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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Universal Depression Screen of Ambulatory Heart Transplant Recipients With Referral for Mental Health Intervention: A Quality Improvement Project. J Nurs Care Qual 2021; 36:236-241. [PMID: 32956136 DOI: 10.1097/ncq.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with a heart transplant and depression have higher rates of graft failure and noncompliance. LOCAL PROBLEM The heart transplant clinic had no standardized approach to assess for depression. METHODS The heart transplant clinic implemented routine use of the Patient Health Questionnaire (PHQ). INTERVENTIONS Team members were educated via an online module about depression. A process for depression screening and follow-up was developed and implemented. RESULTS From July 2018 to February 2019, there were 834 visits; PHQ2 screens were completed during 779 (93%) of those visits with 40 (5%) positive screens. All 40 patients had PHQ9 assessment, with 33 patients (4%) exhibiting moderate or severe depressive symptoms. All 33 patients were provided with mental health resources and received follow-up. Median time to administer PHQ2 was 2 minutes (range 1-3 minutes). CONCLUSIONS Implementation of universal depression screening in a heart transplant clinic is feasible, identifies patients with depression, and does not add significant clinical burden.
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Webb R, Uddin N, Ford E, Easter A, Shakespeare J, Roberts N, Alderdice F, Coates R, Hogg S, Cheyne H, Ayers S. Barriers and facilitators to implementing perinatal mental health care in health and social care settings: a systematic review. Lancet Psychiatry 2021; 8:521-534. [PMID: 33838118 DOI: 10.1016/s2215-0366(20)30467-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
The improvement of perinatal mental health formed part of WHO's Millennium Development Goals. Research suggests that the implementation of perinatal mental health care is variable. To ensure successful implementation, barriers and facilitators to implementing perinatal mental health services need to be identified. Therefore, we aimed to identify the barriers and facilitators to implementing assessment, care, referral, and treatment for perinatal mental health into health and social care services. In this systematic review, we searched CINAHL, Embase, MEDLINE, and PsycINFO with no language restrictions for primary research articles published between database inception and Dec 11, 2019. Forward and backward searches of included studies were completed by March 31, 2020. Studies were eligible if they made statements about factors that either facilitated or impeded the implementation of perinatal mental health assessment, care, referral, or treatment. Partial (10%) dual screening was done. Data were extracted with EPPI-Reviewer 4 and analysed by use of a thematic synthesis. The protocol is registered on PROSPERO, CRD42019142854. Database searching identified 21 535 citations, of which 46 studies were included. Implementation occurred in a wide range of settings and was affected by individual (eg, an inability to attend treatment), health-care professional (eg, training), interpersonal (eg, trusting relationships), organisational (eg, clear referral pathways), political (eg, funding), and societal factors (eg, stigma and culture). A complex range of barriers and facilitators affect the implementation of perinatal mental health policy and practice. Perinatal mental health services should be flexible and women-centred, and delivered by well trained health-care professionals working within a structure that facilitates continuity of carer. Strategies that can be used to improve implementation include, but are not limited to, co-production of services, implementation team meetings, funding, and coalition building. Future research should focus on implementation barriers and facilitators dependent on illness severity, the health-care setting, and inpatient care.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health, City, University of London, London, UK.
| | - Nazihah Uddin
- Centre for Maternal and Child Health, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | - Abigail Easter
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Nia Roberts
- Nuffield Department of Population Health, Bodleian Health Care Libraries, Oxford, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rose Coates
- Centre for Maternal and Child Health, City, University of London, London, UK
| | | | - Helen Cheyne
- NMAHP Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Susan Ayers
- Centre for Maternal and Child Health, City, University of London, London, UK
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Dadich A, Piper A, Coates D. Implementation science in maternity care: a scoping review. Implement Sci 2021; 16:16. [PMID: 33541371 PMCID: PMC7860184 DOI: 10.1186/s13012-021-01083-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used. METHODS To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues' (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form. RESULTS Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication-yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools-rather than for instance, the design of the study. CONCLUSION Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks. REGISTRATION Registered with the Joanna Briggs Institute (registration number not provided).
