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Varambally M, Layton H, Jack SM, Van Lieshout RJ. Mothers' and birthing parents' experiences with 1-day cognitive behavioural therapy-based workshops for postpartum depression: A descriptive qualitative study. J Psychiatr Ment Health Nurs 2024; 31:507-514. [PMID: 38078565 DOI: 10.1111/jpm.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 07/03/2024]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: One in five mothers and birthing parents are affected by postpartum depression (PPD), yet only a small proportion of those with PPD receive treatment. Given cost and accessibility barriers to treatment, brief therapies (e.g. 1 day) could help address PPD on a large scale, though understanding participants' unique experiences with this novel treatment will help guide its refinement and use. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes the experiences, perspectives and satisfaction of participants who attended a 1-day workshop for PPD. Participants appreciate being taught practical techniques and the receipt of social support from facilitators and other attendees in the group setting, while some recommended further 'booster sessions' to enhance effectiveness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: One-day CBT-based workshops may be an effective, low-intensity treatment option that provides helpful skills and builds social networks for individuals with PPD. Additional post-workshop booster sessions may enhance participant satisfaction with this new treatment by providing a reinforcement of their learning and an opportunity to re-connect with other birthing parents. ABSTRACT INTRODUCTION: Postpartum depression (PPD) affects up to one in five mothers and birthing parents. Understanding their perceptions of therapeutic interventions is key to their effectiveness and scalability. AIM The aim of the study was to understand participants' experiences attending an in-person or online 1-day cognitive behavioural therapy (CBT)-based workshop for PPD and compare their experiences participating in either modality. METHOD This descriptive qualitative study was embedded in two separate randomized controlled trials evaluating the effectiveness of 1-day CBT-based workshops for PPD delivered in-person or online. Responses were provided by 94 in-person and 95 online participants about their experiences. Content analysis was used to code and categorize the data. RESULTS Participants appreciated learning skills to improve PPD symptoms and joining a community of individuals with shared experiences. Integrating practical coping techniques after the workshop was reported to be most useful, though some wanted additional post-workshop support. Online participants identified additional barriers to workshop engagement. DISCUSSION Participants who attended either workshop found them to be valuable and effective. Participants valued psychoeducation, social connections and applying practical CBT techniques. IMPLICATIONS FOR PRACTICE One-day CBT-based workshops may be an accessible treatment option for individuals with PPD, providing new skills and social support, though some prefer to receive additional post-workshop support.
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Affiliation(s)
- Meghna Varambally
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Haley Layton
- Health Research Methodology Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Chandraseharan U, Rajendram P, Utravathy V, Karuppiah V, Thilagaratnam S. Development of a needs-based digital portal to support maternal and child health in Singapore. Singapore Med J 2024:00077293-990000000-00136. [PMID: 39028973 DOI: 10.4103/singaporemedj.smj-2022-029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/17/2023] [Indexed: 07/21/2024]
Affiliation(s)
- Usha Chandraseharan
- Youth Engagement and Insights, School Health and Outreach, Health Promotion Board, Singapore
| | - Priyanka Rajendram
- Integrated Health Promotion, MOH Office for Healthcare Transformation, Singapore
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Sajjad A, Shah S, Abbas G, Aslam A, Randhawa F, Khurram H, Assiri A. Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan. PeerJ 2024; 12:e17711. [PMID: 39035151 PMCID: PMC11260416 DOI: 10.7717/peerj.17711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Background and Objectives Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan. Methods A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD. Results Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p < 0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores. Conclusion Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.
