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Collins E, Keedle H, Jackson M, Lequertier B, Schmied V, Boyle J, Kildea S, Dahlen HG. Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility. Women Birth 2024; 37:419-427. [PMID: 38218652 DOI: 10.1016/j.wombi.2023.12.008] [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: 08/05/2023] [Revised: 11/18/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND To reduce transmission risk during the COVID-19 pandemic, 'telehealth' (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives' perspectives regarding telehealth use. METHODS A qualitative study was conducted in Australia during 2020-2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively. FINDINGS Telehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges. CONCLUSION During the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care.
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Affiliation(s)
- Emma Collins
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Melanie Jackson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Level 11, East Tower, 410 Ann Street, Brisbane, Qld 4000, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Jacqueline Boyle
- Monash Centre of Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia.
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Bertram G, Becuzzi N, Wilson E. Trends in perinatal mental health within a tertiary institution from 2013 to 2022. Aust N Z J Obstet Gynaecol 2023; 63:821-824. [PMID: 37317572 DOI: 10.1111/ajo.13720] [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: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
Perinatal mental health (PMH) disorders affect about one in seven women in the peripartum period with significant maternal and neonatal effects. It is important to understand trends in PMH to plan for necessary resource allocation. This study reviews the PMH trends in a major tertiary obstetric centre over 10 years from 2013 to 2022. Over this period there was a significant increase in the rates of anxiety from 7.4 to 18.4% (P < 0.001), depression from 13.6 to 16.3% (P < 0.001) and anxiety and/or depression from 16.5 to 22.6% (P < 0.001). These findings provide further information for resource allocation to improve long-term outcomes.
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Affiliation(s)
- Georgia Bertram
- Mothers, Babies and Womens Health Services, Mater Health, Brisbane, Queensland, Australia
| | - Nadine Becuzzi
- Mothers, Babies and Womens Health Services, Mater Health, Brisbane, Queensland, Australia
| | - Erin Wilson
- Mothers, Babies and Womens Health Services, Mater Health, Brisbane, Queensland, Australia
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Andersen CG, Thomsen LLH, Gram P, Overgaard C. ‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme. Midwifery 2023; 122:103675. [PMID: 37043942 DOI: 10.1016/j.midw.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. DESIGN a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. SETTING nine community-based and hospital-based midwife clinics in the North Region of Denmark. INTERVENTION a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. PARTICIPANTS AND DATA 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. FINDINGS contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. CONCLUSION midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.
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Pope J, Redsell S, Houghton C, Matvienko-Sikar K. Healthcare professionals' experiences and perceptions of providing support for mental health during the period from pregnancy to two years postpartum. Midwifery 2023; 118:103581. [PMID: 36608486 DOI: 10.1016/j.midw.2022.103581] [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: 09/23/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Mental health issues in the perinatal period are common, and can have negative consequences for maternal and child health. Healthcare professionals (HCPs) who provide women with perinatal care are well-placed to detect mental health issues and provide support. This study therefore examines HCPs' experiences and perceptions of providing mental health support during the perinatal period, including during the COVID-19 pandemic. DESIGN An exploratory realist qualitative study was conducted. SETTING Republic of Ireland PARTICIPANTS: A purposive sampling strategy was employed to recruit HCPs (e.g., general practitioners, midwives, public health nurses, practice nurses, doulas, and breastfeeding counsellors), via professional bodies in Ireland. An invitation to participate was also circulated via Twitter. A total of 18 HCPs participated in semi-structured interviews conducted between 18/8/2020 and 24/5/2021. MEASUREMENTS AND FINDINGS Semi-structured interviews were conducted according to a topic guide designed by a multidisciplinary team. Data were analysed using thematic analysis. Four themes were developed: 'Supporting women in healthcare settings,' 'Skills and capacity to provide adequate care,' 'Structural barriers to care provision,' and 'The impact of the COVID-19 pandemic on stress support.' KEY CONCLUSIONS HCPs reported providing emotional support and advocacy, but highlighted challenges, including limited capacity to address women's concerns, clinical culture and hierarchy, insufficient organisational investment, and social inequities in support access. Some HCPs felt these barriers could lead to additional psychological harm. HCPs also reported that the pandemic had introduced novel stressors and changed the nature of the mental health support they provided. IMPLICATIONS FOR PRACTICE Interventions incorporating education and physical resources for HCPs, increased investment in specialist perinatal mental health services, increased investment in holistic supports, and changes to address cultural challenges in care environments, may facilitate - or enhance - support for women.
