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Isobel S. Trauma in the lives of parents experiencing severe perinatal mental illness. Front Psychiatry 2024; 15:1380146. [PMID: 38628255 PMCID: PMC11018874 DOI: 10.3389/fpsyt.2024.1380146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. Method In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Results Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. Discussion The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.
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Affiliation(s)
- Sophie Isobel
- Naamuru Parent and Baby Unit, Sydney Local Health District, Sydney, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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Fisher J, Stanzel K, Nguyen H, Thean P, French D, Popplestone S, Tran T. Impact of a private sector residential early parenting program on clinically significant postnatal depressive symptoms experienced by women: Audit of routinely collected data. Acta Psychiatr Scand 2024. [PMID: 38408371 DOI: 10.1111/acps.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Early parenting services in Australia offer brief structured residential programs to address moderate to severe non-psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium-term impact of a five-night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post-discharge. METHODS Audit of routinely collected medical record data from pre-admission, pre-discharge and post-discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15-month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre-discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre-admission were included as predictors of the likelihood of the changes of the outcomes from pre-admission to pre-discharge and follow up. RESULTS Complete data from 1220 of 1290 (95%) eligible women were available to assess pre-admission to pre-discharge and from 559 (45.8%) to assess pre-discharge to six-week follow-up changes. The mean pre-admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre-discharge it was 7.1 (95% CI: 6.9; 7.4) and at six-week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre-admission to pre-discharge (five nights) and a further reduction of 1.2 points pre-discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months. CONCLUSION Residential early parenting programs, which take a psycho-educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long-term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms.
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Affiliation(s)
- Jane Fisher
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Stanzel
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hau Nguyen
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Patsy Thean
- Early Parenting Centre, Masada Private Hospital, St Kilda East, Victoria, Australia
| | - Danielle French
- Ramsay Hospital Research Foundation, Ramsay Health Care, Sydney, New South Wales, Australia
| | - Sally Popplestone
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Woźniewicz A, Cosci F. Clinical utility of demoralization: A systematic review of the literature. Clin Psychol Rev 2023; 99:102227. [PMID: 36462221 DOI: 10.1016/j.cpr.2022.102227] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.
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Affiliation(s)
- Agnieszka Woźniewicz
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurija Gagarina 11, 87-100 Toruń, Poland
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, via di San salvi n. 12, Florence, Italy; Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 6200, MD, Maastricht, The Netherlands.
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Lee JY, Park SE, Kim YM, Cho HJ, Khang YH. An analysis of the very high level of maternal distress experienced by South Korean women with young children. PLoS One 2022; 17:e0274016. [PMID: 36129903 PMCID: PMC9491576 DOI: 10.1371/journal.pone.0274016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Abstract
This study was conducted as a part of a larger study to identify the needs of a maternal and early childhood home visit program that the South Korean central government has begun to expand nationwide. This survey measured the distress of mothers with children aged 2 years or younger during the transition into motherhood using the Being a Mother scale (BaM-13) and compared the stress levels for each question with those of existing studies in other countries. The survey results revealed that the mean BaM-13 score of the 350 participants was 17.09 (SD = 6.81), with 87.7% showing very high levels of maternal distress, indicated by a score of 9 or above in BaM-13. The item from the BaM-13 with the highest response rate of 2 or 3 points (sum of the percentage of those who answered 2 and 3 points) was “I have missed the life I had before I became pregnant with this baby/toddler,” to which 80.8% of the respondents agreed. The percentage of South Korean mothers who answered 2 or 3 points was higher for every item on the BaM-13 than that of Australian mothers. A comparison of the total BaM-13 score and 3 factors (child experience, adult’s experience, and emotional closeness) of the BaM-13 according to the participants’ characteristics revealed that discrepancies in women’s sociodemographic factors (including smoking and alcohol consumption behaviors) were not significant, whereas differences in the total BaM-13 score and the 3 factors of the BaM-13 according to the mothers’ scores on the Edinburgh Postnatal Depression Scale were noticeable. The high level of maternal distress observed in this study should be reflected in the nurse-led maternal and early childhood home visit program that the South Korean central government is expanding across the country.
