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Isobel S. Trauma in the lives of parents experiencing severe perinatal mental illness. Front Psychiatry 2024; 15:1380146. [PMID: 38628255 PMCID: PMC11018874 DOI: 10.3389/fpsyt.2024.1380146] [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: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. Method In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Results Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. Discussion The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.
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Affiliation(s)
- Sophie Isobel
- Naamuru Parent and Baby Unit, Sydney Local Health District, Sydney, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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Moran E, Noonan M, Mohamad MM, O'Reilly P. Women's experiences of specialist perinatal mental health services: a qualitative evidence synthesis. Arch Womens Ment Health 2023:10.1007/s00737-023-01338-9. [PMID: 37351664 DOI: 10.1007/s00737-023-01338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE Specialist perinatal mental health services identify and treat women experiencing mental health conditions during pregnancy and up to one year post birth. There is limited knowledge about women's experiences of care from specialist services. Evaluation and optimisation of service delivery requires knowledge of women's care experiences. This review aimed to systematically identify, appraise, and synthesise qualitative evidence exploring women's experiences of specialist perinatal mental health services. METHODS A systematic literature search of five databases: Medline (OVID), EMBASE (Elsevier), PsycINFO (EBSCO), CINAHL (EBSCO) and Scopus (Elsevier), grey literature searching, and backward citation, identified a total of 1035 papers of which sixteen met inclusion criteria. Methodological quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. RESULTS Thematic synthesis identified three themes: connected relationships; new beginnings; and meaningful service delivery. Findings identified that relationships developed with clinicians were significant to women and their experience of care. Women valued continuity of care from dedicated non-judgemental clinicians. Peer support from other mothers was perceived as meaningful to women. Through service interventions women gained new insights into their infant's needs and grew in confidence as a mother. CONCLUSIONS Women require provision of flexible and accessible specialist services with clinicians who are sensitive to their individual psychosocial needs and preferences. Examining discharge practices and continuing care needs is essential to ensure the best outcomes for women and their families.
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Affiliation(s)
- Emma Moran
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
- The Department of Nursing and Healthcare, Technological University of the Shannon, Athlone, Co Westmeath, Ireland.
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mas Mahady Mohamad
- Specialist Perinatal Mental Health Services, University Maternity Hospital Limerick, Limerick, Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Stoodley C, McKellar L, Ziaian T, Steen M, Gwilt I, Fereday J. Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e29770. [PMID: 34110301 PMCID: PMC8241434 DOI: 10.2196/29770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period.
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Affiliation(s)
- Cathy Stoodley
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Lois McKellar
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Tahereh Ziaian
- UniSA: Justice & Society, Magill Campus, University of South Australia, Adelaide, Australia
| | - Mary Steen
- UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Adelaide, Australia
| | - Ian Gwilt
- UniSA: Creative, City West Campus, University of South Australia, Adelaide, Australia
| | - Jenny Fereday
- Women's and Children's Health Network, Adelaide, Australia
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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Gordon JM, Gaffney K, Slavitt HC, Williams A, Lauerer JA. Integrating infant mental health practice models in nursing. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:7-23. [PMID: 31913548 DOI: 10.1111/jcap.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 11/29/2022]
Abstract
PROBLEM During the first years of life, the brain is developing rapidly and is especially vulnerable to the effects of trauma and or stress. Early exposure to such early trauma or stress predisposes young children to mental health problems. The practice of infant mental health (IMH) focuses on preventing negative mental health outcomes in infancy and toddlerhood. Currently, IMH is not standard practice in nursing. To enhance IMH in nursing, this manuscript provides an overview of IMH practice models, discusses nursing implications of each model and presents a model for integrating IMH into nursing practice. METHODS A scoping review was conducted with a literature search utilizing the keywords "infant mental health" AND "models of care" in the PubMed and CINHAL databases from 2002 to 2018. FINDINGS Twenty of the publications retrieved met search criteria. Among the 20 articles, 10 addressed clinical-based content related to IMH practice and 10 addressed nonclinical-based content associated with IMH educational training, policy development, or system-based models of care. CONCLUSIONS Nurses are well positioned to impact IMH. The model presented provides the nursing process as a practical framework for the integration of IMH in nursing practice that can be expanded upon as IMH evolves.
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Affiliation(s)
| | - Kathy Gaffney
- Department of Health Promotion and Disease Prevention, UTHSC College of Nursing, Memphis, Tennessee
| | | | - Amy Williams
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Joy A Lauerer
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Gordon JM, Gaffney K, Smith S, Lauerer JA. An illustrative case for addressing infant mental health referrals. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 33:24-29. [PMID: 31774214 DOI: 10.1111/jcap.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/15/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
PROBLEM Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case. METHODS This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems. FINDINGS The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth. CONCLUSIONS The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood.
