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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [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: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use. OBJECTIVE Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences. DESIGN Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy. FINDINGS We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported. CONCLUSIONS Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Hughes A, Weckesser A, Denny E, Junaid F, Nelson-Piercy C, Black M, Allotey J, Thangaratinam S, Dyson J. Barriers and facilitators to healthcare practitioners providing care for pregnant women with epilepsy: A systematic review and narrative synthesis. Seizure 2024; 118:38-46. [PMID: 38631244 DOI: 10.1016/j.seizure.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Anita Hughes
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Annalise Weckesser
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Elaine Denny
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Fatima Junaid
- Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - John Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Judith Dyson
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom.
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Dudeney E, Coates R, Ayers S, McCabe R. Acceptability and content validity of suicidality screening items: a qualitative study with perinatal women. Front Psychiatry 2024; 15:1359076. [PMID: 38666087 PMCID: PMC11044181 DOI: 10.3389/fpsyt.2024.1359076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Suicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited. Aims This study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth. Methods Twenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches. Results Findings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as 'better off dead' or 'killing myself' uncomfortable. Most women preferred the phrase 'ending your life' as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret 'harming myself' to include suicidality, nor did they feel that abstract language such as 'leave this world' was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support. Conclusions Existing suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose McCabe
- Centre for Mental Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
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Broberg L, Bendix JM, Røhder K, Løkkegaard E, Væver M, Grew JC, Johnsen H, Juhl M, de Lichtenberg V, Schiøtz M. Combining the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale in Early Pregnancy in Danish Antenatal Care-A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:454. [PMID: 38673365 PMCID: PMC11050197 DOI: 10.3390/ijerph21040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.
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Affiliation(s)
- Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
- Department of Gynecology and Obstetrics, Slagelse Hospital, Fælledvej 14, 4200 Slagelse, Denmark
| | - Jane M. Bendix
- Department of Gynecology and Obstetrics, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark; (J.M.B.); (E.L.)
| | - Katrine Røhder
- Center for Early Intervention and Family Research, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark; (K.R.); (M.V.)
| | - Ellen Løkkegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark; (J.M.B.); (E.L.)
| | - Mette Væver
- Center for Early Intervention and Family Research, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark; (K.R.); (M.V.)
| | - Julie C. Grew
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
| | - Helle Johnsen
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Mette Juhl
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Science, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark; (H.J.); (M.J.); (V.d.L.)
| | - Michaela Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; (J.C.G.); (M.S.)
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Koerner R, Rechenberg K, Rinaldi K, Duffy A. Are Providers Adequately Screening for Anxiety Symptoms During Pregnancy? Nurs Womens Health 2024; 28:109-116. [PMID: 38278513 DOI: 10.1016/j.nwh.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To examine the difference in prevalence of self-reported anxiety symptoms throughout pregnancy compared to clinical diagnosis of an anxiety disorder by a provider. DESIGN Secondary data analysis of a prospective cohort study of 50 pregnant individuals. SETTING/LOCAL PROBLEM Pregnant individuals commonly experience heightened anxiety symptoms, which are associated with adverse perinatal outcomes. However, a diagnosis of an anxiety disorder by a health care provider is less common, which may result in insufficient mental health intervention. PARTICIPANTS Pregnant individuals were recruited at their first prenatal appointment and followed until birth. INTERVENTION/MEASUREMENTS We examined anxiety symptoms using the Edinburgh Postnatal Depression Scale Anxiety subscale. We conducted a medical record review to examine if pregnant individuals were clinically diagnosed with an anxiety disorder. RESULTS Based on an Edinburgh Postnatal Depression Scale Anxiety subscale cutoff score of ≥5, 40% (n = 20) of individuals experienced anxiety symptoms during pregnancy. However, only 16% (n = 8) of participants were diagnosed with an anxiety disorder by a health care provider. CONCLUSION Anxiety symptoms are prevalent throughout pregnancy and may be underdiagnosed by health care providers. An intervention to increase clinical diagnosis of an anxiety disorder and subsequent referral to a mental health specialist may be indicated.