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Affiliation(s)
- Ann Dadich
- Western Sydney University, School of Business, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Annika Piper
- Western Sydney University, School of Business, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Dominiek Coates
- University of Technology Sydney, Broadway, PO Box 123, Ultimo, NSW 2007 Australia
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Chorwe-Sungani G, Mwagomba M, Kulisewa K, Chirwa E, Jere D, Chipps J. Protocol for assessing feasibility, acceptability and fidelity of screening for antenatal depression (FAFSAD) by midwives in Blantyre District, Malawi. Pilot Feasibility Stud 2021; 7:32. [PMID: 33494838 PMCID: PMC7836563 DOI: 10.1186/s40814-021-00775-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background Depression is often underdiagnosed by treating health professionals. This is a situation in Malawi where there is no routine screening of depression at antenatal clinics. Recently, a Screening Protocol for Antenatal Depression (SPADe) that can be used by midwives to screen for antenatal depression was developed in Blantyre District. SPADe proposes multistage screening of antenatal depression by midwives which may enable early detection and treatment of pregnant women with depression. Proper treatment of antenatal depression can assist in achieving Sustainable Development Goals (SDGs). However, utilisation of SPADe in clinical practice to screening for depression in antenatal clinics has not been established yet. Therefore, the primary aim of this study is to assess feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. The secondary aim was to assess acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. Methods This will be a feasibility study which will consist of scientific investigations that will support movement of evidence-based, effective health care approach, SPADe, from the clinical knowledge base into routine use. This study will consist three phases: phase 1 will introduce SPADe in antenatal clinics in Blantyre District where screening of depression is almost none existent; phase 2 will implement screening of depression using SPADe in antenatal clinics in Blantyre District; and phase 3 will evaluate the screening of antenatal depression using SPADe to establish its feasibility, acceptability and fidelity in antenatal clinics in Blantyre District. Discussion This study will establish and document feasibility, acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. It is expected that midwives will develop more confidence in detecting and dealing with antenatal depression. Consequently, there will be increased numbers of pregnant women detected with depression by midwives and increased accessibility to mental health care by pregnant women in antenatal clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00775-6.
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Affiliation(s)
- Genesis Chorwe-Sungani
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi.
| | - Modesta Mwagomba
- Blantyre District Health Office, Chipatala Avenue, P/Bag 66, Blantyre, Malawi
| | - Kazione Kulisewa
- College of Medicine, University of Malawi, Mahatma Ghandi Rd, P/Bag, 360, Blantyre, Malawi
| | - Ellen Chirwa
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi
| | - Diana Jere
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi
| | - Jennifer Chipps
- University of the Western Cape, Robert Sobukwe Rd, Bellville, Cape Town, 7535, South Africa
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Long MM, Cramer RJ, Jenkins J, Bennington L, Paulson JF. A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders. Arch Womens Ment Health 2019; 22:25-36. [PMID: 29968128 DOI: 10.1007/s00737-018-0876-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
Postpartum depression affects approximately 11% of women. However, screening for perinatal mood and anxiety disorders (PMAD) is rare and inconsistent among healthcare professionals. When healthcare professionals screen, they often rely on clinical judgment, rather than validated screening tools. The objective of the current study is to review the types and effectiveness of interventions for healthcare professionals that have been used to increase the number of women screened and referred for PMAD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PubMed/Medline, PsychInfo/PsychArticles, Cumulative Index to Nursing, Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition databases were used to find studies that implemented an intervention for healthcare professionals to increase screening and referral for PMAD. Twenty-five studies were included in the review. Based on prior quality assessment tools, the quality of each article was assessed using an assessment tool created by the authors. The four main outcome variables were the following: percentage of women screened, percentage of women referred for services, percentage of women screened positive for PMAD, and provider knowledge, attitudes, and/or skills concerning PMAD. The most common intervention type was educational, with others including changes in electronic medical records and standardized patients for training. Study quality and target audience varied among the studies. Interventions demonstrated moderate positive impacts on screening completion rates, referral rates for PMAD, and patient-provider communication. Studies suggested positive receptivity to screening protocols by mothers and providers. Given the prevalence and negative impacts of PMAD on mothers and children, further interventions to improve screening and referral are needed.
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Affiliation(s)
- Molly M Long
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.
| | - Robert J Cramer
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.,Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Jennika Jenkins
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - James F Paulson
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.,Department of Psychology, Old Dominion University, Norfolk, VA, USA
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Screening for Postpartum Depression by Hospital-Based Perinatal Nurses. MCN Am J Matern Child Nurs 2018; 43:324-329. [DOI: 10.1097/nmc.0000000000000470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Albuja AF, Lara MA, Navarrete L, Nieto L. Social Support and Postpartum Depression Revisited: The Traditional Female Role as Moderator among Mexican Women. SEX ROLES 2017; 77:209-220. [PMID: 28936028 PMCID: PMC5602525 DOI: 10.1007/s11199-016-0705-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Women who lack social support tend to have a higher risk of postpartum depression. The present study examined the traditional female role, understood here as the adoption of passive and submissive traits specific to Mexican women, as another risk factor for postpartum depressive symptomatology that interacts with social support. Using two waves of data from a longitudinal study of 210 adult Mexican women (20-44 years-old, Mage = 29.50 years, SD = 6.34), we found that lacking social support during the third trimester of their pregnancy was associated with greater depressive symptoms at 6 months in the postpartum, although this relationship depended on the level of endorsement of the traditional female role during pregnancy. Lower social support during pregnancy predicted greater postpartum depressive symptoms for women with higher endorsement of the traditional female role, even when accounting for prenatal depressive symptoms. These results suggest that Mexican women's experience of social support may depend on their individual adherence to gender roles. Understanding the association between women's traditional roles and social support in the risk for postpartum depression can improve prevention and educational programs for women at risk.
