Yourtime: The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach

INTRODUCTION

Maternal anxiety and depression are major public health issues with prevalence as high as one in five women. There is a need to focus on preventative strategies to enable women to self-monitor their mental health status during pregnancy and postnatally.

AIM

To co-design and test a perinatal mental health digital tool to enable women to self-monitor their mental wellbeing during pregnancy and early parenting and promote positive self-care strategies.

METHODS AND ETHICS

A sequential mixed methods study utilising two stages 1) co-design workshops; 2) fit for purpose pilot with women through a purpose designed survey to evaluate acceptability, useability, functionality, and satisfaction.

FINDINGS

Mothers, midwives, design researchers and students, participated in co-designing a digital tool and prototype application, YourTime. Fourteen participants engaged in the pilot, with all women agreeing that the tool would be beneficial in alerting them to changes in mental wellbeing. Seventy-seven percent agreed that this prototype had the potential to positively affect wellbeing during the perinatal period.

DISCUSSION

The need to develop a perinatal mental health digital tool that enables women to self-monitor their wellbeing was identified. Women reported the YourTime app offered an acceptable and effective means to self-assess and monitor their wellbeing.

CONCLUSION

The YourTime app responds to the growing agenda for digital approaches to address perinatal mental health challenges. The pilot study demonstrated that the app offered potential to alert women to changes in mental wellbeing, but functionality need further development.

The Mediating Effect of Maternal Wellbeing on the Association between Neighborhood Perception and Child Wellbeing: A Longitudinal Investigation

OBJECTIVES

Negative perceptions of one's neighborhood are linked to poor mental and physical health. However, it is unclear how caregiver's neighborhood perception affects health outcomes in children. This study assessed the mediating effect of maternal wellbeing on the association between neighborhood perception and child wellbeing at different time points and overall.

METHOD

A structural equation model (SEM) was used to evaluate whether maternal wellbeing mediates the influence of neighborhood perception on child wellbeing at different ages. The Fragile Families and Child Wellbeing Study data from years 3, 5, and 9 was analyzed. The delta method evaluated the mediation effect of maternal wellbeing, controlling for mothers' age. Direct and indirect effects of neighborhood perception at year 3 on child wellbeing at year 9 via maternal wellbeing at year 5 were analyzed via a longitudinal mediation with a two time points lag.

RESULTS

Maternal wellbeing partially mediated the effect of neighborhood perception on child wellbeing at different ages. Longitudinal mediation analyses revealed that better neighborhood perception at year 3 improved maternal wellbeing at year 5 and child wellbeing at year 9; maternal wellbeing at year 5 partially mediated the effect of neighborhood perception at year 3 on child wellbeing at year 5.

CONCLUSIONS FOR PRACTICE

Our findings suggest that it may be beneficial for mental health practitioners to discuss relationships between neighborhood environment and wellbeing with caregivers, with a focus on reframing negative self-perceptions. Future research should evaluate longitudinal relationships between changes in neighborhood infrastructure and corresponding wellbeing in caregivers and children.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

BACKGROUND

The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores.

METHODS

This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey.

RESULTS

Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05).

CONCLUSIONS

The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

A systematic exploration of a perinatal wellbeing framework through women's experiences of lumbo-pelvic pain

BACKGROUND

Women's wellbeing during the perinatal period has received increasing attention in research, policy and practice, but is often poorly defined and conceptualised. We have developed a framework of perinatal wellbeing (PWB) which we will refine further in this review, using the example of lumbo-pelvic pain (LPP). Perinatal LPP, which includes lower back pain (LBP) and pelvic girdle pain (PGP), is common and can significantly affect women's wellbeing.

AIM

The aims of this review are (1) to synthesise research into women's experiences of LPP and (2) to use these findings to contribute further to developing our framework of PWB.

DESIGNS AND METHODS

A systematic search of online databases was conducted for qualitative studies exploring women's experiences of LPP linked to the perinatal period; 15 papers describing 11 studies were identified. A framework synthesis approach (Carroll et al., 2011; Carroll et al., 2013) was used to synthesise studies, using the PWB framework as the a priori framework.

FINDINGS

The review highlights the impact of LPP on all areas of women's lives and their functioning at every level, as well as the impact of a range of factors on women's experiences. Only one study explored women's experiences of LBP, all others focused on PGP. Findings illustrate how multi-faceted women's wellbeing is in the context of LPP, particularly the importance of relationships and support, but also the role played by wider socio-cultural discourses of pregnancy and motherhood and by women's individual circumstances and characteristics. Findings underline the interconnectedness of physical, emotional and psychological experiences. The review largely confirmed, and further elaborated, the domains of the original framework, but also led to some changes, notably the inclusion of an 'individual factors' domain describing women's individual circumstances and characteristics. The limited discussion of LPP during labour and birth was notable.

CONCLUSIONS AND IMPLICATIONS

Findings support the framework, but also provide evidence for some changes, thus further refining the framework. Women's wellbeing in the perinatal period (with regards to LPP, other issues, or generally) should not be considered in isolation, but needs to take account of women's life context. The perinatal period should be considered a continuum, rather than seeing each part in isolation. For clinical practice, the review underlines the importance of distinguishing between PGP and LBP and offering appropriate, individualised support.

