, women from racial/ethnic minority groups or low-income populations are more likely to experience depression. Thus, in communities where women exhibit many pre-identified risk factors for perinatal depression, the ability to quickly identify those at the highest risk is imperative. This work indicates that among medically and socially high-risk mothers enrolled in a HS program, the overall HSPRS score was not as predictive of perinatal depression as individual responses to key questions. Attention to these responses could result in women receiving much needed services quicker.
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Lee-Carbon L, Nath S, Trevillion K, Byford S, Howard LM, Challacombe FL, Heslin M. Mental health service use among pregnant and early postpartum women. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2229-2240. [PMID: 35902425 PMCID: PMC9636080 DOI: 10.1007/s00127-022-02331-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To explore the proportion and characteristics of women with a mental disorder who have contact with mental health services during pregnancy and the postnatal period in a maternity service in London. METHODS Data from the WEll-being in pregNancy stuDY (WENDY), a prospective cohort study, were used. Women were recruited at their first appointment for antenatal care and assessed for mental disorders using the Structured Clinical Interview DSM-IV Axis I/II Disorders for Research. Clinical, sociodemographic and psychosocial characteristics were collected. Mental health service use data were collected for the period from study entry to 3 months postpartum. RESULTS Two hundred women met diagnostic criteria for a mental disorder. Fifty-five (34%) of these had at least one contact with mental health services. Moderate depression (OR 7.44, CI 2.03-27.28, p < 0.01), severe depression (OR 10.5, CI 2.68-41.12, p < 0.01), past psychiatric hospital admission (OR 3.76, CI 1.05-13.44, p < 0.05), symptoms of anxiety (OR 3.95, CI 1.86-8.37, p < 0.001) and perceived low levels of social support (OR 0.43, CI 0.18-1.01, p = 0.05) were associated with an increased likelihood of contact with mental health services in univariate analyses. However, only moderate (OR 5.92, CI 1.31-26.78, p = 0.02) and severe depression (OR 6.04, CI 1.08-33.72, p = 0.04) remained significant in the multivariate regressions analyses. CONCLUSION Only a third of women with a diagnosable mental disorder at their first antenatal appointment had any contact with mental health services during pregnancy or up to 3 months postpartum. Further research is warranted to elicit perinatal women's views about the potential barriers to accessing professional mental health care.
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Affiliation(s)
- Leonie Lee-Carbon
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Selina Nath
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,Population, Policy and Practice Research & Teaching Department, University College London, London, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Fiona L. Challacombe
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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LeMasters KH, Bledsoe SE, Brooks J, Chavis S, Little E, Pevia K, Daniel L, Jordan K, Schindler A, Lightfoot AF. The MI-PHOTOS Project: Understanding the Health and Wellbeing of Rural Historically Marginalized Mothers Through Photovoice. HEALTH EDUCATION & BEHAVIOR 2021; 49:10901981211057095. [PMID: 34963367 PMCID: PMC9377392 DOI: 10.1177/10901981211057095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the persistent health inequities faced by rural women in the United States, few researchers have partnered with women in rural communities to co-create sustainable change. To fill this gap, Mothers Improving Pregnancy and Postpartum Health Outcomes Through stOry Sharing (MI-PHOTOS) employed a community-based participatory research (CBPR) approach by partnering with mothers, community leaders, and community-based organizations in Robeson County, North Carolina, a rural, racially diverse county. The project's aims were (a) to promote maternal health by listening to mothers' stories of having and raising children in their community and (b) to develop a shared understanding of these mothers' strengths and challenges. MI-PHOTOS utilized photovoice, an exploratory and qualitative CBPR methodology. Grounded theory guided data analysis. During photovoice discussions, conversation focused on maternal experiences and evoked strengths, facilitators, and barriers impacting maternal health. Themes focused on (a) MI-PHOTOS serving as a social support group for the community and family stressors that mothers faced and (b) the necessity of professional support programs. Three overarching findings emerged during this process: (a) MI-PHOTOS as an informal support group, (b) mental health stigmatization, and (c) the need to bridge home visiting programs with peer and confidential therapeutic services. Future work should incorporate mothers' and communities' strengths into program development by drawing on existing home visiting programs, identifying opportunities for peer-support, and creating referral networks for individual, confidential therapeutic services. Through continued community partnership, we can generate fuller understandings of mothers' experiences of having and raising children and ultimately promote health equity among rural mothers.
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Affiliation(s)
| | - Sarah E Bledsoe
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- The University of Maryland, Baltimore, Baltimore, MD, USA
| | - Jada Brooks
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Erica Little
- The University of North Carolina at Pembroke, Pembroke, NC, USA
| | - Kim Pevia
- KAP Inner Prizes, Red Springs, NC, USA
| | - Leah Daniel
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kiva Jordan
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann Schindler
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Depression pharmacotherapy is the predominant treatment available in the rural United States, yet little is known about the broader contextual factors that rural consumers and providers identify as shaping pharmacotherapy use. Thematic analysis was employed to identify emergent themes from interviews and focus groups about pharmacotherapy adherence, effectiveness, and treatment decisions conducted with Appalachian Kentucky women with depression (N = 37) and diverse healthcare providers who care for this population (N = 21). Pharmacotherapy was seen as inadequate to treat depression in the context of extensive socioeconomic burdens and other health comorbidities. Participants felt that providers over-prescribed pharmacotherapy, a pattern attributed to deficiencies in the rural healthcare system overall. Efforts to improve treatment engagement must acknowledge the significant doubts that rural consumers hold about the potential of pharmacotherapy and should consider the utility of extending broader strategies to address the social conditions shaping vulnerability to depression.
