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Dubreucq M, Dupont C, Lambregtse-Van den Berg MP, Bramer WM, Massoubre C, Dubreucq J. A systematic review of midwives' training needs in perinatal mental health and related interventions. Front Psychiatry 2024; 15:1345738. [PMID: 38711873 PMCID: PMC11071341 DOI: 10.3389/fpsyt.2024.1345738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Background Midwives may be key stakeholders to improve perinatal mental healthcare (PMHC). Three systematic reviews considered midwives' educational needs in perinatal mental health (PMH) or related interventions with a focus on depression or anxiety. This systematic review aims to review: 1) midwives' educational/training needs in PMH; 2) the training programs in PMH and their effectiveness in improving PMHC. Methods We searched six electronic databases using a search strategy designed by a biomedical information specialist. Inclusion criteria were: (1) focus on midwives; (2) reporting on training needs in PMH, perinatal mental health problems or related conditions or training programs; (3) using quantitative, qualitative or mixed-methods design. We used the Mixed Methods Appraisal Tool for study quality. Results Of 4969 articles screened, 66 papers met eligibility criteria (47 on knowledge, skills or attitudes and 19 on training programs). Study quality was low to moderate in most studies. We found that midwives' understanding of their role in PMHC (e.g. finding meaning in opening discussions about PMH; perception that screening, referral and support is part of their routine clinical duties) is determinant. Training programs had positive effects on proximal outcomes (e.g. knowledge) and contrasted effects on distal outcomes (e.g. number of referrals). Conclusions This review generated novel insights to inform initial and continuous education curriculums on PMH (e.g. focus on midwives' understanding on their role in PMHC or content on person-centered care). Registration details The protocol is registered on PROSPERO (CRD42021285926).
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Affiliation(s)
- Marine Dubreucq
- Centre referent de rehabilitation psychosociale, GCSMS REHACOOR 42, Saint-Étienne, France
- University Claude Bernard Lyon1, Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon, France
| | - Corinne Dupont
- University Claude Bernard Lyon1, Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon, France
- AURORE Perinatal Network, Hospices civiles de Lyon, Croix Rousse Hospital, Lyon, France
| | - Mijke P. Lambregtse-Van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Catherine Massoubre
- University Hospital of Saint-Étienne & EA 7423 (Troubles du Comportement Alimentaire, Addictions et Poids Extrêmes (TAPE), Université Jean Monnet - Saint-Etienne), Saint-Etienne, France
| | - Julien Dubreucq
- University Hospital of Saint-Étienne, Department of Child and Adolescent Psychiatry, France & Marc Jeannerod Institute of Cognitive Sciences UMR 5229, CNRS & Claude Bernard University, Lyon, France
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Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students' collaboration skills in perinatal mental health. Women Birth 2023:S1871-5192(23)00014-8. [PMID: 36697285 DOI: 10.1016/j.wombi.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/09/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively. AIM The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence. METHODS The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey. FINDINGS Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap. CONCLUSION Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.
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Darwin Z, Blower SL, Nekitsing C, Masefield S, Razaq R, Padgett L, Endacott C, Willan K, Dickerson J. Addressing inequalities in the identification and management of perinatal mental health difficulties: The perspectives of minoritised women, healthcare practitioners and the voluntary sector. Front Glob Womens Health 2022; 3:1028192. [PMID: 36619590 PMCID: PMC9813385 DOI: 10.3389/fgwh.2022.1028192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Perinatal mental health (PMH) difficulties affect approximately one in five birthing women. If not identified and managed appropriately, these PMH difficulties can carry impacts across generations, affecting mental health and relationship outcomes. There are known inequalities in identification and management across the healthcare pathway. Whilst barriers and facilitators have been identified there is a lack of clarity about how these relate to the avoidable and unfair inequalities experienced by various groups of women. Further research is required to understand how to address inequalities in PMH. Aim To understand the key factors that enable and hinder access to PMH care for women from minoritised groups across the PMH care pathway, and how these have been affected by the COVID-19 pandemic. Methods A sequential mixed-methods approach gathered views and experiences from stakeholders in one region in northern England. This included an online survey with 145 NHS healthcare practitioners and semi-structured interviews with 19 women from ethnic minority and/or socio-economically deprived backgrounds who had experienced PMH difficulties, and 12 key informants from the voluntary and community sector workforce. Quantitative data were analysed using descriptive statistics and framework analysis was applied to qualitative data. Findings Barriers and facilitators were mapped using a socio-technical framework to understand the role of (i) processes, (ii) people (organised as women, practitioners and others), (iii) technology, and (iv) the system as a whole in deepening or alleviating inequalities. Influences that were identified as pertinent to inequalities in identification and management included provision of interpreters, digital exclusion, stigma, disempowerment, distrust of services, practitioner attitudes, data capture, representation in the workforce, narrow rules of engagement and partnership working. Stakeholder groups expressed that several barriers were further compounded by the COVID-19 pandemic. Discussion The findings highlight the need for change at the system level to tackle inequalities across the PMH care pathway. Four inter-connected recommendations were developed to enable this systems change: building emotional safety between professionals and women; making PMH a part of core healthcare business; increasing cultural competency specific to PMH; and enhanced partnership working.
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Affiliation(s)
- Zoe Darwin
- School of Human and Health Sciences, Department of Allied Health Professions, Sport and Exercise, University of Huddersfield, Huddersfield, United Kingdom,Correspondence: Zoe Darwin Sarah Blower
| | - Sarah L. Blower
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom,Correspondence: Zoe Darwin Sarah Blower
| | - Chandani Nekitsing
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Sarah Masefield
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Rifat Razaq
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Louise Padgett
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Charlotte Endacott
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Kathryn Willan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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Darwin Z, Domoney J, Iles J, Bristow F, Siew J, Sethna V. Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis. Front Psychiatry 2020; 11:585479. [PMID: 33510656 PMCID: PMC7835428 DOI: 10.3389/fpsyt.2020.585479] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: Five to 10 percentage of fathers experience perinatal depression and 5-15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period. Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies. Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes. Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.
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Affiliation(s)
- Zoe Darwin
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Jill Domoney
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jane Iles
- Department of Psychology, University of Surrey, Surrey, United Kingdom
| | - Florence Bristow
- Community Perinatal Mental Health Service for Croydon, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jasmine Siew
- Department of Experimental Clinical and Health Psychology, Research in Developmental Disorders Lab, Ghent University, Ghent, Belgium.,Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Vaheshta Sethna
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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