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Jannati N, Farokhzadian J, Ahmadian L. The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study. Sultan Qaboos Univ Med J 2021; 21:554-562. [PMID: 34888074 PMCID: PMC8631231 DOI: 10.18295/squmj.4.2021.031] [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: 04/28/2020] [Revised: 07/02/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to describe the experience of healthcare professionals in
providing mental health services to women with postpartum depression
(PPD). Methods In this qualitative study, data were collected through semi-structured
interviews with five physicians, five midwives and five psychologists from
14 urban healthcare centres in Kerman, Iran, from April 2019 to September
2019. Purposeful sampling was used to select the participants. Data were
qualitatively analysed using a content analysis approach. Results Data analysis revealed the main theme of the study: ‘the long way
ahead for comprehensive, integrated and responsive mental health
services’. This theme included four categories: ‘postpartum
depression challenges’, ‘social and personal
factors’, ‘structural challenges’ and ‘need
for change in mental health services’. The participants described
that depression diagnosis is difficult due to insufficient knowledge among
healthcare providers and the hidden signs of PPD. They also described how
different factors such as economic and cultural factors, personality traits,
a community’s lack of knowledge, negative attitude towards
depression and limited family support might cause depression. Moreover,
providing mental health services involves certain challenges, such as
limited human resources, insufficient financial resources and incomplete or
inefficient policy-making. Conclusion Although measures have been taken to provide mental health services, there
are many challenges regarding providing mental health services to mothers.
Therefore, serious measures should be taken to improve mental health
services and re-define the existing measures. Informing the community,
empowering the healthcare providers and attempting to change the
community’s attitudes and beliefs can affect the mental healthcare
of women with depression.
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Affiliation(s)
| | - Jamileh Farokhzadian
- Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Neuroscience Research Center, Institute of Neuropharmacology
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Uptake of referrals for women with positive perinatal depression screening results and the effectiveness of interventions to increase uptake: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e143. [PMID: 32677601 PMCID: PMC7372167 DOI: 10.1017/s2045796020000554] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions. METHODS This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT). RESULTS Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35-50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51-69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23-41%) (odds ratio 1.31, 95% CI 1.13-1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p < 0.01). CONCLUSIONS Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.
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Kumar A, Rao A, O'Rourke K, Hanrahan N. Relationship Between Depression and/or Anxiety and Hospital Readmission Among Women After Childbirth. J Obstet Gynecol Neonatal Nurs 2019; 48:552-562. [PMID: 31356766 DOI: 10.1016/j.jogn.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the relationship between depression and/or anxiety and any psychiatric diagnosis and readmission after childbirth. DESIGN Cross-sectional analysis of administrative data from patient discharge records. SETTING Urban academic medical center in the northeastern United States. PARTICIPANTS Women admitted for childbirth (N = 17,905). METHODS Differences among participants with and without depression and/or anxiety present on admission were compared using t tests and chi-square tests. Risk-adjusted logistic regression models were used to examine the effects of depression and/or anxiety and any psychiatric diagnosis on 7-, 30-, 60-, 90-, and 180-day readmissions after childbirth. RESULTS Significant differences were noted between participants with (n = 1,169) and without (n = 16,736) depression and/or anxiety. Participants with these diagnoses had a higher mean age and a longer mean length of stay during hospitalization for childbirth. A greater proportion of these participants were White, were single, had cesarean births, and were discharged with home health services. The presence of depression and/or anxiety was not significantly associated with readmission. The effect of having any psychiatric diagnosis was significantly associated with a greater risk of readmission at 7 (odds ratio [OR] = 1.51, p = .100), 30 (OR = 1.45, p = .030), 60 (OR = 1.45, p = .026), 90 (OR = 1.56, p = .004), and 180 days (OR =1.74, p < .001) following discharge after childbirth. CONCLUSION In this sample, women with a psychiatric diagnosis, but not depression and/or anxiety alone, were at increased risk for readmission after childbirth.