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Affiliation(s)
- Johanna Pope
- School of Public Health, University College Cork, Western Road, Mardyke, Cork, Ireland; School of Nursing and Midwifery, Aras Moyola, University of Galway, Upper Newcastle, Gaillimh, Ireland.
| | - Sarah Redsell
- School of Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Catherine Houghton
- School of Nursing and Midwifery, Aras Moyola, University of Galway, Upper Newcastle, Gaillimh, Ireland
| | - Karen Matvienko-Sikar
- School of Public Health, University College Cork, Western Road, Mardyke, Cork, Ireland
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San Martin Porter MA, Maravilla J, Kisely S, Betts KS, Salom C, Alati R. Trends of perinatal mental health referrals and psychiatric admissions in Queensland. Aust N Z J Psychiatry 2023; 57:401-410. [PMID: 35229690 DOI: 10.1177/00048674221080405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perinatal depression is often underdiagnosed; consequently, many women suffer perinatal depression without follow-up care. Screening for depressive symptoms during the perinatal period has been recommended in Australia to increase detection and follow-up of women suffering from depressive symptoms. Screening rates have gradually increased over the last decades in Australia. OBJECTIVE To explore trends in referrals of women to community mental health services during the perinatal period, and prenatal and postnatal admissions to psychiatric units, among those who gave birth in Queensland between 2009 and 2015. METHOD Retrospective analyses of data from three linked state-wide administrative data collections. Trend analyses using adjusted Poisson regression models examined 426,242 births. Outcome variables included referrals to specialised mental health services; women admitted with a mood disorder during the second half of their pregnancy and during the first 3 months of the postnatal period; and women admitted with non-affective psychosis disorders during the second half of their pregnancy and during the first 3 months of the postnatal period. RESULTS We found an increase in mental health referrals during the perinatal period over time (adjusted incidence rate ratio, 1.07; 95% confidence interval, [1.06, 1.08]) and a decrease in admissions with mood disorders during the first 3 months of the postnatal period (adjusted incidence rate ratio, 0.95; 95% confidence interval, [0.94, 0.98]). We did not find any changes in rates of admission for other outcomes. CONCLUSION Since the introduction of universal screening in Queensland, referrals for mental health care during the perinatal period have increased, while admissions for mood disorders in the first 3 months after delivery decreased.
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Affiliation(s)
| | - Joemer Maravilla
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Kim S Betts
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Caroline Salom
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia.,Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, QLD, Australia
| | - Rosa Alati
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia.,School of Population Health, Curtin University, Perth, WA, Australia
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Chrzan-Dętkoś M, Murawska N, Walczak-Kozłowska T. 'Next Stop: Mum': Evaluation of a Postpartum Depression Prevention Strategy in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11731. [PMID: 36142005 PMCID: PMC9517552 DOI: 10.3390/ijerph191811731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In the article we present a mid-point evaluation of the postpartum depression (PPD) prevention strategy in Poland. As PPD is associated with potential negative consequences for the mother and infant, the need to introduce screening and treatment is vital. The project covered over 21,500 women in the first year postpartum. The average score in the Edinburgh Postnatal Depression Scale (EPDS), in a screening provided in direct contact, was 4.73 (SD = 4.14, n = 7222), and increased in 55% of women in the follow-up study. In online screening the average score in the EPDS assessment was 16.05 (SD = 5.975, n = 10,454). The 'probable depression' rate (EPDS > 12) in 'direct' contact is 7.3%, and on the online platform-77%. Additionally, 26% of possibly affected mothers assessed in 'direct' contact benefited from psychological consultations. The average score in the EPDS among mothers who benefitted from consultations is 16.24 (SD =4.674, n = 231). Approx. 82% of healthcare providers raised their knowledge of PPD after training sessions. Maintaining the assumptions of the program: training for medical staff, screening conducted throughout the first twelve months postpartum, online platform with the possibility of self-screening and early psychological intervention seem to be justified actions, leading to a higher number of women with risk of PPD referred.
