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Eikemo R, Vikström A, Nyman V, Jonas W, Barimani M. Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden. Scand J Caring Sci 2023; 37:260-270. [PMID: 35781315 DOI: 10.1111/scs.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic. DESIGN New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used. SETTING AND PARTICIPANTS The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed. INTERVENTION All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic. FINDINGS New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs. KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.
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Affiliation(s)
- Ragnhild Eikemo
- Academic Primary Care Centre, Stockholm, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Vikström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Viola Nyman
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mia Barimani
- Academic Primary Care Centre, Stockholm, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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2
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Ali U, Waqas A, Ayub M. Research Trends and Geographical Contribution in the Field of Perinatal Mental Health: A Bibliometric Analysis from 1900 to 2020. WOMEN'S HEALTH REPORTS 2022; 3:661-669. [PMID: 35982774 PMCID: PMC9380875 DOI: 10.1089/whr.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 10/26/2022]
Affiliation(s)
- Usman Ali
- Academic Department of Psychiatry and Behavioral Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Ahmed Waqas
- Institute of Population Health, University of Liverpool, United Kingdom
| | - Muhammad Ayub
- Department of Psychiatry, University College London, London, England
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Blackmore R, Gibson-Helm M, Melvin G, Boyle JA, Fazel M, Gray KM. Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic. Aust N Z J Psychiatry 2022; 56:525-534. [PMID: 34250839 DOI: 10.1177/00048674211025687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. METHODS This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. RESULTS Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). CONCLUSION These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mina Fazel
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), Faculty of Social Sciences, University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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Marti-Castaner M, Hvidtfeldt C, Villadsen SF, Laursen B, Pedersen TP, Norredam M. Disparities in postpartum depression screening participation between immigrant and Danish-born women. Eur J Public Health 2021; 32:41-48. [PMID: 34864938 PMCID: PMC9090168 DOI: 10.1093/eurpub/ckab197] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.
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Affiliation(s)
- Maria Marti-Castaner
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Fredsted Villadsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne Laursen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Dowse E, Chan S, Ebert L, Wynne O, Thomas S, Jones D, Fealy S, Evans TJ, Oldmeadow C. Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis. Matern Child Health J 2021; 24:718-726. [PMID: 32303935 DOI: 10.1007/s10995-020-02906-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes. METHODS A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay. RESULTS Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay. CONCLUSIONS Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.
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Affiliation(s)
- Eileen Dowse
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia. .,University of Newcastle Priority Research Centre for Reproductive Science: Mothers and Babies, Callaghan, Australia.
| | - Sally Chan
- University of Newcastle Priority Research Centre for Brain & Mental Health, Callaghan, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, Australia.,University of Newcastle, UON Singapore Operation, Singapore, Singapore
| | - Lyn Ebert
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Reproductive Science: Mothers and Babies, Callaghan, Australia
| | - Olivia Wynne
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Susan Thomas
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Donovan Jones
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Brain & Mental Health, Callaghan, Australia.,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Port Macquarie Campus, 7 Major Innes Road, Port Macquarie, NSW, 2444, Australia
| | - Shanna Fealy
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Port Macquarie Campus, 7 Major Innes Road, Port Macquarie, NSW, 2444, Australia
| | - Tiffany-Jane Evans
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Christopher Oldmeadow
- School of Nursing and Midwifery, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Intimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers. J Affect Disord 2020; 262:247-257. [PMID: 31732279 DOI: 10.1016/j.jad.2019.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/23/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up. RESULTS One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9). LIMITATIONS Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure. CONCLUSIONS The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.