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Olofsdotter Lauri K, Aspvall K, Mataix-Cols D, Serlachius E, Rück C, Andersson E. An online self-guided cognitive intervention for unwanted intrusive thoughts about harming infants in new parents: initial randomised controlled trial with mediation analysis. Cogn Behav Ther 2023; 52:585-602. [PMID: 37395079 DOI: 10.1080/16506073.2023.2229015] [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: 10/18/2022] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
Approximately one-fifth of new parents struggle with unwanted intrusive thoughts (UITs) about intentionally harming their child. This study evaluated the initial efficacy, feasibility and acceptability of a novel online self-guided cognitive intervention for new parents with distressing UITs. Self-recruited parents (N = 43, 93% female, age 23-43 years) of children 0-3 years reporting daily distressing and impairing UITs were randomized to the 8-week self-guided online cognitive intervention or to waiting-list. The primary outcome was change on the Parental Thoughts and Behaviour Checklist (PTBC) from baseline to week 8 (post-intervention). The PTBC and negative appraisals (mediator) were assessed at baseline, weekly, post-intervention and at the 1-month follow-up. Results showed that the intervention led to statistically significant reductions in distress and impairment associated with UITs at post-intervention (controlled between-group d = 0.99, 95% CI 0.56 to 1.43), which were maintained at the 1-month follow-up (controlled between-group d = 0.90, 95% CI 0.41 to 1.39). The intervention was deemed to be feasible and acceptable by the participants. Change in negative appraisals mediated reductions in UITs but the model was sensitive to mediator-outcome confounders. We conclude that this novel online self-guided cognitive intervention can potentially reduce the distress and impairment associated with UITs in new parents. Large-scale trials are warranted.Abbreviations: UITs: Unwanted Intrusive Thoughts PTBC: Parental Thoughts and Behaviour Checklist.
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Affiliation(s)
- Klara Olofsdotter Lauri
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Aspvall
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christian Rück
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Väyrynen K, Chen A, Leskelä RL, Raussi-Lehto E, Klemetti R, Heinonen S, Torkki P, Tekay A. Introducing standard patient-reported measures (PRMs) into routine maternity care: A pre-implementation qualitative study on women's perspectives in Finland. BMC Health Serv Res 2023; 23:845. [PMID: 37563587 PMCID: PMC10413725 DOI: 10.1186/s12913-023-09818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Systematically using standard patient-reported measures (PRMs) in clinical routines is trending. The International Consortium for Health Outcomes Measurement (ICHOM) has developed condition-specific standard sets of patient-centred measures, one of which is the Pregnancy and Childbirth Standard (PCB) set, where standard PRMs are included. There is limited knowledge on the use of ICHOM PCB set-included PRMs (ICHOM-PCB-PRMs) in routine care. This study investigates women's perspectives on the future implementation of standard ICHOM-PCB-PRMs in routine maternity care in Finland. METHODS Semi-structured interviews were conducted. Pregnant and postpartum women were asked to evaluate each ICHOM-PCB-PRM in several dimensions, e.g., importance and quality of questions, and to provide their views on future implementation in terms of benefits, difficulties, and practices. With the predefined topics and themes, deductive analysis was applied. Ethical committee approval (HUS 220/880/2015) and research permissions were obtained. RESULTS 22 women participated. Participants felt that most of the ICHOM-PCB-PRMs were important, relevant, understandable, and appropriately designed, and agreed that some changes in ICHOM-PCB-PRMs were needed, e.g., adding other important measures, changing the wording, and adding open-ended questions. Women would be hesitant to answer questions honestly if follow-up actions were unclear. Most "outcome" measures could be asked repeatedly as maternal health status changes over time, and "experience" measures could be asked separately for different service providers. Disagreements regarding data collection at birth were observed. PRMs were regarded as a way for women to express their thoughts and feelings. Our participants were concerned about the possible consequences of negatively answering the PREMs questions and the availability of follow-up care. Participants expected that they could answer short and easy questions digitally before appointments, and that instructions and follow-up actions based on their answers should be available. CONCLUSION ICHOM-PCB-PRMs could be applicable in Finnish maternity care, but some modifications may be required. Careful consideration is needed regarding how and when PRMs questions are asked for eliciting more accurate and honest answers and minimizing women feeling judged, embarrassed, or offended. Follow-ups should be available according to women's responses and needs. This study provides insights on the adoption and implementation of standard PRMs in routine maternity care.
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Affiliation(s)
- Kirsi Väyrynen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Hoitajantie 3, Jyväskylä, 40620, Finland
| | - An Chen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland.