Use of traditional and complementary medicine for maternal health and wellbeing by African migrant women in Australia: a mixed method study

BACKGROUND

Traditional medicine serves as a form of primary health care for more than 80% of African populations. Currently, there is no research documenting if and how African migrant communities engage with their traditional health practices and beliefs after they resettle in Western countries. The aim of this study was to examine African migrant women's experiences and perspectives about traditional and complementary medicine use in relation to their maternal health and wellbeing in Australia.

METHODS

We conducted a mixed method study between December 2016 and October 2017. Questionnaires were completed by 319 women and 15 in-depth interviews were conducted among African migrant women residing across the Sydney metropolitan area, Australia. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by Andersen's Socio-behavioural model of health service utilisation.

RESULTS

The findings indicated that use of traditional and complementary medicine was high and continued to be well used following African women's resettlement in Australia. The survey found that 232 (72.7%) women use some form of traditional and complementary medicine for maternal health and wellbeing purposes. Most women (179, 77.2%) reported that maintaining their maternal health and wellbeing was the most common reason for use. The interview findings indicated that access to traditional medicine included making requests from relatives and friends who travelled to Africa looking for a similar medicinal plant in Australia and preparing home remedies with advice from family members and healers back in Africa. Age ≥ 35 years (OR, 16.5; 95%CI, 6.58-41.5; p < 0.001), lower education (OR, 24; 95%CI, 8.18-71.1; p < 0.001), parity (OR, 7.3; 95%CI, 1.22-42.81; p = 0.029), and lower income (OR, 2.7; 95%CI, 1.23-5.83; p = 0.013) were strong predictors of traditional medicine use.

CONCLUSION

Use of traditional and complementary medicine among African migrant women in Sydney remained high following resettlement in Australia. As noted in Andersen's sociobehavioural model of health service utilisation, specific predisposing and enabling factors including age, education and income were associated with use of traditional and complementary medicine.

Examining the Differing Effects of Economic Hardship and Poor Maternal Wellbeing on Cumulative Exposure to Adverse Childhood Experiences

Extensive research supports a strong and cumulative relationship between adverse childhood experiences (ACEs) and risky adult behaviors, mental health disorders, diseases, and health status. Additional factors, such as poor maternal wellbeing and economic hardship, compound the detrimental health and wellbeing implications associated with childhood exposure to ACEs. However, limited research has explored the differentiating effects of economic hardship and maternal wellbeing on a child's cumulative ACE exposure. This study examined the differing effects of poor maternal wellbeing and economic hardship on a child's exposure to ACEs. This study used a random sub-sample (n = 4000) from the 2011 to 2012 National Survey on Children's Health (NSCH), a nationally representative cross-sectional study of children (N = 95,677) between birth and 17 years old. Confirmatory factor analysis results revealed greater economic hardship had a significant direct effect on a child's ACE exposure and poorer maternal wellbeing. Poor maternal wellbeing had a significant mediation-like effect on the relationship between economic hardship and a child's cumulative ACE exposure. Practice and policy implications include early ACE assessments tailored to identify children and families experiencing adversity across multiple domains.

Who is actually asked about their mental health in pregnancy and the postnatal period? Findings from a national survey

BACKGROUND

Pregnancy and the postnatal period is a period of potential vulnerability for women and families. It is UK policy that all women are asked about their mental health and wellbeing early in pregnancy and following the birth to help detect potential problems and prevent serious adverse outcome. However, identification of mental health problems in pregnancy may be less than 50 %. The aim of the study was to find out which women are asked about their mood and mental health during pregnancy and postnatally, and about offer and uptake of treatment.

METHODS

Secondary analysis of a national maternity survey carried out in 2014 which asked about sociodemographic factors, care in pregnancy, childbirth, and the postnatal period with specific questions on emotional and mental health.

RESULTS

The usable response rate to the survey was 47 % (4571 women). Most women recalled being asked about their mental health in pregnancy (82 %) and in the postnatal period (90 %). However, antenatally, Asian and older women were less likely to be asked and to be offered treatment. In the postnatal period, differences were more marked. Non-white women, those living in more deprived areas, and those who had received less education were less likely to be asked about their mental health, to be offered treatment, and to receive support. Women with a trusting relationship with their midwife were more likely to be asked about their mental health.

CONCLUSION

The inequities described in this study suggest that the inverse care law is operating in relation to this aspect of maternity care. Those women most likely to be in need of support and treatment are least likely to be offered it and may be at risk of serious adverse outcomes.

Infant interest in their mother's face is associated with maternal psychological health

Early experience can alter infants' interest in faces in their environment. This study investigated the relationship between maternal psychological health, mother-infant bonding, and infant face interest in a community sample. A visual habituation paradigm was used to independently assess 3.5-month old infants' attention to a photograph of their mother's face and a stranger's face. In this sample of 54 healthy mother-infant pairs, 57% of mothers (N = 31) reported symptoms of at least one of stress response to trauma, anxiety, or depression. Interest in the mother-face, but not stranger-face, was positively associated with the mother's psychological health. In regression analyses, anxiety and depression predicted 9% of the variance in looking to the mother-face. Anxiety was the only significant predictor within the model. No direct associations were found between mother-infant bonding and infants' face interest. Taken together, these findings indicate that infant's visual engagement with their mother's face varies with maternal symptoms of emotional distress, even within a community sample.