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Byatt N, Brenckle L, Sankaran P, Flahive J, Ko JY, Robbins CL, Zimmermann M, Allison J, Person S, Moore Simas TA. Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an active-controlled cluster-randomised trial. Lancet Public Health 2024; 9:e35-e46. [PMID: 38176840 DOI: 10.1016/s2468-2667(23)00268-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Perinatal depression is a common and undertreated condition, with potential deleterious effects on maternal, obstetric, infant, and child outcomes. We aimed to compare the effectiveness of two systems-level interventions in the obstetric setting-the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and the PRogram In Support of Moms (PRISM)-in improving depression symptoms and participation in mental health treatment among women with perinatal depression. METHODS In this cluster-randomised, active-controlled trial, obstetric practices across Massachusetts (USA) were allocated (1:1) via covariate adaptive randomisation to either continue participating in the MCPAP for Moms intervention, a state-wide, population-based programme, or to participate in the PRISM intervention, which involved MCPAP for Moms plus a proactive, multifaceted, obstetric practice-level intervention with intensive implementation support. English-speaking women (aged ≥18 years) who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥10) were recruited from the practices. Patients were followed up at 4-25 weeks of gestation, 32-40 weeks of gestation, 0-3 months postpartum, 5-7 months postpartum, and 11-13 months postpartum via telephone interview. Participants were masked to the intervention; investigators were not masked. The primary outcome was change in depression symptoms (EPDS score) between baseline assessment and 11-13 months postpartum. Analysis was done by intention to treat, fitting generalised linear mixed models adjusting for age, insurance status, education, and race, and accounting for clustering of patients within practices. This trial is registered with ClinicalTrials.gov, NCT02760004. FINDINGS Between July 29, 2015, and Sept 20, 2021, ten obstetric practices were recruited and retained; five (50%) practices were randomly allocated to MCPAP for Moms and five (50%) to PRISM. 1265 participants were assessed for eligibility and 312 (24·7%) were recruited, of whom 162 (51·9%) were enrolled in MCPAP for Moms practices and 150 (48·1%) in PRISM practices. Comparing baseline to 11-13 months postpartum, EPDS scores decreased by 4·2 (SD 5·2; p<0·0001) among participants in MCPAP for Moms practices and by 4·3 (SD 4.5; p<0·0001) among those in PRISM practices (estimated difference between groups 0·1 [95% CI -1·2 to 1·4]; p=0·87). INTERPRETATION Both the MCPAP for Moms and PRISM interventions were equally effective in improving depression symptoms. This finding is important because the 4-point decrease in EPDS score is clinically significant, and MCPAP for Moms has a lower intensity and greater population-based reach than does PRISM. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA.
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jean Y Ko
- Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service, Commissioned Corps, Rockville, MD, USA
| | | | - Martha Zimmermann
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sharina Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA
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Frawley T, McGuinness D. Dysphoric milk ejection reflex (D-MER) and its implications for mental health nursing. Int J Ment Health Nurs 2023; 32:620-626. [PMID: 36705232 DOI: 10.1111/inm.13115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
Dysphoric milk ejection reflect (D-MER) is a dysphoria which women may experience within seconds of commencing breastfeeding. It is only recently gaining recognition in the academic literature and may have important implications for breastfeeding continuation, differential diagnosis and perinatal mental health. This perspective piece introduces the topic, sets out the physiological processes underpinning the experience and outlines why increased awareness of D-MER is important for the profession of mental health nursing.
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Affiliation(s)
- Timothy Frawley
- Mental Health Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Denise McGuinness
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Marshman A, Saunders E, Chaves D, Morton Ninomiya ME. Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review. Midwifery 2023; 117:103544. [PMID: 36580794 DOI: 10.1016/j.midw.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients. METHODS A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care. RESULTS Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels. DISCUSSION While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels. CONCLUSION Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.
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Affiliation(s)
| | | | | | - Melody E Morton Ninomiya
- Wilfrid Laurier University; Centre for Addiction and Mental Health; Canada Research Chair (Tier II) in Community-Driven Knowledge Mobilization and Pathways to Wellness.
