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Trinh TG, Schwarze CE, Müller M, Goetz M, Hassdenteufel K, Wallwiener M, Wallwiener S. Implementing a Perinatal Depression Screening in Clinical Routine: Exploring the Patient's Perspective. Geburtshilfe Frauenheilkd 2022; 82:1082-1092. [PMID: 36186149 PMCID: PMC9525145 DOI: 10.1055/a-1844-9246] [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: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Perinatal depression (PND) is a frequently observed mental disorder, showing a prevalence of up to 20% and resulting in unfavorable maternal and neonatal outcomes. Targeted screening for PND offers the potential to identify and treat undiagnosed cases and help prevent its deleterious consequences. The aim of the present study was to evaluate participants' personal attitudes and acceptance of a routine screening program for PND in pregnancy care, identify any potential underlying factors, and appraise the general perspective on perinatal mental health problems. Methods In total, 732 women in their second trimester of pregnancy took part in a PND screening program that was incorporated in routine prenatal care using the Edinburgh Postnatal Depression Scale (EPDS) and completed a web-based survey on screening acceptance. Results Participants viewed PND screening as useful (78.7%, n = 555/705), especially in terms of devoting attention to perinatal mental health problems (90.1%, n = 630/699), easy to complete (85.4%, n = 606/710), and without feelings of discomfort (88.3%, n = 628/711). Furthermore, women with previous or current mental health issues rated the usefulness of screening significantly higher, as did women with obstetric risks (p < 0.01 - p = 0.04). The final regression model explained 48.4% of the variance for screening acceptance. Conclusion Patient acceptance for PND screening was high in our study cohort, supporting the implementation of screening programs in routine pregnancy care with the potential to identify, sensitize, and treat undiagnosed patients to reduce stigmatization and offer access to tailored dedicated PND care programs.
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Affiliation(s)
- Thuy Giang Trinh
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | | | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Maren Goetz
- Department of General Pediatrics, University Childrenʼs Hospital, Heidelberg, Germany
| | | | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany,Correspondence Prof. Stephanie Wallwiener, MD Department of Obstetrics and GynecologyHeidelberg
UniversityIm Neuenheimer Feld 44069120
HeidelbergGermany
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Aongola M, Kaonga P, Michelo C, Zgambo J, Lupenga J, Jacobs C. Acceptability and associated factors of indoor residual spraying for malaria control by households in Luangwa district of Zambia: A multilevel analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000368. [PMID: 36962710 PMCID: PMC10021563 DOI: 10.1371/journal.pgph.0000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
The global burden of malaria has increased from 227 million cases in 2019 to 247 million cases in 2020. Indoor residual spraying (IRS) remains one of the most effective control strategies for malaria. The current study sought to measure the acceptability level and associated factors of indoor residual spraying. A cross sectional study was conducted from October to November 2020 in sixteen urban and rural communities of Luangwa district using a cluster sampling method, Multilevel analysis was used to account for the hierarchical structure of the data. The acceptability level of indoor residual spraying among household heads was relatively high at 87%. Individuals who felt the timing was not appropriate were associated with decreased odds of accepting IRS (AOR = 0.55, 95% CI: 0.20-0.86). Positive attitude was associated with increased odds of accepting IRS (AOR = 29.34, 95% CI: 11.14-77.30). High acceptability level was associated with unemployment (AOR = 1.92, 95% CI: 1.07-3.44). There were no associations found between acceptability levels and community-level factors such as information, education, communication dissemination, awareness achieved through door-to-door sensitization, and public address system. Acceptability level of indoor residual spraying was relatively high among households of Luangwa District suggesting that the interventions are more acceptable which is essential in reaching malaria elimination by 2030. Finding that community factors known to influence acceptability such as information, education and communication as well as awareness were not important to influencing acceptability suggests need for reinforcing messages related to indoor residual spraying and redefining the community sensitization approaches to make indoor residual spraying more acceptable.
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Affiliation(s)
- Maureen Aongola
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Strategic Centre for Health Systems Metrics & Evaluation, School of Public Health, University of Zambia, Lusaka, Zambia
- Harvest Research Institute, Harvest University, Lusaka, Zambia
| | - Jessy Zgambo
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Joseph Lupenga
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Strategic Centre for Health Systems Metrics & Evaluation, School of Public Health, University of Zambia, Lusaka, Zambia
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Haßdenteufel K, Lingenfelder K, Schwarze CE, Feisst M, Brusniak K, Matthies LM, Goetz M, Wallwiener M, Wallwiener S. Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study. JMIR Ment Health 2021; 8:e26665. [PMID: 34890349 PMCID: PMC8709910 DOI: 10.2196/26665] [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: 12/20/2020] [Revised: 02/11/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. OBJECTIVE The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. METHODS In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. RESULTS Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. CONCLUSIONS The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women's personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term.
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Affiliation(s)
- Kathrin Haßdenteufel
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Katrin Lingenfelder
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | | | - Manuel Feisst
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Katharina Brusniak
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Lina Maria Matthies
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Maren Goetz
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
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Abstract
OBJECTIVES The aim of this study was to determine the (1) proportion of screened postpartum depression (PPD)-positive mothers, (2) associated risk factors, and (3) impact of PPD screening in a pediatric emergency department (PED). STUDY DESIGN We performed a pilot cohort study using a convenience sample of mothers (n = 209, all ages) of infant patients 6 months or younger presenting to a PED. Mothers completed a computerized survey that included the Edinburgh Postnatal Depression Scale. We assessed frequency of positive screens and performed multivariable logistic regression to identify associated risk factors. We assessed maternal attitudes toward screening at enrollment and 1-month follow-up with positive-screen mothers. Differences in ED utilization were measured. RESULTS Fifty-seven of 209 mothers (27%; 95% confidence interval [CI], 21%-33%) screened positive for PPD, with 14 (7%) reporting suicidal thoughts. Forty-seven percent (97/209) had never previously been screened, including 58% (33/57) of PPD screen-positive mothers. Current unemployment status (adjusted odds ratio [aOR], 2.76; 95% CI, 1.25-6.13) and first-time motherhood (aOR, 3.92; 95% CI, 1.72-8.91) were associated with a positive screen. At 1-month follow-up, mothers (35/37) reported PED-based PPD screening was important. After adjustment for sociodemographic factors, PPD screen-positive mothers had increased PED utilization (aOR, 1.29; 95% CI, 1.03-1.61). CONCLUSIONS Approximately 1 in 4 mothers screened positive for PPD in a PED, with almost 1 in 10 reporting suicidal thoughts. The majority of PPD screen-positive mothers had not been screened previously. Our study helps to inform future efforts for interventions to support mothers of young infants who use the PED for care.
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Reilly N, Kingston D, Loxton D, Talcevska K, Austin MP. A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 2020; 33:51-59. [DOI: 10.1016/j.wombi.2019.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
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Ransing R, Kukreti P, Deshpande S, Godake S, Neelam N, Raghuveer P, Mahadevaiah M, Kataria D, Patil S, Puri M, Padma K. Perinatal depression-knowledge gap among service providers and service utilizers in India. Asian J Psychiatr 2020; 47:101822. [PMID: 31710947 DOI: 10.1016/j.ajp.2019.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lack of access to perinatal mental health (PMH) services is a significant public health problem in India. Barriers to accessing PMH services include the stigma, non-availability of services, poor knowledge, negative perception, attitude among perinatal women (PWs) and service providers. The present study attempted to examine the knowledge gap regarding perinatal depression (PD) among service providers [Nursing providers (NPs), Medical Practitioners (MPs)] and service utilizers (PWs). METHODS This cross-sectional study was conducted in two tertiary care teaching hospitals of India, one in a major metro and the other in a rural area. PWs, MPs and NPs were assessed for knowledge about PD using a semi-structured proforma and Perinatal Depression Monitor. RESULTS Among the 270 PWs, 8.51% were knowledgeable (PWA) and 91.49% were ignorant (PWB) about depression. PWB group were low educated (n = 140, 56.68%), and unemployed (n = 207, 83.80%) with lower family income [(≤₹10,356 per month), n = 170, 68.28%)]. There was knowledge discrepancy among NPs, MPs and PWA group in terms of a) PD is a normal part of pregnancy (agree- NPs = 71.52%, MPs = 10.00%, PWA-17.39%), b)biological causes of PD (agree- NPs = 45.23%, MPs = 70.00%, PWA = 26.03%) and c)antidepressant medications for PD (useful- NPs = 23.80%, MPs = 70.00%, PWA = 21.73%). Majority of the respondents agreed that all women should be screened for depression during pregnancy (NPs = 34.78%, MPs = 80.95%, PWA = 95.00%) and postpartum periods (NPs = 34.78%, MPs = 76.19%, PWA = 90.00%). CONCLUSIONS Low PD literacy among the PWs, misconception about aetiology and management among the NPs could be major barrier for delivery and utilisation of PD services. Thus, there is an urgent need to improve PD literacy among PWs and NPs.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical college
| | - Prerna Kukreti
- Lady Hardinge Medical College, Department of Psychiatry, C-604 Shaheed Bhagat Singh, Road, DI, India.
| | - Smita Deshpande
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi 110001
| | - Shashwati Godake
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri
| | - Neelam Neelam
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | | | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS)
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College
| | - Kumari Padma
- Department of Psychiatry, BKL Walawalkar Rural Medical College
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Khanlari S, Barnett AM B, Ogbo FA, Eastwood J. Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy Childbirth 2019; 19:221. [PMID: 31266468 PMCID: PMC6604146 DOI: 10.1186/s12884-019-2378-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness. MAIN TEXT The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment. CONCLUSION The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care.