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Affiliation(s)
- Ryan Jenkins
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA.
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11
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Haight SC, Ko JY, Yogman MW, Farr SL. Postpartum Depressive Symptoms and Screening Opportunities at Health Care Encounters. J Womens Health (Larchmt) 2021; 30:731-738. [PMID: 32633692 PMCID: PMC11262126 DOI: 10.1089/jwh.2020.8373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The American College of Obstetricians and Gynecologists recommends that providers screen women for depression at the postpartum checkup. If this checkup is the only screening opportunity, women who do not attend or whose depressive episode occurs at a different time may not be identified. We evaluated women's encounters with postpartum health care to identify screening opportunities for postpartum depressive symptoms (PDS). Materials and Methods: Pregnancy Risk Assessment Monitoring System (PRAMS) data for 2012-2015 from eight jurisdictions (n = 23,990, representing 1,939,865 women) were used to calculate percentage of women reporting attendance at postpartum checkups, well-child visits, or postpartum home visitation, by presence of PDS. PDS were assessed using a modified two-item Patient Health Questionnaire. Using Modified Poisson regression, adjusted prevalence ratios (aPR) and confidence intervals (95% CI) were calculated to compare health services by PDS, adjusted for sociodemographic characteristics. Results: Almost all women with or without PDS attended a postpartum checkup (85.1% and 91.4%; aPR: 0.96; 95% CI: 0.93-0.99) and their infants attended a well-child visit (97.3% and 98.9%; aPR: 0.99; 95% CI: 0.98-1.00); 13.7% and 10.9% received home visitation (aPR: 1.18; 95% CI: 1.02-1.35). Of women with PDS who missed their postpartum checkup, 13.5% reported infant attendance at well-child visits, and 2.0% received home visitation. Of women with PDS, 98.8%, 86.1%, and 11.2% attended 1, 2, or 3 health services. Conclusion: A large percentage of women with PDS may attend well-child visits or receive home visitation, representing opportunities for depression screening and referral for care.
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Affiliation(s)
- Sarah C. Haight
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Commissioned Corps of the U.S. Public Health Service, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Michael W. Yogman
- Department of Pediatrics, Harvard Medical School, Harvard University and Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Latendresse G, Bailey E, Iacob E, Murphy H, Pentecost R, Thompson N, Hogue C. A Group Videoconference Intervention for Reducing Perinatal Depressive Symptoms: A Telehealth Pilot Study. J Midwifery Womens Health 2021; 66:70-77. [PMID: 33576146 PMCID: PMC8684833 DOI: 10.1111/jmwh.13209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Perinatal depression occurs in 12% to 18% of childbearing women. Telehealth is a promising platform for delivering perinatal mental health care, particularly during a pandemic when in-person services have been significantly curtailed. However, there is little research to document the feasibility of telehealth to address perinatal depression. This pilot study evaluated the feasibility and preliminary results of an 8-week facilitated group videoconference intervention. METHODS The study enrolled pregnant and postpartum women into an 8-week group mindfulness-based cognitive behavioral intervention, delivered via videoconference platform. Women receiving care at outpatient clinics who either screened positive for perinatal depression symptoms or had risk factors predictive of perinatal depression were invited to participate. Women attended weekly one-hour group sessions using their own electronic device and completed the Edinburgh Postnatal Depression Scale (EPDS) at several time points. Session attendance and survey completion rates were evaluated. RESULTS A total of 47 women enrolled (8 postpartum; 39 prenatal) into groups of 4 to 6. Twenty-four (51.1%) women were currently experiencing mild to moderate perinatal depression symptoms (EPDS score of 10-20), whereas 23 (48.9%) women had EPDS scores less than 10 but were at high risk for developing perinatal depression due to health history and significant life events. Seventy percent of women attended at least 5 of the 8 sessions. Trajectories of EPDS measures were promising (ie, downward among those with current perinatal depression symptoms and stable among those at high risk for developing perinatal depression). DISCUSSION These observational results are promising, suggesting further study of effectiveness for women with symptoms of perinatal depression, as well as for women at high risk for developing perinatal depression. Randomized trials could evaluate the effectiveness of the intervention, compared with standard of care approaches. Telehealth interventions can be tailored to meet the needs of different communities, and increase access to care, regardless of where women live or inability to receive in-person services.