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Dahlen HG, Munoz AM, Schmied V, Thornton C. The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years. BMJ Open 2018; 8:e019566. [PMID: 29695386 PMCID: PMC5922470 DOI: 10.1136/bmjopen-2017-019566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intimate partner violence (IPV) is a global health issue affecting mainly women and is known to escalate during pregnancy and impact negatively on obstetric and perinatal outcomes. The aim of this study is to determine the incidence of IPV in a pregnant multicultural population and to determine the relationship between IPV reported at booking interview and maternal and perinatal outcomes. DESIGN This is a retrospective population-based data study. We analysed routinely collected data (2006-2016) from the ObstetriX system on a cohort of pregnant women. SETTING AND PARTICIPANTS 33 542 women giving birth in a major health facility in Western Sydney. PRIMARY OUTCOMES Incidence of IPV, association with IPV and other psychosocial variables and maternal and perinatal outcomes. RESULT 4.3% of pregnant women reported a history of IPV when asked during the routine psychosocial assessment. Fifty-four per cent were not born in Australia, and this had increased significantly over the decade. Women born in New Zealand (7.2%) and Sudan (9.1%) were most likely to report IPV at the antenatal booking visit, with women from China and India least likely to report IPV. Women who reported IPV were more likely to report additional psychosocial concerns including Edinburgh Postnatal Depression Scale scores > 13 (7.6%), thoughts of self-harm (2.4%), childhood abuse (23.6%), and a history of anxiety and depression (34.2%). Women who reported IPV were more likely to be Australian born, smoke and be multiparous and to have been admitted for threatened preterm labour (Adjusted Odds Ratio (AOR) 1.8, 95% CI 1.28 to 2.39). CONCLUSIONS A report of IPV at the first antenatal booking visit is associated with a higher level of reporting on all psychosocial risks, higher antenatal admissions, especially for threatened preterm labour. More research is needed regarding the effectiveness of current IPV screening for women from other countries.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Ana Maria Munoz
- Blacktown Mount Druitt Hospitals, Blacktown, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, 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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Sensitivity and Specificity of the SRQ-20 and the EPDS in Diagnosing Major Depression Ante- and Postnatally in a South African Birth Cohort Study. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9854-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Factors affecting implementation of perinatal mental health screening in women of refugee background. Implement Sci 2016; 11:150. [PMID: 27863498 PMCID: PMC5116191 DOI: 10.1186/s13012-016-0515-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background. METHODS Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral. RESULTS Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation. CONCLUSIONS This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.
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Laddipeerla A, Alexander J, Lattanzio A. Reflections on Aboriginal perinatal mental health, mothers, babies, families and community: A South Australian trainee's experience. Australas Psychiatry 2015; 23:693-5. [PMID: 26129814 DOI: 10.1177/1039856215592316] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper explores novel training opportunities that the Expanded Setting Training Program (ESTP) provides for advanced psychiatry trainees. It is a reflection of a trainee's learning experiences during a year-long posting in Aboriginal Perinatal Mental Health, working alongside the Aboriginal Family Birthing Program, coupled with reflection and supervision. CONCLUSIONS ESTP provided a fertile area to hone an advanced trainee's skills in the niche areas of Aboriginal mental health, perinatal mental health, culture and psychiatry. In addition, it provided skills in the area of leadership, health advocacy and the establishment and maintenance of successful programs in disadvantaged, culturally and linguistically diverse communities. The ESTP Aboriginal Mental Health rotation provides a unique experience for training, and the learning opportunities are limited only by the creativity of the trainee and supervisor.
