1
|
Rondung E, Massoudi P, Nieminen K, Wickberg B, Peira N, Silverstein R, Moberg K, Lundqvist M, Grundberg Å, Hultcrantz M. Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy. Acta Obstet Gynecol Scand 2024; 103:423-436. [PMID: 38014572 PMCID: PMC10867370 DOI: 10.1111/aogs.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. MATERIAL AND METHODS On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). REGISTRATION PROSPERO CRD42021236333. RESULTS We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92). CONCLUSIONS Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.
Collapse
Affiliation(s)
- Elisabet Rondung
- Department of Psychology and Social WorkMid Sweden UniversityÖstersundSweden
| | - Pamela Massoudi
- Department of PsychologyUniversity of GothenburgGothenburgSweden
- Department of Research and DevelopmentRegion KronobergSweden
| | - Katri Nieminen
- Department of Obstetrics and Gynecology in Norrköping and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Nathalie Peira
- Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
| | - Rebecca Silverstein
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Klas Moberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Martina Lundqvist
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Åke Grundberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Monica Hultcrantz
- Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
| |
Collapse
|
2
|
Moberg C, Grundberg Å, Konradsen H, Kallström AP, Leung AY, Kabir ZN. Meeting own needs and supporting ability to care: Family caregivers' and health care professionals' perspectives on professional support provided through a potential mobile application. Dementia (London) 2022; 21:1120-1134. [PMID: 35300535 DOI: 10.1177/14713012211065313] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A majority of persons with dementia in Sweden live in their own homes and are often cared for by family members. Caring for a family member may be a positive experience. It may, however, also be a negative experience as symptoms like disturbing behavior and delusions may be difficult to encounter. The burden of being a family caregiver has been shown to affect the caregivers' quality of life. OBJECTIVE To explore stakeholders' perspectives on a potential mobile application through which family caregivers could be supported by healthcare professionals in caring for a person with dementia living at home. METHOD Eight individual interviews with family caregivers and a focus group with eight healthcare professionals specialized in dementia care were analyzed using content analysis method. RESULTS The findings suggest that a mobile application can support family caregivers to meet their own needs in terms of finding structure in everyday life, how to get information and support in their own pace, and how to care for themselves. The findings also suggest the necessity of accessing relevant contact networks to be supported in the ability to care for a family member with dementia. CONCLUSION Healthcare and social services mediated support provided through user-friendly mobile application has the potential to support family caregivers both in taking care of a person with dementia and caring for themselves. Moreover, it is important that the information provided to family caregivers is personalized according to the needs of the family caregivers as the family member's dementia advances.
Collapse
Affiliation(s)
- Cecilia Moberg
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
| | - Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Stockholm, Sweden
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden; Faculty of Health and Medical Sciences, Department of Clinical Medicine, 4321University of Copenhagen, Kobenhavn, Denmark; Department of Gastroenterology, Herley and Gentofte Hospital, Copenhagen, Denmark
| | - Ana Paula Kallström
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
| | - Angela Ym Leung
- Centre for Gerontological Nursing, School of Nursing, 105806The Hong Kong Polytechnic University of Hong Kong, China
| | - Zarina N Kabir
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Grundberg Å, Sandberg J, Craftman ÅG. Childrens' and young adults' perspectives of having a parent with dementia diagnosis: A scoping review. Dementia (London) 2021; 20:2933-2956. [PMID: 34096358 DOI: 10.1177/14713012211023653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden. DESIGN AND METHODS Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed. FINDINGS Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support. CONCLUSIONS The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.