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Almutairi HA, Alyousef SM, Alhamidi SA, Almoammar DN. Exploring the Healthcare Services' Contribution to Reducing Postpartum Depression. SAGE Open Nurs 2023; 9:23779608231171780. [PMID: 37181734 PMCID: PMC10170593 DOI: 10.1177/23779608231171780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services. Objective The purpose of this study was to explore nurses' perceptions towards health services' contribution to lowering the incidence of PPD. Methods An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method. Results Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses. Conclusion The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.
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Affiliation(s)
| | - Seham Mansour Alyousef
- Community and Psychiatric Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Sami Abdulrahman Alhamidi
- Department of Maternal and Child Health, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Danah Nasser Almoammar
- Department of Psychiatric and Mental Health Care, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Lee W, DiGiacomo M, Draper B, Agar MR, Currow DC. A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying. J Palliat Care 2022; 37:535-544. [PMID: 36083631 PMCID: PMC9465534 DOI: 10.1177/08258597221121453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To ascertain palliative physicians’ and
consultation-liaison psychiatrists’ perceptions of depression care processes in
patients with very poor prognoses, exploring key challenges and postulating
solutions. Methods: A qualitative focus group study involving three
1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted
between November-December 2020. Fellows and trainees were recruited from
Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal
Australian and New Zealand College of Psychiatrists (n = 4). Data underwent
conventional qualitative content analysis. Results: Participants
perceived depression care to be complex and challenging. Perceived barriers
included: inadequate palliative care psychiatry skills with variation in
clinical approaches; lack of supportive health infrastructure (poor access to
required interventions and suboptimal linkage between palliative care and
psychiatry); lack of research support; and societal stigma. Suggested solutions
included integrating care processes between palliative care and psychiatry to
improve clinician training, establish supportive health systems and promote
innovative research designs. Conclusions: Developing clinician
training, supportive health systems and innovative research strategies centering
on integrating palliative care and psychiatry care processes may be integral to
optimising depression care when providing care to people with very poor
prognoses.
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Affiliation(s)
- Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia.,St Vicent's Clinical School, University of New South Wales, Sydney, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Brian Draper
- School of Psychiatry, 7800University of New South Wales, Sydney, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, Australia
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Umuziga MP, Adejumo O, Hynie M. A cross-sectional study of the prevalence and factors associated with symptoms of perinatal depression and anxiety in Rwanda. BMC Pregnancy Childbirth 2020; 20:68. [PMID: 32005191 PMCID: PMC6995211 DOI: 10.1186/s12884-020-2747-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Perinatal depression and anxiety are increasingly recognized as important public health issues in low and middle-income countries such as Rwanda and may have negative consequences for both mothers and their infants. Maternal mental health may be particularly challenged in Rwanda because of the prevalence of risk factors such as poverty, low education levels, negative life events and marital problems. However, there are limited data about perinatal depression and anxiety symptoms in Rwanda. This study thus aimed to explore the prevalence of symptoms of perinatal depression and anxiety in Rwanda, and factors associated with them. Methods A sample of 165 women in the perinatal period (second and third trimester of pregnancy, up to 1 year postnatal) were interviewed individually over 1 month in October 2013. Women were interviewed at 5 of 14 health centres in the Eastern Province or the affiliated district hospital. Participants answered socio-demographic questions and scales measuring symptoms of perinatal depression (EPDS: Edinburgh Postnatal Depression Scale) and anxiety (SAS: Zung Self-rating Anxiety Scale). Results Among women in the antenatal period (N = 85), 37.6% had symptoms indicating possible depression (EPDS ≥10) and 28.2% had symptoms associated with clinical levels of anxiety (SAS > 45). Among women within the postnatal period (N = 77), 63.6% had symptoms of possible depression, whereas 48,1% had symptoms of probable anxiety. Logistic regression showed that symptoms of postnatal depression were higher for respondents who had four or more living children relative to those having their first child (Odds Ratio: 0.07, C.I. = 0.01–0.42), and for those with a poor relationship with their partner (Odds Ratio: .09, C.I. =0.03–0.25). Any lifetime exposure to stressful events was the only predictor of symptoms of postnatal anxiety (Odds Ratio = 0.20, C.I. = 0.09–0.44). Conclusions Symptoms of postnatal depression and anxiety were prevalent in this Rwandan sample and most strongly predicted by interpersonal and social factors, suggesting that social interventions may be a successful strategy to protect against maternal mental health problems in the Rwandan context.