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Affiliation(s)
- Aparna Laddipeerla
- Consultant Psychiatrist, Country Health SA, Rural and Remote Mental Health Service, Parkside, Fullarton, SA, and; Clinical Senior Lecturer, The University of Adelaide, Division of Psychiatry, School of Medicine, Adelaide, SA, Australia
| | - Jacob Alexander
- Senior Consultant Psychiatrist, Rural and Remote Mental Health Service, Fullarton, SA, and; Director of Training, Rural and Remote Mental Health Network Country Health, Fullarton, and; Director of Clinical Training, Mental Health Directorate, Central Adelaide Health Network, The Adelaide Pre-vocational Psychiatry Program (TAPPP), Adelaide, SA, Australia
| | - Adriana Lattanzio
- Senior Consultant Psychiatrist, Rural and Remote Mental Health Service, Fullarton, SA, Australia
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Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study. BMC Pregnancy Childbirth 2015; 15:292. [PMID: 26552427 PMCID: PMC4640409 DOI: 10.1186/s12884-015-0681-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Bryanne Barnett
- School of Psychiatry, Clinical Director, St John of God Raphael Centre, Medicine, University of New South Wales, 36-38 First Avenue, Blacktown, NSW, 2148, Australia. .,St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Jane Kohlhoff
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. .,Karitane, P.O. Box 241, Villawood, 2163 NSW, Australia.
| | - Maya Elizabeth Drum
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Ana Maria Munoz
- Clinical Midwifery Consultant, Blacktown Hospital, Blacktown, Australia.
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Reilly N, Yin C, Monterosso L, Bradshaw S, Neale K, Harrison B, Austin MP. Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Reilly
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Carolyn Yin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Leanne Monterosso
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
- University of Notre Dame Australia; Murdoch Western Australia Australia
- School of Nursing and Midwifery; Edith Cowan University of Western Australia; Joondalup Western Australia Australia
| | - Sue Bradshaw
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Kizzi Neale
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Beate Harrison
- Murdoch Raphael Centre; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
- The Black Dog Institute; Prince of Wales Hospital; Burwood New South Wales Australia
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14
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Leach LS, Christensen H, Mackinnon A. Pregnancy and levels of depression and anxiety: a prospective cohort study of Australian women. Aust N Z J Psychiatry 2014; 48:944-51. [PMID: 24819936 DOI: 10.1177/0004867414533013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The effects of pregnancy on depression and anxiety remain unclear. Previous research is predominantly cross-sectional, not representative of the general community, and does not include data on mental health prior to pregnancy. This study used longitudinal Australian population-based data to examine whether pregnancy is associated with increases in women's anxiety and depression levels (from pre-pregnancy). METHOD A community sample of Australian women aged 20-24 years were recruited prospectively and assessed in 1999, 2003 and 2007. At the follow-up assessments 76 women were pregnant (with no prior children) and 542 remained nulliparous. Mixed models repeated measures analyses of variance were undertaken to compare change in levels of anxiety and depression (Goldberg Anxiety and Depression scales) between those who became pregnant and those who remained non-pregnant. RESULTS Pregnancy was not associated with increased symptoms of depression or anxiety. No association was found with depression, while pregnancy was associated with a decrease in anxiety. Including somatic items in the measures of depression and anxiety resulted in higher symptom levels in pregnancy, suggesting possible item bias. CONCLUSIONS This study is one of the first to follow a community sample of women from pre-pregnancy to pregnancy. The findings suggest that pregnancy is not typically detrimental to women's mental health. The current study offers a starting point for future prospective studies to follow women from pre-pregnancy to postpartum. Study limitations to be improved upon in follow-up research include expanding the sample size, and including both pregnancy-specific measures and trimester-specific data. Future research should continue to identify those women who are most (and least) at risk during pregnancy in order to target resources and assistance most effectively.