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, Aalto, FI-00076, Finland.
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland.
- School of Public Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang Province, 310053, China.
| | - Riikka-Leena Leskelä
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland
| | - Eija Raussi-Lehto
- Customer-oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, Myllypurontie 1, Helsinki, 00920, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Otakaari 3, Espoo, 02150, Finland
| | - Reija Klemetti
- Finnish National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
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Nakidde G, Kumakech E, Mugisha JF. Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges. BMC Pregnancy Childbirth 2023; 23:477. [PMID: 37370024 DOI: 10.1186/s12884-023-05763-7] [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: 12/31/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. METHODS In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. RESULTS Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. CONCLUSIONS The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.
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Affiliation(s)
- Gladys Nakidde
- Department of Obstetrics and Gynecology, College of medicine, Pan African University of life and Earth Sciences Institute, University of Ibadan, Ibadan, Nigeria.
- Department of Nursing, Faculty of Nursing and Health sciences, Bishop Stuart University, Mbarara, Uganda.
| | - Edward Kumakech
- Department of Nursing and midwifery, Faculty health sciences, Lira University, Lira, Uganda
| | - John F Mugisha
- Department of Obstetrics and Gynecology, College of medicine, Pan African University of life and Earth Sciences Institute, University of Ibadan, Ibadan, Nigeria
- Department of Health sciences, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
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9
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Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
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Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
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10
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Chen A, Väyrynen K, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The acceptability of implementing patient-reported measures in routine maternity care: A systematic review. Acta Obstet Gynecol Scand 2023; 102:406-419. [PMID: 36647292 PMCID: PMC10008272 DOI: 10.1111/aogs.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. MATERIAL AND METHODS Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. RESULTS Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. CONCLUSIONS Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Nordic Healthcare Group OyHelsinkiFinland
- Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Women`s Health and Perinatology Research grroup, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
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11
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Marshman A, Saunders E, Chaves D, Morton Ninomiya ME. Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review. Midwifery 2023; 117:103544. [PMID: 36580794 DOI: 10.1016/j.midw.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients. METHODS A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care. RESULTS Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels. DISCUSSION While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels. CONCLUSION Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.
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Affiliation(s)
| | | | | | - Melody E Morton Ninomiya
- Wilfrid Laurier University; Centre for Addiction and Mental Health; Canada Research Chair (Tier II) in Community-Driven Knowledge Mobilization and Pathways to Wellness.
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12
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Smith PA, Kilgour C, Rice D, Callaway LK, Martin EK. Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. BMC Health Serv Res 2022; 22:1265. [PMID: 36261823 PMCID: PMC9583548 DOI: 10.1186/s12913-022-08633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08633-8.
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Affiliation(s)
- Patricia A Smith
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.
| | - Catherine Kilgour
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia
| | - Deann Rice
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia
| | - Leonie K Callaway
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia
| | - Elizabeth K Martin
- Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia
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13
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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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14
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Chen A, Väyrynen K, Schmidt A, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The impact of implementing patient-reported measures in routine maternity care: a systematic review. Acta Obstet Gynecol Scand 2022; 101:1184-1196. [PMID: 36065150 PMCID: PMC9812106 DOI: 10.1111/aogs.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. MATERIAL AND METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). RESULTS Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. CONCLUSIONS The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.
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Affiliation(s)
- An Chen
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland,Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Riikka‐Leena Leskelä
- Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Paulus Torkki
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical ScienceIntervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden,Women's Health and Perinatology Research Group, Department of Clinical MedicineUiT ‐ The Arctic University of NorwayTromsøNorway
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15
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Kusumawati Y, Widyawati W, Dewi FST. [Vulnerable to mental health problems: Pregnant women and husband's perception in Surakarta, Indonesia]. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:334-343. [PMID: 36084999 DOI: 10.1016/j.enfcle.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/10/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to explore the perception of women and their husbands on the vulnerability of pregnant women to mental health disorders. METHOD Qualitative study using a phenomenological approach. The inclusion criteria were pregnant women of the second and third-trimester gestation (13-35 weeks). The exclusion criteria were pregnant women with complications and who had a family record of mental disorders. Data was collected using focus group discussion and in-depth interviews at four Primary Health Cares in Surakarta, Indonesia. Then, the data were analyzed through thematic analysis, which was supported by the OpenCode 4.02® software. RESULTS This study uncovered two main topics, firstly the factors that trigger the vulnerability of pregnant women to experience mental disorders and secondly perceived barriers to managing mental health during pregnancy and postpartum. Pregnant women and husbands recognize that they need to get mental health information. CONCLUSION Unstable emotions during pregnancy are considered normal and neglected by their surroundings. Lack of knowledge about mental health in pregnancy justifies the need to increase education in this area in order to prevent prenatal and postpartum depression.