Collapse
Affiliation(s)
- Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Solna, Sweden
| | - Jonas Sandberg
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
4
|
Kabir ZN, Leung AYM, Grundberg Å, Boström AM, Lämås K, Kallström AP, Moberg C, Cronfalk BS, Meijer S, Konradsen H. Care of family caregivers of persons with dementia (CaFCa) through a tailor-made mobile app: study protocol of a complex intervention study. BMC Geriatr 2020; 20:305. [PMID: 32847495 PMCID: PMC7449058 DOI: 10.1186/s12877-020-01712-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, family members account for the main source of caregiving of persons with dementia living at home. Providing care to family members with dementia often has negative health consequences for caregivers such as stress, depression and low quality of life. Yet, formal support for family caregivers (FCs) is limited. Telehealth technology has the potential to provide health care and social support to FCs. This study aims to assess the effectiveness of providing support by healthcare professionals (HPs) through a mobile app in reducing stress, depressive symptoms and loneliness, and improving mental health and quality of life of FCs of persons with dementia. METHODS Using a pragmatic intervention design, this study will use pre- and post-intervention assessment to evaluate the effectiveness of the proposed intervention in a sample of 78 FCs of persons with dementia (PWD). The intervention will be implemented by approximately 5 HPs specialized in dementia care based in the municipalities in Sweden. The main thrust of the intervention is to provide professional support, with help of an interactive mobile app, to family members in their caregiving role for PWDs. Qualitative interviews with HPs and FCs form the groundwork of the development of the mobile app. By using the app on smart phone or tablet, the FC, in groups of 8-10, will communicate with peers and a HP exchanging ideas on how to deal with PWD's behavioral and cognitive changes and get support. They will also be able to discuss stressful events and access mindfulness exercises focused on themselves. Quantitative data will be collected before and at three time points after the 8-week intervention to assess changes in the health outcomes of the FCs. In-depth interviews will be conducted after the intervention to capture the experiences of FCs and HPs regarding the ease of use and acceptability of the app. DISCUSSION This tailor-made mobile app has the high potential to be a practical platform for supporting FCs to alleviate stress and improve mental health irrespective of distance to the nearest health care or social service center. TRIAL REGISTRATION ISRCTN, ISRCTN46137262 . Registered 10 October 2019.
Collapse
Affiliation(s)
- Zarina Nahar Kabir
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.
| | - Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Åke Grundberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,R&D unit, Stockholms Sjukhem, Stockholm, Sweden
| | | | - Ana Paula Kallström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden
| | - Cecilia Moberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden
| | - Berit Seiger Cronfalk
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.,Division of Nursing, Red Cross University College, Stockholm, Sweden
| | | | - Hanne Konradsen
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.,Herlev and Gentofte Hospital, Department of Gastroenterology, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Abstract
BACKGROUND The occurrence of behavioural changes and problems, and degree of paranoid thoughts, are significantly higher among people who have experienced extreme trauma such as during the Holocaust. People with dementia and traumatic past experiences may have flashbacks reminding them of these experiences, which is of relevance in caring situations. In nursing homes for people with dementia, nursing assistants are often the group of staff who provide help with personal needs. They have firsthand experience of care and managing the devastating outcomes of inadequate understanding of a person's past experiences. AIM The aim was to describe nursing assistants' experiences of caring for older people with dementia who have experienced Holocaust trauma. RESEARCH DESIGN A qualitative descriptive and inductive approach was used, including qualitative interviews and content analysis. PARTICIPANTS AND RESEARCH CONTEXT Nine nursing assistants from a Jewish nursing home were interviewed. ETHICAL CONSIDERATIONS The study was approved by the Regional Ethical Review Board, Stockholm. FINDINGS The theme 'Adapting and following the survivors' expression of their situation' was built on two categories: Knowing the life story enables adjustments in the care and Need for flexibility in managing emotional expressions. DISCUSSION AND CONCLUSION The world still witnesses genocidal violence and such traumatic experiences will therefore be reflected in different ways when caring for survivors with dementia in the future. Person-centred care and an awareness of the meaning of being a survivor of severe trauma make it possible to avoid negative triggers, and confirm emotions and comfort people during negative flashbacks in caring situations and environments. Nursing assistants' patience and empathy were supported by a wider understanding of the behaviour of people with dementia who have survived trauma.