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Affiliation(s)
- Ji Yun Lee
- The Support Team for the Early Life Health Management Project of Korea, Seoul, Korea
- The Support Team for the Seoul Healthy First Step Project, Seoul, Korea
- College of Nursing, Kangwon National University, Chuncheon, Korea
| | - Sae Eun Park
- The Support Team for the Early Life Health Management Project of Korea, Seoul, Korea
- The Support Team for the Seoul Healthy First Step Project, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Yu-Mi Kim
- The Support Team for the Early Life Health Management Project of Korea, Seoul, Korea
- The Support Team for the Seoul Healthy First Step Project, Seoul, Korea
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hong-Jun Cho
- The Support Team for the Early Life Health Management Project of Korea, Seoul, Korea
- The Support Team for the Seoul Healthy First Step Project, Seoul, Korea
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Ho Khang
- The Support Team for the Early Life Health Management Project of Korea, Seoul, Korea
- The Support Team for the Seoul Healthy First Step Project, Seoul, Korea
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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5
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Gan LL, Gong S, Kissane DW. Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a 'specifier' in mental illness. Aust N Z J Psychiatry 2022; 56:1104-1129. [PMID: 34879712 DOI: 10.1177/00048674211060746] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Demoralisation is a state of poor coping characterised by low morale, hopelessness, subjective incompetence, and loss of meaning and purpose in life. While studied extensively in oncology and palliative care, there has been recent exploration in broader medical and mental health settings. The aim was to investigate the prevalence of demoralisation and associated sociodemographic and psychological factors across these clinical settings. METHOD Six electronic databases were used to locate articles from January 2014 to March 2020. A pre-publication update of non-oncology populations was completed in September 2021. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence of demoralisation was determined through % prevalence and mean demoralisation score; this was synthesised through meta-analysis of single means to determine pooled mean prevalence of Demoralisation Scale scores using the 'R' statistical software. RESULTS Demoralisation has been examined in 52 studies (n = 11,670) and found to be prevalent in 24-35% of oncology and non-oncology, including mental health, populations. The mean score on the Demoralisation Scale was 24.3 (95% confidence interval, CI = [21.3, 27.3]). There was evidence of divergent validity in addition to significant comorbidity between depression, demoralisation and suicidal ideation. Burdensome physical symptoms, and psychological and demographic factors are strongly correlated with demoralisation. CONCLUSION There remains a need to recognise demoralisation in various clinical and cultural settings and to strongly consider its inclusion as a 'specifier' within formal nosological systems for adjustment and depressive disorders. This is important to initiate targeted interventions and prevent significant morbidity.
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Affiliation(s)
- Lucy L Gan
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Susanna Gong
- Department of Psychiatry, Monash Health, Clayton, VIC, Australia
| | - David W Kissane
- Department of Psychiatry, Monash Health, Clayton, VIC, Australia.,School of Medicine, University of Notre Dame Australia and Cunningham Centre for Palliative Medicine Research, St Vincent's Sydney, Sydney, NSW, Australia.,Cabrini Health, Monash University, Clayton, VIC, Australia
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Bull C, Teede H, Carrandi L, Rigney A, Cusack S, Callander E. Evaluating the development, woman-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs): A systematic review protocol. BMJ Open 2022; 12:e058952. [PMID: 35144957 PMCID: PMC8845328 DOI: 10.1136/bmjopen-2021-058952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Woman-centred care is the right of every woman receiving maternity care, irrespective of where care is being received and who is providing care. This protocol describes a planned systematic review that will identify, describe and critically appraise the psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). The woman-centricity of PROM and PREM development and content validation (ie, the extent to which women were involved in these processes) will also be assessed. This information will be used to develop a maternity PROMs and PREMs database to support service and system performance measurement, and value-based maternity care initiatives. METHODS AND ANALYSIS This study will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of outcome measurement instruments. Studies identified via MEDLINE, CINAHL Plus, PsycINFO and EMBASE describing the development, content validation and/or psychometric evaluation of PROMs and PREMs specifically designed for maternity populations throughout pregnancy, childbirth and postnatal periods will be considered if published from 2010 onward, in English, and available in full text. The COSMIN risk of bias checklist will be used to evaluate the quality of studies reporting on the development, content validation and/or psychometric evaluation of PROMs and PREMs. COSMIN criteria for good content validity will be used to assess the woman-centricity of PROM and PREM development and content validation studies. COSMIN standards of good psychometric properties will be used to evaluate the validity and reliability of the identified instruments. ETHICS AND DISSEMINATION Ethical permission for this research is not required. The findings of this research will be submitted for publication in an international, peer-reviewed journal. Abstracts for national and international conference presentations will also be submitted. The proposed maternity PROMs and PREMs database will be freely accessible online, and developed with consumer input to ensure its usefulness to a range of maternity care stakeholders. PROSPERO REGISTRATION NUMBER CRD42021288854.