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Affiliation(s)
- Marie Providence Umuziga
- School of Nursing, College of Medicine and Health Sciences, University of Rwanda, 3286, Kigali, Rwanda.
| | - Oluyinka Adejumo
- School of Nursing, College of Medicine and Health Sciences, University of Rwanda, 3286, Kigali, Rwanda
| | - Michaela Hynie
- Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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Lever Taylor B, Kandiah A, Johnson S, Howard LM, Morant N. A qualitative investigation of models of community mental health care for women with perinatal mental health problems. J Ment Health 2020; 30:594-600. [DOI: 10.1080/09638237.2020.1714006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Abiramy Kandiah
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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Ransing R, Kukreti P, Deshpande S, Godake S, Neelam N, Raghuveer P, Mahadevaiah M, Kataria D, Patil S, Puri M, Padma K. Perinatal depression-knowledge gap among service providers and service utilizers in India. Asian J Psychiatr 2020; 47:101822. [PMID: 31710947 DOI: 10.1016/j.ajp.2019.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lack of access to perinatal mental health (PMH) services is a significant public health problem in India. Barriers to accessing PMH services include the stigma, non-availability of services, poor knowledge, negative perception, attitude among perinatal women (PWs) and service providers. The present study attempted to examine the knowledge gap regarding perinatal depression (PD) among service providers [Nursing providers (NPs), Medical Practitioners (MPs)] and service utilizers (PWs). METHODS This cross-sectional study was conducted in two tertiary care teaching hospitals of India, one in a major metro and the other in a rural area. PWs, MPs and NPs were assessed for knowledge about PD using a semi-structured proforma and Perinatal Depression Monitor. RESULTS Among the 270 PWs, 8.51% were knowledgeable (PWA) and 91.49% were ignorant (PWB) about depression. PWB group were low educated (n = 140, 56.68%), and unemployed (n = 207, 83.80%) with lower family income [(≤₹10,356 per month), n = 170, 68.28%)]. There was knowledge discrepancy among NPs, MPs and PWA group in terms of a) PD is a normal part of pregnancy (agree- NPs = 71.52%, MPs = 10.00%, PWA-17.39%), b)biological causes of PD (agree- NPs = 45.23%, MPs = 70.00%, PWA = 26.03%) and c)antidepressant medications for PD (useful- NPs = 23.80%, MPs = 70.00%, PWA = 21.73%). Majority of the respondents agreed that all women should be screened for depression during pregnancy (NPs = 34.78%, MPs = 80.95%, PWA = 95.00%) and postpartum periods (NPs = 34.78%, MPs = 76.19%, PWA = 90.00%). CONCLUSIONS Low PD literacy among the PWs, misconception about aetiology and management among the NPs could be major barrier for delivery and utilisation of PD services. Thus, there is an urgent need to improve PD literacy among PWs and NPs.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical college
| | - Prerna Kukreti
- Lady Hardinge Medical College, Department of Psychiatry, C-604 Shaheed Bhagat Singh, Road, DI, India.