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Affiliation(s)
- Yuli Kusumawati
- Public Health Program, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Central Java, Indonesia.
| | - Widyawati Widyawati
- Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
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16
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Critiquing the evolution of maternity care preferences research: A systematic mixed studies review. Midwifery 2022; 111:103386. [DOI: 10.1016/j.midw.2022.103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
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17
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Kusumawati Y, Widyawati W, Dewi FST. Vulnerable to mental health problems: Pregnant women and husband's perception in Surakarta, Indonesia. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Thomson G, Diop MQ, Stuijfzand S, Horsch A. Policy, service, and training provision for women following a traumatic birth: an international knowledge mapping exercise. BMC Health Serv Res 2021; 21:1206. [PMID: 34742293 PMCID: PMC8571982 DOI: 10.1186/s12913-021-07238-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background High numbers of women experience a traumatic birth, which can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) onset, and negative and pervasive impacts for women, infants, and families. Policies, suitable service provision, and training are needed to identify and treat psychological morbidity following a traumatic birth experience, but currently there is little insight into whether and what is provided in different contexts. The aim of this knowledge mapping exercise was to map policy, service and training provision for women following a traumatic birth experience in different European countries. Methods A survey was distributed as part of the COST Action “Perinatal mental health and birth-related trauma: Maximizing best practice and optimal outcomes”. Questions were designed to capture country level data; care provision (i.e., national policies or guidelines for the screening, treatment and/or prevention of a traumatic birth, service provision), and nationally mandated pre-registration and post-registration training for maternity professionals. Results Eighteen countries participated. Only one country (the Netherlands) had national policies regarding the screening, treatment, and prevention of a traumatic birth experience/CB-PTSD. Service provision was provided formally in six countries (33%), and informally in the majority (78%). In almost all countries (89%), women could be referred to specialist perinatal or mental health services. Services tended to be provided by midwives, although some multidisciplinary practice was apparent. Seven (39%) of the countries offered ‘a few hours’ professional/pre-registration training, but none offered nationally mandated post-registration training. Conclusions A traumatic birth experience is a key public health concern. Evidence highlights important gaps regarding formalized care provision and training for care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07238-x.
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Affiliation(s)
- Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK.
| | - Magali Quillet Diop
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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19
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Martin-Key NA, Spadaro B, Schei TS, Bahn S. Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study. J Med Internet Res 2021; 23:e27132. [PMID: 34033582 PMCID: PMC8183599 DOI: 10.2196/27132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the United Kingdom, with outbreaks of disease, like the COVID-19 pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. Objective The aim of this study was to conduct a mixed methods evaluation of the current state of perinatal mental health care provision in the United Kingdom, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. Methods Women, partners, and midwives were recruited to participate in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Behavior model and summarized using descriptive statistics. Results A total of 829 women, 103 partners, and 90 midwives participated in the study. The provision of adequate perinatal mental health care support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The majority of respondents (n=781, 76.42%) expressed that they would feel comfortable or very comfortable using or recommending a digital mental health assessment. The majority of women and partners showed a preference for in-person consultations (n=417, 44.74%), followed by a blended care approach (ie, both in-person and online consultations) (n=362, 38.84%), with fewer participants preferring online-only consultations (n=120, 12.88%). Identified benefits and barriers mainly related to physical opportunity (eg, accessibility), psychological capability (eg, cognitive skills), and automatic motivation (eg, emotions). Conclusions This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision making in the assessment of perinatal mental health concerns in the United Kingdom.
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Affiliation(s)
- Nayra Anna Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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20
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Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105226. [PMID: 34069073 PMCID: PMC8156805 DOI: 10.3390/ijerph18105226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Abstract
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
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21
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Dadi AF, Miller ER, Azale T, Mwanri L. "We do not know how to screen and provide treatment": a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia. Int J Ment Health Syst 2021; 15:41. [PMID: 33952338 PMCID: PMC8098000 DOI: 10.1186/s13033-021-00466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. METHODS We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. RESULTS The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation. CONCLUSIONS This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.