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Affiliation(s)
- Aqsa Sajjad
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ghulam Abbas
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Fawad Randhawa
- Department of Endocrinology, King Edward Medical University, Lahore, Pakistan
| | - Haris Khurram
- Department of Mathematics and Computer Science, Faculty of Science and Technology Prince of Songkla University, Pattani Campus, Thailand
- Department of Science and Humanities, National University of Computer and Emerging Science, Chiniot-Faisalabad Campus, Chiniot, Pakistan
| | - Abdullah Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Özhüner Y, Özerdoğan N. The effect of the Watson model-based psycho-educational intervention on preventing postpartum depression. J Eval Clin Pract 2024. [PMID: 38979880 DOI: 10.1111/jep.14051] [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: 03/10/2024] [Revised: 05/11/2024] [Accepted: 06/01/2024] [Indexed: 07/10/2024]
Abstract
RATIONALE Psycho-education application is effective in reducing the risk of postpartum depression (PPD) and increasing the level of social support. The quality of care increases with the implementation of Watson's Theory of Human Caring Model (WTHCM)-based care programs to reduce the risk of PPD. AIMS This study aimed to evaluate the impact of a psycho-educational intervention based on the Watson model on pregnant women in preventing PPD. Additionally, the effect of the psycho-educational intervention on women's perceptions of social support in relation to PPD was evaluated. METHODS A randomized-controlled pretest-posttest control group intervention study design was used. The sample consisted of 91 women (intervention:45, control:46) in their 20th to 32nd gestational week. While all women received routine care at the family health centre the intervention group was additionally applied a psycho-educational intervention based on the WTHCM. Chi-square and t-test analysis methods were performed to determine the homogeneity of the intervention and control groups. The t-test method was used to compare group scores. Multiple regression analysis was employed to compare multiple variables. RESULTS Following the psycho-educational intervention, the total Edinburgh Postpartum Depression Scale of the intervention group was found significantly lower than that of the control group, but the total and friend subscale scores on the Multidimensional Scale of Perceived Social Support (MSPSS) were higher (p < 0.05). The regression analysis results indicate that friend and family support, which are sub-dimensions of the MSPSS, exhibited a significant decrease in both groups. Furthermore, this decline had a greater impact on reducing the PPD level in the intervention group compared to the control group. It was found that while the support of the significant other sub-dimension reduced the PPD level in the intervention group, it did not make a significant difference in the control group. CONCLUSIONS The Watson's Theory of Human Caring Model-based psycho-educational intervention program decreased women's risk of PPD and increased their social support levels. It is recommended to use approaches that include psycho-educational intervention in postpartum midwifery care.
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Affiliation(s)
- Yasemin Özhüner
- Vadişehir Family Health Center Vadişehir Mah., Eskişehir, Turkey
| | - Nebahat Özerdoğan
- Department of Midwifery, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Turkey
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Pokharel A, Ramalho R, Das BK, Rongmei L, Jatchavala C, Gürcan A, Ransing R. Technology-based Interventions to Reduce the Treatment Gap for Common Perinatal Mental Disorders in Low- and Middle-income Countries (LMICs): Challenges and the Way Forward. Indian J Psychol Med 2024; 46:370-372. [PMID: 39056036 PMCID: PMC11268284 DOI: 10.1177/02537176231225649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Affiliation(s)
- Arpana Pokharel
- Dept. of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
- Dept. of Psychiatry, Devdaha Medical College, Devdaha, Nepal, India
| | - Rodrigo Ramalho
- Dept. of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Bipul Kumar Das
- Dept. of Pediatrics, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Lungan Rongmei
- Dept. of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Chonnakarn Jatchavala
- Dept. of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
- Dept. of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Ahmet Gürcan
- Dept. of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | - Ramdas Ransing
- Dept. of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
- Dept. of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Mancinelli E, Gabrielli S, Salcuni S. A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study. JMIR Hum Factors 2024; 11:e50098. [PMID: 38753421 PMCID: PMC11140274 DOI: 10.2196/50098] [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: 06/19/2023] [Revised: 10/05/2023] [Accepted: 03/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. OBJECTIVE This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated. METHODS A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. RESULTS Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. CONCLUSIONS Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
- Fondazione Bruno Kessler, Trento, Italy
| | | | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