| | - Smita Deshpande
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi 110001
| | - Shashwati Godake
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri
| | - Neelam Neelam
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | | | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS)
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College
| | - Kumari Padma
- Department of Psychiatry, BKL Walawalkar Rural Medical College
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Moore Simas TA, Brenckle L, Sankaran P, Masters GA, Person S, Weinreb L, Ko JY, Robbins CL, Allison J, Byatt N. The PRogram In Support of Moms (PRISM): study protocol for a cluster randomized controlled trial of two active interventions addressing perinatal depression in obstetric settings. BMC Pregnancy Childbirth 2019; 19:256. [PMID: 31331292 PMCID: PMC6647165 DOI: 10.1186/s12884-019-2387-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Perinatal depression, the most common pregnancy complication, is associated with negative maternal-offspring outcomes. Despite existence of effective treatments, it is under-recognized and under-treated. Professional organizations recommend universal screening, yet multi-level barriers exist to ensuring effective diagnosis, treatment, and follow-up. Integrating mental health and obstetric care holds significant promise for addressing perinatal depression. The overall study goal is to compare the effectiveness of two active interventions: (1) the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a state-wide, population-based program, and (2) the PRogram In Support of Moms (PRISM) which includes MCPAP for Moms plus a proactive, multifaceted, practice-level intervention with intensive implementation support. METHODS This study is conducted in two phases: (1) a run-in phase which has been completed and involved practice and patient participant recruitment to demonstrate feasibility for the second phase, and (2) a cluster randomized controlled trial (RCT), which is ongoing, and will compare two active interventions 1:1 with ten Ob/Gyn practices as the unit of randomization. In phase 1, rates of depressive symptoms and other demographic and clinical features among patients were examined to inform practice randomization. Patient participants to be recruited in phase 2 will be followed longitudinally until 13 months postpartum; they will have 3-5 total study visits depending on whether their initial recruitment and interview was at 4-24 or 32-40 weeks gestation, or 1-3 months postpartum. Sampling throughout pregnancy and postpartum will ensure participants with different depressive symptom onset times. Differences in depression symptomatology and treatment participation will be compared between patient participants by intervention arm. DISCUSSION This manuscript describes the full two-phase study protocol. The study design is innovative because it combines effectiveness with implementation research designs and integrates critical components of participatory action research. Our approach assesses the feasibility, acceptance, efficacy, and sustainability of integrating a stepped-care approach to perinatal depression care into ambulatory obstetric settings; an approach that is flexible and can be tailored and adapted to fit unique workflows of real-world practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02760004, registered prospectively on May 3, 2016.
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Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605 USA
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, UMass Memorial Health Care, 119 Belmont Street, Worcester, MA 01605 USA
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Grace A. Masters
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Sharina Person
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Fallon Health, Worcester, MA USA
| | - Jean Y. Ko
- Centers for Disease Control and Prevention, Atlanta, GA USA
- U.S. Public Health Service, Comissioned Corps, Maryland, USA
| | | | - Jeroan Allison
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
| | - Nancy Byatt
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655 USA
- Department of Psychiatry, UMass Memorial Health Care, 6 Lake Avenue, Worcester, MA 01655 USA
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Abstract
Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.
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Affiliation(s)
- Nancy Byatt
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
| | - Wanlu Xu
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA
| | - Leonard L Levin
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,c Department of Pediatrics , Francis A. Countway Library of Medicine, Harvard Medical School , Boston , MA , USA
| | - Tiffany A Moore Simas
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
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Roy M, Dagenais P, Pinsonneault L, Déry V. Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review. Int J Health Plann Manage 2018; 34:e111-e130. [PMID: 30378709 DOI: 10.1002/hpm.2687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum. METHODS To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review. RESULTS Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations. CONCLUSION To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.
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Affiliation(s)
- Mathieu Roy
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre Dagenais
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Linda Pinsonneault
- Eastern Townships Public Health Department, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Véronique Déry
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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12
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Harvey ST, Bennett JA, Burmeister E, Wyder M. Evaluating a nurse-led community model of service for perinatal mental health. Collegian 2018. [DOI: 10.1016/j.colegn.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N. A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings. Clin Obstet Gynecol 2018; 61:573-590. [PMID: 29553986 PMCID: PMC6059986 DOI: 10.1097/grf.0000000000000360] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, and sustainability through novel reimbursement mechanisms.