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Affiliation(s)
- Liana S Leach
- Psychiatric Epidemiology and Social Issues Unit, Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
| | | | - Andrew Mackinnon
- ORYGEN Research Centre, The University of Melbourne, Melbourne, Australia
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15
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Xu F, Sullivan EA, Li Z, Burns L, Austin MP, Slade T. The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia. BMC Womens Health 2014; 14:119. [PMID: 25263987 PMCID: PMC4261248 DOI: 10.1186/1472-6874-14-119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/23/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth. METHODS This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded. RESULTS There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders. CONCLUSIONS This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
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Affiliation(s)
- Fenglian Xu
- />National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031 Australia
| | - Elizabeth A Sullivan
- />Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Zhuoyang Li
- />Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Lucy Burns
- />National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031 Australia
| | - Marie-Paule Austin
- />Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Tim Slade
- />National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031 Australia
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16
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Geia LK, West R, Power T. Editorial: addressing perinatal mental health issues for Aboriginal and Torres Strait Island parents and their families: working towards better maternity outcomes. Contemp Nurse 2014; 46:70-2. [PMID: 24716764 DOI: 10.5172/conu.2013.46.1.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lynore K Geia
- School of Nursing, Midwifery & Nutrition, James Cook University, Townsville, QLD, Australia, 2. Lynore K Geia is a proud woman of Bwgcolman, born and raised on Palm Island, Queensland
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17
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Xu F, Li Z, Binns C, Bonello M, Austin MP, Sullivan E. Does infant feeding method impact on maternal mental health? Breastfeed Med 2014; 9:215-21. [PMID: 24621349 DOI: 10.1089/bfm.2013.0142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Breastfeeding has been reported to reduce the risk of postpartum anxiety and depression. However, little is known of the effects of breastfeeding on hospital admissions for postpartum mental disorders. MATERIALS AND METHODS This is a population-based longitudinal cohort study using linked data. All mothers who gave birth to a live infant between 2007 and 2008 in New South Wales, Australia were followed up for 1 year for hospital admissions with diagnoses of psychiatric and/or substance use disorders. RESULTS There were 186,452 women who were reported as giving birth in New South Wales between 2007 and 2008. The "any breastfeeding" rate at the time of discharge was 87.1%. In total, 2,940 mothers were admitted to the hospital with psychiatric diagnoses within 12 months of birth. The first hospital admission for the diagnoses of overall mental illness was 32 days earlier for non-breastfeeding mothers compared with those with full breastfeeding. Mothers who did not breastfeed were more likely to be admitted to the hospital in the first year postpartum for schizophrenia (adjusted relative risk [ARR]=2.0; 95% confidence interval [CI] 1.3, 3.1), bipolar affective disorders (ARR=1.9; 95% CI 1.1, 3.5), and mental illness due to substance use (ARR=1.8; 95% CI 1.3, 2.5) compared with full breastfeeding mothers. CONCLUSIONS Breastfeeding is associated with a decrease in the risk of subsequent maternal hospital admissions for schizophrenia, bipolar affective disorders, and mental illness due to substance use, in the first postpartum year.
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Affiliation(s)
- Fenglian Xu
- 1 National Drug and Alcohol Research Centre, University of New South Wales , Sydney, New South Wales, Australia
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18
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Length of stay for mental and behavioural disorders postpartum in primiparous mothers: a cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3540-52. [PMID: 24681554 PMCID: PMC4025045 DOI: 10.3390/ijerph110403540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/08/2014] [Accepted: 01/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous research showed that there was a significant increase in psychiatric hospital admission of postpartum mothers. The aim of the current study is to describe the length of hospital stays and patient days for mental and behavioural disorders (MBD) of new mothers in the first year after birth. METHOD This was a cohort study based on linked population data between the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC). The study population included primiparous mothers aged from 18 to 44 who gave birth between 1 July 2000 and 31 December 2005. The Kaplan-Meier method was used to describe the length of hospital stay for MBD. RESULTS For principal diagnoses of MBD, the entire length of hospital stay in the first year postpartum was 11.38 days (95% CI: 10.70-12.06) for mean and 6 days (95% CI: 5.87-6.13) for median. The length of hospital stay per admission was 8.47 days (95% CI: 8.03-8.90) for mean and 5 days (95% CI: 4.90-5.10) for median. There were 5,129 patient days of hospital stay per year for principal diagnoses of postpartum MBD in new mothers between 1 July 2000 and 31 December 2005 in NSW, Australia. CONCLUSIONS MBD, especially unipolar depressions, adjustment disorders, acute psychotic episodes, and schizophrenia, or schizophrenia-like disorders during the first year after birth, placed a significant burden on hospital services due to long hospital stays and large number of admissions.