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Lawrence CG, Breau G, Yang L, Hellerstein OS, Hippman C, Kennedy AL, Ryan D, Shulman B, Brotto LA. Effectiveness of a web-enabled psychoeducational resource for postpartum depression and anxiety among women in British Columbia. Arch Womens Ment Health 2024:10.1007/s00737-024-01468-8. [PMID: 38709329 DOI: 10.1007/s00737-024-01468-8] [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: 11/28/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Postpartum depression (PPD) and anxiety (PPA) affect nearly one-quarter (23%) of women in Canada. eHealth is a promising solution for increasing access to postpartum mental healthcare. However, a user-centered approach is not routinely taken in the development of web-enabled resources, leaving postpartum women out of critical decision-making processes. This study aimed to evaluate the effectiveness, usability, and user satisfaction of PostpartumCare.ca, a web-enabled psychoeducational resource for PPD and PPA, created in partnership with postpartum women in British Columbia. METHODS Participants were randomized to either an intervention group (n = 52) receiving access to PostpartumCare.ca for four weeks, or to a waitlist control group (n = 51). Measures evaluating PPD (Edinburgh Postnatal Depression Scale) and PPA symptoms (Perinatal Anxiety Screening Scale) were completed at baseline, after four weeks, and after a two-week follow-up. User ratings of website usability and satisfaction and website metrics were also collected. RESULTS PPD and PPA symptoms were significantly reduced for the intervention group only after four weeks, with improvements maintained after a two-week follow-up, corresponding with small-to-medium effect sizes (PPD: partial η2 = 0.03; PPA: partial η2 = 0.04). Intervention participants were also more likely than waitlist controls to recover from clinical levels of PPD symptoms (χ 2 (1, n = 63) = 4.58, p = .032) and PostpartumCare.ca's usability and satisfaction were rated favourably overall. CONCLUSION Findings suggest that a web-enabled psychoeducational resource, created in collaboration with patient partners, can effectively reduce PPD and PPA symptoms, supporting its potential use as a low-barrier option for postpartum women. TRIAL REGISTRATION Protocol for this trial was preregistered on NIH U.S. National Library of Medicine, ClinicalTrials.gov as of May 2022 (ID No. NCT05382884).
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Affiliation(s)
- Claire G Lawrence
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, UK.
| | - Lily Yang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Orli S Hellerstein
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Catriona Hippman
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Moulaei K, Moulaei R, Bahaadinbeigy K. Barriers and facilitators of using health information technologies by women: a scoping review. BMC Med Inform Decis Mak 2023; 23:176. [PMID: 37670281 PMCID: PMC10478440 DOI: 10.1186/s12911-023-02280-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND AND AIM Health information technologies play a vital role in addressing diverse health needs among women, offering a wide array of services tailored to their specific requirements. Despite the potential benefits, the widespread utilization of these technologies by women faces numerous barriers and challenges. These barriers can cause women to either reduce their usage of health technologies or refrain from using them altogether. Therefore, this review was done with the aim of identifying and classifying barriers and facilitators. METHODS Some databases, including PubMed, Web of Sciences, and Scopus were searched using related keywords. Then, according to the inclusion and exclusion criteria, the articles were evaluated and selected. Finally, the barriers and facilitators were identified and classified. RESULTS Out of 14,399 articles, finally 35 articles were included in the review. In general, 375 barriers (232 items) and facilitators (143 items) were extracted from the studies. After merging similar items, 121 barriers (51 items) and facilitators (70 items) identified were organized into five main themes (management, technological, legal and regulatory, personal, and data and information management). The most important barriers were "privacy, confidentiality, and security concerns" (n = 24), "deficiencies and limitations of infrastructure, software, hardware, and network" (n = 19), "sociocultural challenges" (n = 15), and "poor economic status" (n = 15). Moreover, the most important facilitators were "increasing awareness, skills and continuous education of women" (n = 17, in personal theme), "providing training services" (n = 14, in management theme), "simple, usable, and user-friendly design of technologies" (n = 14, in technological theme), and "providing financial or non-financial incentives (motivation) for women" (n = 14, in personal theme). CONCLUSION This review showed that in order to use technologies, women face many barriers, either specific to women (such as gender inequality) or general (such as lack of technical skills). To overcome these barriers, policymakers, managers of organizations and medical centers, and designers of health systems can consider the facilitators identified in this review.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Moulaei
- School of medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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van Kessel R, Roman-Urrestarazu A, Anderson M, Kyriopoulos I, Field S, Monti G, Reed SD, Pavlova M, Wharton G, Mossialos E. Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review. J Med Internet Res 2023; 25:e48000. [PMID: 37490322 PMCID: PMC10410406 DOI: 10.2196/48000] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Samantha Field
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus 2023; 15:e41381. [PMID: 37546054 PMCID: PMC10400812 DOI: 10.7759/cureus.41381] [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: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.