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Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
- Department of Pediatrics
| | - Michael P. Flynn
- University of Massachusetts Medical School, Worcester, MA
- Department of Obstetrics and Gynecology
| | | | | | - Leonard L. Levin
- University of Massachusetts Medical School, Worcester, MA
- Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA
- Department of Family and Community Medicine
| | - Kathleen Biebel
- University of Massachusetts Medical School, Worcester, MA
- Department of Psychiatry
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
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14
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Willey SM, Cant RP, Williams A, McIntyre M. Maternal and child health nurses work with refugee families: Perspectives from regional Victoria, Australia. J Clin Nurs 2018; 27:3387-3396. [PMID: 29356230 DOI: 10.1111/jocn.14277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. BACKGROUND Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. DESIGN This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed, prior to inductive thematic analysis. METHODS This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed verbatim, prior to inductive thematic analysis. RESULTS Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: "How to identify women from a refugee background"; "The Maternal and Child Health nurse role when working with families from a refugee background"; "Interpreting issues"; and "Access to other referral agencies." Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. CONCLUSIONS To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. RELEVANCE TO CLINICAL PRACTICE Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice.
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Affiliation(s)
- Suzanne M Willey
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, Vic., Australia
| | - Robyn P Cant
- Nursing & Midwifery, Monash University, Clayton Campus, Clayton, Vic., Australia
| | - Allison Williams
- Nursing & Midwifery, Monash University, Clayton Campus, Clayton, Vic., Australia
| | - Meredith McIntyre
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, Vic., Australia
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15
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Casey M, O'Connor L, Cashin A, Smith R, O'Brien D, Nicholson E, O'Leary D, Fealy G, McNamara M, Glasgow ME, Stokes D, Egan C. An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. NURSE EDUCATION TODAY 2017; 56:35-40. [PMID: 28654814 DOI: 10.1016/j.nedt.2017.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/19/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services. DESIGN A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles. DATA SOURCES A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper. REVIEW METHOD To facilitate a systematic approach to searching the literature, the PICO framework, was adapted. RESULTS The database search yielded 437 articles relevant to the analysis of specialist and advanced practice in relation to quality care, cost and access to services with additional articles added in a manual review of reference lists. In the final review a total of 86 articles were included as they fulfilled the eligibility criteria. CONCLUSION The evidence presented in the 86 articles indicates that nursing and midwifery practitioners continue to be under-utilised despite the evidence that greater reliance on advanced nurse practitioners could improve accessibility of primary care services while also saving on cost. Results point to continued difficulties associated with accurate measurement of the impact of these roles on patient outcomes. This review demonstrates that there is a need for robust measurement of the impact of these roles on patient outcomes.
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Affiliation(s)
- Mary Casey
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Laserina O'Connor
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Andrew Cashin
- Southern Cross University, Military Road, East Lismore, NSW 2480, Australia.
| | - Rita Smith
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Denise O'Brien
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Emma Nicholson
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Denise O'Leary
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Gerard Fealy
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Martin McNamara
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mary Ellen Glasgow
- Duquesne University, 600 Forbes Avenue, Fisher Hall 540B, Pittsburg, PA 15282, United States.
| | - Diarmuid Stokes
- UCD Library, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Claire Egan
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Kwee JL, McBride HL. Working together for women’s empowerment: Strategies for interdisciplinary collaboration in perinatal care. J Health Psychol 2016; 21:2742-2752. [DOI: 10.1177/1359105315586211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Women’s experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.