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Dauber S, Ferayorni F, Henderson C, Hogue A, Nugent J, Alcantara J. Substance Use and Depression in Home Visiting Clients: Home Visitor Perspectives on Addressing Clients' Needs. JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 45:396-412. [PMID: 28408768 PMCID: PMC5385706 DOI: 10.1002/jcop.21855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/07/2016] [Indexed: 06/07/2023]
Abstract
Substance use and depression are prevalent among mothers enrolled in home visiting programs and are significant risk factors for child maltreatment, yet most home visiting programs are staffed by workers who lack the training and clinical skills to address these risks. Emanating from one state network's interest in advancing its practice in this area, the current study surveyed 159 home visitors on their current practices, training, knowledge, and perceived self‐efficacy, and perceived system‐ and client‐level barriers regarding client substance use and depression. Home visitors reported managing maternal depression more extensively than substance use, though overall management of both risk areas was low. More training was associated with more extensive management of both risk domains, as was greater home visitor knowledge and self‐efficacy. Implications for the development of strategies to improve home visitor management of client behavioral health risks, including enhanced skills‐based training and supervision, are discussed.
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Affiliation(s)
- Sarah Dauber
- The National Center on Addiction and Substance Abuse
| | | | | | - Aaron Hogue
- The National Center on Addiction and Substance Abuse
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Bell L, Feeley N, Hayton B, Zelkowitz P, Tait M, Desindes S. Barriers and Facilitators to the Use of Mental Health Services by Women With Elevated Symptoms of Depression and Their Partners. Issues Ment Health Nurs 2016; 37:651-659. [PMID: 27192032 DOI: 10.1080/01612840.2016.1180724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This qualitative descriptive study explored the barriers and facilitators to the use of mental health services reported by women with elevated symptoms of depression in the postpartum period and their partners. Data were collected through individual semi-structured interviews of 30 heterosexual couples. Content analysis revealed five principal barriers and facilitators: (a) accessibility and proximity, (b) appropriateness and fit, (d) stigma, (e) encouraged to seek help, and (f) personal characteristics. The study highlights the importance of barriers and facilitators to be taken into consideration in order to promote the use of mental health services for women with elevated symptoms of depression in the postpartum period.
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Affiliation(s)
- Linda Bell
- a Sherbrooke University , Faculty of Medicine and Health Science , Sherbrooke , Quebec , Canada
| | - Nancy Feeley
- b Jewish General Hospital , Centre for Nursing Research , Montreal , Quebec , Canada
| | - Barbara Hayton
- c Jewish General Hospital Institute of Community and Family Psychiatry , Montreal , Quebec , Canada
| | - Phyllis Zelkowitz
- c Jewish General Hospital Institute of Community and Family Psychiatry , Montreal , Quebec , Canada
| | - Madeleine Tait
- c Jewish General Hospital Institute of Community and Family Psychiatry , Montreal , Quebec , Canada
| | - Sophie Desindes
- d Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
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Abstract
PURPOSE To determine effectiveness of an educational intervention in reducing or preventing symptoms of postpartum depression (PPD). STUDY DESIGN AND METHODS English-speaking women age 18 or older with a singleton, term, healthy newborn were recruited from an 11-bed maternity unit in Southern New Hampshire. Using a quasi-experimental design, the first 120 respondents received usual care (control), and the following 120 respondents received the education (treatment) including PPD predictors, symptoms, prevention, and management. Current risk factors were measured using the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Symptoms of depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks, 3 months, and 6 months postpartum. Two-proportion z-tests were used to determine whether the education had a significant impact on EPDS scores at each of the three follow-ups. RESULTS There was no significant difference in symptoms of depression as measured by the EPDS between the treatment and control group at 6 weeks, 3 months, or 6 months postpartum. However, consistent with previous studies, low socioeconomic status and a history of depression or anxiety prior to or during the pregnancy were significant predictors of PPD. CLINICAL IMPLICATIONS Postpartum nursing discharge education did not decrease depression symptoms up to 6 months after discharge. More research is needed to determine the most appropriate timing and content of education about PPD. Many women at risk can be identified prior to birth. Education to improve literacy about PPD may need to be provided prenatally and reinforced during postpartum hospitalization and after discharge.
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Affiliation(s)
- Deborah McCarter-Spaulding
- Deborah McCarter-Spaulding is an Assistant Professor, Department of Nursing, Saint Anselm College, and Staff Nurse, The Mom's Place, Catholic Medical Center, Manchester, NH. She can be reached via e-mail at . Stephen Shea is an Associate Professor, Department of Mathematics, Saint Anselm College, Manchester, NH
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Horowitz JA, Murphy CA, Gregory K, Wojcik J, Pulcini J, Solon L. Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. J Obstet Gynecol Neonatal Nurs 2014; 42:287-300. [PMID: 23682696 DOI: 10.1111/1552-6909.12038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. DESIGN Randomized clinical trial (RCT) with three phases. METHODS In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants. SETTING Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes. PARTICIPANTS Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol. RESULTS Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups. CONCLUSIONS Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.