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Affiliation(s)
- Rishika Saharoy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Pettman D, O'Mahen H, Blomberg O, Svanberg AS, von Essen L, Woodford J. Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:208. [PMID: 36991389 PMCID: PMC10052839 DOI: 10.1186/s12888-023-04547-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Depression during the perinatal period (during pregnancy and the year after childbirth) is common and associated with a range of negative effects for mothers, infants, family members, and wider society. Although existing evidence suggests cognitive behavioral therapy (CBT) based interventions are effective for perinatal depression, less is known about the effect of CBT-based interventions on important secondary outcomes, and a number of potential clinical and methodological moderators have not been examined. METHODS A systematic review and meta-analysis primarily examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of depression. Secondary aims examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of anxiety, stress, parenting, perceived social support, and perceived parental competence; and explored clinical and methodological moderators potentially associated with effectiveness. A systematic search of electronic databases and other sources was performed up to November 2021. We included randomized controlled trials comparing CBT-based interventions for perinatal depression with control conditions allowing for the isolation of the effects of CBT. RESULTS In total, 31 studies (5291 participants) were included in the systematic review and 26 studies (4658 participants) were included in the meta-analysis. The overall effect size was medium (hedges g = - 0.53 [95% CI - 0.65 to - 0.40]); with high heterogeneity. Significant effects were also found for anxiety, individual stress, and perceived social support, however few studies examined secondary outcomes. Subgroup analysis identified type of control, type of CBT, and type of health professional as significant moderators of the main effect (symptoms of depression). Some concerns of risk of bias were present in the majority of studies and one study had a high risk of bias. CONCLUSIONS CBT-based interventions for depression during the perinatal period appear effective, however results should be interpreted with caution given high levels of heterogeneity and low quality of included studies. There is a need to further investigate possibly important clinical moderators of effect, including the type of health professional delivering interventions. Further, results indicate a need to establish a minimum core data set to improve the consistency of secondary outcome collection across trials and to design and conduct trials with longer-term follow-up periods. TRIAL REGISTRATION CRD42020152254 .
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Affiliation(s)
- Danelle Pettman
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Heather O'Mahen
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Oscar Blomberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Bartal A, Jagodnik KM, Chan SJ, Babu MS, Dekel S. Identifying women with postdelivery posttraumatic stress disorder using natural language processing of personal childbirth narratives. Am J Obstet Gynecol MFM 2023; 5:100834. [PMID: 36509356 PMCID: PMC9995215 DOI: 10.1016/j.ajogmf.2022.100834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Maternal mental disorders are considered a leading complication of childbirth and a common contributor to maternal death. In addition to undermining maternal welfare, untreated postpartum psychopathology can result in child emotional and physical neglect and associated significant pediatric health costs. Some women may experience traumatic childbirth and develop posttraumatic stress disorder symptoms after delivery (childbirth-related posttraumatic stress disorder). Although women are routinely screened for postpartum depression in the United States, there is no recommended protocol to inform the identification of women who are likely to experience childbirth-related posttraumatic stress disorder. Advancements in computational methods of free text have shown promise in informing the diagnosis of psychiatric conditions. Although the language in narratives of stressful events has been associated with posttrauma outcomes, whether the narratives of childbirth processed via machine learning can be useful for childbirth-related posttraumatic stress disorder screening is unknown. OBJECTIVE This study aimed to examine the use of written narrative accounts of personal childbirth experiences for the identification of women with childbirth-related posttraumatic stress disorder. To this end, we developed a model based on natural language processing and machine learning algorithms to identify childbirth-related posttraumatic stress disorder via the classification of birth narratives. STUDY DESIGN Overall, 1127 eligible postpartum women who enrolled in a study survey during the COVID-19 pandemic provided short written childbirth narrative accounts in which they were instructed to focus on the most distressing aspects of their childbirth experience. They also completed a posttraumatic stress disorder symptom screen to determine childbirth-related posttraumatic stress disorder. After the exclusion criteria were applied, data from 995 participants were analyzed. A machine learning-based Sentence-Transformers natural language processing model was used to represent narratives as vectors that served as inputs for a neural network machine learning model developed in this study to identify participants with childbirth-related posttraumatic stress disorder. RESULTS The machine learning model derived from natural language processing of childbirth narratives achieved good performance (area under the curve, 0.75; F1 score, 0.76; sensitivity, 0.8; specificity, 0.70). Moreover, women with childbirth-related posttraumatic stress disorder generated longer narratives (t test results: t=2.30; p=.02) and used more negative emotional expressions (Wilcoxon test: sadness: p=8.90e-04; W=31,017; anger: p=1.32e-02; W=35,005.50) and death-related words (Wilcoxon test: p=3.48e-05; W=34,538) in describing their childbirth experience than those with no childbirth-related posttraumatic stress disorder. CONCLUSION This study provided proof of concept that personal childbirth narrative accounts generated in the early postpartum period and analyzed via advanced computational methods can detect with relatively high accuracy women who are likely to endorse childbirth-related posttraumatic stress disorder and those at low risk. This suggests that birth narratives could be promising for informing low-cost, noninvasive tools for maternal mental health screening, and more research that used machine learning to predict early signs of maternal psychiatric morbidity is warranted.