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Affiliation(s)
- Claudia Bull
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Monash University, Clayton, Victoria, Australia
| | - Lane Carrandi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Azure Rigney
- Maternity Choices Australia, Springwood, Queensland, Australia
| | - Sally Cusack
- Maternity Choices Australia, Springwood, Queensland, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Arshad A, Foresti K, Rech MM, Brakoulias V, Zubaran C. Demoralization, depression and anxiety in postpartum women of culturally and linguistic diverse backgrounds in Australia. Eur J Midwifery 2021; 5:45. [PMID: 34708192 PMCID: PMC8496309 DOI: 10.18332/ejm/140791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/25/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The present study aims to investigate whether mothers from Culturally and Linguistically Diverse (CALD) backgrounds present with higher levels of demoralization in comparison with their non-minority counterparts, and to explore potential correlations between demoralization and anxiety as well as depression in the same sample of mothers. METHODS Women admitted to a public tertiary care teaching hospital were invited to participate in the study within 24–48 hours following delivery. The study compared women who did not regard English as their main spoken language to native English-speaking women. Women were asked to complete the demographic Kissane Demoralization Scale (KDS) and Being a Mother Scale (BaM-13) questionnaires. Participants were contacted by phone, 6 to 8 weeks after they had completed the KDS and the BaM-13 questionnaires, to complete an Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Scale (STAI) questionnaires. RESULTS Mothers of CALD background presented with significantly higher scores on the KDS (p<0.001), STAI (p<0.001) and EPDS (p<0.001) scales in comparison with their non-CALD counterparts. Furthermore, when mothers were reassessed after 6 to 8 weeks, higher KDS scores in the postnatal period predicted significantly higher anxiety and depression scores, according to STAI (p<0.001) and the EPDS (p<0.001), respectively. CONCLUSIONS The results of this study reveal that, mothers of CALD background manifest higher levels of demoralization as well as anxiety and depression in the postpartum period when compared with their non-CALD counterparts.
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Affiliation(s)
- Adeel Arshad
- Department of Mental Health, Western Sydney Local Health District, Sydney, Australia
| | - Katia Foresti
- Sunnyside Clinic, Sydney, Australia.,Hornsby Specialist Centre, Sydney, Australia
| | - Matheus M Rech
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - Vlasios Brakoulias
- Department of Mental Health, Western Sydney Local Health District, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Carlos Zubaran
- Sunnyside Clinic, Sydney, Australia.,Hornsby Specialist Centre, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,School of Medicine, The University of Notre Dame, Sydney, Australia
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Wilson N, Wynter K, Anderson C, Rajaratnam SMW, Fisher J, Bei B. More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program. BMC Psychiatry 2019; 19:48. [PMID: 30696418 PMCID: PMC6352433 DOI: 10.1186/s12888-019-2024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB). METHOD Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity. RESULTS Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG. CONCLUSIONS In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.
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Affiliation(s)
- Nathan Wilson
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Karen Wynter
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
- Centre for Quality and Patient Safety Research - Western Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Clare Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC, Australia
| | - Shanthakumar M W Rajaratnam
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC, Australia
- NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jane Fisher
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
- Masada Early Parenting Centre, Masada Private Hospital, East St Kilda, VIC, Australia
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia.
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Wynter K, Wilson N, Thean P, Bei B, Fisher J. Psychological and sleep-related functioning among women with unsettled infants in Victoria, Australia: a cross-sectional study. J Reprod Infant Psychol 2018; 37:413-428. [DOI: 10.1080/02646838.2018.1556787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karen Wynter
- Global Public Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Nursing & Midwifery – Western Health Partnership, Deakin University, Melbourne, Australia
| | - Nathan Wilson
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Patsy Thean
- Early Parenting Centre, Masada Private Hospital, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jane Fisher
- Global Public Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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Bobevski I, McKenzie DP, Rowe H, Kissane DW, Clarke DM, Fisher J. Measuring postnatal demoralisation: adaptation of the Demoralisation Scale-II (DS-II) for postnatal use. J Reprod Infant Psychol 2018; 36:561-577. [PMID: 30252502 DOI: 10.1080/02646838.2018.1519781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the psychometric properties of the Demoralisation Scale II (DS-II) and adapt it for use with women in the postnatal period. BACKGROUND Demoralisation is a psychological state characterised by a sense of incompetence and feelings of helplessness and hopelessness in response to a stressful situation. The postnatal period is a life stage of many disruptions. Women may lose their confidence and become demoralised if feeling unprepared for the tasks of motherhood. The DS-II is a 16-item scale developed among cancer patients, but with content that is also relevant postnatally, including items on sense of failure, helplessness, hopelessness, isolation, entrapment and loss of purpose. METHODS Rasch analysis was used to investigate the psychometric properties of the DS-II and refine the scale for postnatal use. RESULTS Participants were 209 women admitted with their babies to a residential early parenting programme. A 14-item revised scale was derived, the Postnatal DS-II, showing good psychometric properties, discriminant validity and sensitivity to change, and being well targeted to the sample. CONCLUSION The Postnatal DS-II could have utility as an assessment tool, helping clinicians to understand better women's postnatal experiences, assess the effectiveness of interventions and communicate with women in a meaningful and non-stigmatising way.