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Affiliation(s)
- Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW 2308 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
| | - Bryanne Barnett AM
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington Campus, Kensington, NSW 2052 Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052 Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006 Australia
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Andenes E. Når skjema blir ein del av omsorga:. TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-01-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Steardo L, Caivano V, Sampogna G, Di Cerbo A, Fico G, Zinno F, Del Vecchio V, Giallonardo V, Torella M, Luciano M, Fiorillo A. Psychoeducational Intervention for Perinatal Depression: Study Protocol of a Randomized Controlled Trial. Front Psychiatry 2019; 10:55. [PMID: 30814962 PMCID: PMC6381058 DOI: 10.3389/fpsyt.2019.00055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022] Open
Abstract
Perinatal depression (PD) is a severe and disabling condition impacting negatively on children in terms of adverse neonatal outcomes and on the well-being of women and their families. All pregnant women attending the unit of Gynecology and Obstetrics Service of the University of Campania "L. Vanvitelli" will be screened for PD using the Edinburgh Postpartum Depression Scale (EPDS). Women with a score ≥10 at the EPDS will be invited to receive a full psychiatric assessment. The required sample size is of 126 women with PD which will be randomly allocated to either an experimental group, receiving a uni-familiar psychoeducational intervention, or to a control group, receiving the Best Treatment Option (BTO). Patients will be evaluated through several assessment instruments: Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Manchester Short Assessment of Quality of Life (MANSA), Family Assessment Device (FAD), Family Coping Questionnaire (FCQ), and Pattern of Care Schedule (PCS). Patients will be evaluated at baseline, 3, 6, 9, and 12 months post-randomization. The severity of depressive symptoms at the HAM-D scale has been selected as primary outcome. Other outcome measures include improvement in the severity of anxiety symptoms, of global and personal functioning, an improvement in family members' coping strategies and in the level of quality of life. It has been highlighted the importance of developing screening and treating programs for PD, and our study will use rigorous study design to evaluate the efficacy of the adaption of a well-known family psychoeducational model to the treatment of PD. The aims of present trial are to: (1) develop an informative package for pregnant women with PD; (2) promote a screening programme for PD; (3) identify those (socio-demographic and pregnancy-related environmental) factors associated with a higher risk to develop a perinatal or postnatal depression; (4) evaluate the efficacy of a new experimental psychoeducational intervention in reducing the depressive symptoms during pregnancy compared to the BTO.
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Affiliation(s)
- Luca Steardo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vito Caivano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Arcangelo Di Cerbo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanna Fico
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Zinno
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Torella
- Department of Gynecology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Sims DJ, Fowler C. Postnatal psychosocial assessment and clinical decision-making, a descriptive study. J Clin Nurs 2018; 27:3739-3749. [PMID: 29775993 DOI: 10.1111/jocn.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. DESIGN A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. METHODS This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment. RESULTS The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. CONCLUSION The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. RELEVANCE TO CLINICAL PRACTICE Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.
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Affiliation(s)
- Deborah Jane Sims
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Cathrine Fowler
- Faculty of Health, Tresillian Chair in Child and Family Health, University of Technology Sydney, Ultimo, NSW, Australia
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Perinatal mental health and psychosocial risk screening in a community maternal and child health setting: evaluation of a digital platform. Prim Health Care Res Dev 2018. [DOI: 10.1017/s1463423618000336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Screening women for depression and psychosocial risk during the perinatal period is recognised best practice. Screening by current pen and paper methods can be time consuming, and prone to scorer error. The lack of readily available translated versions of screening tools also excludes many women from different cultures.
Aim
To evaluate a perinatal mental health digital screening platform, iCOPE. The trial was conducted in a community maternal and child health setting in Melbourne, Australia.
Method
A descriptive, cohort design was used. All women attending the urban clinic were invited to complete their routine perinatal screening on the digital platform, designed to automate score calculations and produce instant clinical and client reports whilst collecting data in real time. Screening included the Edinburgh Postnatal Depression Scale (EPDS) and psychosocial risk questions in line with current national clinical guidelines. Functionality of iCOPE was assessed according to duration of screening, completion rates, accuracy of reporting and level of engagement by women.
Results
During the trial, 144 screens were performed. The mean screening time was 6.7 min (SD=3.78). Most (65.7% n=94) women took between 3 and 6 min. Mean EPDS score was 7.2 with 16% (n=23) scoring 13 or more. The accuracy of reports was 100% and screening completion rate was 99.3%. Many women (81.3%) requested a copy of their personal report.
Discussion
The iCOPE platform was efficient in terms of screening time, scoring accuracy, and engagement of women. The automated production of tailored client and clinical reports enabled screening outcomes to be instantly communicated to women and health professionals. The collection of data in real time facilitated the monitoring of screening rates and evaluation of outcomes by clinicians and service managers.
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Abstract
Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.
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Marsay C, Manderson L, Subramaney U. Changes in mood after screening for antenatal anxiety and depression. J Reprod Infant Psychol 2018; 36:347-362. [PMID: 29601209 DOI: 10.1080/02646838.2018.1453601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Screening programmes with referral are a valuable strategy for mitigating consequences of perinatal depression on mothers and their families. The effectiveness of these screening programmes needs to be measured. One potential problem in assessing outcomes is measurement reactivity where the actual measure results in changes in the people being measured. AIM The aim of this article is to explain the mechanisms and circumstances by which measurement reactivity occurred in a sample of antenatal women who participated in a screening interview. METHODS Fifty-five women who participated in an antenatal screening interview in their second trimester were re-interviewed in their third trimester. These qualitative interviews were conducted between September 2015 and April 2016. RESULTS The qualitative data suggested that measurement reactivity occurred through mechanisms such as the disclosure, gaining self-knowledge, validation of experiences, and personal agency which resulted in them seeking out support from others. CONCLUSION Although the screening interview appeared to improve women's outcomes, this may have occurred through measurement reactivity. This needs to be considered when designing studies that aim to assess the effectiveness of screening with intervention for antenatal depression.
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Affiliation(s)
- Carina Marsay
- a Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Parktown , South Africa
| | - Lenore Manderson
- b Public Health and Medical Anthropology, School of Public Health , University of the Witwatersrand , Parktown , South Africa
| | - Ugasvaree Subramaney
- c Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Littlewood E, Ali S, Dyson L, Keding A, Ansell P, Bailey D, Bates D, Baxter C, Beresford-Dent J, Clarke A, Gascoyne S, Gray C, Hackney L, Hewitt C, Hutchinson D, Jefferson L, Mann R, Marshall D, McMillan D, North A, Nutbrown S, Peckham E, Pervin J, Richardson Z, Swan K, Taylor H, Waterhouse B, Wills L, Woodhouse R, Gilbody S. Identifying perinatal depression with case-finding instruments: a mixed-methods study (BaBY PaNDA – Born and Bred in Yorkshire PeriNatal Depression Diagnostic Accuracy). HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background
Perinatal depression is well recognised as a mental health condition but < 50% of cases are identified in routine practice. A case-finding strategy using the Whooley questions is currently recommended by the National Institute for Health and Care Excellence.
Objectives
To determine the diagnostic accuracy, acceptability and cost-effectiveness of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to identify perinatal depression.
Design
A prospective diagnostic accuracy cohort study, with concurrent qualitative and economic evaluations.
Setting
Maternity services in England.
Participants
A total of 391 pregnant women.
Main outcome measures
Women completed the Whooley questions, EPDS and a diagnostic reference standard (Clinical Interview Schedule – Revised) during pregnancy (20 weeks) and postnatally (3–4 months). Qualitative interviews were conducted with health professionals (HPs) and a subsample of women.