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Affiliation(s)
- June Andrews Horowitz
- Boston College, W. F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
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Slattengren AH, Prasad S, Kaiseruddin MA. PURLs: Should you screen for postpartum depression? THE JOURNAL OF FAMILY PRACTICE 2013; 62:E1-E3. [PMID: 24288714 PMCID: PMC3948499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Yes. Evidence suggests that screening new moms for depression leads to better outcomes, and should be routine.
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Affiliation(s)
- Andrew H Slattengren
- North Memorial Family Medicine Residency, University of Minnesota, Minneapolis, MN, USA
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Matthey S, Ross-Hamid C. Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord 2012; 141:213-21. [PMID: 22695259 DOI: 10.1016/j.jad.2012.02.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/03/2012] [Accepted: 02/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Edinburgh Depression Scale (EDS/EPDS) is routinely used in many clinical services to screen for probable distress in antenatal and postnatal women. Typically a single administration of this scale results in a referral to a specialist mental health service if the woman scores above the service's cut-off score on the measure - that is, scores 'high'. A few postnatal studies have shown, however, that many women when re-tested just a few weeks later no longer score 'high'. This study explored this phenomenon in a sample of pregnant women, using both the EDS and an anxiety self-report measure (Hospital Anxiety and Depression Scale - Anxiety subscale: HADS-A). METHOD 164 English-speaking pregnant women attending a local public hospital's antenatal clinic for their first appointment participated. At this appointment they completed the EDS and the HADS-A, and predicted how they might be feeling in about two-week time. Approximately two weeks later they were interviewed by phone and again completed the EDS and the HADS-A, and answered questions about possible mood changes. RESULTS Regardless of which of several cut-off scores on the EDS or HADS-A was used to define 'high' scorers, approximately 50% (±6%) of women scoring high at their first appointment on either measure no longer scored 'high' two weeks later. Common reasons given for their mood improvement included reduced morning sickness, reassuring results from routine tests (e.g., ultrasounds), fear of miscarriage subsiding, and a sense of reassurance following their hospital visit. Many of the women were accurate in predicting at their first appointment that they would be feeling better within a few weeks. LIMITATIONS The administration procedure for completion of the measures on the two occasions was different. Women initially completed the measures by hand, and on the second occasion over the phone. CONCLUSION Half the women screened as having emotional distress - that is, scoring 'high' on self-report mood measures (i.e., EDS and HADS-A) - during their first hospital visit in pregnancy are likely to have transient distress for predictable reasons. Referring women to specialist mental health services based upon just one administration of these measures will therefore result in a large number of unnecessary referrals, thus possibly overstretching the resources available. We therefore believe that when women score high on a self-report mood measure, enquiring as to why this is the case, and about whether the woman expects to feel differently in a few weeks time, together with a second administration of the measures in a few weeks is a better practice, unless there are good clinical reasons to do otherwise. In addition, studies reporting prevalence rates of perinatal distress should not simply use a one-off administration of a self-report mood scale to state the probable rate of disorders or distress.
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Affiliation(s)
- Stephen Matthey
- Infant, Child and Adolescent Mental Health Service, South Western Sydney Local Health District, Australia.
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Yawn BP, Olson AL, Bertram S, Pace W, Wollan P, Dietrich AJ. Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:363964. [PMID: 22900157 PMCID: PMC3413986 DOI: 10.1155/2012/363964] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/07/2012] [Accepted: 06/21/2012] [Indexed: 12/19/2022]
Abstract
The value and appropriateness of universal postpartum depression (PPD) screening remains controversial in the United States. To date, several PPD screening programs have been introduced and a few have been evaluated. Among those programs that have been evaluated, most report screening rates, diagnosis rates, or treatment initiation rates. Only four studies included patient outcomes such as the level of depressive symptoms at 6 to 12 months postpartum, and only two reported success in improving outcomes. Program characteristics that appear to result in low rates of diagnosis and followup after PPD screening include requirements for a formal psychiatric evaluation, the need to refer women to another site for therapy, and failure to integrate the PPD screening into the care provided at the woman's or her child's medical home. The two programs that reported improved outcomes were both self-contained within primary care and included specific followup, management, and therapy procedures. Both resulted in the need for outside referrals in less than 10% of women diagnosed with postpartum depression. Future studies should be based on the successful programs and their identified facilitators while avoiding identified barriers. To affect policies, the future program must report maternal outcomes going beyond the often reported process outcomes of screening, referral, and therapy initiation rates.
