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Almutairi HA, Alyousef SM, Alhamidi SA, Almoammar DN. Exploring the Healthcare Services' Contribution to Reducing Postpartum Depression. SAGE Open Nurs 2023; 9:23779608231171780. [PMID: 37181734 PMCID: PMC10170593 DOI: 10.1177/23779608231171780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services. Objective The purpose of this study was to explore nurses' perceptions towards health services' contribution to lowering the incidence of PPD. Methods An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method. Results Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses. Conclusion The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.
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Affiliation(s)
| | - Seham Mansour Alyousef
- Community and Psychiatric Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Sami Abdulrahman Alhamidi
- Department of Maternal and Child Health, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Danah Nasser Almoammar
- Department of Psychiatric and Mental Health Care, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Navarrete L, Lara MA, Berenzon S, Mora-Rios J. Challenges of Perinatal Depression Care in Mexico City Health Centers. Int J Womens Health 2022; 14:1667-1679. [PMID: 36510491 PMCID: PMC9739043 DOI: 10.2147/ijwh.s381196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background Perinatal depression is a common mental disorder regarded as a severe public health problem. Studies have shown that incorporating mental health care into primary health services that provide pregnancy care makes it easier for women to seek help for depressive symptoms. In this context, the following question is of interest: How prepared are primary health services in Mexico City that provide pregnancy and postpartum care to treat perinatal depression? This article seeks to explore the perceptions and knowledge of perinatal depression in health professionals and analyze the barriers to its care at primary care centers in Mexico City. Methods An exploratory study with a qualitative approach was conducted. Doctors, nurses, social workers who provide maternal and childcare, mental health personnel, and the directors of four centers were interviewed. Interviews were audio-recorded and transcribed for thematic analysis. Results Most primary care personnel are unaware of the Official Standard that recommends providing maternal mental health care during the perinatal period. There is no initiative for its incorporation into routine care. A significant barrier to its implementation is health professionals' biased, stereotyped perception of perinatal depression, motherhood, and the role of women. Other barriers include the workload of health professionals, the division of care between professionals, and the lack of communication between the latter. Women with psychological symptoms are not referred to mental health staff in a timely manner. Social workers are in closer contact with women and are more willing to address their emotional distress. Conclusion Maternal mental health care, contingent on pregnancy, childbirth, and puerperium care at primary care centers is currently not possible due to the lack of knowledge, barriers, and directors' dependence on hospital management decisions.
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Affiliation(s)
- Laura Navarrete
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico,Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous, University of Mexico, Mexico City, Mexico
| | - Ma Asunción Lara
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico,Correspondence: Ma Asunción Lara, Tel +52 55 4160 5170, Fax +52 55 5513 3446, Email
| | - Shoshana Berenzon
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Jazmin Mora-Rios
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico
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Branquinho M, Shakeel N, Horsch A, Fonseca A. Frontline health professionals’ perinatal depression literacy: A systematic review. Midwifery 2022; 111:103365. [DOI: 10.1016/j.midw.2022.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
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Dadi AF, Miller ER, Azale T, Mwanri L. "We do not know how to screen and provide treatment": a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia. Int J Ment Health Syst 2021; 15:41. [PMID: 33952338 PMCID: PMC8098000 DOI: 10.1186/s13033-021-00466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. METHODS We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. RESULTS The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation. CONCLUSIONS This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.
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Affiliation(s)
- Abel Fekadu Dadi
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emma R. Miller
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Telake Azale
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
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McRae N, Bello G, Svensson K, Solano-González M, Wright RJ, Niedzwiecki MM, Calapiz MT, Amarasiriwardena C, Schnaas L, Tamayo-Ortiz M, Téllez-Rojo MM, Wright RO. Blood manganese levels during pregnancy and postpartum depression: A cohort study among women in Mexico. Neurotoxicology 2019; 76:183-190. [PMID: 31730893 DOI: 10.1016/j.neuro.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/16/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Occupational studies have shown an association between elevated Mn exposure and depressive symptoms. Blood Mn (BMn) naturally rises during pregnancy due to mobilization from tissues, suggesting it could contribute to pregnancy and postpartum depressive symptoms. OBJECTIVES To assess the association between BMn levels during pregnancy and postpartum depression (PPD), creating opportunities for possible future interventions. METHODS We studied 561 women from the reproductive longitudinal Programming Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) cohort in Mexico City. BMn was measured at the 2nd and 3rd trimesters, as well as delivery. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD symptoms at 12-months postpartum. We used a generalized linear model assuming a Poisson distribution to assess the association between BMn levels and PPD, with adjustments for age, stress and depressive symptoms during pregnancy, education, socioeconomic status, and contemporaneous blood lead levels. RESULTS The mean ± standard deviation (SD) EPDS score at 12-months postpartum was 6.51 ± 5.65, and 17.11% of women met the criteria for possible PPD (score ≥ 13). In adjusted models, BMn during the 3rd trimester (β: 0.13, 95% CI: 0.04-0.21) and BMn levels averaged at the 2nd and 3rd trimester (β: 0.14, 95% CI: 0.02-0.26) had a positive association with EPDS scores at 12 months postpartum. BMn at the 2nd trimester (β: 0.07, 95% CI: -0.09-0.22) and delivery (β: 0.03, 95% CI: -0.04-0.10) had a non-significant positive association with EPDS scores at 12-months postpartum. Stress and depressive symptoms during pregnancy was associated with higher EPDS scores at 12-months postpartum in all of the adjusted models but were only significant when either BMn during 3rd trimester or BMn averaged across 2nd and 3rd trimester was assessed as the exposure. DISCUSSION Our results demonstrate that elevated BMn levels during pregnancy predict PPD symptoms and could be a potential pathway for intervention and prevention of PPD.