Results
Diagnostic accuracy results: depression prevalence rates were 10.3% during pregnancy and 10.5% postnatally. The Whooley questions and EPDS (cut-off point of ≥ 10) performed reasonably well, with comparable sensitivity [pregnancy: Whooley questions 85.0%, 95% confidence interval (CI) 70.2% to 94.3%; EPDS 82.5%, 95% CI 67.2% to 92.7%; postnatally: Whooley questions 85.7%, 95% CI 69.7% to 95.2%; EPDS 82.9%, 95% CI 66.4% to 93.4%] and specificity (pregnancy: Whooley questions 83.7%, 95% CI 79.4% to 87.4%; EPDS 86.6%, 95% CI 82.5% to 90.0%; postnatally: Whooley questions 80.6%, 95% CI 75.7% to 84.9%; EPDS 87.6%, 95% CI 83.3% to 91.1%). Diagnostic accuracy of the EPDS (cut-off point of ≥ 13) was poor at both time points (pregnancy: sensitivity 45%, 95% CI 29.3% to 61.5%, and specificity 95.7%, 95% CI 93.0% to 97.6%; postnatally: sensitivity 62.9%, 95% CI 44.9% to 78.5%, and specificity 95.7%, 95% CI 92.7% to 97.7%). Qualitative evaluation: women and HPs were supportive of screening/case-finding for perinatal depression. The EPDS was preferred to the Whooley questions by women and HPs, mainly because of its ‘softer’ wording. Whooley question 1 was thought to be less acceptable, largely because of the terms ‘depressed’ and ‘hopeless’, leading to women not revealing their depressive symptoms. HPs identified a ‘patient-centred’ environment that focused on the mother and baby to promote discussion about mental health. Cost-effectiveness results: screening/case-finding using the Whooley questions or the EPDS alone was not the most cost-effective strategy. A two-stage strategy, ‘Whooley questions followed by the Patient Health Questionnaire’ (a measure assessing depression symptomatology), was the most cost-effective strategy in the range between £20,000 and £30,000 per quality-adjusted life-year in both the prenatal and postnatal decision models.
Limitations
Perinatal depression diagnosis was not cross-referenced with women’s medical records so the proportion of new cases identified is unknown. The clinical effectiveness and cost-effectiveness of screening/case-finding strategies was not assessed as part of a randomised controlled trial.
Conclusions
The Whooley questions and EPDS had acceptable sensitivity and specificity, but their use in practice might be limited by low predictive value and variation in their acceptability. A two-stage strategy was more cost-effective than single-stage strategies. Neither case-finding instrument met National Screening Committee criteria.
Future work
The yield of screening/case-finding should be established with reference to health-care records. The clinical effectiveness and cost-effectiveness of screening/case-finding for perinatal depression needs to be tested in a randomised controlled trial.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Elizabeth Littlewood
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lisa Dyson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Pat Ansell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Della Bailey
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Debrah Bates
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Catherine Baxter
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Jules Beresford-Dent
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha Gascoyne
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Carol Gray
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Lisa Hackney
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Dorothy Hutchinson
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Laura Jefferson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rachel Mann
- Department of Health Sciences, University of York, York, UK
| | - David Marshall
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Alice North
- Patient and public involvement representative, York, UK
| | - Sarah Nutbrown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kelly Swan
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Holly Taylor
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Bev Waterhouse
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Louise Wills
- Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Harrogate, UK
| | - Rebecca Woodhouse
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
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15
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Fletcher R, Kay-Lambkin F, May C, Oldmeadow C, Attia J, Leigh L. Supporting men through their transition to fatherhood with messages delivered to their smartphones: a feasibility study of SMS4dads. BMC Public Health 2017; 17:953. [PMID: 29237439 PMCID: PMC5729488 DOI: 10.1186/s12889-017-4978-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022] Open
Abstract
Background The transition to parenthood can be a challenging time, in which both mothers and fathers experience increased risk of distress and depression. Mothers are more likely than fathers to engage with services and have their mental health monitored and attended to during the perinatal period. The present study aimed to explore whether smartphone technology could be used to address fathers’ needs across their transition to fatherhood. Methods A corpus of messages, including linked information and mood tracking software, was designed to support and enhance paternal relationships with their babies, their partners and themselves across the perinatal period. Messages were sent to project participants (N = 520) from 12-weeks’ gestation to 24-weeks after birth. Results Of those fathers enrolled (N = 520), 21.5% scored >13 on K6 and completion rate (85%) was similar between these and other fathers. Most fathers (63.1%) clicked at least one link and responses were received for 20.5% of mood tracker questions. The probability of reporting worse mood scores decreased over time. Fathers completing post study surveys (N = 101) reported that messages helped them in their experience of becoming a new dad (92.8%), as well as helping them develop a strong relationship with their new child (54.9%), and in their relationship with their partner (79%). Conclusions The present study has demonstrated that it is both feasible and acceptable to support new fathers with SMS4dads, a relationship-focused messaging system designed to be delivered to smartphones across fathers’ transition to parenthood.
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Affiliation(s)
- Richard Fletcher
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Francis Kay-Lambkin
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Chris May
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, LOT 1 kookaburra circuit, New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, LOT 1 kookaburra circuit, New Lambton Heights, NSW, 2305, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, LOT 1 kookaburra circuit, New Lambton Heights, NSW, 2305, Australia
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16
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Improving help-seeking for postnatal depression and anxiety: a cluster randomised controlled trial of motivational interviewing. Arch Womens Ment Health 2017; 20:791-801. [PMID: 28776105 DOI: 10.1007/s00737-017-0767-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/24/2017] [Indexed: 12/12/2022]
Abstract
Low uptake of treatment by women with symptoms of postnatal depression and anxiety is consistently reported. This study examined whether a brief motivational interviewing (MI) intervention delivered by Maternal and Child Health Nurses (MCHNs) during routine emotional health assessments improves help-seeking following childbirth. In this parallel two-group cluster randomised controlled trial, MCHNs delivered a MI intervention ('PRIMER', n = 20) or Routine Care (n = 20) at women's (n = 541) postnatal consultations. The primary outcome was help-seeking over the 12 months post-birth. Other outcomes were emotional distress measured by the Edinburgh Postnatal Depression Scale, Beck Depression Inventory-Revised and Depression Anxiety Stress Scales, and barriers to help-seeking obtained by self-report via a checklist of potential barriers that was presented to women to select from if applicable. 27.4% of the sample experienced emotional distress over the 12 months post-birth. When comparing women who experienced emotional distress with those who did not, odds of seeking help were 4.0 times higher for the MI condition than Routine Care (p = .004). Of the women who sought help from a psychologist, 47.6% in the MI condition attended 6 + sessions versus 20.0% in Routine Care (numbers too small for reliable significance test). There was a non-significant trend of lower depression, anxiety and stress in the MI condition. Three risk factors for postnatal depression predicted help-seeking: antenatal anxiety (OR = 2.8, p = .002), depression history (OR = 2.5, p = .002) and self-esteem (OR = 0.7, p = .04). Common barriers to seeking help were thinking that one would or should be able to manage without help (endorsed by 11.1%). Treatment uptake for postnatal distress can be increased with MI. Training MCHNs in MI was feasible and valued. Given the devastating effects of depression, further research is needed to ascertain whether MI can improve mental health outcomes. Australian New Zealand Clinical Trials Registry (ACTRN12611000635965), 22 June 2011.
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17
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Kingston D, Biringer A, Veldhuyzen van Zanten S, Giallo R, McDonald S, MacQueen G, Vermeyden L, Austin MP. Pregnant Women's Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial. JMIR Ment Health 2017; 4:e42. [PMID: 29054833 PMCID: PMC5670313 DOI: 10.2196/mental.6888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/18/2017] [Accepted: 07/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pregnant women's perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. OBJECTIVE The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women's perceptions of risk and benefit of disclosure. METHODS Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women's perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. RESULTS Of the 675 eligible women approached, 636 (94.2%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. CONCLUSIONS Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women's vulnerability throughout the screening process with strategies such as addressing women's concerns, explaining the rationale for screening, and discussing how results will be used. TRIAL REGISTRATION Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6tRKtGC4M).