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Affiliation(s)
| | - Kathy Gaffney
- Department of Health Promotion and Disease Prevention, College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sharlene Smith
- College of Nursing, University of South Florida, Tampa, Florida
| | - Joy A Lauerer
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Myors KA, Cleary M, Johnson M, Schmied V. 'Modelling a Secure-Base' for Women with Complex Needs: Attachment-Based Interventions Used by Perinatal and Infant Mental Health Clinicians. Issues Ment Health Nurs 2018; 39:226-232. [PMID: 29172815 DOI: 10.1080/01612840.2017.1378784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants.
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Affiliation(s)
- Karen A Myors
- a School of Nursing and Midwifery , Western Sydney University , Sydney , NSW , Australia
| | - Michelle Cleary
- b School of Health Sciences , University of Tasmania , Sydney , NSW , Australia
| | - Maree Johnson
- c Faculty of Health Sciences , Australian Catholic University , Sydney , NSW , Australia
| | - Virginia Schmied
- a School of Nursing and Midwifery , Western Sydney University , Sydney , NSW , Australia
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Simpson M, Schmied V, Dickson C, Dahlen HG. Postnatal post-traumatic stress: An integrative review. Women Birth 2018; 31:367-379. [PMID: 29337007 DOI: 10.1016/j.wombi.2017.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
PROBLEM Post-traumatic stress disorder and post-traumatic stress symptoms following birth occur amongst a small proportion of women but can lead to poor maternal mental health, impairment in mother-infant bonding and relationship stress. This integrative review aims to examine the associated risk factors and women's own experiences of postnatal post-traumatic stress in order to better understand this phenomenon. METHOD Fifty three articles were included and critically reviewed using the relevant Critical Appraisal Skills Program checklists or Strengthening the Reporting of Observational studies in Epidemiology assessment tool. FINDINGS Risk factors for postnatal post-traumatic stress symptoms and disorder include factors arising before pregnancy, during the antenatal period, in labour and birth and in the postnatal period. Potential protective factors against postnatal post-traumatic stress have been identified in a few studies. The development of postnatal post-traumatic stress can lead to negative outcomes for women, infants and families. DISCUSSION Risk factors for post-traumatic stress symptoms and disorder are potentially identifiable pre-pregnancy and during the antenatal, intrapartum and postnatal periods. Potential protective factors have been identified however they are presently under researched. Predictive models for postnatal post-traumatic stress disorder development have been proposed, however further investigation is required to test such models in a variety of settings. CONCLUSIONS Postnatal post-traumatic stress symptoms and disorder have been shown to negatively impact the lives of childbearing women. Further investigation into methods and models for identifying women at risk of developing postnatal post-traumatic stress following childbirth is required in order to improve outcomes for this population of women.
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Affiliation(s)
- Madeleine Simpson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Cathy Dickson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia; Ingham Institute, Liverpool, NSW, Australia.
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Coates D, Saleeba C, Howe D. Profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e154-e163. [PMID: 28868664 DOI: 10.1111/hsc.12489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery.
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Affiliation(s)
- Dominiek Coates
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
| | - Christine Saleeba
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
| | - Deborah Howe
- Children and Young People's Mental Health, Central Coast Local Health District, Central Coast Mental Health, Gosford, NSW, Australia
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A randomized controlled trial: effects of a prenatal depression intervention on perinatal outcomes among Chinese high-risk pregnant women with medically defined complications. Arch Womens Ment Health 2017; 20:333-344. [PMID: 28058505 DOI: 10.1007/s00737-016-0712-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/21/2022]
Abstract
UNLABELLED Prenatal psychosocial health has been linked with health behaviors, maternal health, and birth outcomes. This randomized controlled trial evaluated the effects of a prenatal depression intervention on birth outcomes and maternal physical and psychological status at 42 days postpartum. Three hundred fifty-two high-risk pregnant women exposed to obstetric complications with an Edinburgh Postnatal Depression Scale (EPDS) ≥ 9 or a Postpartum Depression Screening Scale (PDSS) ≥ 60 were randomly assigned to the intervention group (n = 176) and control group (n = 176). The intervention group underwent a six-session couple-separated psycho-educational program; the control group received the usual care. All participants were asked to complete questionnaires at late pregnancy (>28 weeks), 3 days postpartum, and 42 days postpartum. The intervention group had a significantly lower cesarean rate and shorter third stage of labor (p < .05). At 42 days after delivery, only 5.1% of participants were lost to follow-up, and the intervention group had significantly less minor and major depression, more sleep time, more satisfaction with their husband and other family members, less concern about taking care of baby, and less breast milk insufficiency than the control group (p < .05). A prenatal psychological intervention model for high-risk pregnant women holds potential as a preventive program that addresses maternal health and birth outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-IOR-15006433), http://www.chictr.org.cn/enIndex.aspx (retrospectively registered).
