1
|
Heslin M, Jin H, Trevillion K, Ling X, Nath S, Barrett B, Demilew J, Ryan EG, O'Connor S, Sands P, Milgrom J, Bick D, Stanley N, Hunter MS, Howard LM, Byford S. Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model. BMC Health Serv Res 2022; 22:774. [PMID: 35698125 PMCID: PMC9190075 DOI: 10.1186/s12913-022-08115-x] [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: 07/05/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration N/A Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08115-x.
Collapse
Affiliation(s)
- Margaret Heslin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Huajie Jin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kylee Trevillion
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Xiaoxiao Ling
- Department of Statistical Science, University College London, London, UK
| | - Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Barbara Barrett
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jill Demilew
- King's College Hospital NHS Foundation Trust, London, UK
| | - Elizabeth G Ryan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | | | - Polly Sands
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Heidelberg West, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwick NHS Foundation Trust, Coventry, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Myra S Hunter
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Louise M Howard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|
2
|
Koire A, Van Horne BS, Nong YH, Cain CM, Greeley CS, Puryear L. Patterns of peripartum depression screening and detection in a large, multi-site, integrated healthcare system. Arch Womens Ment Health 2022; 25:603-610. [PMID: 35332376 DOI: 10.1007/s00737-022-01223-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine peripartum depression (PD) screening patterns within and across the prenatal and postpartum periods and assess the incidence of new positive screens during standard screening protocol timepoints to inform practice, particularly when limited screenings can be conducted.This is a retrospective observational study of women screened for PD through a large, integrated health system using the Edinburgh Postnatal Depression Scale (EPDS) within their obstetrics and pediatric practices. Pregnancies with an EPDS score for at least one obstetric and one pediatric appointment between November 2016 and October 2019 were included (n = 3240). The data were analyzed using chi-squared test, Student's t-test, and binary logistic regression analyses. An EPDS score of 10 or higher was considered a positive screen.The positive screening rate for this cohort was 18.5%, with a prenatal positive rate of 9.9% and a postpartum positive rate of 8.6%. Single relationship status showed a higher rate of PD overall. Two thirds of women were not screened until their third trimester, resulting in delayed detection for an estimated 28% of women who ultimately screened positive. Few new positive screens (1.3%) were detected after 9 weeks postpartum in women who had completed all recommended prior screens.Obstetric providers should screen for PD as early in pregnancy as possible and continue to screen as often as feasible regardless of previous negative EPDS scores. Prioritizing screening more often in pregnancy and before 9 weeks postpartum is optimal to avoid delays in detection and intervention.
Collapse
Affiliation(s)
- Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bethanie S Van Horne
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA. .,Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA.
| | - Yen H Nong
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA.,Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Cary M Cain
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA.,Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Christopher S Greeley
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA.,Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Lucy Puryear
- Obstetrics and Gynecology, Menninger Department of Psychiatry, Baylor College of Medicine, 6651 Main Street, Houston, TX, USA
| |
Collapse
|
3
|
Marshall EJ, Thompson AP. Shedding Light on the Difficulties and Challenges Experienced by Mothers of Infants. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00093.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emma J Marshall
- School of Psychology, Charles Sturt University, Wagga Wagga,
| | | |
Collapse
|
4
|
Trevillion K, Ryan EG, Pickles A, Heslin M, Byford S, Nath S, Bick D, Milgrom J, Mycroft R, Domoney J, Pariante C, Hunter MS, Howard LM. An exploratory parallel-group randomised controlled trial of antenatal Guided Self-Help (plus usual care) versus usual care alone for pregnant women with depression: DAWN trial. J Affect Disord 2020; 261:187-197. [PMID: 31634678 DOI: 10.1016/j.jad.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 10/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Depression is a common antenatal mental disorder associated with significant maternal morbidity and adverse fetal outcomes. However, there is a lack of research on the effectiveness or cost-effectiveness of psychological interventions for antenatal depression. METHODS A parallel-group, exploratory randomised controlled trial across five hospitals. The trial compared Guided Self-Help, modified for pregnancy, plus usual care with usual care alone for pregnant women meeting DSM-IV criteria for mild-moderate depression. The trial objectives were to establish recruitment/follow-up rates, compliance and acceptability, and to provide preliminary evidence of intervention efficacy and cost-effectiveness. The primary outcome of depressive symptoms was assessed by blinded researchers using the Edinburgh Postnatal Depression Scale at 14-weeks post-randomisation. RESULTS 620 women were screened, 114 women were eligible and 53 (46.5%) were randomised. 26 women received Guided Self-Help - 18 (69%) attending ≥4 sessions - and 27 usual care; n = 3 women were lost to follow-up (follow-up rate for primary outcome 92%). Women receiving Guided Self-Help reported fewer depressive symptoms at follow-up than women receiving usual care (adjusted effect size -0.64 (95%CI: -1.30, 0.06) p = 0.07). There were no trial-related adverse events. The cost-effectiveness acceptability curve showed the probability of Guided Self-Help being cost-effective compared with usual care ranged from 10 to 50% with a willingness-to-pay range from £0 to £50,000. CONCLUSIONS AND LIMITATIONS Despite intense efforts we did not meet our anticipated recruitment target. However, high levels of acceptability, a lack of adverse events and a trend towards improvements in symptoms of depression post-treatment indicates this intervention is suitable for talking therapy services.