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Affiliation(s)
| | | | | | - Rebecca Giallo
- Murdoch Children's Research Institute, Victoria, Australia
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18
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Gilbert AL, Balio C, Bauer NS. Making the Legal and Ethical Case for Universal Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Curr Probl Pediatr Adolesc Health Care 2017; 47:267-277. [PMID: 28916453 DOI: 10.1016/j.cppeds.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postpartum depression (PPD), part of a larger spectrum of perinatal mood and anxiety disorders, affects up to 15% of women following the birth of an infant. Fathers may also be affected. PPD not only affects caregivers, but also impacts infants through mechanisms such as inadequate caregiver-infant interactions and non-adherence to safety practices. The negative impact on infants may extend across the life course through adulthood. This article seeks to move the needle toward universal screening for PPD using validated tools in pediatric primary care settings for new caregivers by making the legal and ethical case for this course of action in a manner that is both compelling and accessible for clinicians. Toward this end, we summarize current literature as it applies to provider responsibilities, liabilities and perspectives; and caregiver autonomy, confidentiality, and privacy. We then assess utility by balancing the benefits and burdens of this approach to practices, providers, and caregivers; and take the analysis one step further by looking across multiple populations to assess distributive justice. We conclude that there is a strong ethical case for universal screening for PPD in pediatric primary care settings using validated tools when informed consent can be obtained and appropriate follow-up services are available and accessible. Clinical considerations, practical resources, and areas ripe for future research are also addressed.
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Affiliation(s)
- Amy Lewis Gilbert
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
| | - Casey Balio
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Nerissa S Bauer
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
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It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings. Obstet Gynecol Surv 2017; 72:553-568. [DOI: 10.1097/ogx.0000000000000477] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ing H, Fellmeth G, White J, Stein A, Simpson JA, McGready R. Validation of the Edinburgh Postnatal Depression Scale (EPDS) on the Thai-Myanmar border. Trop Doct 2017; 47:339-347. [PMID: 28699396 PMCID: PMC5613805 DOI: 10.1177/0049475517717635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Postnatal depression is common and may have severe consequences for women and their children. Locally validated screening tools are required to identify at-risk women in marginalised populations. The Edinburgh Postnatal Depression Scale (EPDS) is one of the most frequently used tools globally. This cross-sectional study assessed the validity and acceptability of the EPDS in Karen and Burmese among postpartum migrant and refugee women on the Thai–Myanmar border. The EPDS was administered to participants and results compared with a diagnostic interview. Local staff provided feedback on the acceptability of the EPDS through a focus group discussion. Results from 670 women showed high accuracy and reasonable internal consistency of the EPDS. However, acceptability to local staff was low, limiting the utility of the EPDS in this setting despite its good psychometrics. Further work is required to identify a tool that is acceptable and sensitive to cultural manifestations of depression in this vulnerable population.
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Affiliation(s)
- Harriet Ing
- 1 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gracia Fellmeth
- 1 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,2 Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jitrachote White
- 1 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Alan Stein
- 3 Department of Psychiatry, University of Oxford, Oxford, UK
| | - Julie A Simpson
- 4 School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rose McGready
- 1 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,5 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Amlôt R, Carter H, Riddle L, Larner J, Chilcott RP. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR). PLoS One 2017. [PMID: 28622352 PMCID: PMC5473560 DOI: 10.1371/journal.pone.0179309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an "Initial Operational Response" by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer's forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.
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Affiliation(s)
- Richard Amlôt
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
- * E-mail:
| | - Holly Carter
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Lorna Riddle
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Joanne Larner
- Research Centre for Topical Drug Delivery and Toxicology, School of Pharmacy, University of Hertfordshire, Hatfield, United Kingdom
| | - Robert P. Chilcott
- Research Centre for Topical Drug Delivery and Toxicology, School of Pharmacy, University of Hertfordshire, Hatfield, United Kingdom
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Walker LO, Murphey CL, Xie B. Missed Opportunities for Postpartum Behavioral and Psychosocial Health Care and Acceptability of Screening Options. J Obstet Gynecol Neonatal Nurs 2016; 45:614-24. [DOI: 10.1016/j.jogn.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
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Littlewood E, Ali S, Ansell P, Dyson L, Gascoyne S, Hewitt C, Keding A, Mann R, McMillan D, Morgan D, Swan K, Waterhouse B, Gilbody S. Identification of depression in women during pregnancy and the early postnatal period using the Whooley questions and the Edinburgh Postnatal Depression Scale: protocol for the Born and Bred in Yorkshire: PeriNatal Depression Diagnostic Accuracy (BaBY PaNDA) study. BMJ Open 2016; 6:e011223. [PMID: 27297012 PMCID: PMC4916566 DOI: 10.1136/bmjopen-2016-011223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Perinatal depression is well recognised as a mental health condition but <50% of cases are identified by healthcare professionals in routine clinical practice. The Edinburgh Postnatal Depression Scale (EPDS) is often used to detect symptoms of postnatal depression in maternity and child services. The National Institute for Health and Care Excellence (NICE) recommends 2 'ultra-brief' case-finding questions (the Whooley questions) to aid identification of depression during the perinatal period, but this recommendation was made in the absence of any validation studies in a perinatal population. Limited research exists on the acceptability of these depression case-finding instruments and the cost-effectiveness of routine screening for perinatal depression. METHODS AND ANALYSIS The diagnostic accuracy of the Whooley questions and the EPDS will be determined against a reference standard (the Client Interview Schedule-Revised) during pregnancy (around 20 weeks) and the early postnatal period (around 3-4 months post partum) in a sample of 379 women. Further outcome measures will assess a range of psychological comorbidities, health-related quality of life and resource utilisation. Women will be followed up 12 months postnatally. The sensitivity, specificity and predictive values of the Whooley questions and the EPDS will be calculated against the reference standard at 20 weeks pregnancy and 3-4 months post partum. Acceptability of the depression case-finding instruments to women and healthcare professionals will involve in-depth qualitative interviews. An existing decision analytic model will be adapted to determine the cost-effectiveness of routine screening for perinatal depression. ETHICS AND DISSEMINATION This study is considered low risk for participants. Robust protocols will deal with cases where risk of depression, self-harm or suicide is identified. The protocol received favourable ethical opinion from the North East-York Research Ethics Committee (reference: 11/NE/0022). The study findings will be published in peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Elizabeth Littlewood
- Department of Health Sciences, Mental Health and Addiction Research Group, University of York, York, UK
| | - Shehzad Ali
- Department of Health Sciences, Mental Health and Addiction Research Group, University of York, York, UK
| | - Pat Ansell
- Department of Health Sciences, Epidemiology and Cancer Statistics Research Group, University of York, York, UK
| | - Lisa Dyson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha Gascoyne
- Department of Health Sciences, Mental Health and Addiction Research Group, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rachel Mann
- Social Policy Research Unit, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, Mental Health and Addiction Research Group, University of York, York, UK Hull York Medical School, University of York, York, UK
| | | | - Kelly Swan
- Department of Health Sciences, Epidemiology and Cancer Statistics Research Group, University of York, York, UK
| | - Bev Waterhouse
- Children, Women & Families Division, Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Halifax, UK
| | - Simon Gilbody
- Department of Health Sciences, Mental Health and Addiction Research Group, University of York, York, UK Hull York Medical School, University of York, York, UK
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate the rationale for screening women for postpartum depression• Assess tools for screening for postpartum depression OBJECTIVE To perform a qualitative literature review on screening for postpartum depression (PPD), as applicable to the general psychiatrist. Results are classified by instrument, timing, and clinical setting of the screen. DATA SOURCES A literature search was conducted using the PubMed database for English-language articles published since January 1987. Of the 2406 citations initially identified, 61 articles remained after application of inclusion and exclusion criteria. RESULTS Among numerous screening tools for PPD, the Edinburgh Postnatal Depression Scale is the most widely used. Data suggest that screening for PPD should commence soon after delivery, with subsequent screens at multiple time-points in the postpartum period. Primary care, pediatric, and obstetric settings are all viable locations for screening, but are ineffective without follow-up mental health evaluations. Less data are available to define optimal patterns either for screening in psychiatric settings or for the psychiatrist's role in managing perinatal depression. CONCLUSIONS The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and most authors firmly recommend screening for PPD. The Edinburgh Postnatal Depression Scale can be administered in various clinical settings. Screening should occur at multiple time-points throughout the first postpartum year. The psychiatrist's role in early detection and prevention of PPD requires further exploration.
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25
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Feeley N, Bell L, Hayton B, Zelkowitz P, Carrier ME. Care for Postpartum Depression: What Do Women and Their Partners Prefer? Perspect Psychiatr Care 2016; 52:120-30. [PMID: 25711930 DOI: 10.1111/ppc.12107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the preferences of those who accept a mental health assessment and those who do not. DESIGN AND METHODS Thirty couples participated in a qualitative study. Nineteen couples accepted a mental health assessment and 11 declined. FINDINGS Acceptors wanted more contact with professionals. Decliners preferred support from their informal network, parental leave, and exercise. However, acceptors also cited these preferences. PRACTICE IMPLICATIONS Nurses should tailor care to couples' preferences, helping them identify and utilize preferred resources. Mental health care might be more acceptable to decliners if provided in obstetrical care.