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Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health 2016; 16:69. [PMID: 27782825 PMCID: PMC5078921 DOI: 10.1186/s12905-016-0344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor mental health in the perinatal period can impact negatively on women, their infants and families. Australian State and Territory governments are investing in routine psychosocial assessment and depression screening with referral to services and support, however, little is known about how well these services are used. The aim of this paper is to report on the health services used by women for their physical and mental health needs from pregnancy to 12 months after birth and to compare service use for women who have been identified in pregnancy as having moderate-high psychosocial risk with those with low psychosocial risk. METHODS One hundred and six women were recruited to a prospective longitudinal study with five points of data collection (2-4 weeks after prenatal booking, 36 weeks gestation, 6 weeks postpartum, 6 months postpartum and 12 months postpartum) was undertaken. Data were collected via face-to-face and telephone interviews, relating to psychosocial risk factors, mental health and service use. The prenatal psychosocial risk status of women (data available for 83 of 106 women) was determined using the Antenatal Risk Questionnaire (ANRQ) and was used to compare socio-demographic characteristics and service use of women with 'low' and 'moderate to high' risk of perinatal mental health problems. RESULTS The findings indicate high use of postnatal universal health services (child and family health nurses, general practitioners) by both groups of women, with limited use of specialist mental health services by women identified with moderate to high risk of mental health problems. While almost all respondents indicated that they would seek help for mental health concerns most had a preference to seek help from partners and family before accessing health professionals. CONCLUSION These preliminary data support local and international studies that highlight the poor uptake of specialist services for mental health problems in postnatal women, where this may be required. Further research comparing larger samples of women (with low and psychosocial high risk) are needed to explore the extent of any differences and the reasons why women do not access these specialist services.
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Affiliation(s)
- Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia.
| | - Rachel Langdon
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
- Centre for Applied Nursing Research (a joint facility of the South Western Sydney Local Health District and Western Sydney University, Liverpool, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
| | - Stephen Matthey
- School of Psychology, University of Sydney and Research Director, Infant, Child & Adolescent Mental Health Service, South West Sydney Local Health District, Sydney, Australia
| | - Lynn Kemp
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
| | - Marie-Paule Austin
- Chair, Perinatal Mental Health Unit University of New South Wales & St John of God Health Care, Burwood , Sydney, Australia
- The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
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Myors KA, Cleary M, Johnson M, Schmied V. A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos? BMC Health Serv Res 2015; 15:316. [PMID: 26260057 PMCID: PMC4531515 DOI: 10.1186/s12913-015-0977-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women at risk of poor perinatal mental health benefit from coordinated approaches to care. Perinatal and infant mental health (PIMH) services have been established to support women with social and emotional needs. This paper examines the nature and extent of collaboration within two PIMH services in Australia. METHODS A convergent, embedded, mixed methods design was used. Two hundred and forty four medical records were reviewed, 13 professionals (six PIMH clinicians, two PIMH service managers, and five key stakeholders) and 11 women service-users participated in semi-structured interviews. RESULTS Three broad themes were drawn from the data, Theme 1: We don't sit in silos … but they do, Theme 2: We need to enhance communication, and Theme 3: Collaboration is hard work. Perinatal and infant mental health clinicians believe they work collaboratively with other service providers. Key stakeholders and documentation in the medical records reveal that collaboration is nominal. CONCLUSIONS Professionals believe that collaboration is essential for women with complex needs. Perinatal and infant mental health clinicians are skilled at building relationships with women, however further support is needed to build trusting relationships with other service providers. Women service-users also need to be involved in the collaborative process to become equal partners in their care.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
- Centre for Applied Nursing Research, Affiliated with the Ingham Institute of Applied Medical Research, Sydney South West Local Health District, Liverpool, NSW, 2170, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
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Myors KA, Johnson M, Cleary M, Schmied V. Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study. Int J Ment Health Nurs 2015; 24:241-52. [PMID: 25521937 DOI: 10.1111/inm.12109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed-methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non-engagement are 'time to rethink' and 'stigma'. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: 'back to basics' and 'building trust', therapeutic engagement: 'making myself useful', engagement at discharge: 'woman or clinician led', and models that facilitate engagement.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
| | - Maree Johnson
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South West Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
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