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Reilly N, Harris S, Loxton D, Chojenta C, Forder P, Milgrom J, Austin MP. Referral for management of emotional health issues during the perinatal period: does mental health assessment make a difference? Birth 2013; 40:297-306. [PMID: 24344711 DOI: 10.1111/birt.12067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND There exists little evidence that routine assessment of current or past mental health in the perinatal period positively impacts on rates of referral for emotional health issues. This study aimed to evaluate the impact of this early intervention approach on reported referrals for emotional health issues during pregnancy and the first postpartum year. METHOD A subsample of women (N = 1,804) drawn from the Australian Longitudinal Study on Women's Health participated in the study. RESULTS Multivariate analyses showed that predictors of being given a referral for emotional health issues during pregnancy and the postnatal period, respectively, included assessment of past mental health (Adjusted Odds Ratio [AOR] = 4.40, p < 0.001, and AOR = 5.69, p < 0.001), assessment of current mental health (AOR = 2.47, p < 0.001, and AOR = 2.72, p < 0.001), and reported experience of significant emotional distress (AOR = 2.58, p < 0.001, and AOR = 2.83, p < 0.001). The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment. CONCLUSIONS This study highlights that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals. Importantly, results suggest that enquiry about current mental health is associated with appropriate rates of referral rather than a nonspecific inflation of referrals. In line with Australia's Clinical Practice Guidelines for Perinatal Mental Health, the value of a comprehensive approach to mental health assessment to aid decision making around referral for further assessment or care is particularly evident.
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Affiliation(s)
- Nicole Reilly
- Perinatal and Women's Mental Health Unit, St. John of God Health Care and University of New South Wales, Burwood, NSW, Australia
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20
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van der Ham J, Berry K, Hoehn E, Fraser J. A collaborative approach to perinatal and infant mental health service delivery in Australia. Australas Psychiatry 2013; 21:371-5. [PMID: 23681973 DOI: 10.1177/1039856213486302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this paper is to report on the development and implementation of a community-based perinatal and infant mental health day program for mothers with psychiatric illness. The program was initiated through interagency collaboration between adult mental health, infant mental health and community child health services in Queensland, Australia in response to calls for an integrated approach that could be delivered state-wide if successful. Preliminary results of the program's evaluation are provided. METHOD A pre-post survey design was used to assess the influence the program had on maternal mental and emotional well-being and the maternal-infant relationship. Twenty-one women receiving treatment for perinatal mental illness gave consent to attend the 6-week day program integrating three currently separate and discrete services: adult mental health, infant mental health and community child health. RESULTS Clinically and statistically significant improvements were observed for maternal mental health, and parent-infant relationships following the program. CONCLUSIONS These findings support interagency collaboration between adult mental health, infant mental health and community child health services to deliver services to women with mental illness with newborns and their families. The utility of using a collaborative approach in a community setting endorses more comprehensive and longer-term evaluation of effectiveness and cost benefit.