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Affiliation(s)
- Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Linda Bell
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Barbara Hayton
- Perinatal Mental Health Service, Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Eve Carrier
- Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Williams C, Turner K, Burns A, Bennert K. Midwives and women׳s views on using UK recommended depression case finding questions in antenatal care. Midwifery 2016; 35:39-46. [DOI: 10.1016/j.midw.2016.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/07/2015] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
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BenDavid DN, Hunker DF, Spadaro KC. Uncovering the Golden Veil: Applying the Evidence for Telephone Screening to Detect Early Postpartum Depression. J Perinat Educ 2016; 25:37-45. [PMID: 26848249 DOI: 10.1891/1058-1243.25.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Postpartum depression (PPD) is often detected later than symptom onset, or even undetected, because of lack of prompt or adequate screening. An evidence-based PPD screening protocol using a telephone-based format within a primary care practice was developed to identify symptoms and initiate treatment between 2 and 3 weeks postpartum. The Edinburgh Postnatal Depression Scale was used, with positive screens referred for provider and support services, and then tracked for follow-through. Fifty-two percent of women screened positive. Sixty-four percent accepted both provider and support referrals, with 89% follow-through with provider referrals and 78% follow-through with support referrals. Outcomes support early screening for PPD using a telephone-based format to effectively identify symptoms and acceptance of referrals by participants.
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Kingston D, Austin MP, McDonald SW, Vermeyden L, Heaman M, Hegadoren K, Lasiuk G, Kingston J, Sword W, Jarema K, Veldhuyzen van Zanten S, McDonald SD, Biringer A. Pregnant Women's Perceptions of Harms and Benefits of Mental Health Screening. PLoS One 2015; 10:e0145189. [PMID: 26696004 PMCID: PMC4687889 DOI: 10.1371/journal.pone.0145189] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background A widely held concern of screening is that its psychological harms may outweigh the benefits of early detection and treatment. This study describes pregnant women's perceptions of possible harms and benefits of mental health screening and factors associated with identifying screening as harmful or beneficial. Methods This study analyzed a subgroup of women who had undergone formal or informal mental health screening from our larger multi-site, cross-sectional study. Pregnant women >16 years of age who spoke/read English were recruited (May-December 2013) from prenatal classes and maternity clinics in Alberta, Canada. Descriptive statistics were generated to summarize harms and benefits of screening and multivariable logistic regression identified factors associated with reporting at least one harm or affirming screening as a positive experience (January-December 2014). Results Overall study participation rate was 92% (N = 460/500). Among women screened for mental health concerns (n = 238), 63% viewed screening as positive, 69% were glad to be asked, and 87% took it as evidence their provider cared about them. Only one woman identified screening as a negative experience. Of the 6 harms, none was endorsed by >7% of women, with embarrassment being most cited. Women who were very comfortable (vs somewhat/not comfortable) with screening were more likely to report it as a positive experience. Limitations Women were largely Caucasian, well-educated, partnered women; thus, findings may not be generalizable to women with socioeconomic risk. Conclusions Most women perceived prenatal mental health screening as having high benefit and low harm. These findings dispel popular concerns that mental health screening is psychologically harmful.
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Affiliation(s)
- Dawn Kingston
- Faculty of Nursing, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Marie-Paule Austin
- St John of God Chair Perinatal & Women’s Mental Health, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sheila W. McDonald
- Population, Public, and Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Lydia Vermeyden
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Maureen Heaman
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Gerri Lasiuk
- Faculty of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Joshua Kingston
- Faculty of Science (Computer Science), MacEwan University, Edmonton, Alberta, Canada
| | - Wendy Sword
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Karly Jarema
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sarah D. McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Radiology, and Clinical, Epidemiology & Biostatistics McMaster University, Hamilton, Ontario, Canada
| | - Anne Biringer
- Department of Family and Community Medicine, University of Toronto, Ada and Slaight Family Director of Maternity Care, Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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A systematic review on the acceptability of perinatal depression screening. J Affect Disord 2015; 188:284-303. [PMID: 26386439 DOI: 10.1016/j.jad.2015.06.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perinatal depression (PND) affects approximately 10-15% of women, worldwide. PND screening, using screening tools, has been undertaken by a broad range of healthcare professionals in different settings. Our objective was to explore the acceptability of PND screening and how acceptability was being assessed. METHODS A systematic literature review of studies that explored the acceptability of PND screening was carried out throughout MEDLINE, PsycINFO, PubMed, CINAHL, Embase, Maternity and Infant Care and Joanna Briggs Institute databases. RESULTS Twenty-eight out of twenty-nine publications reported PND screening to be acceptable to most participants. A wide range of terms, questions and statements was used to infer, assess or report on acceptability. There was no uniform, psychometrically tested tool used to measure acceptability across the studies. LIMITATIONS Broad inclusion criteria and methodological differences limited comparisons, but are overcome by the comprehensiveness of the data and the lack of uniformity across studies. CONCLUSIONS Even though PND screening appears acceptable, it is difficult to draw conclusions about PND screening acceptability as studies used different methods to infer, assess or report on acceptability. The lack of a uniform, psychometrically tested tool to measure acceptability is not unique to PND. Nonetheless, the majority of perinatal women and healthcare professionals reported positive attitudes towards PND screening using different tools in different settings, indicating that it may be the responsibility of all healthcare professionals who come into contact with perinatal women.
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Kingston DE, Biringer A, McDonald SW, Heaman MI, Lasiuk GC, Hegadoren KM, McDonald SD, Veldhuyzen van Zanten S, Sword W, Kingston JJ, Jarema KM, Vermeyden L, Austin MP. Preferences for Mental Health Screening Among Pregnant Women: A Cross-Sectional Study. Am J Prev Med 2015; 49:e35-43. [PMID: 26143952 DOI: 10.1016/j.amepre.2015.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The process of mental health screening can influence disclosure, uptake of referral, and treatment; however, no studies have explored pregnant women's views of methods of mental health screening. The objectives of this study are to determine pregnant women's comfort and preferences regarding mental health screening. METHODS Pregnant women were recruited (May-December 2013) for this cross-sectional descriptive survey from prenatal classes and maternity clinics in Alberta, Canada, if they were aged >16 years and spoke/read English. Descriptive statistics summarized acceptability of screening, and multivariable logistic regression identified factors associated with women's comfort with screening methods. Analysis was conducted in January-December 2014. RESULTS The participation rate was 92% (N=460/500). Overall, 97.6% of women reported that they were very (74.8%) or somewhat (22.8%) comfortable with mental health screening in pregnancy. Women were most comfortable with completing paper- (>90%) and computer-based (>82%) screening in a clinic or at home, with fewest reporting comfort with telephone-based screening (62%). The majority of women were very/somewhat comfortable with provider-initiated (97.4%) versus self-initiated (68.7%) approaches. Women's ability to be honest with their provider about emotional health was most strongly associated with comfort with each method of screening. CONCLUSIONS The majority of pregnant women viewed prenatal mental health screening favorably and were comfortable with a variety of screening methods. These findings provide evidence of high acceptability of screening--a key criterion for implementation of universal screening--and suggest that providers can select from a variety of screening methods best suited for their clinical setting.
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Affiliation(s)
- Dawn E Kingston
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.
| | - Anne Biringer
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sheila W McDonald
- Population, Public, and Aboriginal Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Maureen I Heaman
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gerri C Lasiuk
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathy M Hegadoren
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, Radiology, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Wendy Sword
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Joshua J Kingston
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Karly M Jarema
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lydia Vermeyden
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Marie-Paule Austin
- St. John of God Chair Perinatal and Women's Mental Health, School Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Mann R, Adamson J, Gilbody S. The acceptability of case-finding questions to identify perinatal depression. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.9.630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joy Adamson
- Senior Lecturer in Epidemiology University of York
| | - Simon Gilbody
- Director of the Mental Health and Addictions Research Group University of York and Hull York Medical School
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Intimate partner violence and suicidal ideation in pregnant women. Arch Womens Ment Health 2015; 18:573-8. [PMID: 25753680 PMCID: PMC4506210 DOI: 10.1007/s00737-015-0515-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
Intimate partner violence (IPV) during pregnancy is a major public health issue with significant implications for maternal mental health. Less studied is the association between IPV during pregnancy and suicidal ideation. This study reports the prevalence and correlates of suicidal ideation among low-income pregnant women receiving prenatal care at a university obstetrical clinic from February 2009 to March 2010. We performed a cross-sectional analysis of 166 women surveyed between 24 and 28 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen (AAS). Multiple logistic regression identified factors associated with antenatal suicidal ideation. The prevalence of suicidal ideation was 22.89 %. In the fully adjusted model, antenatal depressive symptomatology (OR = 17.04; 95 % CI 2.10-38.27) and experiencing IPV (OR = 9.37; 95 % CI 3.41-25.75) were significantly associated with an increased risk of antenatal suicidal ideation. The prevalence of antenatal suicidal ideation in the current study was higher than other population-based samples though this sample was predominantly single, low-income, and 19 % experienced IPV during pregnancy. Given the strong association of antenatal suicidal ideation, depressive symptomatology, and IPV, health care providers are urged to identify those women at risk so that antenatal care can be tailored to best support optimal maternal and neonatal outcomes.