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Affiliation(s)
- Alon Bartal
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel (Drs Bartal and Jagodnik)
| | - Kathleen M Jagodnik
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel (Drs Bartal and Jagodnik)
| | - Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Mses Chan and Babu)
| | - Mrithula S Babu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Mses Chan and Babu)
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Drs Dekel and Jagodnik).
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Ely-Ledesma E, Champagne-Langabeer T. Advancing Access to Healthcare through Telehealth: A Brownsville Community Assessment. Healthcare (Basel) 2022; 10:healthcare10122509. [PMID: 36554033 PMCID: PMC9778105 DOI: 10.3390/healthcare10122509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: This paper focuses on the development of a community assessment for telehealth using an interprofessional lens, which sits at the intersection of public health and urban planning using multistakeholder input. The paper analyzes the process of designing and implementing a telemedicine plan for the City of Brownsville and its surrounding metros. (2) Methods: We employed an interprofessional approach to CBPR which assumed all stakeholders as equal partners alongside the researchers to uncover the most relevant and useful knowledge to inform the development of telehealth community assessment. (3) Results: Key findings include that: physicians do not have the technology, financial means, or staff to provide a comprehensive system for telemedicine; and due to language and literacy barriers, many patients are not able to use a web-based system of telemedicine. We also found that all stakeholders believe that telehealth is a convenient tool that has the capacity to increase patient access and care. (4) Conclusions: Ultimately, the use of an interprofessional community-based participatory research (CBPR) design allowed our team to bring together local knowledge with that of trained experts to advance the research efforts.
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Affiliation(s)
- Edna Ely-Ledesma
- Department of Planning and Landscape Architecture, University of Wisconsin-Madison, Madison, WI 53706, USA
- Correspondence:
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Bartal A, Jagodnik KM, Chan SJ, Babu MS, Dekel S. Identifying Women with Post-Delivery Posttraumatic Stress Disorder using Natural Language Processing of Personal Childbirth Narratives. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.08.30.22279394. [PMID: 36093354 PMCID: PMC9460977 DOI: 10.1101/2022.08.30.22279394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Maternal mental disorders are considered a leading complication of childbirth and a common contributor to maternal death. In addition to undermining maternal welfare, untreated postpartum psychopathology can result in child emotional and physical neglect, and associated significant pediatric health costs. Some women may experience a traumatic childbirth and develop posttraumatic stress disorder (PTSD) symptoms following delivery (CB-PTSD). Although women are routinely screened for postpartum depression in the U.S., there is no recommended protocol to inform the identification of women who are likely to experience CB-PTSD. Advancements in computational methods of free text has shown promise in informing diagnosis of psychiatric conditions. Although the language in narratives of stressful events has been associated with post-trauma outcomes, whether the narratives of childbirth processed via machine learning can be useful for CB-PTSD screening is unknown. Objective This study examined the utility of written narrative accounts of personal childbirth experience for the identification of women with provisional CB-PTSD. To this end, we developed a model based on natural language processing (NLP) and machine learning (ML) algorithms to identify CB-PTSD via classification of birth narratives. Study Design A total of 1,127 eligible postpartum women who enrolled in a study survey during the COVID-19 era provided short written childbirth narrative accounts in which they were instructed to focus on the most distressing aspects of their childbirth experience. They also completed a PTSD symptom screen to determine provisional CB-PTSD. After exclusion criteria were applied, data from 995 participants was analyzed. An ML-based Sentence-Transformer NLP model was used to represent narratives as vectors that served as inputs for a neural network ML model developed in this study to identify participants with provisional CB-PTSD. Results The ML model derived from NLP of childbirth narratives achieved good performance: AUC 0.75, F1-score 0.76, sensitivity 0.8, and specificity 0.70. Moreover, women with provisional CB-PTSD generated longer narratives (t-test results: t=2 . 30, p=0 . 02 ) and used more negative emotional expressions (Wilcoxon test: 'sadness': p=8 . 90e- 04 , W=31,017 ; 'anger': p=1 . 32e- 02 , W=35,005 . 50 ) and death-related words (Wilcoxon test: p=3 . 48e- 05 , W=34,538 ) in describing their childbirth experience than those with no CB-PTSD. Conclusions This study provides proof of concept that personal childbirth narrative accounts generated in the early postpartum period and analyzed via advanced computational methods can detect with relatively high accuracy women who are likely to endorse CB-PTSD and those at low risk. This suggests that birth narratives could be promising for informing low-cost, non-invasive tools for maternal mental health screening, and more research that utilizes ML to predict early signs of maternal psychiatric morbidity is warranted.