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Byatt N, Levin LL, Ziedonis D, Moore Simas TA, Allison J. Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review. Obstet Gynecol 2015; 126:1048-1058. [PMID: 26444130 PMCID: PMC4618720 DOI: 10.1097/aog.0000000000001067] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine a wide range of study designs and outcomes to estimate the extent to which interventions in outpatient perinatal care settings are associated with an increase in the uptake of depression care. DATA SOURCES PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, and Scopus (EMBASE) were searched for studies published between 1999 and 2014 that evaluated mental health care use after screening for depression in perinatal care settings. METHODS OF STUDY SELECTION Inclusion criteria were: 1) English language; 2) pregnant and postpartum women who screened positive for depression; 3) exposure (validated depression screening in outpatient perinatal care setting); and, 4) outcome (mental health care use). Searches yielded 392 articles, 42 met criteria for full-text review, and 17 met inclusion criteria. Study quality was assessed using a modified Downs and Black scale. TABULATION, INTEGRATION, AND RESULTS Articles were independently reviewed by two abstractors and consensus reached. Study design, intervention components, and mental health care use were defined and categorized. Seventeen articles representing a range of study designs, including one randomized controlled trial and one cluster randomized controlled trial, were included. The average quality rating was 61% (31.0-90.0%). When no intervention was in place, an average of 22% (13.8-33.0%) of women who screened positive for depression had at least one mental health visit. The average rate of mental health care use was associated with a doubling of this rate with patient engagement strategies (44%, 29.0-90.0%), on-site assessments (49%, 25.2-90.0%), and perinatal care provider training (54%, 1.0-90.0%). High rates of mental health care use (81%, 72.0-90.0%) were associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers. CONCLUSION Screening alone was associated with 22% mental health care use among women who screened positive for depression; however, implementation of additional interventions was associated with a two to fourfold increased use of mental health care. Although definitive studies are still needed, screening done in conjunction with interventions that target patient, health care provider, and practice-level barriers is associated with increased improved rates of depression detection, assessment, referral, and treatment in perinatal care settings.
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Affiliation(s)
- Nancy Byatt
- Departments of Psychiatry, Obstetrics and Gynecology, Pediatrics, Family Medicine and Community Health, and Quantitative Health Sciences and the Lamar Soutter Library, University of Massachusetts Medical School, Worcester, Massachusetts
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Gillies D, Buykx P, Parker AG, Hetrick SE. Consultation liaison in primary care for people with mental disorders. Cochrane Database Syst Rev 2015; 2015:CD007193. [PMID: 26384252 PMCID: PMC6463953 DOI: 10.1002/14651858.cd007193.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Approximately 25% of people will be affected by a mental disorder at some stage in their life. Despite the prevalence and negative impacts of mental disorders, many people are not diagnosed or do not receive adequate treatment. Therefore primary health care has been identified as essential to improving the delivery of mental health care. Consultation liaison is a model of mental health care where the primary care provider maintains the central role in the delivery of mental health care with a mental health specialist providing consultative support. Consultation liaison has the potential to enhance the delivery of mental health care in the primary care setting and in turn improve outcomes for people with a mental disorder. OBJECTIVES To identify whether consultation liaison can have beneficial effects for people with a mental disorder by improving the ability of primary care providers to provide mental health care. SEARCH METHODS We searched the EPOC Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), and bibliographic databases: MEDLINE, EMBASE, CINAHL and PsycINFO, in March 2014. We also searched reference lists of relevant studies and reviews to identify any potentially relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared consultation liaison to standard care or other service models of mental health care in the primary setting. Included participants were people attending primary care practices who required mental health care or had a mental disorder, and primary care providers who had direct contact with people in need of mental health care. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of identified studies against the inclusion criteria and extracted details including the study design, participants and setting, intervention, outcomes and any risk of bias. We resolved any disagreements by discussion or referral to a third author. We contacted trial authors to obtain any missing information.We collected and analysed data for all follow-up periods: up to and including three months following the start of treatment; between three and 12 months; and more than 12 months following the start of therapy.We used a random-effects model to calculate the risk difference (RD) for binary data and number needed to treat for an additional beneficial outcome (NNTB), if differences between groups were significant. The mean difference (MD) or standardised mean difference (SMD) was calculated for continuous data. MAIN RESULTS There were 8203 citations identified from database searches and reference