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Patterns of psychiatric admission in Australian pregnant and childbearing women. Soc Psychiatry Psychiatr Epidemiol 2022; 57:611-621. [PMID: 34292361 DOI: 10.1007/s00127-021-02137-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The early postnatal period is a time of increased risk for psychiatric admission. However, there is scope to further examine if this increase in risk extends to the entire perinatal period (pregnancy and first postnatal year), and how it compares to admission outside of the perinatal period. METHODS Data were linked across birth and hospital admission registers from July 2000 to December 2009. The study cohort, consisting of all pregnant and childbearing women with a psychiatric history, was divided into two groups: case women (at least one perinatal principal psychiatric admission in the study period) (38%) and comparison women (no perinatal principal psychiatric admissions) (62%). Outcomes were admission rate and length of stay adjusted for diagnosis, socio-demographic factors and timing of admission. RESULTS Antenatal and postnatal admissions rates were both higher than non-perinatal admission rates for case women for all diagnoses. There was little evidence that women with perinatal admissions were at an increased risk of admissions at other times. Socially disadvantaged women had significantly fewer and shorter admissions than their respective counterparts. CONCLUSIONS The entire perinatal period is a time of increased risk for admission across the range of psychiatric disorders, compared to other times in a woman's childbearing years. Reduced admission rate and length of stay for socially disadvantaged women suggest lack of equity of access highlighting the importance of national perinatal mental health policy initiatives inclusive of disadvantaged groups.
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Chambers GM, Botha W, Reilly N, Black E, Kingston D, Austin MP. The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study. Women Birth 2021; 35:e133-e141. [PMID: 34099393 DOI: 10.1016/j.wombi.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Although perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain. AIM To compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA). METHODS Women attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an 'at-risk' flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the 'at-risk' flag for PIPA than for Usual-Care. Each model's performance was evaluated using the midwife's agreement with the 'at-risk' flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach. FINDINGS Both models performed well at identifying 'at-risk' women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying 'at-risk' women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted. DISCUSSION Overall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as 'at-risk' and 'not at-risk' of perinatal psychosocial morbidity.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Willings Botha
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia; Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia.
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Dadi AF, Miller ER, Azale T, Mwanri L. "We do not know how to screen and provide treatment": a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia. Int J Ment Health Syst 2021; 15:41. [PMID: 33952338 PMCID: PMC8098000 DOI: 10.1186/s13033-021-00466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. METHODS We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. RESULTS The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation. CONCLUSIONS This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.
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Affiliation(s)
- Abel Fekadu Dadi
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emma R. Miller
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Telake Azale
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
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Austin MPV, Reilly N, Mule V, Kingston D, Black E, Hadzi-Pavlovic D. Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment. Women Birth 2021; 35:e125-e132. [PMID: 33895108 DOI: 10.1016/j.wombi.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician. AIMS To assess the impact of psychosocial risk, current symptoms and mode of assessment on women's honesty of disclosure at psychosocial assessment. METHODS Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were 'always honest' and 'not always honest'. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk. FINDINGS 10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18-2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16-2.62, p<0.05; aOR=2.08, 95%CI: 1.11-3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest. DISCUSSION A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback. CONCLUSION Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Royal Hospital for Women, Sydney, Barker St, Randwick, NSW 2031, Australia.
| | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
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11
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Moss KM, Reilly N, Dobson AJ, Loxton D, Tooth L, Mishra GD. How rates of perinatal mental health screening in Australia have changed over time and which women are missing out. Aust N Z J Public Health 2020; 44:301-306. [PMID: 32510784 DOI: 10.1111/1753-6405.12999] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017). METHODS A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. RESULTS From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally. CONCLUSIONS Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.
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Affiliation(s)
- Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Nicole Reilly
- Research Centre for Generational Health and Ageing, University of Newcastle, New South Wales.,School of Nursing and Midwifery, University of Newcastle, New South Wales
| | - Annette J Dobson
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, New South Wales
| | - Leigh Tooth
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
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12
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Moss KM, Loxton D, Dobson AJ, Slaughter V, Mishra GD. Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study. Arch Womens Ment Health 2020; 23:53-62. [PMID: 30656489 DOI: 10.1007/s00737-019-0941-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13 years. The current study includes children aged 0-12 years (N = 5532, M = 6.99 years, SD = 3.22 years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0-4 years (unstandardized regression coefficient (B) = - 0.26, 95%CI - 0.38, - 0.13) and children aged 5-12 years (B = - 0.25, 95%CI - 0.34, - 0.16), and by post-birth maternal stress (B = - 0.04, 95%CI - 0.08, - 0.01), and parenting (B = - 0.03, 95%CI - 0.04, - 0.02) in children aged 5-12 years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.