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Affiliation(s)
- Abel Fekadu Dadi
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emma R. Miller
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Telake Azale
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
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Why do some pregnant women not fully disclose at comprehensive psychosocial assessment with their midwife? Women Birth 2021; 35:80-86. [PMID: 33781709 DOI: 10.1016/j.wombi.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022]
Abstract
PROBLEM While comprehensive psychosocial assessment is recommended as part of routine maternity care, unless women engage and disclose, psychosocial risk will not be identified or referred in a timely manner. We need to better understand and where possible overcome the barriers to disclosure if we are to reduce mental health morbidity and complex psychosocial adversity. AIMS To assess pregnant women's attitude to, and reasons for non-disclosure at, comprehensive psychosocial assessment with their midwife. METHODS Data from 1796 pregnant women were analysed using a mixed method approach. After ascertaining women's comfort with, attitude to, and non-disclosure at psychosocial screening, thematic analysis was used to understand the reasons underpinning non-disclosure. FINDINGS 99% of participants were comfortable with the assessment, however 11.1% (N = 193) reported some level of nondisclosure. Key themes for non-disclosure included (1) Normalising and negative self-perception, (2) Fear of negative perceptions from others, (3) Lack of trust of midwife, (4) Differing expectation of appointment and (5) Mode of assessment and time issues. DISCUSSION Factors associated with high comfort and disclosure levels in this sample include an experienced and skilled midwifery workforce at the study site and a relatively advantaged and mental health literate sample. Proper implementation of psychosocial assessment policy; setting clear expectations for women and, for more vulnerable women, extending assessment time, modifying mode of assessment, and offering continuity of midwifery care will help build rapport, improve disclosure, and increase the chance of early identification and intervention. CONCLUSIONS This study informs approaches to improving comprehensive psychosocial assessment in the maternity setting.
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Chrzan-Dętkoś M, Walczak-Kozłowska TZ. How do new mothers perceive screening for perinatal depression? HEALTH PSYCHOLOGY REPORT 2021; 9:207-216. [PMID: 38084232 PMCID: PMC10501423 DOI: 10.5114/hpr.2021.102823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Countries recognize the risk of mental health difficulties during the perinatal period and the potential benefits of screening and early detection of depressive symptom-atology. This study aimed to analyse mothers' views on screening for postpartum depression (PPD) in Poland, where a new standard of perinatal care imposed (from January 2019) the obligation to monitor women' postpartum mental state. PARTICIPANTS AND PROCEDURE 150 women participated in the study. In the first stage, PPD symptoms were assessed with the Edinburgh Post-natal Depression Scale (EPDS) among postpartum women during midwives' home visits. The second stage consisted of a telephone survey with the EPDS and questions exploring mothers' perception of midwife competencies in screening for PPD. RESULTS Most women identified as relatively high midwives' competencies in communicating information about PPD, interpretation of the EPDS score and their ability to create comfortable conditions of the assessment and further discussion about postpartum mental health changes. Women with an elevated level of PPD symptoms assessed as significantly lower midwives' competence in this last aspect and those who had a caesarean section tend to assess as lower the usefulness of provided information on care of a newborn. CONCLUSIONS Midwives should be aware and prepared for a possible critical attitude of patients, which may be a sign of a depression. Otherwise, medical staff may not be willing to interact with a mother and offer her help and support. The ability to create a friendly condition in spite of adversity can contribute to the desire of women to undergo screening, discussion about the result and further treatment.
