Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services

OBJECTIVES

Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy.

METHODS

Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported.

RESULTS

The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]).

CONCLUSION

Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.

Primary mental health prevention in partners of mothers with a major mental illness: SMS4Dads

BACKGROUND

Mental health promotion and prevention with expecting and new fathers has historically been challenging. Approximately 10% of this population report experiencing depression in the post-partum period and 18% report experiencing anxiety. This population may be further at risk if their partner has a mental illness.

OBJECTIVE

To assess if information provided by SMS may be a way to reach a vulnerable population of new fathers with partners who have a mental illness.

METHOD

Twenty-three new and expecting fathers who have partners with a mental illness were engaged in a qualitative assessment of their experience with the SMS4Dads programme.

RESULTS

This analysis showed that at risk new fathers appreciated the information received during the programme and reported acting on this, making changes in the way they interact with their children.

CONCLUSION

The combination of timely, accurate and practical information delivered in a novel way, likely contributed to the reports of improved interactions within the family unit.

Transition to Parenthood: Antenatal Education Promotes Perinatal Mental Health When Collaboratively Delivered by Midwives, Mental Health Peer Workers and Perinatal and Infant Mental Health Professionals

Transition to Parenthood is a two-session (antenatal and postnatal) module for inclusion in a birth and parenting education course, designed to proactively support perinatal and infant mental health. In this pilot study, 299 mothers and 241 fathers/partners participated in the whole module, with 35 mothers completing pre- and post-program measures of depression, anxiety, stress, and parenting confidence. Statistically significant improvements were found on all four measures with high effect sizes. Participant ratings of learning and satisfaction were high and persisted over time. These results provide support for the usefulness of group-based birth and parenting education that focuses on perinatal and infant mental health, with mental health peer workers co-delivering the program.

Health of the Nation Outcome Scales for Infants field trial: concurrent validity

BACKGROUND

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0-47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes.

AIMS

To examine the concurrent validity of the HoNOSI.

METHOD

Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress.

RESULTS

The HoNOSI was statistically significantly correlated with the PIR-;GAS, rs = -0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency.

CONCLUSIONS

There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia

Perinatal mental illness is a known risk to maternal–infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes “Together in Mind,” a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6‐week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016–18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post‐program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p < .000); Depression, Anxiety and Stress Scale (DASS‐21) (d = 0.5; p < .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p < .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p < .000), Ages and Stages Questionnaire: Social‐Emotional (6 months) (d = 0.83; p < .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal–infant relationship within the context of complex maternal mental health issues.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants

BACKGROUND

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency.

AIMS

We aimed to investigate the interrater reliability of the HoNOSI.

METHOD

Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes.

RESULTS

Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7).

CONCLUSIONS

There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Supporting partners of mothers with severe mental illness through text - a feasibility study

OBJECTIVE

During the perinatal period, partners of mothers with severe mental illness (SMI) play an important role in managing the new baby and supporting the mothers' wellbeing. Providing information via mobile phone on infant care, partner support and self-care may assist partners in their support role.

METHOD

Partners (n = 23) of mothers with SMI were enrolled in a partner-focused SMS service sending brief texts 14 times per month for a maximum of 10 months. Partners (n = 16) were interviewed on exit and their responses analysed for acceptability and perceived usefulness of the texts.

RESULTS

Partners remained with the programme and expressed high acceptability of the texts. Participants identified effects such as increased knowledge of and interaction with their baby; effective support for their partner; and reassurance that 'things were normal'. Few partners sought support for their own mental health.

CONCLUSIONS

Texts supplied to mobile phones of partners of new mothers with SMI may increase partners' support. The texts in this study were acceptable to partners and were reported to enhance a partner's focus on the mother's needs, raise the partner's awareness of the infant's needs, and support the partner's confidence and competence in infant care.

The importance of external clinical facilitation for a perinatal and infant telemental health service

INTRODUCTION

Clinical facilitation is an established strategy for introducing innovation into clinical practice. The Queensland Centre for Perinatal and Infant Mental Health has used clinical facilitation to establish a telehealth service to support perinatal and infant mental health in regional, rural and remote areas of the Australian state of Queensland. The aim of this study is to explore the role of clinical facilitation in implementing and sustaining the telehealth service.

METHODS

Semi-structured interviews were conducted with 14 remote-site users of the telehealth service. Interviews were analysed using thematic analysis.

RESULTS

Two dominant themes emerged: unmet need and service visibility. The study confirms the usefulness of telehealth as a way to address unmet need for specialist mental health services in regional, rural and remote areas. The study also provides evidence that a telehealth service with intermittent demand requires a consistent clinical facilitator, to keep the service visible to remote-site clinicians and maintain awareness of the service as a referral option.

CONCLUSION

Previous research has identified the importance of clinical facilitation in initial service implementation. This study demonstrates the necessity of clinical facilitation for ongoing service provision. Facilitation is likely to be more important where the telehealth service responds to intermittent or infrequent clinical need, compared with high-volume services where clinics are conducted routinely.

A collaborative approach to perinatal and infant mental health service delivery in Australia

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.

Moving targets, long-lived infrastructure, and increasing needs for integration and adaptation in water management: an illustration from Switzerland

Switzerland provides an example of successful management of water infrastructure and water resources that was accomplished largely without integration across sectors. Limitations in this approach have become apparent; decisions that were formerly based only on technical and economic feasibility must now incorporate broader objectives such as ecological impact. In addition, current and emerging challenges relate to increasingly complex problems that are likely to demand more integrated approaches. If such integration is to be of benefit, it must be possible to redirect resources across sectors, and the synergies derived from integration must outweigh the additional cost of increased complexity.