Collapse
Affiliation(s)
- K Trevillion
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom.
| | - E G Ryan
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - A Pickles
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M Heslin
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Nath
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - D Bick
- Departmentof Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - J Milgrom
- University of Melbourne and Parent-Infant Research Institute, Melbourne, Australia
| | - R Mycroft
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - J Domoney
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - C Pariante
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M S Hunter
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - L M Howard
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| |
Collapse
|
5
|
Trevillion K, Domoney J, Pickles A, Bick D, Byford S, Heslin M, Milgrom J, Mycroft R, Pariante C, Ryan E, Hunter M, Howard LM. Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self help for WomeN (DAWN): study protocol for a randomised controlled trial. Trials 2016; 17:503. [PMID: 27756349 PMCID: PMC5070149 DOI: 10.1186/s13063-016-1632-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a common antenatal mental disorder and is associated with an increased risk of adverse effects on the fetus and significant morbidity for the mother; if untreated it can also continue into the post-natal period and affect mother-infant interactions. There has been little research evaluating the effectiveness or cost-effectiveness of antenatal psychological interventions for antenatal depression, particularly for mild to moderate disorders. International guidelines recommend a stepped care approach starting with Guided Self Help, and the aim of this exploratory trial is to investigate Guided Self Help modified for pregnancy. METHODS The DAWN trial is an exploratory randomised controlled trial of the effectiveness and cost-effectiveness of antenatal Guided Self Help, modified for pregnancy and delivered by National Health Service Psychological Wellbeing Practitioners. Antenatal Guided Self Help, in addition to usual care, is compared with usual care for pregnant women diagnosed with mild to moderate depression and mixed anxiety and depression, using the Structured Clinical Interview for DSM-IV Disorders. Modifications for pregnancy include perinatal mental health training, addressing pregnancy-specific worries and including sections on health issues in pregnancy and planning for parenthood. Women allocated to Guided Self Help will be seen for up to eight sessions by a Psychological Wellbeing Practitioner (including an initial assessment session); there will also be an appointment at 12 weeks after delivery. Research measures including the Edinburgh Postnatal Depression Scale (primary outcome) and other measures of depression, anxiety, quality of life and service use will be collected from women before random allocation, 14 weeks after random allocation and at 12 weeks after delivery. Potential psychological mechanisms of the intervention will be explored using the Pregnancy-Related Thoughts Questionnaire and the Metacognitive Awareness Questionnaire. DISCUSSION The DAWN trial is the first exploratory trial to investigate the efficacy of antenatal Guided Self Help for pregnant women with mild to moderate depression meeting DSM-IV diagnostic criteria. Recruitment started January 2015 and is expected to be completed by July 2016. TRIAL REGISTRATION ISRCTN registry: ISRCTN83768230 . Registered on 8 August 2014.
Collapse
Affiliation(s)
- Kylee Trevillion
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jill Domoney
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Debra Bick
- Florence Nightingale Faculty of Nursing and Midwifery, Division of Women’s Health, King’s College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jeannette Milgrom
- University of Melbourne and Parent-Infant Research Institute, Melbourne, Australia
| | - Rachel Mycroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Carmine Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth Ryan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Myra Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Louise Michele Howard
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
6
|
Top ED, Karaçam Z. Effectiveness of Structured Education in Reduction of Postpartum Depression Scores: A Quasi-Experimental Study. Arch Psychiatr Nurs 2016; 30:356-62. [PMID: 27256941 DOI: 10.1016/j.apnu.2015.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 09/16/2015] [Accepted: 12/17/2015] [Indexed: 12/21/2022]
Abstract
The aim of this study was to evaluate effectiveness of structured education in reduction of postpartum depression scores among women. This was a quasi-experimental study with a pre-post tests and a control group. Non-random sampling was used and the study included a total of 103 Turkish women, 52 of whom were in the intervention group and 51 were in the control group. The women in the intervention group were offered structured education for postpartum depression and given structured education material. Effectiveness of the education given was evaluated by comparing scores for Edinburg Postpartum Depression Scale obtained before and after delivery between the intervention and the control groups. Before education, median score (8.0±4.8) for Edinburg Postpartum Depression Scale of the intervention group were significantly higher the than the control group (6.0±6.0, p=0.010), but the groups were statistically similar in terms of having depression (intervention: 17.3%, control: 11.8%, p=0.425). After education, the median score for Edinburg Postpartum Depression Scale and the ratio of the women having depression in the intervention group were significantly lower than in the control group (respectively intervention: 4.0±3.0, control: 10.0±4.0, p=0.000; intervention: 7.7%, control: 25.5%, p=0.015). Besides, the median score (8.0±4.8) of the intervention group before education were significantly higher than the score (4.0±3.0) obtained after education (p=0.000), while the median score (6.0±6.0) of the control group before education were lower than the score (10.0±4.0) obtained after education (p=0.000). This study revealed that structured education offered to women by nurses was effective in reducing the postpartum depression scores and the numbers of women having depression.