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Affiliation(s)
| | - Tamara Z. Walczak-Kozłowska
- Institute of Psychology, University of Gdansk, Gdansk, Poland
- Department of Psychology, Gdansk, University of Physical Education and Sport, Gdansk, Poland
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Adjorlolo S, Aziato L. Barriers to addressing mental health issues in childbearing women in Ghana. Nurs Open 2020; 7:1779-1786. [PMID: 33072362 PMCID: PMC7544842 DOI: 10.1002/nop2.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/26/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of the study is to investigate factors hampering the provision of mental health services by nurses and midwives to childbearing women to assist in the prioritization and distribution of limited mental health resources. Design This is a cross‐sectional self‐report study. Methods Data collected from 309 nurses and midwives were analysed using descriptive and inferential statistic, namely chi‐square and analysis of variance (ANOVA). Results The barriers reported by the participants include unavailability of mental health services (77%), lack of knowledge of mental health in women from different tribes (75.7%), lack of a clear mental healthcare pathway (75.1%), heavy workload (74.1%) and lack of knowledge of mental health issue (74.1%). These barriers are less likely to be reported by participants who are males, old and who have practiced for a long time. Conclusions Systematic effort to restructure the healthcare delivery system, including equipping healthcare professionals with requisite knowledge, skills and competencies in maternal mental health, is highly recommended.
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Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health School of Nursing and Midwifery College of Health Sciences University of Ghana Accra Ghana.,Research and Grant Institute of Ghana Accra Ghana
| | - Lydia Aziato
- Department of Adult Health School of Nursing and Midwifery College of Health Sciences University of Ghana Accra Ghana
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Thiséus J, Perrin S, Cervin M. Intrusive thoughts and compulsive behaviors in postpartum women: Psychometric properties of the Parental Thoughts and Behaviors Checklist. Psychiatry Res 2019; 278:194-198. [PMID: 31212232 DOI: 10.1016/j.psychres.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Validated measures to assess intrusive thoughts and compulsive behaviors in postpartum women are few. In the present study, we investigated the psychometric properties of such a measure - a self-report version of the Parental Thoughts and Behaviors Checklist (PTBC). Via an online survey platform, 488 women who had given birth during the last year completed the PTBC along with measures of general obsessive-compulsive symptoms, depression, anxiety, parental stress and quality of life. Scores on the PTBC and its subscales showed good to excellent internal consistency, correlated in the expected direction with the other measures in the study, and discriminated between women with and without a history of OCD. Finally, exploratory factor analyses yielded nine thematic factors of intrusive thoughts and compulsive behaviors which largely corresponded to the themes identified by the developers of the interview-based version of the PTBC. This self-report version of the PTBC was found to possess good psychometric properties and to have a factor structure that largely overlapped with the structure of the interview-based version. Further evaluation of this version is needed, but the measure holds promise as a tool that may aid in the assessment of postpartum OCD in primary care and in psychiatric settings.
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Affiliation(s)
| | - Sean Perrin
- Lund University, Department of Psychology, Lund, Sweden
| | - Matti Cervin
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden.
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Experiences of Women with Postpartum Depression Participating in a Support Group Led by Mental Health Providers. MCN Am J Matern Child Nurs 2019; 44:228-233. [PMID: 31261300 DOI: 10.1097/nmc.0000000000000533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to explore experiences of women currently with or at high risk for developing postpartum depression (PPD) who were participating in a postpartum support group facilitated by mental health providers. STUDY DESIGN AND METHODS Using a qualitative design, women ≥18 years of age, who had given birth within the past 2 years, and who were currently attending, or had attended the PPD support group within the past year were invited to participate. The women provided demographic data and participated in a semistructured face-to-face interview. Data were analyzed using qualitative content analysis. RESULTS Seven women between 27 and 38 years of age participated. Most were married and college educated. At time of the interviews, participants were between 5 months and 2 years postpartum and all reported taking antidepressant medications for their symptoms. Qualitative content analysis revealed three overall themes: attendance, impact, and medication adherence, with associated subthemes. CLINICAL IMPLICATIONS Women attending a PPD support group facilitated by mental health providers felt supported, were more likely to disclose their symptoms to other women in the same situation, and were able to share their feelings without fear of judgment. Having concerns about antidepressant medication addressed at each meeting promoted medication adherence. Nurses working with childbearing women should be aware of community support services available for women at risk for developing PPD.
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Thomson G, Garrett C. Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England. Midwifery 2019; 71:63-70. [DOI: 10.1016/j.midw.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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Kimmel MC, Cox E, Schiller C, Gettes E, Meltzer-Brody S. Pharmacologic Treatment of Perinatal Depression. Obstet Gynecol Clin North Am 2018; 45:419-440. [DOI: 10.1016/j.ogc.2018.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bayrampour H, Hapsari AP, Pavlovic J. Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery 2018; 59:47-58. [DOI: 10.1016/j.midw.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/08/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
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