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Affiliation(s)
- Alon Bartal
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | | | - Sabrina J. Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mrithula S. Babu
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Corresponding Author:
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15
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Tang JJ, Malladi I, Covington MT, Ng E, Dixit S, Shankar S, Kachnowski S. Consumer acceptance of using a digital technology to manage postpartum depression. Front Glob Womens Health 2022; 3:844172. [PMID: 36090598 PMCID: PMC9453037 DOI: 10.3389/fgwh.2022.844172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
The goal of the study was to evaluate the end user experience using the MamaLift Plus app for 2 weeks to support the treatment of their postpartum depression (PPD). A total of 14 participants completed the study and their experiences are reported in this publication. Participants reported that MamaLift Plus is an acceptable, highly usable, and practical mobile tool to use weekly for the management of their PPD. More research is warranted to evaluate the benefit of digital behavior health interventions, especially in patient populations where mental health care may be limited or harder to access by patients.
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Affiliation(s)
- Jian Jenny Tang
- The Mount Sinai Hospital, Obstetrics, Gynecology and Reproductive Science, New York, NY, United States
| | - Indira Malladi
- Curio Digital Therapeutics, Princeton, NJ, United States
- *Correspondence: Indira Malladi
| | | | - Eliza Ng
- Curio Digital Therapeutics, Princeton, NJ, United States
- Coalition for Asian-American Independent Physician Associations, New York, NY, United States
| | - Shailja Dixit
- Curio Digital Therapeutics, Princeton, NJ, United States
| | - Sid Shankar
- Curio Digital Therapeutics, Princeton, NJ, United States
| | - Stan Kachnowski
- Health Innovation and Technology Laboratory, New York, NY, United States
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Koire A, Nong YH, Cain CM, Greeley CS, Puryear LJ, Van Horne BS. Longer wait time after identification of peripartum depression symptoms is associated with increased symptom burden at psychiatric assessment. J Psychiatr Res 2022; 152:360-365. [PMID: 35785579 DOI: 10.1016/j.jpsychires.2022.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
Untreated peripartum depression (PD) affects one in seven women and is associated with negative maternal outcomes. This retrospective observational study used health record data from an integrated health system in Texas to assess the extent to which time to access reproductive psychiatry influences the mental health of peripartum women. Women with at least one screening for depression symptoms conducted in obstetric or pediatric settings between May 2014 and October 2019 and subsequently seen by the reproductive psychiatry clinic (n=490) were included. Descriptive and inferential statistics were used to assess timing and factors related to psychiatry follow-up. Findings from this study demonstrated that the average time between a positive screen and a psychiatry assessment was 5 weeks. At psychiatry referral appointments, 85% of women continued to screen positive for PD symptoms. Depression symptom scores at the psychiatry appointment were significantly higher than scores precipitating the referral (p = 0.002). Wait time between initial positive screen and referral appointment was positively correlated with clinically meaningful increases in depression symptom scores (p < 0.001). Each week spent waiting for an appointment produced a 13% increase in odds of clinically meaningful worsening of PD scores and 9% increase in odds of developing new self-harm ideation. Given the findings that a longer period between primary care referral and subspecialty appointment has a negative impact on the mental health of women, this study supports the need for earlier psychiatric assessment to minimize decompensation. Expansion of reproductive psychiatry services are needed to support peripartum women and improve maternal outcomes.