Collapse
Affiliation(s)
| | | | | | - Åke Grundberg
- Department of Nursing Science, Sophiahemmet University, Sweden
| | - Carina Lundh Hagelin
- Department of Caring, Science and Karolinska Institutet; Department of Neurobiology, Caring Sciences and Society, Ersta Sköndal Bräcke University College, Sweden
| |
Collapse
|
6
|
Swall A, Craftman Å, Grundberg Å, Wiklund E, Väliaho N, Hagelin CL. Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia. Int J Palliat Nurs 2019; 25:65-71. [PMID: 30785819 DOI: 10.12968/ijpn.2019.25.2.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: Persons with dementia may have severe physical and psychological symptoms at the end of life. A therapy dog used in their care can provide comfort and relieve their anxiety. The dog handler guides the dog during the interaction with the patient. AIM: To describe the impact of therapy dogs on people with dementia in the final stages of life from the perspective of the dog handler. METHODS: Interviews were conducted and analysed using qualitative content analysis. FINDINGS: The dog provides comfort and relief through its presence and by responding to the physical and emotional expressions of the dying person. CONCLUSIONS: Interactions with dogs were found to have a positive impact on persons with dementia and eased the symptoms associated with end of life according to the dog handlers.
Collapse
Affiliation(s)
- Anna Swall
- Senior lecturer, RN, Faculty of Health Sciences, School of Health and Social Studies, Dalarna University, Sweden
| | - Åsa Craftman
- Senior lecturer, Department of Nursing Science, Sophiahemmet University, Sweden
| | - Åke Grundberg
- Senior lecturer, Department of Nursing Science, Sophiahemmet University, Sweden
| | | | - Nina Väliaho
- Ms in Nursing, Palliative Care Unit, Borås, Sweden
| | - Carina Lundh Hagelin
- Associate Professor, Senior Lecturer, RN, Ersta Sköndal Bräcke University College, Sweden and Karolinska Institutet, Department of Neurobiology, Care Science and Society, Stockholm, Sweden
| |
Collapse
|
7
|
Craftman ÅG, Grundberg Å, Westerbotn M. Experiences of home care assistants providing social care to older people: A context in transition. Int J Older People Nurs 2018; 13:e12207. [PMID: 30063125 DOI: 10.1111/opn.12207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 12/26/2022]
Abstract
AIM The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes. BACKGROUND With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field. DESIGN A qualitative inductive design was used. METHODS A descriptive, qualitative study using focus group interviews and content analysis. FINDINGS The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting. CONCLUSIONS Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation. IMPLICATIONS FOR PRACTICE The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.
Collapse
Affiliation(s)
| | | | - Margareta Westerbotn
- Sophiahemmet University, Stockholm, Sweden.,Department of clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
8
|
Grundberg Å, Hansson A, Hillerås P, Religa D. District nurses' perspectives on detecting mental health problems and promoting mental health among community‐dwelling seniors with multimorbidity. J Clin Nurs 2016; 25:2590-9. [DOI: 10.1111/jocn.13302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Pernilla Hillerås
- Sophiahemmet University Stockholm Sweden
- Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Karolinska Institutet Huddinge Sweden
| | - Dorota Religa
- Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Karolinska Institutet Huddinge Sweden
| |
Collapse
|
9
|
Grundberg Å, Hansson A, Religa D, Hillerås P. Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. J Multidiscip Healthc 2016; 9:83-95. [PMID: 26966371 PMCID: PMC4771392 DOI: 10.2147/jmdh.s99388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients' mental health status. AIM To describe HCAs' perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity. METHODS We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs. RESULTS Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors' own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. CONCLUSION The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers' decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.
Collapse
Affiliation(s)
- Åke Grundberg
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | | | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Pernilla Hillerås
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
- Sophiahemmet University, Stockholm, Sweden
| |
Collapse
|