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Reilly N, Yin C, Monterosso L, Bradshaw S, Neale K, Harrison B, Austin MP. Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Reilly
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Carolyn Yin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Leanne Monterosso
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
- University of Notre Dame Australia; Murdoch Western Australia Australia
- School of Nursing and Midwifery; Edith Cowan University of Western Australia; Joondalup Western Australia Australia
| | - Sue Bradshaw
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Kizzi Neale
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Beate Harrison
- Murdoch Raphael Centre; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
- The Black Dog Institute; Prince of Wales Hospital; Burwood New South Wales Australia
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Perelini F, Blair N, Wilson N, Farrell A, Aitken A. Family acceptability of school-based echocardiographic screening for rheumatic heart disease in a high-risk population in New Zealand. J Paediatr Child Health 2015; 51:682-8. [PMID: 25756837 DOI: 10.1111/jpc.12829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/30/2022]
Abstract
AIM Echocardiographic screening for rheumatic heart disease has been piloted in high-risk areas in New Zealand and internationally, and fulfils most of the criteria for a targeted screening programme. The question of acceptability of rheumatic heart disease screening has not been assessed, and the aim of our study was to assess parental acceptability of a school-based echocardiographic screening programme in a high-risk population in New Zealand. METHODS A post-screening questionnaire was developed to survey parents of children who underwent echocardiographic screening. The families of 34 children with abnormal scan results and a sample of 80 children with normal scan results were surveyed by phone within 4 months of screening. RESULTS Positive results were seen in all survey questions in both normal and abnormal scan groups. All families were supportive of an ongoing screening programme. Of children with abnormal results, 62% of their parents reported that they would treat their child differently; however, all responses were positive health-promoting outcomes. CONCLUSION The study showed strong positive support for school-based echocardiographic screening by a community with high acute rheumatic fever incidence. The study did not detect any short-term negative effects in those with abnormal results. The survey result shows family and community support for the establishment of echocardiographic screening programmes in high acute rheumatic fever areas provided there is adequate infrastructural support.
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Affiliation(s)
- Fiona Perelini
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nikki Blair
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nigel Wilson
- Green Lane Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Alan Farrell
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Andrew Aitken
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
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Milgrom J, Gemmill AW, Ericksen J, Burrows G, Buist A, Reece J. Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Aust N Z J Psychiatry 2015; 49:236-45. [PMID: 25586754 DOI: 10.1177/0004867414565474] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women. Antidepressant treatment may have a number of practical disadvantages, including a preference by women to avoid medication while breastfeeding. Consequently, more information about the relative benefits of the two modalities in the perinatal period is helpful. In the treatment of depressive disorders there is some evidence that combination therapies (pharmacological plus psychological treatment) may be more efficacious than either form of mono-therapy in isolation. However, in the treatment of postnatal depression, such evidence is limited. METHOD Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either: 1) cognitive behavioural therapy (CBT); 2) sertraline, or 3) a combination of both treatment modalities. Psychometric measures were collected weekly for 12 weeks, with a follow-up at 24 weeks. RESULTS Symptoms of depression and anxiety were reduced to a significant degree following all three treatments. CBT mono-therapy was found to be superior to both sertraline mono-therapy and combination therapy after 12 weeks. The CBT mono-therapy group appeared to display the most rapid initial gains after treatment commencement. CONCLUSIONS In this sample, a specialised CBT program for postnatal depression was found to be superior as a mono-therapy compared to sertraline, a commonly prescribed SSRI antidepressant. This is in contrast to previous studies which have found no detectable difference in the efficacies of drug and psychological treatment for postnatal depression. Unlike some previous work, this study allowed a statistically independent evaluation of CBT mono-therapy for postnatal depression compared to both antidepressant and combination therapy. In line with previous studies in postpartum women, there was no detectable advantage of combining pharmacological and psychological treatments in the short term.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia
| | - Graham Burrows
- Department of Psychiatry, Austin Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Anne Buist
- Department of Psychiatry, Austin Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - John Reece
- RMIT University & Australian College of Applied Psychology, Melbourne, Australia
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Tahirkheli NN, Cherry AS, Tackett AP, McCaffree MA, Gillaspy SR. Postpartum depression on the neonatal intensive care unit: current perspectives. Int J Womens Health 2014; 6:975-87. [PMID: 25473317 PMCID: PMC4247145 DOI: 10.2147/ijwh.s54666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As the most common complication of childbirth affecting 10%–15% of women, postpartum depression (PPD) goes vastly undetected and untreated, inflicting long-term consequences on both mother and child. Studies consistently show that mothers of infants in the neonatal intensive care unit (NICU) experience PPD at higher rates with more elevated symptomatology than mothers of healthy infants. Although there has been increased awareness regarding the overall prevalence of PPD and recognition of the need for health care providers to address this health issue, there has not been adequate attention to PPD in the context of the NICU. This review will focus on an overview of PPD and psychological morbidities, the prevalence of PPD in mothers of infants admitted to NICU, associated risk factors, potential PPD screening measures, promising intervention programs, the role of NICU health care providers in addressing PPD in the NICU, and suggested future research directions.
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Affiliation(s)
- Noor N Tahirkheli
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amanda S Cherry
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alayna P Tackett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Mary Anne McCaffree
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stephen R Gillaspy
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Holloway EE, Sturrock BA, Lamoureux EL, Keeffe JE, Rees G. Depression screening among older adults attending low-vision rehabilitation and eye-care services: Characteristics of those who screen positive and client acceptability of screening. Australas J Ageing 2014; 34:229-34. [PMID: 24854153 DOI: 10.1111/ajag.12159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 (PHQ-2) in these settings. METHODS One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. RESULTS Thirty-seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%). CONCLUSION The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group.
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Affiliation(s)
- Edith E Holloway
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Bonnie A Sturrock
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Singapore Eye Research Institute, National University of Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Jill E Keeffe
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C. Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res 2014; 215:341-6. [PMID: 24370337 DOI: 10.1016/j.psychres.2013.10.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 09/24/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
The prevalence of postpartum depression is approximately 13%. Postpartum depression is associated with a higher maternal morbidity and mortality, and also with pervasive effects on the emotional, cognitive and behavioral development of the child. The aim of our study was to identify socio-demographic, psychosocial and obstetrical risk factors of postpartum depression in a middle class community sample, using a prospective design. We enrolled consecutively 312 pregnant outpatients in a single maternity unit. The first assessment was conducted between 32 and 41 weeks gestation, and a second time between 6 and 8 weeks after delivery. Depressive symptoms were measured using the French version of the Edinburgh Postnatal Depression Scale (EPDS). A cut-off score of 12/30 or above was considered as indicative of Major Depression. Of the initial sample of 312 women, 264 (84.6%) were followed-up between 6 and 8 weeks after delivery and considered for analysis. Depression during pregnancy, migrant status, and physical abuse by the partner were independently associated with postpartum depression when considered together, whereas physical complications were significantly associated with postpartum depression only when adjusting for antenatal depression. Depression during pregnancy, history of physical abuse, migrant status and postpartum physical complications are four major risk factors for postpartum depression.
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Affiliation(s)
- Adeline Gaillard
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Service Hospitalo-Universitaire, Centre Hospitalier Sainte Anne, Paris, France
| | - Yann Le Strat
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Laurent Mandelbrot
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Gynecology and Obstetrics Departments, Colombes, France
| | - Hawa Keïta
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Anesthesiology Department, Colombes, France
| | - Caroline Dubertret
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France.