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Affiliation(s)
| | - ElLois Bailey
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Hannah Murphy
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Ryoko Pentecost
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Nancy Thompson
- Rollns School of Public Health, Emory University, Atlanta, Georgia
| | - Carol Hogue
- Rollns School of Public Health, Emory University, Atlanta, Georgia
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Premji SS, Dobson KS, Prashad A, Yamamoto S, Tao F, Zhu B, Wu X, Lu M, Shao S. What stakeholders think: perceptions of perinatal depression and screening in China's primary care system. BMC Pregnancy Childbirth 2021; 21:15. [PMID: 33407228 PMCID: PMC7789622 DOI: 10.1186/s12884-020-03473-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
Background Mental health in China is a significant issue, and perinatal depression has been recognized as a concern, as it may affect pregnancy outcomes. There are growing calls to address China’s mental health system capacity issues, especially among vulnerable groups such as pregnant women due to gaps in healthcare services and inadequate access to resources and support. In response to these demands, a perinatal depression screening and management (PDSM) program was proposed. This exploratory case study identified strategies for successful implementation of the proposed PDSM intervention, informed by the Consolidated Framework for Implementation Research (CFIR) framework, in Ma’anshan city, Anhui province. Methods This qualitative study included four focus group discussions and two in-depth individual interviews with participants using a semi-structured interview guide. Topics examined included acceptance, utility, and readiness for a PDSM program. Participants included perinatal women and their families, policymakers, and healthcare providers. Interviews were transcribed verbatim, coded, and analyzed for emergent themes. Results The analysis revealed several promising factors for the implementation of the PDSM program including: utilization of an internet-based platform, generation of perceived value among health leadership and decision-makers, and the simplification of the screening and intervention components. Acceptance of the pre-implementation plan was dependent on issues such as the timing and frequency of screening, ensuring high standards of quality of care, and consideration of cultural values in the intervention design. Potential challenges included perceived barriers to the implementation plan among stakeholders, a lack of trained human health resources, and poor integration between maternal and mental health services. In addition, participants expressed concern that perinatal women might not value the PDSM program due to stigma and limited understanding of maternal mental health issues. Conclusion Our analysis suggests several factors to support the successful implementation of a perinatal depression screening program, guidelines for successful uptake, and the potential use of internet-based cognitive behavioral therapy. PDSM is a complex process; however, it can be successfully navigated with evidence-informed approaches to the issues presented to ensure that the PDSM is feasible, effective, successful, and sustainable, and that it also improves maternal health and wellbeing, and that of their families. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03473-y.
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Affiliation(s)
- Shahirose Sadrudin Premji
- School of Nursing, Faculty of Health, York University, HNES 313, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Keith S Dobson
- Department of Psychology, University of Calgary, Administration 235A, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Anupa Prashad
- School of Nursing, Faculty of Health, York University, HNES 313, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Shelby Yamamoto
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, People's Republic of China
| | - Beibei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, People's Republic of China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, People's Republic of China
| | - Mengjuan Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, People's Republic of China
| | - Shanshan Shao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, People's Republic of China
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14
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Solness CL, Kroska EB, Holdefer PJ, O'Hara MW. Treating postpartum depression in rural veterans using internet delivered CBT: program evaluation of MomMoodBooster. J Behav Med 2020; 44:454-466. [PMID: 33052526 PMCID: PMC7556583 DOI: 10.1007/s10865-020-00188-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
Depression in the postpartum period impacts approximately 13–26% of the general population. This number can be much higher for rural veteran women who face additional barriers to accessing specialized mental health services due to isolation and cultural factors. This study reports on a program evaluation of MomMoodBooster, a coach-supported internet-delivered CBT program for the treatment of maternal depression in veteran women. Repeated measures ANOVA, run with this sample of 326 women, demonstrated an overall positive effect size across outcome measures and engagement with no differences found between rural women and their urban counterparts. Some differences between urban and rural participants were found in total and average time spent with coaches as well as ratings of coach helpfulness, possibly indicating some cultural differences between coaches and rural women that need to be addressed. These results and the results of earlier trials suggest that MomMoodBooster can be a valid and efficacious option for reaching under-served veteran populations with specialized postpartum mental health support and is as effective with rural women as with urban women
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Affiliation(s)
- Cara L Solness
- The U.S. Department of Veterans Affairs (VA) Office of Rural Health's Veterans Rural Health Resource Center in Iowa City, Iowa City, USA.,Department of Psychological and Quantitative Foundations, The University of Iowa, Iowa City, IA, USA
| | - Emily B Kroska
- The U.S. Department of Veterans Affairs (VA) Office of Rural Health's Veterans Rural Health Resource Center in Iowa City, Iowa City, USA.,Department of Psychological and Brain Sciences, The University of Iowa, 340 Iowa Ave., Iowa City, IA, 52242, USA
| | - Paul J Holdefer
- The U.S. Department of Veterans Affairs (VA) Office of Rural Health's Veterans Rural Health Resource Center in Iowa City, Iowa City, USA.,Department of Psychological and Brain Sciences, The University of Iowa, 340 Iowa Ave., Iowa City, IA, 52242, USA
| | - Michael W O'Hara
- The U.S. Department of Veterans Affairs (VA) Office of Rural Health's Veterans Rural Health Resource Center in Iowa City, Iowa City, USA. .,Department of Psychological and Brain Sciences, The University of Iowa, 340 Iowa Ave., Iowa City, IA, 52242, USA.