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Affiliation(s)
- Joyce van der Ham
- Adult Mental Health Services, Metro North Hospital and Health Services, Brisbane, QLD, Australia
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21
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Rollans M, Schmied V, Kemp L, Meade T. ‘We just ask some questions…’ the process of antenatal psychosocial assessment by midwives. Midwifery 2013; 29:935-42. [DOI: 10.1016/j.midw.2012.11.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 09/21/2012] [Accepted: 11/16/2012] [Indexed: 11/25/2022]
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Rowe HJ, Holton S, Fisher JRW. Postpartum emotional support: a qualitative study of women's and men's anticipated needs and preferred sources. Aust J Prim Health 2013; 19:46-52. [PMID: 22951012 DOI: 10.1071/py11117] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/12/2011] [Indexed: 11/23/2022]
Abstract
Australian health policy emphasises prevention, early intervention and improved pathways to treatment for perinatal mental disorders. Primary care is vital to achieving these aims. The aim of this study was to understand the anticipated needs and preferred sources of mental health information and support of men and women expecting their first baby. Nulliparous English-speaking expectant parents attending childbirth education programs in public and private hospitals participated in single sex small group discussions in late pregnancy. Discussions were audio-recorded, transcribed and analysed thematically using the group as the unit of analysis. Eight groups (22 women; 16 men) encompassing diverse socioeconomic circumstances were conducted. Analyses showed idealised fantasies consistently tempered with realistic expectations about adjustment to life with a baby. However, there were diverse and gendered views about whether primary care providers should discuss mental health with parents of infants and willingness to complete written questionnaires or be referred for specialist mental health care. Men regard primary family care as mother not father inclusive. Expectant parents readily anticipate realistic postnatal adjustment and need for emotional support. Increased provision of services that meet men's needs and public understanding and acceptance of Australian integrated models of primary postnatal mental health care are needed.
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Affiliation(s)
- Heather J Rowe
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
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23
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Rollans M, Schmied V, Kemp L, Meade T. Negotiating policy in practice: child and family health nurses' approach to the process of postnatal psychosocial assessment. BMC Health Serv Res 2013; 13:133. [PMID: 23565716 PMCID: PMC3637412 DOI: 10.1186/1472-6963-13-133] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
Background There is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth. In the state of New South Wales, Australia the Supporting Families Early policy provides a framework of assessment and support for women and families and includes routine psychosocial assessment and depression screening. This study investigated the approach taken by Child and Family Health Nurses (CFHNs) following birth to assessment and screening as recommended by state policy. This was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically. Methods This was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically. Results CFHNs demonstrated a range of approaches to assessment and screening. Psychosocial assessment was conducted in 50% (10 out of the 20) of the interactions observed; however, all the women were screened using the Edinburgh Depression Scale. Four major themes that represent the approach taken to the assessment process were identified: ‘Engagement: getting that first bit right’, ‘Doing some paperwork’, ‘Creating comfort’ and ‘Psychosocial assessment: doing it another way’. Nurses utilised other skills such as observing the women interacting with their baby, taking note of non verbal communication and using intuition to develop a clinical decision. Conclusion Overall, nurses’ took a sensitive and caring approach to assessment and screening, however, there were differences in interpretations of the policy recommendations across the two sites. Nurses adopt a flexible, relationship-based approach to the assessment process; however, they experience tension when required to incorporate structured psychosocial assessment processes. To undertake assessment and screening effectively, CFHNs require ongoing support, training and supervision to maintain this sensitive and emotionally challenging work.
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Affiliation(s)
- Mellanie Rollans
- School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia.
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24
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Matthey S, Fisher J, Rowe H. Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations. J Affect Disord 2013; 146:224-30. [PMID: 23116811 DOI: 10.1016/j.jad.2012.09.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perinatal anxiety symptoms and disorders are prevalent and disabling but have not to date been a focus for specific clinical and public health attention. The EPDS is widely used to detect probable depression, and many studies have also found that three items from this scale load on an anxiety factor, in both the antenatal and postnatal periods. In addition, studies have found clinically significant correlations between the EPDS and various anxiety-specific measures in the perinatal period. The aim of this paper is to examine studies which address the capacity of the EPDS to detect anxiety disorders, to assess whether the EPDS performs differently in women with depressive or anxiety disorders and to consider the implications for future research and clinical practice. METHODS The English-language perinatal mental health literature was searched. Six studies with data pertaining to the capacity of the EPDS to detect perinatal anxiety disorders in women were identified. These studies provide information on i) comparison of total EPDS score by diagnoses of anxiety and depression and ii) comparison of the anxiety subscale score (EPDS-3A) by diagnoses of anxiety and depression. RESULTS There is evidence from both sets of information that the EPDS is useful for screening for anxiety in women and emerging evidence that Total EPDS and EPDS-3A can distinguish depression from anxiety reliably. LIMITATIONS The findings are based on a small number of studies, conducted in a variety of clinical and community settings in different languages and countries, and with variable sample sizes, some of which lack power to ensure reliable conclusions. CONCLUSIONS The EPDS appears to detect perinatal anxiety disorders, but further research is required to establish the clinical and public health value of the EPDS for this purpose, and whether it has more robust psychometric properties or is more feasible and acceptable than existing anxiety-specific measures.