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Kingston D, McDonald S, Tough S, Austin MP, Hegadoren K, Lasiuk G. Public views of acceptability of perinatal mental health screening and treatment preference: a population based survey. BMC Pregnancy Childbirth 2014; 14:67. [PMID: 24521267 PMCID: PMC3925362 DOI: 10.1186/1471-2393-14-67] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 02/05/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND At a prevalence rate of 13-25%, mental health problems are among the most common morbidities of the prenatal and postnatal periods. They have been associated with increased risk of preterm birth and low birthweight, child developmental delay, and poor child mental health. However, very few pregnant and postpartum women proactively seek help or engage in treatment and less than 15% receive needed mental healthcare. While system-related barriers limit accessibility and availability of mental health services, personal barriers, such as views of mental health and its treatment, are also cited as significant deterrents of obtaining mental healthcare. The purposes of this population-based study were to identify the public's views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views. METHODS A computer-assisted telephone survey was conducted by the Population Research Laboratory with a random sample of adults in Alberta, Canada. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Interviews were conducted in English and were less than 30 minutes in duration. Descriptive and multivariable regression analyses were conducted. RESULTS Among the 1207 respondents, 74.8% had post-secondary education, 16.3% were 18-34 years old, and two-thirds (66.1%) did not have children <18 years living at home. The majority of respondents strongly agreed/agreed that all women should be screened in the prenatal (63.0%) and postpartum periods (72.7%). Respondents reported that when seeking help and support their first choice would be a family doctor. Preferred treatments were talking to a doctor or midwife and counseling. Knowledge of perinatal mental health was the main factor associated with different treatment preferences. CONCLUSIONS The high acceptability of universal perinatal mental health screening among the public provides a strong message regarding the public value for routine screening during pregnancy and postpartum periods. Perinatal mental health literacy is the most prominent determinant of screening and treatment acceptability and preference. Efforts to enhance population literacy as part of a multifaceted perinatal mental health strategy may optimize pregnant and postpartum women's mental health.
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Affiliation(s)
- Dawn Kingston
- University of Alberta, 11405-87th Avenue, Edmonton, T6G 1C9 Alberta, Canada
| | | | | | | | - Kathy Hegadoren
- University of Alberta, 11405-87th Avenue, Edmonton, T6G 1C9 Alberta, Canada
| | - Gerri Lasiuk
- University of Alberta, 11405-87th Avenue, Edmonton, T6G 1C9 Alberta, Canada
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Kingston D, McDonald S, Biringer A, Austin MP, Hegadoren K, McDonald S, Giallo R, Ohinmaa A, Lasiuk G, MacQueen G, Sword W, Lane-Smith M, van Zanten SV. Comparing the feasibility, acceptability, clinical-, and cost-effectiveness of mental health e-screening to paper-based screening on the detection of depression, anxiety, and psychosocial risk in pregnant women: a study protocol of a randomized, parallel-group, superiority trial. Trials 2014; 15:3. [PMID: 24383441 PMCID: PMC3892094 DOI: 10.1186/1745-6215-15-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stress, depression, and anxiety affect 15% to 25% of pregnant women. However, substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. Moreover, pregnant women are often reluctant to disclose their mental health concerns to a healthcare provider. Identifying screening and assessment tools and procedures that are acceptable to both women and service providers, cost-effective, and clinically useful is needed. METHODS/DESIGN The primary objective of this randomized, parallel-group, superiority trial is to evaluate the feasibility and acceptability of a computer tablet-based prenatal psychosocial assessment (e-screening) compared to paper-based screening. Secondary objectives are to compare the two modes of screening on: (1) the level of detection of prenatal depression and anxiety symptoms and psychosocial risk; (2) the level of disclosure of symptoms; (3) the factors associated with feasibility, acceptability, and disclosure; (4) the psychometric properties of the e-version of the assessment tools; and (5) cost-effectiveness. A sample of 542 women will be recruited from large, primary care maternity clinics and a high-risk antenatal unit in an urban Canadian city. Pregnant women are eligible to participate if they: (1) receive care at one of the recruitment sites; (2) are able to speak/read English; (3) are willing to be randomized to e-screening; and (4) are willing to participate in a follow-up diagnostic interview within 1 week of recruitment. Allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment on a computer tablet, while those in the control group will complete the same assessment in paper-based form. All women will complete baseline questionnaires at the time of recruitment and will participate in a diagnostic interview within 1 week of recruitment. Research assistants conducting diagnostic interviews and physicians will be blinded. A qualitative descriptive study involving healthcare providers from the recruitment sites and women will provide data on feasibility and acceptability of the intervention. We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01899534.
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Affiliation(s)
- Dawn Kingston
- University of Alberta, 11405-87th Avenue, Edmonton, T6G 1C9, Canada.
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Christl B, Reilly N, Smith M, Sims D, Chavasse F, Austin MP. The mental health of mothers of unsettled infants: is there value in routine psychosocial assessment in this context? Arch Womens Ment Health 2013; 16:391-9. [PMID: 23775393 DOI: 10.1007/s00737-013-0360-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
This study aims to investigate the (1) pattern of psychosocial risk factors among mothers of unsettled infants, (2) the relationship between these risk factors and current mental health status and (3) acceptability of psychosocial risk assessment in the parentcraft setting. Women with unsettled infants aged up to 12 months were assessed using the Edinburgh Postnatal Depression Scale, a diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)) and a psychosocial assessment tool, the Postnatal Risk Questionnaire (PNRQ). Of the women, 27.5 % met the MINI diagnostic criteria for a current (predominantly) anxiety disorder, and 43.1 %, for a past psychiatric diagnosis. On the Edinburgh Postnatal Depression Scale, 29.9 % of women scored above 12 (mean 9.8; SD 5.1). The most common psychosocial risk factors were high trait anxiety (40.9 %), past mental health problems (40.7 %), perfectionistic traits (38.1 %) and 'abuse trauma' of any kind (31.6 %). The likelihood of meeting diagnostic criteria for a current mental illness was significantly increased for women who experienced emotional abuse during childhood (adj. odds ratio (OR) 3.386; p = 0.006), had high trait anxiety (adj. OR = 2.63, p = 0.003) or had a negative birth experience (adj. OR 2.78; p = 0.015). The majority of women (78 %) felt moderately to very comfortable completing the PNRQ. The results showed high rates of current anxiety disorders (almost twice that of the general postnatal population) and multiple significant psychosocial risk factors among mothers with unsettled infants. Identification of specific psychosocial risk factors in mothers of unsettled infants can help to address issues beyond infant settling difficulties such as mother-infant interaction, especially for mothers with unresolved issues around their own parenting or trauma history.
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Affiliation(s)
- Bettina Christl
- Perinatal and Women's Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, 13 Grantham St., Burwood, NSW, 2134, Australia,
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Screening parents of high-risk infants for emotional distress: rationale and recommendations. J Perinatol 2013; 33:748-53. [PMID: 23807720 DOI: 10.1038/jp.2013.72] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/13/2013] [Accepted: 05/23/2013] [Indexed: 11/08/2022]
Abstract
Having a baby hospitalized in a neonatal intensive care unit (NICU) is a potentially traumatic event for parents. This article summarizes research documenting heightened symptoms of depression and post-traumatic stress in these parents and reviews studies of the relationship of parental distress with impaired infant and child development. We describe an array of validated screening devices for depression and post-traumatic stress, along with research on risk factors for elevated scores. In making recommendations for screening both mothers and fathers for emotional distress in the NICU, we (a) present commentary on the pros and cons of screening, (b) propose a timetable for screening and (c) describe both supportive interventions for parents in the NICU and a variety of referral possibilities for parents most at risk.
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Milgrom J, Gemmill AW. Screening for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2013; 28:13-23. [PMID: 24095728 DOI: 10.1016/j.bpobgyn.2013.08.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 06/20/2013] [Accepted: 08/22/2013] [Indexed: 01/03/2023]
Abstract
Perinatal depression is prevalent, under-diagnosed and can have serious long-term effects on the wellbeing of women, their partners and infants. In the absence of active identification strategies, most women with perinatal depression will neither seek nor receive help. To enable early detection and timely intervention, universal screening is coming to be seen as best practice in many settings. Although the strength of recommendations and the preferred methods of identification vary in different countries (e.g. the Edinburgh Postnatal Depression Scale, brief case-finding questions), appropriate training for health professionals in wider psychosocial assessment is essential to maximise usefulness while minimising potential harms. Clear pathways of systematic follow up of all positive screening results with a diagnostic procedure and access to effective treatment are centrally important both for the clinical effectiveness of screening and for health system costs. It is also necessary to further build on the emerging evidence base for the clinical effectiveness of screening.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia
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Gemmill AW, Worotniuk T, Holt CJ, Skouteris H, Milgrom J. Maternal psychological factors and controlled child feeding practices in relation to child body mass index. Child Obes 2013; 9:326-37. [PMID: 23782306 DOI: 10.1089/chi.2012.0135] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The rise of childhood obesity in Western society has focused attention on parental feeding practices. Despite evidence that controlled feeding influences child weight, there is a paucity of research examining predictors of controlled feeding. The aim of this study was to determine whether maternal antenatal and/or concurrent anxiety and depressive symptoms, including stress, predicted controlled feeding and whether maternal controlled feeding practices, in turn, predict child BMI. METHODS In total, 203 mothers participated in a longitudinal follow-up survey. Mothers' self-reported symptoms of anxiety and depression were measured both in pregnancy and at 2-7 years postpartum. Maternal-reported child BMI and maternal use of restriction, pressure to eat, and monitoring were measured at 2-7 years postpartum. RESULTS Feeding practices were not uniformly predictive of child BMI. Maternal use of restriction and monitoring were partially positively predicted by concurrent maternal stress and negatively partially predicted by concurrent depression. Thus, mothers enduring high stress appeared to employ more controlled feeding patterns, whereas mothers experiencing depression seemingly employed lower levels of controlled feeding. CONCLUSIONS Findings that maternal anxiety and depression affect levels of controlled feeding are of particular interest and broadly supportive of the few existing studies. Given the mixed results linking controlled feeding to child BMI reported in previous research, further work is required to determine the relationships between maternal mood, child feeding practices, and BMI.