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15
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Musana JW, Cohen CR, Kuppermann M, Gerona R, Wanyoro A, Aguilar D, Santos N, Temmerman M, Weiss SJ. Association of differential symptoms of stress to hair cortisol and cortisone concentrations among pregnant women in Kenya. Stress 2020; 23:556-566. [PMID: 31747807 DOI: 10.1080/10253890.2019.1696305] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives: The purpose of this study was to characterize the stress experienced by pregnant women in Kenya and assess the relationship between perceived stress and stress-related biomarkers of cortisol and cortisone.Background: Kenyan women are exposed to multiple stressors that may result in chronic stress. However, antenatal stress has not been examined and characterized in Kenya; nor has the relationship between pregnant women's self-reported stress and stress biomarkers been established.Methods: One hundred and fifty women were recruited between 22 and 28 weeks gestation. Participants completed the Perceived Stress Scale (PSS) and a sociodemographic questionnaire. Hair samples were obtained for analysis of cortisol and cortisone. Factor analysis was used to extract unique clusters of stress symptoms from items in the PSS. Regression models were computed to examine relationships of stress to cortisone and cortisol, controlling for obstetric risk.Results: Mean age of the women was 25 years (SD = 5, ±16-41). Their degree of perceived stress and cortisol/cortisone concentrations both indicated moderate levels of stress. There was no association between general perceived stress and either hair cortisol or cortisone. However, factor analysis of the PSS identified three clusters of stress symptoms and one cluster - a woman's negative frame of mind regarding life and inefficacy in handling its problems - was associated with higher levels of cortisone (β= -.231, p = 0.011).Conclusions: Specific stress symptoms may have unique relationships to specific biomarkers and be more useful in assessment than general perceived stress. Assays of both hair cortisol and cortisone might enable a more comprehensive assessment of glucocorticoid activity and better prediction of health risks from stress.Lay summaryUnderstanding stress among rural pregnant Kenyan women may help in addressing risks during pregnancy that lead to adverse birth outcomes. Findings suggest that a woman's tendency to think negatively about life and to doubt her ability to handle life's problems are symptoms of stress that may contribute to higher levels of stress hormones. Assessing women's specific symptoms of stress and different stress hormones during pregnancy may more effectively identify women who need intervention to reduce their health risk.
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Affiliation(s)
- Joseph W Musana
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Roy Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Anthony Wanyoro
- Department of Obstetrics and Gynaecology, Kenyatta University, Nairobi, Kenya
| | - David Aguilar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Nicole Santos
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
| | - Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco, CA, USA
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16
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Snell-Rood C, Jenkins R, Hudson K, Frazier C, Noble W, Feltner F. Building interventions when distress is under debate: a case study from Appalachia. Transcult Psychiatry 2019; 56:918-946. [PMID: 31042120 DOI: 10.1177/1363461519833580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Scholarship on idioms of distress has emphasized cross-cultural variation, but devoted less attention to intra-cultural variation-specifically, how the legitimacy of distress may vary according to the context in which it is expressed, social position, and interaction with medical categories of distress. This variation can pose challenges for interventionists seeking to establish culturally acceptable ways of identifying distress and creating relevant resources for recovery. We describe efforts over three years (2014-2016) to identify and adapt a culturally appropriate evidence-based intervention for depressed rural Appalachian women. Though the prevalence of depression among rural women is high, limited services and social barriers restrict treatment access. Formative research revealed varied understandings of distress. Depression was (a) medicalized as a treatable condition, (b) stigmatized as mental illness, (c) accepted as a non-pathological reaction to regional poverty and gendered caregiving responsibilities, (d) rejected as a worthy justification for seeking individual care, and (e) less represented in comparison to other competing forms of distress (i.e., multiple morbidities, family members' distress). In a small pilot trial, we applied an implementation science perspective to identify and implement appropriate evidence-based programming for the context. We outline how we reached Appalachian women despite these diverse understandings of depression and established a flexible medicalization of depression that enabled us to legitimize care-seeking, work with varied rural healthcare professionals, and engender culturally relevant support. Our adaptation and implementation of the concept of "mental health recovery" enabled the development of programming that furthered non-pathological communicative distress while resisting the normalization that silences women in the context of deep health disparities.
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Affiliation(s)
| | | | - Keisha Hudson
- University of Kentucky, Center of Excellence in Rural Health
| | - Carole Frazier
- University of Kentucky, Center of Excellence in Rural Health
| | - Wayne Noble
- University of Kentucky, Center of Excellence in Rural Health
| | - Frances Feltner
- University of Kentucky, Center of Excellence in Rural Health
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Snell-Rood C, Feltner F, Schoenberg N. What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System? Community Ment Health J 2019; 55:63-73. [PMID: 29299719 DOI: 10.1007/s10597-017-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/26/2017] [Indexed: 01/18/2023]
Abstract
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 207H University Hall #7360, Berkeley, CA, 94720, USA.
| | | | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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18
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Abstract
Kinship processes contribute to the experience and interpretation of depression-generating empathy as well as silencing. We explore intersubjective experiences of depression among kin with the aim of understanding how depression can reveal kinship expectations and evolving concepts of distress. In interviews with 28 low-income rural Appalachian women about their depression, participants articulated depression as a social process that neither starts nor ends in themselves. Yet kinship obligations to recognize family members' depression limited women's ability to admit distress, let alone request care. The intersubjective experience of depression among kin can challenge the individual expression of distress.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences School of Public Health University of California, Berkeley 207H University Hall Berkeley, CA 94720-7360 859-559-7640
| | - Merkel Richard
- Department of Psychiatry and Neurobehavioral Sciences, School of Medicine, University of Virginia, P.O. Box 800623, Charlottesville, VA 22908-0623, 434-243-4646, rlm3
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, 125 Medical Behavioral Science Building, Lexington, KY 40536-0086, 859-323-8175, n
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Johnson JE, Wiltsey-Stirman S, Sikorskii A, Miller T, King A, Blume JL, Pham X, Moore Simas TA, Poleshuck E, Weinberg R, Zlotnick C. Protocol for the ROSE sustainment (ROSES) study, a sequential multiple assignment randomized trial to determine the minimum necessary intervention to maintain a postpartum depression prevention program in prenatal clinics serving low-income women. Implement Sci 2018; 13:115. [PMID: 30134941 PMCID: PMC6106826 DOI: 10.1186/s13012-018-0807-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More research on sustainment of interventions is needed, especially return on investment (ROI) studies to determine cost-benefit trade-offs for effort required to sustain and how much is gained when effective programs are sustained. The ROSE sustainment (ROSES) study uses a sequential multiple assignment randomized (SMART) design to evaluate the effectiveness and cost-effectiveness of a stepwise approach to sustainment of the ROSE postpartum depression prevention program in 90 outpatient clinics providing prenatal care to pregnant women on public assistance. Postpartum depression (PPD) is common and can have lasting consequences. Outpatient clinics offering prenatal care are an opportune place to provide PPD prevention because most women visit while pregnant. The ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program is a group educational intervention to prevent PPD, delivered during pregnancy. ROSE has been found to reduce cases of PPD in community prenatal settings serving low-income pregnant women. METHODS All 90 prenatal clinics will receive enhanced implementation as usual (EIAU; initial training + tools for sustainment). At the first time at which a clinic is determined to be at risk for failure to sustain (i.e., at 3, 6, 9, 12, and 15 months), that clinic will be randomized to receive either (1) no additional implementation support (i.e., EIAU only), or (2) low-intensity coaching and feedback (LICF). If clinics receiving LICF are still at risk at subsequent assessments, they will be randomized to either (1) EIAU + LICF only, or (2) high-intensity coaching and feedback (HICF). Additional follow-up interviews will occur at 18, 24, and 30 months, but no implementation intervention will occur after 18 months. Outcomes include (1) percent sustainment of core program elements at each time point, (2) health impact (PPD rates over time at each clinic) and reach, and (3) ROI (costs and cost-effectiveness) of each sustainment step. Hypothesized mechanisms include sustainment of capacity to deliver core elements and engagement/ownership. DISCUSSION This study is the first randomized trial evaluating the ROI of a stepped approach to sustainment, a critical unanswered question in implementation science. It will also advance knowledge of implementation mechanisms and clinical care for an at-risk population. TRIAL REGISTRATION Clinicaltrials.gov, NCT03267563 . Registered June 14, 2018.
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Affiliation(s)
- Jennifer E. Johnson
- Division of Public Health, Michigan State University, 200 East 1st St Room 366, Flint, MI 48502 USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, Dissemination and Training Division and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road (NC-PTSD 334), Menlo Park, CA 94025 USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, 909 Fee Rd Room 321, East Lansing, MI 48824 USA
| | - Ted Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive Suite 900, Calverton, MD 20705 USA
| | - Amanda King
- Mayo Clinic, 200 First St, Rochester, MN 55901 USA
| | - Jennifer L. Blume
- Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Xuan Pham
- Spectrum Health, 221 Michigan Street, Suite 402 MC 118, Grand Rapids, 49503 USA
| | - Tiffany A. Moore Simas
- University of Massachusetts Medical School/UMass Memorial Health Care, Memorial campus - 119 Belmont Street - Jaquith 2.008, Worcester, MA 01605 USA
| | - Ellen Poleshuck
- University of Rochester Medical Center, 601 Elmwood Ave, Box PSYCH, Rochester, NY 14642 USA
| | - Rebecca Weinberg
- Allegheny Health Network, 4815 Liberty Avenue, Mellon Pavilion, Suite GR4, Pittsburgh, PA 15224 USA
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI 02906 USA
- University of Cape Town, Cape Town, South Africa
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Abstract
PURPOSE The aim of this study was to characterize nursing care provided by the research nurses from the Baby Behavioral Educational Enhancement of Pregnancy (Baby BEEP) study as they delivered a telephone social support intervention to low-income, pregnant women in the Midwestern United States. STUDY DESIGN AND METHODS This was a descriptive qualitative study that used Peplau's Theory of Interpersonal Relations to frame and interpret the analysis. RESULTS Research nurses from the Baby BEEP study found a novel way to reach a vulnerable population through weekly telephone interactions. Acting in several of Peplau's nursing roles, the care they provided led to a remarkable retention rate and therapeutic nurse-patient relationships. The Baby BEEP study demonstrated the provision of a well-received psychosocial support intervention that can be used to help underserved women throughout pregnancy. CLINICAL IMPLICATIONS Telenursing care provided to low-income, rural women was well received and reflected the principles in Peplau's Theory of Interpersonal Relations. Nurses may use this type of nursing care to support women who are difficult to reach and typically experience low levels of support. This article describes the nursing care provided by the Baby BEEP nurses and provides a model for future, novel approaches to social support in a vulnerable and difficult-to-reach population.