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Affiliation(s)
| | - M Asunción Lara
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | - Laura Navarrete
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | - Lourdes Nieto
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
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Cole JCM, Olkkola M, Zarrin HE, Berger K, Moldenhauer JS. Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects. J Obstet Gynecol Neonatal Nurs 2017. [PMID: 28646642 DOI: 10.1016/j.jogn.2017.04.131] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU. DESIGN A standardized universal mental health postpartum screening and referral protocol was developed for parents of high-risk neonates. SETTING/LOCAL PROBLEM The project occurred at the Garbose Family Special Delivery Unit, the world's first obstetrics unit housed within a pediatric hospital serving healthy women who give birth to newborns with prenatally diagnosed fetal anomalies. Parents of neonates admitted to the NICU are at greater risk to develop postpartum psychological distress; therefore, early identification is critical. PATIENTS A total of 1,327 participants were screened, including 725 women who gave birth to live newborns at the Garbose Family Special Delivery Unit and 602 fathers. INTERVENTION/MEASUREMENTS Obstetric nurses asked parents to complete a screening tool that assessed their psychological risk in the postpartum period. A system for mental health triage and referral was available for parents with elevated scores. RESULTS Overall monthly screening procedure compliance rates were high (96.5% mothers and 79.6% fathers). Women (5.5%, n = 40) and men (5.5%, n = 33) showed high risk for traumatic stress, and 35.9% (n = 260) of women and 9.5% (n = 57) of men showed elevated risk for major depression in the imediate postpartum period. CONCLUSION Incorporating the screening process into routine nursing practice with immediate mental health triage and referral made the program feasible. The risk factors identified add to the growing knowledge about parents of newborns in the NICU.
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A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 47:114-121. [PMID: 28482172 DOI: 10.1016/j.jogn.2016.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 11/22/2022] Open
Abstract
Mothers whose infants are hospitalized in the NICU are frequently emotionally distressed, particularly early in the hospitalization. The Family-Centered Developmental Care philosophy, widely adopted by NICUs, calls for an expanded focus on the well-being of the entire family. In this article, we describe an innovative, nurse-delivered program for emotionally distressed mothers of infants in the NICU that includes screening and an empirically supported counseling approach: Listening Visits.
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McCabe-Beane JE, Segre LS, Perkhounkova Y, Stuart S, O’Hara MW. The identification of severity ranges for the Edinburgh Postnatal Depression Scale. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2016.1141346] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The purpose of this article was to evaluate attitudes of mothers of newborns hospitalized on the neonatal intensive care unit (NICU) toward nurse-delivered depression screening and counseling. NICU mothers ( N = 200) completed questionnaires assessing their views toward being screened for depression by nurses, treatment provider preference, and interest in learning about Listening Visits (LV), a nurse-delivered intervention. The views of 23 LV recipients were also assessed. Most mothers were receptive to depression screening by nurses, two thirds would see a nurse for counseling, and half were interested in learning more about LV. Among LV recipients, half readily embraced the idea and the remaining recipients were skeptical but opted to try. After receiving LV, recipients unanimously rated LV and the skill of the LV provider highly. Screening and counseling by NICU nurses could increase detection of depression and treatment use among at-risk women. Assessing nurses’ perspectives about implementing this model of care is an important future research direction.
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Tabb KM, Choi S, Pineros-Leano M, Meline B, McDonald HG, Kester R, Huang H. Perinatal depression screening in a Women, Infants, and Children (WIC) program: perception of feasibility and acceptability among a multidisciplinary staff. Gen Hosp Psychiatry 2015; 37:305-9. [PMID: 25858684 DOI: 10.1016/j.genhosppsych.2015.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Best practices for addressing women's mental health and screening for depression in public health clinics are not available. Clinic staff are often responsible for screening for depression; however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. METHODS During December 2012, we conducted four focus groups using a semistructured interview guide with public health clinic staff of varying disciplines (n=25) in a Special Supplemental Nutrition Program for Women, Infants, and Children. All interviews were audio recorded and analyzed using thematic analysis. RESULTS We found five descriptive themes related to acceptability and feasibility of screening for perinatal depression in a public health clinic. The main themes include (1) literacy barriers, (2) need for referrals and follow-up with outside services, (3) training and capacity needs, (4) stigma of depression, and (5) location and privacy of screening. Although multiple barriers to universal depression screening in a public health clinic were identified, participants found value in practice of screening low-income women for depression. CONCLUSION Factors for facilitating implementation of systematic depression screening in a public health clinic have been identified. Implications discuss how policy makers and public health clinic administrators can improve the universal depression screening process.
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Affiliation(s)
- Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Shinwoo Choi
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Maria Pineros-Leano
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Brandon Meline
- Champaign-Urbana Public Health District, Champaign, IL 61820, USA
| | - Hellen G McDonald
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Rachel Kester
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02138, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02138, USA
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Kim HJ, Park E, Storr CL, Tran K, Juon HS. Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0127760. [PMID: 26029911 PMCID: PMC4452590 DOI: 10.1371/journal.pone.0127760] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/20/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors. METHODS Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics. RESULTS A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino). CONCLUSION There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.
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Affiliation(s)
- Hee Jun Kim
- School of Nursing, University of Maryland, Baltimore, Maryland, United States of America
| | - EunMi Park
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Carla L. Storr
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland, United States of America
| | - Katherine Tran
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States of America
- * E-mail:
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