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Affiliation(s)
- Irene Bobevski
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia.,b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Dean P McKenzie
- c Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.,d Research Development & Governance, Epworth HealthCare , Melbourne , Australia
| | - Heather Rowe
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - David W Kissane
- b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - David M Clarke
- b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Jane Fisher
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
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11
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Wilson N, Wynter K, Fisher J, Bei B. Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours. BMC Psychiatry 2018; 18:309. [PMID: 30253778 PMCID: PMC6156854 DOI: 10.1186/s12888-018-1892-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence in relatively healthy populations suggests that postpartum depression and fatigue are likely distinct but related experiences. However, differentiating depression and fatigue in clinical settings remains a challenge. This study aimed to assess if depression and fatigue are distinct constructs in women with relatively high fatigue and psychological distress symptoms attending a residential program that assists with unsettled infant behaviour. METHODS 167 women (age: M = 34.26, SD = 4.23) attending a private residential early parenting program completed the Depression Anxiety Stress Scale (DASS21-D), Fatigue Severity Scale (FSS) and self-report sleep variables before program commencement. Confirmatory Factor Analysis examined the associations between depression and fatigue latent factors. RESULTS A two-factor model of separate but related depression and fatigue constructs provided a significantly better fit to the data than a one-factor model of combined depression and fatigue (p < .001). In the two-factor model, the depression and fatigue latent factors were moderately correlated (.41). Further predictive utility of this two-factor model was demonstrated as both depression and fatigue factors were independently predicted by worse self-reported sleep efficiency. CONCLUSIONS This study provides empirical evidence that for women attending a clinical service with relatively high fatigue and psychological distress, postpartum depression and fatigue remain separate but related experiences. These findings suggest that in women seeking clinical support in the postpartum period, both depression and fatigue need to be carefully assessed to ensure accurate diagnoses, and (b) whilst depression intervention may improve fatigue, targeted fatigue intervention may also be warranted.
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Affiliation(s)
- Nathan Wilson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC, 3800, Australia
| | - Karen Wynter
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Quality and Patient Safety Research - Western Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Jane Fisher
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Masada Early Parenting Centre, Masada Private Hospital, East St Kilda, VIC, Australia
| | - Bei Bei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC, 3800, Australia.
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Bobevski I, Rowe H, Clarke DM, McKenzie DP, Fisher J. Early postnatal demoralisation among primiparous women in the community: measurement, prevalence and associated factors. BMC Pregnancy Childbirth 2015; 15:259. [PMID: 26459266 PMCID: PMC4603773 DOI: 10.1186/s12884-015-0680-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022] Open
Abstract
Background Demoralisation is a psychological state occurring in stressful life situations where a person feels unable to respond effectively to their circumstances, characterised by feelings of distress, subjective incompetence, helplessness and hopelessness. The period after the birth of a first baby is a time of great changes and disruptions to many aspects of the mother's physical, psychological and social functioning. This can lead to feelings of distress, a sense of incompetence and helplessness. This study aimed to examine: (1) the psychometric properties of the Demoralisation Scale in a community setting; (2) the prevalence of demoralisation symptoms among primiparous women in the community; and (3) factors that are uniquely associated with demoralisation in the early postnatal period. Methods Primiparous women attending community maternal health centres (n = 400) were recruited and administered the study's questionnaires through a telephone interview. Results The Demoralisation Scale was found to be a reliable and valid tool among women in the community who had recently given birth. Higher levels of demoralisation were independently associated with lower confidence on going home from the hospital after birth, lower rating of mother's self-rated global health, more than 3 h of infant crying and fussing in the last 24 h, and a controlling partner, after symptoms of depression and anxiety, and vulnerable personality characteristics were controlled for. Conclusions The relevance of demoralisation to postnatal health practitioners in the community is in helping them to better understand women's experiences and to intervene in a way that is more meaningful and less stigmatising to women.
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Affiliation(s)
- Irene Bobevski
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - David M Clarke
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Dean P McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Research Development & Governance, Epworth HealthCare, Melbourne, Australia.
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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