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Hansotte E, Payne SI, Babich SM. Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review. Public Health Rev 2017; 38:3. [PMID: 29450075 PMCID: PMC5809911 DOI: 10.1186/s40985-017-0050-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
Problem statement and significance Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? Methods A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Results Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. Implications for practice This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.
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Affiliation(s)
- Elinor Hansotte
- 1Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
| | - Shirley I Payne
- 2Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Suite 111, Bloomington, IN 47405 USA
| | - Suzanne M Babich
- 1Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
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Wang Y, Wang X, Liu F, Jiang X, Xiao Y, Dong X, Kong X, Yang X, Tian D, Qu Z. Negative Life Events and Antenatal Depression among Pregnant Women in Rural China: The Role of Negative Automatic Thoughts. PLoS One 2016; 11:e0167597. [PMID: 27977715 PMCID: PMC5157981 DOI: 10.1371/journal.pone.0167597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have looked at the relationship between psychological and the mental health status of pregnant women in rural China. The current study aims to explore the potential mediating effect of negative automatic thoughts between negative life events and antenatal depression. METHODS Data were collected in June 2012 and October 2012. 495 rural pregnant women were interviewed. Depressive symptoms were measured by the Edinburgh postnatal depression scale, stresses of pregnancy were measured by the pregnancy pressure scale, negative automatic thoughts were measured by the automatic thoughts questionnaire, and negative life events were measured by the life events scale for pregnant women. We used logistic regression and path analysis to test the mediating effect. RESULTS The prevalence of antenatal depression was 13.7%. In the logistic regression, the only socio-demographic and health behavior factor significantly related to antenatal depression was sleep quality. Negative life events were not associated with depression in the fully adjusted model. Path analysis showed that the eventual direct and general effects of negative automatic thoughts were 0.39 and 0.51, which were larger than the effects of negative life events. CONCLUSIONS This study suggested that there was a potentially significant mediating effect of negative automatic thoughts. Pregnant women who had lower scores of negative automatic thoughts were more likely to suffer less from negative life events which might lead to antenatal depression.
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Affiliation(s)
- Yang Wang
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Xiaohua Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Fangnan Liu
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xiaoning Jiang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Yun Xiao
- Maternal and Child Health Hospital in Mianzhu County, Deyang, Sichuan, China
| | - Xuehan Dong
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xianglei Kong
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xuemei Yang
- Teacher Education College, Sichuan Normal University, Chengdu, Sichuan, China
| | - Donghua Tian
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Zhiyong Qu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
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Postpartum psychiatric emergency visits: a nested case-control study. Arch Womens Ment Health 2016; 19:1019-1027. [PMID: 27511109 DOI: 10.1007/s00737-016-0651-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.
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Snell-Rood C, Hauenstein E, Leukefeld C, Feltner F, Marcum A, Schoenberg N. Mental health treatment seeking patterns and preferences of Appalachian women with depression. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2016; 87:233-241. [PMID: 27322157 DOI: 10.1037/ort0000193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia-a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants' perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality-not merely access-limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women's self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study's findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation. (PsycINFO Database Record
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Affiliation(s)
- Claire Snell-Rood
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Amber Marcum
- Department of Psychology, University of Kentucky
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine
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An Integrative Review of Postpartum Depression in Rural U.S. Communities. Arch Psychiatr Nurs 2016; 30:418-24. [PMID: 27256951 DOI: 10.1016/j.apnu.2015.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/05/2015] [Accepted: 12/13/2015] [Indexed: 11/24/2022]
Abstract
AIM This study's aim is to synthesize and summarize the literature on postpartum depression (PPD) in U.S. rural populations. BACKGROUND Internationally, PPD has a high prevalence in rural communities. Although women in rural U.S. communities have higher rates of depression outside of the postpartum time period, little study has been conducted on PPD in U.S. rural populations. It is unknown whether rural women in the United States have high rates of PPD as is common in rural populations internationally. DESIGN We used integrative literature review using Whittemore and Knafl's (2005) methodology. DATA SOURCES AND METHODS We searched the databases MEDLINE, CINAHL, PsycINFO, and Academic Search Premier with the words "postpartum depression" or "postnatal depression" and the word "rural." RESULTS We found 11 articles with empirical data that met the criteria and thus were included in the review. Seven articles were quantitative, two were qualitative, one was mixed methods, and one was a nonexperimental design. Five foci emerged in the literature including (a) screening and prevalence, (b) demographic factors, (c) program creation and implementation, (d) mental health care seeking, and (e) social support. The results suggest that prevalence of PPD may be higher in rural U.S. areas, that implementing PPD prevention and screening programs for rural women is feasible, and that women in rural areas rely on informal networks and may face a stigma for seeking mental health care. CONCLUSIONS Further research is needed on PPD in rural U.S. POPULATIONS Specifically, this research should focus on the mix of variables found throughout this review such as race and income level. Nurses should lead for changes in clinical practice and policy that increase screening and interventions for PPD in rural communities.