Collapse
Affiliation(s)
- Ekin Dila Top
- İzmir Katip Çelebi University Faculty of Health Sciences, Division of Nursing, İzmir, Turkey
| | - Zekiye Karaçam
- Adnan Menderes University Aydın School of Health, Division of Midwifery, Aydın, Turkey.
| |
Collapse
|
7
|
Nakić Radoš S, Herman R, Tadinac M. Is the Predictability of New-Onset Postpartum Depression Better During Pregnancy or in the Early Postpartum Period? A Prospective Study in Croatian Women. Health Care Women Int 2015; 37:23-44. [DOI: 10.1080/07399332.2014.992522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
8
|
Santos HPO, Sandelowski M, Gualda DMR. Bad thoughts: Brazilian women's responses to mothering while experiencing postnatal depression. Midwifery 2013; 30:788-94. [PMID: 24315035 DOI: 10.1016/j.midw.2013.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE this study explores Brazilian women's experiences of mothering of their infants while experiencing postnatal depression. DESIGN a cross-language qualitative descriptive design. METHOD the sample was composed of 15 women diagnosed with postnatal depression in a psychiatric institute in São Paulo, Brazil. Open-ended interviews were conducted and the data underwent thematic analysis. RESULTS 13 women worried that harm would come to their infants. Seven of these women self-identified as potential sources of harm, with two women physically hurting their infants. The remaining six women worried about unknown agents, such as disease, hurting their infants. In response to these bad thoughts, women mothered their infants in one of four ways: (1) transferred care, completely delegating this task to family members; (2) shared care, asking family members to share the responsibility; (3) sole care, having to look after their infants by themselves because they had no available family support; (4) and smother care, being hyper-vigilant, constantly watching their infants and not trusting infant care to anyone else. CONCLUSIONS the bad thoughts influenced the women's adaptation to mothering their infants. Health professionals should assess these thoughts early in the postnatal period and the women's mothering responses for the protection of mother and child.
Collapse
Affiliation(s)
| | - Margarete Sandelowski
- University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, CB # 7460 Carrington Hall, Chapel Hill, NC 27599, USA.
| | - Dulce Maria Rosa Gualda
- University of São Paulo at São Paulo School of Nursing, USP, Av Dr Eneas de Carvalho Aguiar 419, Cerqueira Cesar, São Paulo, SP 054470-3000, Brazil.
| |
Collapse
|
9
|
Howard LM, Oram S, Galley H, Trevillion K, Feder G. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 2013; 10:e1001452. [PMID: 23723741 PMCID: PMC3665851 DOI: 10.1371/journal.pmed.1001452] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/10/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). METHODS AND FINDINGS We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. CONCLUSIONS High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.
Collapse
Affiliation(s)
- Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, King's College London, London, UK.
| | | | | | | | | |
Collapse
|
10
|
Bick D, Murrells T, Weavers A, Rose V, Wray J, Beake S. Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit. BMC Pregnancy Childbirth 2012; 12:41. [PMID: 22672354 PMCID: PMC3489602 DOI: 10.1186/1471-2393-12-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 05/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women's views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated. METHODS Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women's views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression. RESULTS Data were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3 months post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively post-intervention. Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care. CONCLUSIONS It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.
Collapse
Affiliation(s)
- Debra Bick
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | - Trevor Murrells
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | | | - Val Rose
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Julie Wray
- The University of Salford, School of Nursing and Midwifery, Manchester, UK
| | - Sarah Beake
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
| |
Collapse
|
11
|
The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial. BMC Pregnancy Childbirth 2011; 11:57. [PMID: 21812968 PMCID: PMC3161003 DOI: 10.1186/1471-2393-11-57] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 08/03/2011] [Indexed: 11/15/2022] Open
Abstract
1 Abstract
Collapse
|
12
|
Abstract
This review approaches the topic of childbirth and mental illness using a model of perinatal health which takes into consideration the multiple determinants of health, approached from a lifespan perspective. The paper seeks to answer four broad questions using this model and available literature: (1) What is the relationship between childbirth and mental disorders? (2) How common are mental disorders during childbearing, and what is the perinatal course of illness? (3) What are the effects of mental illness during childbearing on foetal and infant developmental outcomes? (4) How do you approach the detection and treatment of mental disorders during the perinatal period?
Collapse
Affiliation(s)
- Kristin L Leight
- Women's Program in Psychiatry, Columbia University Medical Center, New York, NY 10032, USA.
| | | | | | | |
Collapse
|