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25
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Laios L, Rio I, Judd F. Improving maternal perinatal mental health: integrated care for all women versus screening for depression. Australas Psychiatry 2013; 21:171-5. [PMID: 23426096 DOI: 10.1177/1039856212466432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this article is to highlight the debate about universal routine screening and psychosocial assessment in the perinatal period, and suggest an alternative/additional approach to improving maternal perinatal mental illness. CONCLUSIONS Universal routine screening and psychosocial assessment in the perinatal period has been introduced in Australia despite a lack of evidence that this affects perinatal maternal morbidity. Furthermore, this approach is not designed to detect maternal illnesses such as schizophrenia, bipolar disorder, borderline personality disorder, although it is these women and their infants who have the highest rates of morbidity and mortality. We propose that any approach to improving maternal perinatal mental health should be tailored to particular situations and populations, with mental health care (inclusive of all mental illness, not just depression) integrated into, and thus a routine aspect of, maternity care provided to all women throughout the perinatal period.
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Affiliation(s)
- Lia Laios
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia
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26
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Johnson M, Schmeid V, Lupton SJ, Austin MP, Matthey SM, Kemp L, Meade T, Yeo AE. Measuring perinatal mental health risk. Arch Womens Ment Health 2012; 15:375-86. [PMID: 22851128 PMCID: PMC3443336 DOI: 10.1007/s00737-012-0297-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 07/15/2012] [Indexed: 10/31/2022]
Abstract
The purpose of this review was to critically analyse existing tools to measure perinatal mental health risk and report on the psychometric properties of the various approaches using defined criteria. An initial literature search revealed 379 papers, from which 21 papers relating to ten instruments were included in the final review. A further four papers were identified from experts (one excluded) in the field. The psychometric properties of six multidimensional tools and/or criteria were assessed. None of the instruments met all of the requirements of the psychometric properties defined. Some had used large sample sizes but reported low positive predictive values (Antenatal Risk Questionnaire (ANRQ)) or insufficient information regarding their clinical performance (Antenatal Routine Psychosocial Assessment (ARPA)), while others had insufficient sample sizes (Antenatal Psychosocial Health Assessment Tool, Camberwell Assessment of Need-Mothers and Contextual Assessment of Maternity Experience). The ANRQ has fulfilled the requirements of this analysis more comprehensively than any other instrument examined based on the defined rating criteria. While it is desirable to recommend a tool for clinical practice, it is important that clinicians are made aware of their limitations. The ANRQ and ARPA represent multidimensional instruments commonly used within Australia, developed within large samples with either cutoff scores or numbers of risk factors related to service outcomes. Clinicians can use these tools, within the limitations presented here, to determine the need for further intervention or to refer women to mental health services. However, the effectiveness of routine perinatal psychosocial assessment continues to be debated, with further research required.
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Affiliation(s)
- M Johnson
- Centre for Applied Nursing Research, South Western Sydney Local Health District/University of Western Sydney, Sydney, NSW, Australia.