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26
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Chojenta CL, Lucke JC, Forder PM, Loxton DJ. Maternal Health Factors as Risks for Postnatal Depression: A Prospective Longitudinal Study. PLoS One 2016; 11:e0147246. [PMID: 26785131 PMCID: PMC4718697 DOI: 10.1371/journal.pone.0147246] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE While previous studies have identified a range of potential risk factors for postnatal depression (PND), none have examined a comprehensive set of risk factors at a population-level using data collected prospectively. The aim of this study was to explore the relationship between a range of factors and PND and to construct a model of the predictors of PND. METHODS Data came from 5219 women who completed Survey 5 of the Australian Longitudinal Study on Women's Health in 2009 and reported giving birth to a child. RESULTS Over 15% of women reported experiencing PND with at least one of their children. The strongest positive associations were for postnatal anxiety (OR = 13.79,95%CI = 10.48,18.13) and antenatal depression (OR = 9.23,95%CI = 6.10,13.97). Positive associations were also found for history of depression and PND, low SF-36 Mental Health Index, emotional distress during labour, and breastfeeding for less than six months. CONCLUSIONS Results indicate that understanding a woman's mental health history plays an important role in the detection of those who are most vulnerable to PND. Treatment and management of depression and anxiety earlier in life and during pregnancy may have a positive impact on the incidence of PND.
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Affiliation(s)
- Catherine L. Chojenta
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | - Jayne C. Lucke
- Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Peta M. Forder
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | - Deborah J. Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
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Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health. Matern Child Health J 2015; 18:2393-407. [PMID: 24748241 PMCID: PMC4220111 DOI: 10.1007/s10995-014-1479-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.
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28
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Meintjes I, Field S, Sanders L, van Heyningen T, Honikman S. Improving child outcomes through maternal mental health interventions. J Child Adolesc Ment Health 2015; 22:73-82. [PMID: 25859765 DOI: 10.2989/17280583.2010.528576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This commentary will provide a general overview of the public health considerations of maternal mental illness, both from a global perspective as well as from the South African context. The paper will outline the consequences of maternal mental illness for mothers as well as their offspring, through the life stages from pregnancy until adulthood. The paper then describes the Perinatal Mental Health Project (PMHP), an intervention that addresses maternal mental health in Cape Town, South Africa. The evidence emerging from this example contributes to the case for integrating maternal mental health into the mainstream health environment.
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Affiliation(s)
- Ingrid Meintjes
- a Perinatal Mental Health Project, Department of Psychiatry and Mental Health , University of Cape Town , 46 Sawkins Road , Rondebosch , 7700 , Cape Town
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29
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Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015; 175:34-52. [PMID: 25590764 DOI: 10.1016/j.jad.2014.12.041] [Citation(s) in RCA: 452] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries. METHODS A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview. RESULT The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression. LIMITATION All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results. CONCLUSION The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.
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Affiliation(s)
- M N Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
| | - N H Nik Hazlina
- Women Health Development Unit, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - A R Asrenee
- Department of Psychiatry, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - W M A Wan Emilin
- Perpustakaan Hamdan Tahir, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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30
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Cheng TC, Lo CC. Domestic Violence and Treatment Seeking: A Longitudinal Study of Low-Income Women and Mental Health/Substance Abuse Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:735-59. [DOI: 10.2190/hs.44.4.d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.
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31
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Shelton MM, Schminkey DL, Groer MW. Relationships among prenatal depression, plasma cortisol, and inflammatory cytokines. Biol Res Nurs 2014; 17:295-302. [PMID: 25230746 DOI: 10.1177/1099800414543821] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A secondary pilot study was carried out as part of a larger parent study of thyroid function in pregnancy and postpartum. All women in the parent study (N = 631) had blood samples, demographic data, and measures of perceived stress and dysphoric moods collected between 16 and 26 weeks' gestation. The current study was completed with a subset of 105 pregnant women to examine the relationships among perceived stress, depression, plasma cortisol, and cytokines during the second trimester of pregnancy. Stress was measured using Cohen's Perceived Stress Scale and dysphoric moods using the Profile of Mood States Depression/Dejection Scale. Cytokines were measured by a 12-plex analysis on a Luminex-200, and cortisol was measured by enzyme-linked immunosorbent assay on stored plasma samples. Stress and depression scores were highly correlated, and depressive symptoms were inversely correlated with 3 of the 12 cytokines: interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and IL-7. Cortisol was inversely correlated with proinflammatory cytokines (IL-1β and TNF-α) and anti-inflammatory cytokines (IL-4, IL-5, IL-10, and IL-13). These data support the new conceptualizations of normal pregnancy as an inflammatory state that is carefully regulated, as both excessive and inadequate inflammation are potentially hazardous to the health of the pregnancy and fetus.
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Affiliation(s)
| | - Donna L Schminkey
- University of Virginia, School of Nursing and School of Medicine, Charlottesville, VA, USA
| | - Maureen W Groer
- University of South Florida, College of Nursing, Tampa, FL, USA
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32
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Pooler J, Perry DF, Ghandour RM. Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC. Matern Child Health J 2014; 17:1969-80. [PMID: 23329168 DOI: 10.1007/s10995-013-1224-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006-2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97-1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39-1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.