lists. We included 12 trials with 2605 consumer participants and more than 905 primary care practitioner participants. Eleven trials compared consultation liaison to standard care and one compared consultation liaison to collaborative care, with a case manager co-ordinating mental health care. People with depression were included in eight trials; and one trial each included people with a variety of disorders: depression, anxiety and somatoform disorders; medically unexplained symptoms; and drinking problems. None of the included trials reported separate data for children or older people.There was some evidence that consultation liaison improved mental health up to three months following the start of treatment (two trials, n = 445, NNTB 8, 95% CI 5 to 25) but there was no evidence of its effectiveness between three and 12 months. Consultation liaison also appeared to improve consumer satisfaction (up to three months: one trial, n = 228, NNTB 3, 95% CI 3 to 5; 3 to 12 months: two trials, n = 445, NNTB 8, 95% CI 5 to 17) and adherence (3 to 12 months: seven trials, n = 1251, NNTB 6, 95% CI 4 to 13) up to 12 months. There was also an improvement in the primary care provider outcomes of providing adequate treatment between three to 12 months (three trials, n = 797, NNTB 7, 95% CI 4 to 17) and prescribing pharmacological treatment up to 12 months (four trials, n = 796, NNTB 13, 95% CI 7 to 50). There was also some evidence that consultation liaison may not be as effective as collaborative care in regards to symptoms of mental disorder, disability, general health status, and provision of treatment.The quality of these findings were low for all outcomes however, apart from consumer adherence from three to 12 months, which was of moderate quality. Eight trials were rated a high risk of performance bias because consumer participants were likely to have known whether or not they were allocated to the intervention group and most outcomes were self reported. Bias due to attrition was rated high in eight trials and reporting bias was rated high in six. AUTHORS' CONCLUSIONS There is evidence that consultation liaison improves mental health for up to three months; and satisfaction and adherence for up to 12 months in people with mental disorders, particularly those who are depressed. Primary care providers were also more likely to provide adequate treatment and prescribe pharmacological therapy for up to 12 months. There was also some evidence that consultation liaison may not be as effective as collaborative care in terms of mental disorder symptoms, disability, general health status, and provision of treatment. However, the overall quality of trials was low particularly in regards to performance and attrition bias and may have resulted in an overestimation of effectiveness. More evidence is needed to determine the effectiveness of consultation liaison for people with mental disorders particularly for those with mental disorders other than depression.
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Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | - Penny Buykx
- University of SheffieldSchool of Health and Related Research (ScHARR)Regents CourtSheffieldSouth YorkshireUKS1 4DA
- Monash University School of Rural HealthPO Box 666BendigoVictoriaAustralia3552
| | - Alexandra G Parker
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVICAustralia3054
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
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Khajehei M. Mental health of perinatal women. World J Obstet Gynecol 2015; 4:46-51. [DOI: 10.5317/wjog.v4.i2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/06/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Pregnancy and childbirth are major stressors for some women. They can be followed by deterioration in mental health status and cause mental illnesses during perinatal period. Undetected and untreated perinatal mental illnesses can have negative unexpected impacts on parenting skills of the women and children’s development. Mentally ill mothers may not effectively attend their children’s needs in a timely manner and may experience an unfavourable mother-child attachment affecting the child’s language, social, emotional and cognitive development. The rate of pregnancy and postnatal health complications and interventions is higher among mentally ill women with some certain risk factors. The mentally ill mothers along with their partners need comprehensive support and counselling to be able to care for their infants and establish strong parent-child bond and attachment. Mental health campaigns across the world have endeavoured to increase the knowledge and awareness of the public towards perinatal mental health illnesses. To this aim, a routine screening is recommended in order to identify the women who are at risk of mood or anxiety disorder during perinatal period. The development of knowledge on perinatal mental illnesses among public and the health professionals has resulted in timely recognition and treatment of perinatal mental illnesses. Although great volumes of research show high prevalence of perinatal mental illnesses and their impacts on parenting confidence and competence as well as child’s developmental process, there is still lack of research on various aspects of perinatal mental illnesses. To enable early prevention, diagnosis and intervention, it is crucial to identify families who are at an increased risk of perinatal mental illnesses and provide support and intervention to minimise the adverse outcomes. The children’s needs may not be met by providing treatment to parental mental illnesses alone. It is also important to understand the impact of specific parenting behaviours on child outcomes which is modified by the quality of parenting.
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