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Affiliation(s)
- Barbara P. Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA
| | - Ardis L. Olson
- Departments of Pediatrics and Community and Family Medicine, Dartmouth Medical School, Dartmouth Medical School, Hanover, NH 03755, USA
| | - Susan Bertram
- Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA
| | - Wilson Pace
- National Research Network, American Academy of Family Physicians, Leawood, KS 66211, USA
| | - Peter Wollan
- Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA
| | - Allen J. Dietrich
- Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03735, USA
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Yawn BP, Dietrich AJ, Wollan P, Bertram S, Graham D, Huff J, Kurland M, Madison S, Pace WD. TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 2012; 10:320-9. [PMID: 22778120 PMCID: PMC3392291 DOI: 10.1370/afm.1418] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers. METHODS In this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks' postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation). RESULTS Among the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months' (P=.001) postpartum. CONCLUSIONS Primary care-based screening, diagnosis, and management improved mother's depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.
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Affiliation(s)
- Barbara P Yawn
- Olmsted Medical Center, Department of Research, Rochester, MN 55904, USA.
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Chen H, Wang J, Ch'ng YC, Mingoo R, Lee T, Ong J. Identifying mothers with postpartum depression early: integrating perinatal mental health care into the obstetric setting. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:309189. [PMID: 21941662 PMCID: PMC3173886 DOI: 10.5402/2011/309189] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/07/2011] [Indexed: 11/23/2022]
Abstract
With prevalence rates of postnatal depression (PND) as high as at least 7%, there was a need for early detection and intervention of postpartum mental illness amongst Singaporean mothers. This is a report on the first year results of our country's first PND Intervention Programme. The programme consists of two phases: (1) postpartum women were screened with the Edinburgh Postnatal Depression Scale and provided appropriate care plans; (2) individualized clinical intervention using a case management multidisciplinary team model. Screening for PND was generally acceptable, as 64% eligible women participated voluntarily. Nine percent (126) were identified as probable cases from 1369 women. Forty-one women accepted intervention and achieved 78% reduction in the EPDS symptom scores to below the cutoff of 13, 76% had improvement in GAF functioning scores, and 68% had improved health quality scores. Preliminary results are promising, and this intervention model can be replicated.
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Affiliation(s)
- Helen Chen
- Postnatal Depression Intervention Programme, Mental Wellness Service, Kandang Kerbau Women's and Children's Hospital (KKH), 100 Bukit Timah Road, Singapore 229899
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Horowitz JA, Murphy CA, Gregory KE, Wojcik J. A community-based screening initiative to identify mothers at risk for postpartum depression. J Obstet Gynecol Neonatal Nurs 2010; 40:52-61. [PMID: 21121945 DOI: 10.1111/j.1552-6909.2010.01199.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To conduct a community-based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices. DESIGN Descriptive correlational. SETTINGS Two academic medical centers, a university research office, and participants' homes. PARTICIPANTS Five thousand one hundred and sixty-nine postpartum women age 14 to 49 years. METHODS The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4 to 6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ≥10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD. RESULTS Six hundred and seventy-four (13%) women had EPDS scores ≥10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self-administered and mailed in the EPDS than women who were screened via telephone had scores ≥10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White and having less than high school education were associated with higher PPD scores. CONCLUSIONS The AHRQ framework was effective in guiding a large-scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation.
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Affiliation(s)
- June Andrews Horowitz
- W.F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
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Abstract
Both depression and diabetes are common in the perinatal period and result in serious consequences for mother and fetus. Although the association between depression and diabetes is well established, few studies have examined the association between these disorders during the perinatal period, when the etiology of depression and diabetes may differ from other periods over the life course. This article reviews the four most relevant epidemiologic papers that examined the association between depression and diabetes in the perinatal period and makes recommendations for future studies about how best to examine the association between these disorders during the perinatal period.
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Affiliation(s)
- Laura J Rasmussen-Torvik
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Suite 300, Minneapolis, MN 55454-1015, USA
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