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Affiliation(s)
- Jennifer Pooler
- Altarum Institute, 4 Milk Street, Third Floor, Portland, ME, 04101-4164, USA,
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Jesse DE, Kim H, Herndon C. Social support and self-esteem as mediators between stress and antepartum depressive symptoms in rural pregnant women. Res Nurs Health 2014; 37:241-52. [PMID: 24797585 DOI: 10.1002/nur.21600] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/11/2022]
Abstract
The purpose of this secondary analysis was to determine whether satisfaction with social support and self-esteem mediated the relationship between antepartum stress and depressive symptoms in women attending prenatal clinics in a rural Southeastern community (N = 318). Path analysis with linear regression indicated that the relationship between antepartum stress and depressive symptoms was partially mediated by higher levels of the internal resources of satisfaction with social support and self-esteem. Self-esteem had a greater influence on the relationship between antepartum stress and depressive symptoms than did satisfaction with social support. These findings suggest further study to determine whether developing culturally tailored interventions that emphasize stress reduction activities in addition to enhancing self-esteem and increasing satisfaction with social support can decrease the burden of antepartum depressive symptoms in rural low-income women.
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Affiliation(s)
- D Elizabeth Jesse
- Associate Professor, East Carolina University College of Nursing, 3160 Health Sciences Building, Greenville, NC 27858; Brody School of Medicine, Greenville, NC
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34
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Le HN, Perry DF, Genovez M, Cardeli E. In their own voices: Latinas' experiences with a randomized controlled trial. QUALITATIVE HEALTH RESEARCH 2013; 23:834-846. [PMID: 23539092 DOI: 10.1177/1049732313482591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We conducted exit interviews with a random sample of 39 predominantly Central American immigrant mothers who had completed a longitudinal randomized controlled trial to prevent perinatal depression. We found that rates and levels of perinatal depression in the intervention and control groups were lower than expected and did not differ between groups at 1 year postpartum. Therefore, we conducted extensive semistructured interviews to (a) understand why these high-risk women had such low rates of major depressive episodes and depressive symptoms, and (b) determine if the mechanisms responsible for reductions in depression differed between the intervention and usual care groups. We discovered that the intervention group learned specific mood-management skills from their participation in the intervention, and that the control group experienced their participation in the study as a "low-dose" intervention. Our experience highlights the importance of conducting qualitative studies to understand quantitative outcomes of intervention studies.
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Affiliation(s)
- Huynh-Nhu Le
- George Washington University, Washington, District of Columbia 20052, USA.
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35
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Evans EC, Bullock LFC. Optimism and other psychosocial influences on antenatal depression: a systematic review. Nurs Health Sci 2012; 14:352-61. [PMID: 22762538 DOI: 10.1111/j.1442-2018.2012.00700.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Antenatal depression is a debilitating experience for many women with significant personal and familial sequelae. Low-income pregnant women living in rural settings are especially vulnerable because of isolation, decreased resources, and stressful living environments. This systematic review summarizes what is known about antenatal depression and synthesizes the evidence regarding the role psychosocial variables could play in the development of safe, effective, and culturally-acceptable non-pharmacological interventions. Searches of the CINAHL, MEDLINE, PSYCHINFO, and ERIC databases, as well as the Cochrane Library, were conducted in September 2010 to identify articles relevant to our topic of study. Psychosocial variables have a significant association with antenatal depression. Optimism has been shown to be inversely correlated with depression, and directly correlated with improved birth outcomes. Optimism is a potentially modifiable variable that could be used to design antenatal prevention and treatment programs. As depression continues to increase in prevalence, and treatment options for pregnant women remain limited, effective interventions must be developed that address the psychosocial variables examined in this review.
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Affiliation(s)
- Emily C Evans
- School of Nursing, University of Virginia, Charlottesville, Virginia 22908-0826, USA.
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36
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Price SK, Corder-Mabe J, Austin K. Perinatal depression screening and intervention: enhancing health provider involvement. J Womens Health (Larchmt) 2012; 21:447-55. [PMID: 22309209 DOI: 10.1089/jwh.2011.3172] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The authors of this study collaborated in the analysis of public health survey data in order to inform future statewide interventions that could systematically enhance depression screening and mental health service use for women of reproductive age. The primary objective of the study was to empirically inform and test the program theory components of a motivational interviewing intervention that we anticipate will guide statewide practice and policy priorities. METHODS Data were examined from a survey of healthcare practitioners statewide (n=1498) regarding their practices with and perceptions of perinatal depression care for women. Confirmatory factor analysis (CFA) was used to measure two latent constructs: health provider confidence in the ability to diagnose and treat and the importance placed on screening and treatment. Structural equation modeling (SEM) was used to test a program theory supporting motivational interviewing using a model implied relationship between confidence and importance on screening and treatment/referral practices. RESULTS The data fit the model; the model provisionally supports motivational interviewing as an intervention influencing provider attitudes and practices surrounding perinatal depression screening and treatment/referral. CONCLUSIONS Ultimately, study findings support statewide public health efforts to expand the role of health providers in recognizing and responding to perinatal depression and suggest that motivational interviewing techniques that augment importance and confidence may lead to enhanced screening and referral/treatment outcomes for pregnant and postpartum women.
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Affiliation(s)
- Sarah Kye Price
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA.
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37
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Villegas L, McKay K, Dennis CL, Ross LE. Postpartum Depression Among Rural Women From Developed and Developing Countries: A Systematic Review. J Rural Health 2010; 27:278-88. [PMID: 21729155 DOI: 10.1111/j.1748-0361.2010.00339.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laura Villegas
- Social Equity and Health Research Section, Centre for Addiction and Mental Health, Toronto, Canada
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