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Affiliation(s)
- Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia.
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, New Lambton Heights, New South Wales, 2305, Australia
| | - Annette J Dobson
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Virginia Slaughter
- School of Psychology, The University of Queensland, St Lucia, Queensland, 4067, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
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Reilly N, Kingston D, Loxton D, Talcevska K, Austin MP. A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 2020; 33:51-59. [DOI: 10.1016/j.wombi.2019.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
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Engagement with perinatal mental health services: a cross-sectional questionnaire survey. BMC Pregnancy Childbirth 2019; 19:170. [PMID: 31088414 PMCID: PMC6518724 DOI: 10.1186/s12884-019-2320-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Perinatal depression and/or anxiety disorders are undertreated pregnancy complications. This is partly due to low rates of engagement by women. This study aimed to identify barriers and facilitators to women accessing perinatal mental health services in an outer metropolitan hospital in Queensland, Australia. METHODS Data was collected from pregnant women through a cross-sectional survey. Women rated the extent certain factors influenced their engagement. Respondents were separated into three groups: women who were not offered a referral to perinatal mental health services, women who were offered a referral but did not engage, and women who engaged. RESULTS A total of 218 women participated. A response rate of 71% was achieved. 38.1% of participants did not believe themselves knowledgeable about mental illness in the perinatal period, and 14.7% did not recall being asked about their mental health during their pregnancy. Of those participants who recalled being asked about their mental health, 37.1% were offered a referral. Of these, just over a third (36.2%) accepted, and out of this group, 40% attended an appointment. Regardless of referral and engagement status, the factors identified as influencing participant engagement were time restraints, lack of childcare support, and encouragement by family and health care professionals. Stigma was not identified as a barrier. CONCLUSIONS Perinatal mental health service engagement could be improved by health services: ensuring universal screening and actively engaging women in the process: assisting with childcare; improving appointment immediacy and accessibility; and educating health care professionals about their influence on women's engagement.
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Noonan M, Jomeen J, Galvin R, Doody O. Survey of midwives’ perinatal mental health knowledge, confidence, attitudes and learning needs. Women Birth 2018; 31:e358-e366. [DOI: 10.1016/j.wombi.2018.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
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Consensus on the assessment of disordered eating in pregnancy: an international Delphi study. Arch Womens Ment Health 2018; 21:383-390. [PMID: 29249043 DOI: 10.1007/s00737-017-0806-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/12/2017] [Indexed: 01/08/2023]
Abstract
This study aimed to assess and develop consensus on the assessment of disordered eating in pregnancy. A three-round modified Delphi approach was used. Participants were international clinicians and researchers (N = 26) with extensive knowledge on and/or clinical experience with eating disorders, particularly in relation to pregnancy and/or women's health. Clear consensus among the panel, defined as 75% agreement, was reached regarding the assessment of disordered eating in pregnancy, in addition to potential assessment methods. Antenatal assessment of disordered eating was perceived to be crucial and ideally occur in a routine manner. Despite agreement that various assessment methods would be relevant in assessing disordered eating in pregnancy, psychometrically sound brief screening instruments were perceived to be most feasible for practitioners and women accessing antenatal care; however, these instruments must be pregnancy-specific and delivered in an authentic and caring manner to be beneficial.
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Referrals to Mental Health Services: Exploring the Referral Process in Genetic Counseling. J Genet Couns 2017; 27:289-300. [DOI: 10.1007/s10897-017-0147-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
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Noonan M, Doody O, Jomeen J, Galvin R. Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review. Midwifery 2017; 45:56-71. [DOI: 10.1016/j.midw.2016.12.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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The impact of routine assessment of past or current mental health on help-seeking in the perinatal period. Women Birth 2014; 27:e20-7. [PMID: 25154772 DOI: 10.1016/j.wombi.2014.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial. AIM The current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum. METHODS A subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N=398) or in the 12 months following birth (N=380) participated in the study. RESULTS Multivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR=0.09, 95%CI: 0.04-0.24) and the postpartum (adjOR=0.07, 95%CI: 0.02-0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR=0.26, 95%CI: 0.15-0.45; postnatal: adjOR=0.14, 95%CI: 0.07-0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident. CONCLUSION This study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.
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