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Affiliation(s)
- Nia McRae
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ghalib Bello
- London Institute of Medical Sciences, Imperial College, London, UK
| | | | - Maritsa Solano-González
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Rosalind J Wright
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan M Niedzwiecki
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mariana Torres Calapiz
- Division of Community Interventions Research, National Institute of Perinatology, Mexico City, Mexico
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lourdes Schnaas
- Division of Community Interventions Research, National Institute of Perinatology, Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico; Consejo Nacional de Ciencia y Tecnología, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Robert O Wright
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Place JMS, Allen-Leigh B, Billings DL, Dues KM, de Castro F. Detection and care practices for postpartum depressive symptoms in public-sector obstetric units in Mexico: Qualitative results from a resource-constrained setting. Birth 2017; 44:390-396. [PMID: 28833511 DOI: 10.1111/birt.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is amenable to detection and treatment, but effectively addressing it is contingent on policies, practices, and health care providers working together to address the issue. The aim of this study is to describe a sample of health care providers' existing practices in public-sector obstetric units in Mexico related to detecting and offering care to women with depressive symptomology. METHODS Semi-structured interviews with 40 health care providers (16 physicians, 13 nurses, three social workers, and eight psychologists) from one tertiary-level and two secondary-level, public-sector obstetric units, were conducted by members of a trained research team from May to July 2012. Qualitative data were analyzed in Spanish according to Grounded Theory, using Nvivo 10 software. RESULTS Lack of hospital guidelines, training, and time constraints are reasons given for not detecting PPD symptoms among women. Providers reported that their role is cursory and limited to giving women anticipatory guidance for what to expect emotionally after childbirth or providing a trusting atmosphere for women to express their feelings. Care is fragmented and inadequate, in part because of the lack of protocols that define who makes mental health referrals and where. Providers indicated PPD is important but not prioritized in health care for pregnant and postpartum women. CONCLUSION Critical needs in obstetric units include formal mental health care detection and care protocols during the perinatal period, strategies to address mental health needs despite short hospital stays, and training for providers on how to implement detection and care protocols and strategies.
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Affiliation(s)
- Jean Marie S Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Betania Allen-Leigh
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Deborah L Billings
- Choose Well Initiative, Columbia, SC, USA.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kiya M Dues
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
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de Castro F, Place JM, Villalobos A, Rojas R, Barrientos T, Frongillo EA. Poor early childhood outcomes attributable to maternal depression in Mexican women. Arch Womens Ment Health 2017; 20:561-568. [PMID: 28601985 DOI: 10.1007/s00737-017-0736-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.
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Affiliation(s)
- Filipa de Castro
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jean Marie Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA.
| | - Aremis Villalobos
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rosalba Rojas
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Tonatiuh Barrientos
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
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de Castro F, Place JMS, Billings DL, Rivera L, Frongillo EA. Risk profiles associated with postnatal depressive symptoms among women in a public sector hospital in Mexico: the role of sociodemographic and psychosocial factors. Arch Womens Ment Health 2015; 18:463-71. [PMID: 25416532 DOI: 10.1007/s00737-014-0472-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 10/18/2014] [Indexed: 03/02/2023]
Abstract
This study examined the association between postnatal depressive symptoms and a set of demographic and psychosocial factors among 604 women attending a public hospital for postnatal care in Mexico City. Specific profiles of women that would indicate an increased probability for developing postnatal depression (PND) based on discrete combinations of risk and protective factors were generated. In a logistic model, followed by the estimation of predicted probabilities, we examined the association between depressive symptomatology and psychosocial factors: low social support, unplanned pregnancies, history of depression, and exposure to moderate or severe intimate partner violence (IPV) during pregnancy. Postnatal depressive symptomatology was reported by 10.6 % of the women, as measured by scores at 12 or above on the Edinburgh Postnatal Depression Scale. The cumulative probability of presenting PND in the simultaneous presence of the psychosocial factors was 67.0 %; however, this could be reduced to 5.5 % through preventive measures that work to eliminate low social support, unplanned pregnancy, and exposure to severe IPV during pregnancy. Early identification of psychosocial risk factors, specifically low social support, unplanned pregnancies, history of depression, and exposure to violence during pregnancy, is recommended.
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Affiliation(s)
- Filipa de Castro
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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