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27
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Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. J Affect Disord 2011; 132:301-10. [PMID: 20952072 DOI: 10.1016/j.jad.2010.09.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 08/10/2010] [Accepted: 09/24/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rates of help-seeking for Postnatal Depression (PND) are generally low and population screening has the potential to increase diagnosis rates. Of central importance is the screening instrument's Positive Predictive Value (PPV), which is itself influenced by the prevalence of the condition. When PPV exceeds prevalence, screening defines a screen-positive group with a higher prevalence to which diagnostic-stage procedures can be targeted, a necessary component of a screening program's potential for cost-effectiveness. METHODS Employing the best available estimates of the prevalence of PND we applied Bayes' Theorem to map the parameter space for the Positive Predictive Value of the Edinburgh Postnatal Depression Scale (EPDS) across a realistic range of values. Only seven methodologically comparable validation studies are available for major depression and/or minor depression. RESULTS Screening with the EPDS always facilitated an increase in identification rates, over the key range of prevalence values. The EPDS defined a sub-group with prevalence between 5-fold and 17-fold greater than the general population. A central estimate of PPV (at a prevalence of 6.8%) was 62%. LIMITATIONS Few high-quality data are available for analysis and therefore better estimates, of both PND prevalence and of screening accuracy, in the populations where screening takes place are needed. CONCLUSIONS Our estimates of PPV indicate that population screening with an instrument at least as accurate as the EPDS could successfully increase the number of cases identified and, therefore, treatment rates. Comparisons with the performance of physical health-screening programs appear favourable. Appropriate training for health professionals is essential to minimize potential harms, and following all positive screening results with a formal diagnostic procedure is likely to be useful both clinically and in terms of health system costs.
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Fisher JR, Rowe HJ, Hammarberg K. Admission of women, with their infants, for psychological and psychiatric causes in Victoria, Australia. Aust N Z J Public Health 2011; 35:146-50. [DOI: 10.1111/j.1753-6405.2010.00653.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mensah FK, Kiernan KE. Maternal general health and children's cognitive development and behaviour in the early years: findings from the Millennium Cohort Study. Child Care Health Dev 2011; 37:44-54. [PMID: 20955451 DOI: 10.1111/j.1365-2214.2010.01150.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mothers often experience physical and psychological difficulties during the post-natal period and these may continue through the early years of raising children and have negative effects on engagement and caregiving. Pathways between maternal depression, parental engagement and caregiving and children's subsequent development have been described in longitudinal studies; yet, less is known about how other aspects of maternal health may influence children's development. METHODS A longitudinal analysis within the Millennium Cohort Study was conducted including 7906 families from England. Maternal general health and psychological well-being were assessed when their children were 9 months and 3 years old, socio-demographic characteristics were assessed at 9 months, and engagement and caregiving were assessed at 3 years. These were examined as predictors of children's learning and development and behaviour at age 5. RESULTS There are clear associations between maternal general health and children's development with regard to both learning and development and behaviour. These effects are reduced if psychological distress is taken into account; yet, maternal general health maintains importance as a predictor for children's subsequent development. There is evidence of an association via engagement and caregiving which links maternal health to children's development and evidence of the influence of underlying socio-demographic disadvantage. CONCLUSION General maternal health as well as psychological well-being during the early years of raising children may be influential for children's development. This study suggests the need for a broader recognition of maternal health as well as psychological well-being as a foundation for family well-being, and speaks to support for mothers in maintaining engagement and caregiving for their children during periods of ill health.
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Affiliation(s)
- F K Mensah
- Department of Social Policy and Social Work, University of York Institute for Effective Education, University of York, Heslington, York, UK
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Austin M, Reilly N, Milgrom J, Barnett B. A national approach to perinatal mental health in Australia: exercising caution in the roll‐out of a public health initiative. Med J Aust 2010. [DOI: 10.5694/j.1326-5377.2010.tb03440.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marie‐Paule Austin
- Perinatal and Women's Mental Health, St John of God Health Care, Sydney, NSW
| | - Nicole Reilly
- Perinatal and Women's Mental Health, St John of God Health Care, Sydney, NSW
| | - Jeannette Milgrom
- School of Behavioural Science, University of Melbourne, Melbourne, VIC
| | - Bryanne Barnett
- School of Psychiatry, University of New South Wales, Sydney, NSW
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