[Survey of nursing services with regard to mechanical ventilation at home]

BACKGROUND

Homecare for mechanically ventilated patients is complex and challenging for homecare institutions. The framework conditions of homecare are regulated by a likewise complex social legislation. The German Respiratory Society (DGP) and the German Interdisciplinary Society for Home Care Ventilation (DIGAB) have published recommendations on the structure of homecare for ventilated patients in their recent guideline and recommended a certification of homecare nursing services.

RATIONALE

Prior to a certification process, the homecare task force of the DIGAB conducted a survey in order to compare the current structures with the guideline recommendations.

METHODS

Voluntary disclosure of information by means of a written questionnaire consisting of eleven items was requested.

RESULTS

37 homecare institutions with a total of 78 subsidiaries providing service all over Germany returned their questionnaires. While educational standards are mostly in line with the guideline recommendation, it was found that only 43 % of 812 recorded patients followed up with a specialised weaning centre or centre for ventilation. 84 % of these patients were ventilated invasively. In spite of the fact that all homecare institutions took care of invasively ventilated patients, there was a lack of company-owned standards for specific nursing measures.

CONCLUSIONS

Homecare for ventilated patients in Germany has reached a decent degree of organisation, while follow-up with specialised centres for ventilation, and with that medical specialist care appears to be underserved. The certification process for homecare institutions should be pursued with emphasis in order to create uniform quality standards. The number of invasively ventilated patients in homecare settings is probably higher than previously estimated and could be the result of a lack of weaning capacity.

Natural attenuation potential of downwelling streams for perfluorochemicals and other emerging contaminants

Stream augmentation with tertiary treated municipal wastewater-i.e., recycled water-is increasingly considered as an ecologically beneficial way to utilize recycled water, especially in semi-arid regions of the American Southwest. There is concern that emerging contaminants, i.e. unregulated but biologically active organic compounds, may be present in recycled water and will impact on the aquatic environment and the underlying groundwater. Emerging contaminants include a wide variety of chemically disparate compounds, including pharmaceuticals, endocrine disruptors, and residues of perfluorochemical surfactants (PFCs). This paper presents background data on the occurrence and transport of PFC in Upper Silver Creek (USC) and Coyote Creek, in San Jose, California. USC feeds into Coyote Creek, which discharges into San Francisco Bay. Augmenting the natural flow of Coyote Creek with highly treated recycled water is currently being considered as a means to provide more freshwater to the river ecosystem. The reach of interest is approximately 1,000 m where USC flows on alluvial fan deposits. Data indicate that some PFCs are refractory.

Experimental and modeling study of adsorption-desorption processes with application to a deep-well injection radioactive waste disposal site

Radionuclide (Sr-90 and Cs-137) behavior in the subsurface environment was evaluated with respect to natural attenuation, sorption and desorption kinetics, and equilibrium. Batch experiments were conducted with synthesized groundwater or acid (NaNO3; pH approximately 3) solutions under different temperature (T=20 and 70 degrees C) and pressure (P=Patm and P=3 MPa) conditions. Samples of sedimentary rock were selected as the solid phase from a radioactively contaminated site associated with deep-well injection of the radioactive waste. Groundwater and a NaNO3 waste-brine solution were used as the liquid phase. All experiments revealed hysteresis in radionuclide adsorption. Moreover, some of the experiments indicated that the adsorption process may be irreversible. A simultaneous temperature and pressure increase leads to anomalous behavior of the adsorption kinetics: a period of a rapid concentration drop of the radionuclides in solution, which is caused by their sorption uptake, is changed by a stage of a gradual increase in the corresponding concentrations. To explain the observed phenomena, several hypotheses were examined. Thus, an analytical model describing the mutual interference of adsorption kinetics and dissolution of carbonate minerals was developed resulting in a nonmonotonic behavior of the concentration curves obtained at the adsorption stage. For the description of the batch experiments with radionuclides at room temperature and atmospheric pressure, a dual-site adsorption model has been used.

Characterization of iron and manganese precipitates from an in situ ground water treatment plant

Aquifer samples from the precipitation zone of an in situ iron and manganese removal plant that was operated for 10 years were analyzed for iron and manganese minerals. Measurements were performed by various chemical extraction techniques (5 M HCI, 0.008 M Ti(III)-EDTA, 0.114 M ascorbic acid), X-ray diffraction and Mössbauer spectroscopy. Chemical extractions showed that iron was precipitated as ferric oxides, whereas manganese was not oxidized but deposited as Mn(II) probably within carbonates. The ferric oxides in particular accumulate preferentially in the smaller grain- size fractions. This tendency was observed to a lesser extent for manganese. X-ray diffraction and Mössbauer spectroscopy showed that the ferric oxides were mainly crystalline (goethite, 50% to 100% of the iron). Ferrihydrite was found as well, but only as a minor fraction (< or = 12%). Pure manganese minerals were not found by X-ray diffraction. The precipitated amounts of iron (5 to 27 micromol/g Fe as ferric oxide) and manganese (1 to 4 micromol/g Mn) during 10 years operation of the treatment plant agree with values that were estimated from operational parameters (9 to 31 micromol/g Fe and 3 to 6 micromol/g Mn). Considering the small amounts of precipitated iron and manganese, no long-term risks of clogging of the aquifer are expected.