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Affiliation(s)
- Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria, Australia.
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Psychometric properties and diagnostic accuracy of the edinburgh postnatal depression scale in a sample of Iranian women. IRANIAN JOURNAL OF MEDICAL SCIENCES 2012; 37:32-8. [PMID: 23115428 PMCID: PMC3470287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/15/2011] [Accepted: 09/29/2011] [Indexed: 12/05/2022]
Abstract
BACKGROUND Edinburgh Postnatal Depression Scale (EPDS) has been used as a reliable screening tool for postpartum depression in many countries. This study aimed to assess the psychometric properties and diagnostic accuracy of the EPDS in a sample of Iranian women. METHODS Using stratified sampling 262 postpartum women (2 weeks-3 months after delivery) were selected from urban and rural health center in the city of Isfahan. They were interviewed using EPDS and Hamilton depression rating scale (HDRS). Data were assessed using factor analysis, diagnosis analysis of receiver operating characteristic (ROC) curve, Cronbach's alpha and Pearson correlation coefficient. RESULTS The age of then participants ranged 18-45 years (26.6±5.1). Based on a cut-off point of >13 for HDRS, 18.3% of the participants. The overall reliability (Cronbach's alpha) of EPDS was 0.79. There was a significant correlation (r(2)=0.60, P value<0.01) between EPDS and HDRS. Two factor analysis showed that anhedonia and depression were two explanatory factors. At a cut-off point12 the sensitivity of the questionnaire was 78% (95% CI: 73%-83%) and its specificity was 75% (95% CI: 72%-78%). CONCLUSION The Persian version of the EPDS showed appropriate psychometric properties diagnostic accuracy index. It can be used by health system professionals for detection, assessment and treatment for mothers with post partum depression.
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Bilszta J, Ericksen J, Buist A, Milgrom J. A Qualitative Study of Health Professionals Involved in the Care and Treatment of Women with Postnatal Emotional Distress. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2010.9721814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mann R, Gilbody S. Validity of two case finding questions to detect postnatal depression: a review of diagnostic test accuracy. J Affect Disord 2011; 133:388-97. [PMID: 21146230 DOI: 10.1016/j.jad.2010.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/16/2010] [Accepted: 11/16/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND Postnatal depression (PND) is a serious condition associated with negative consequences for the wellbeing of mother and infant. In the UK routine screening for PND is not currently recommended, although the use of two case finding questions in routine practice to identify PND has been advocated in policy guidance. The diagnostic test accuracy (DTA) of the two questions has been reviewed in general population samples; however a review of their validity in postnatal populations is unknown. The aim of this rapid review was to identify studies of DTA of two case finding questions (2CFQ) for PND detection. METHODS DTA studies were included which compared the 2CFQ to gold standard diagnostic criteria. Sources searched included Medline, PsychInfo, Medion, ARIF and cited reference search via Web of Science. RESULTS Seven studies were identified which used a two question instrument to detect PND. Only one study compared the 2CFQ to standardised diagnostic criteria in a USA postnatal population. The test reported 100% sensitivity and 62% specificity at 4 postnatal weeks. The test was excellent at 'ruling out' PND given a negative response to both questions. False positive rates were high indicating unnecessary follow-up for a substantial number of women. CONCLUSION The review found limited evidence for use of the 2CFQ approach to detect PND. Further primary research should be undertaken to assess the DTA of the 2CFQ approach recommended for use in UK postnatal populations; this will ultimately inform the utility of current UK policy guidance.
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Affiliation(s)
- Rachel Mann
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom.
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Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. J Affect Disord 2011; 132:301-10. [PMID: 20952072 DOI: 10.1016/j.jad.2010.09.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 08/10/2010] [Accepted: 09/24/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rates of help-seeking for Postnatal Depression (PND) are generally low and population screening has the potential to increase diagnosis rates. Of central importance is the screening instrument's Positive Predictive Value (PPV), which is itself influenced by the prevalence of the condition. When PPV exceeds prevalence, screening defines a screen-positive group with a higher prevalence to which diagnostic-stage procedures can be targeted, a necessary component of a screening program's potential for cost-effectiveness. METHODS Employing the best available estimates of the prevalence of PND we applied Bayes' Theorem to map the parameter space for the Positive Predictive Value of the Edinburgh Postnatal Depression Scale (EPDS) across a realistic range of values. Only seven methodologically comparable validation studies are available for major depression and/or minor depression. RESULTS Screening with the EPDS always facilitated an increase in identification rates, over the key range of prevalence values. The EPDS defined a sub-group with prevalence between 5-fold and 17-fold greater than the general population. A central estimate of PPV (at a prevalence of 6.8%) was 62%. LIMITATIONS Few high-quality data are available for analysis and therefore better estimates, of both PND prevalence and of screening accuracy, in the populations where screening takes place are needed. CONCLUSIONS Our estimates of PPV indicate that population screening with an instrument at least as accurate as the EPDS could successfully increase the number of cases identified and, therefore, treatment rates. Comparisons with the performance of physical health-screening programs appear favourable. Appropriate training for health professionals is essential to minimize potential harms, and following all positive screening results with a formal diagnostic procedure is likely to be useful both clinically and in terms of health system costs.
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The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth 2011; 26:17-25. [PMID: 21764399 DOI: 10.1016/j.wombi.2011.06.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 05/30/2011] [Accepted: 06/23/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the value of the antenatal risk questionnaire (ANRQ) as a predictor of postnatal depression, to evaluate its acceptability to pregnant women and midwives, and to consider its use as part of a model for integrated psychosocial risk assessment in the antenatal setting. METHOD This paper further analysed published data from the pregnancy risk questionnaire in a sample of 1196 women. We extracted 12 items from the original 23 item pregnancy risk questionnaire to assess how the shorter ANRQ would perform, and undertook the analysis in the subset who were administered the composite international diagnostic interview (CIDI) at 2 or 4 months postpartum to assess for major depression (N=276). We also sampled a subset of pregnant participants (N=378) and midwives (N=44) to assess the tool's acceptability to these groups respectively. FINDINGS ROC curve analysis for the ANRQ yielded an acceptable area under the curve of 0.69. The most 'clinically' useful cut off on the ANRQ was a score of 23 or more, yielding a sensitivity of 0.62 and specificity of 0.64 with positive predictive value of 0.3. The odds that a woman scoring 23 or more on the ANRQ is also a case was 6.3 times greater than for a woman scoring less than 23. Acceptability of the ANRQ was high among both women and midwives. CONCLUSION The ANRQ is a highly acceptable self-report psychosocial assessment tool which aids in the prediction of women who go on to develop postnatal depression. In combination with a symptom based screening measure (e.g., the Edinburgh postnatal depression scale) and routine questions relating to drug and alcohol use and domestic violence, the ANRQ becomes most useful as a key element of a "screening intervention" aimed at the early identification of mental health risk and morbidity across the perinatal period. Evaluation of this model in terms of clinical outcomes remains to be undertaken.
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Milgrom J, Holt CJ, Gemmill AW, Ericksen J, Leigh B, Buist A, Schembri C. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling. BMC Psychiatry 2011; 11:95. [PMID: 21615968 PMCID: PMC3121669 DOI: 10.1186/1471-244x-11-95] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/27/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists. METHODS This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres) and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups. RESULTS Mean scores on the Beck Depression Inventory (BDI-II) at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028). However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%), and subsequent treatment uptake (40%) were low. CONCLUSIONS Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research.
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Affiliation(s)
- Jeannette Milgrom
- Department of Psychology, Psychological Sciences, University of Melbourne, Victoria 3010, Australia.
| | - Christopher J Holt
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Bronwyn Leigh
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Anne Buist
- Northpark Hospital, Victoria, Australia,Department of Medicine, University of Melbourne, Victoria, Australia
| | - Charlene Schembri
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
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