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Affiliation(s)
- Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, 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 J Puryear
- Obstetrics and Gynecology, Menninger Department of Psychiatry, Baylor College of Medicine, 6651 Main Street, Houston, TX, 77030, 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.
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Hilow HJ, Whibley D, Kratz AL, Ghanbari H. A focus group study to inform design of a symptom management intervention for adults with atrial fibrillation. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 2:246-255. [PMID: 35265916 PMCID: PMC8890334 DOI: 10.1016/j.cvdhj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Current symptom management approaches for patients with atrial fibrillation (AF) focus on addressing heart rhythm and do not include management of behavioral or emotional contributors to symptom manifestation or severity. Objective To inform content development of a digitally delivered AF symptom self-management program by exploring patients’ experiences of the impact of AF symptoms and their perspectives on behavioral approaches to symptom management. Methods This was a qualitative study of 3 focus groups composed of adults living with symptomatic AF. Group transcripts underwent thematic content analysis to identify themes and subthemes. Themes were matched to available self-management strategies that could be adapted for use in a digitally delivered AF symptom self-management program. Results Six major themes (with subthemes) were identified: symptoms (anxiety, fatigue, stress/other negative emotions, AF-specific symptoms, heart rhythm); social aspects (social impact, social support); AF treatments (medication, procedures); health behaviors (sleep, physical activity, hydration, breathing/mindfulness/relaxation); positive emotions; and AF education and information gathering. Symptom self-management strategies were identified that could be used to address these symptom-related themes. Conclusion Patients with AF reported a wide range of emotional, physical, and social impacts of the condition. They endorsed attempts to self-manage symptoms and an interest in learning more about how to effectively self-manage. Findings indicate the potential for a digital self-management program to address existing gaps in AF symptom–related care.
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Affiliation(s)
- Henry J. Hilow
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Hamid Ghanbari
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Address reprint requests and correspondence: Dr Hamid Ghanbari, Department of Internal Medicine, Section of Cardiology, University of Michigan, 1425 E Ann St, Ann Arbor, MI 48109.
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Mothers' Experiences with Child Protection Services: Using Qualitative Feminist Poststructuralism. NURSING REPORTS 2021; 11:913-928. [PMID: 34968278 PMCID: PMC8715453 DOI: 10.3390/nursrep11040084] [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: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The postpartum period is often portrayed as a blissful, calm and loving time when mothers, partners and family members bond with their newborn babies. However, this time may be experienced quite differently when mothers are monitored by Child Protection Services. Having a baby under these circumstances can be very difficult and traumatizing. While all new parents require support and information to help them through the transition to parenthood and address physical and psycho-social changes, mothers who are involved with Child Protection Services require more specialized support as they encounter higher incidences of postpartum stressors and higher rates of poverty, mental illness and substance abuse. The impact of support for mothers involved with Child Protection Services is not well-understood from the perspective of mothers. AIM The aim of the study was to understand how new mothers in Nova Scotia prioritized their postpartum needs and where they went to obtain information and support. METHODS Feminist poststructuralism was the methodology used to understand how the experiences of five mothers who accessed a family resource center and had been involved with Child Protection Services in Nova Scotia Canada had been personally, socially and institutionally constructed. RESULTS Themes include: (1) We are Mothers, (2) Being Red Flagged, (3) Lack of Trust, (4) Us Against Them and (5) Searching for Supportive Relationships. CONCLUSION Personal stories from all participants demonstrated how they experienced stigma and stereotypes from healthcare workers and were often not recognized as mothers. They also struggled to find information, supports and services to help them keep or regain their babies.
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Siddhpuria S, Breau G, Lackie ME, Lavery BM, Ryan D, Shulman B, Kennedy AL, Brotto LA. Women’s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: A User Involvement Study (Preprint). JMIR Form Res 2021; 6:e33411. [PMID: 35737435 PMCID: PMC9264129 DOI: 10.2196/33411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Shailee Siddhpuria
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Genevieve Breau
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Madison E Lackie
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brynn M Lavery
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
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