Perinatal mental health

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Recognising and acting on perinatal mental health

Recognising and acting on perinatal mental health

The most common perinatal mental health problems are depression and anxiety, which affect between 10 and 15% of women in pregnancy and after birth. 3 However, there are many other disorders that are often missed because professionals who work in perinatal services are less aware of them. These include posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), phobias, panic, adjustment problems, bi-polar disorder and bonding disorders. These disorders are not as common as depression and anxiety but still affect a large number of women. For example, 3- 4% of women will develop PTSD following a traumatic birth, which equates to at least 21,000 women per year in the UK. 4 Birth-related PTSD is particularly interesting because of the possibility to prevent it through antenatal preparation and appropriate support and care during birth. Risk factors for birth-related PTSD are depression during pregnancy, fear of childbirth, negative experiences during birth, an assisted or caesarean birth, poor support, and dissociation during birth. 5
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Assessment of perinatal mental health problems

Assessment of perinatal mental health problems

Parsonage, Knapp, Iemmi, & Adelaja, 2014). For the period between 2016 and 2021 parliament has dedicated £350 million to perinatal mental health and the National Institute for Health and Care Excellence (NICE) recently published a quality standard related to antenatal and postnatal mental health pathways (Hansard, 2016; NICE, 2016). This identifies perinatal mental health as an area of high priority for quality improvement. Identifying mental health problems is one area that is targeted for quality improvement (NICE, 2016). Clinical guidelines now exist to identify depression and anxiety in the perinatal period but a number of debates continue in the literature concerning screening and assessment of mental health at this time. This chapter provides an overview of research on perinatal mental health screening and assessment. The chapter begins with a consideration of the breadth of perinatal mental health problems experienced, their prevalence and associated consequences. The chapter then discusses key relevant conceptual issues to identifying perinatal mental health: how they are defined and classified and the high rates of comorbidity of different symptoms and disorders. Relevant theories and current and past assessment practices are then discussed. The chapter finishes with a consideration of barriers to successful identification of problematic perinatal mental health.
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Perinatal mental health screening trial

Perinatal mental health screening trial

Therefore perinatal mental health services have been set up and are concerned with the prevention, detection and treatment of perinatal mental health problems that complicate pregnancy and the postpartum year. However, studies have shown that up to three quarters of the women meeting DSM criteria for depression and anxiety are not recognised and only one in ten women requiring mental health services receive it. 1 While health care system barriers are present which limit a woman’s accessibility to mental health services, there are other significant barriers to consider. These include stigma, lack of understanding of whether symptoms are abnormal or a typical pregnancy experience, lack of support persons who understand their concerns, and fear that disclosing symptoms may lead others to think that they are incompetent mothers. 4
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Should perinatal mental health be everyone's business?

Should perinatal mental health be everyone's business?

Although pregnancy and birth are a positive time for most women, between 10 and 20% of women suffer from mental health problems during this time. Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, post- traumatic stress disorder following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common but is one of the leading indirect causes of maternal death (MBRRACE, 2014). In the UK there has been increased awareness of the importance of perinatal mental health in recent years, which has prompted a demand for change in prioritisation and health services. In this editorial we consider some of the factors that contributed to this and the challenges we face if we are to implement change in primary care. In doing so, we do not provide an exhaustive list but focus on contributors that may be useful to consider. We also outline the argument for why perinatal mental health should be everyone’s business.
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Perinatal mental health service provision in Switzerland and the UK

Perinatal mental health service provision in Switzerland and the UK

In the most recent report, [2] 22 perinatal-psychiatric units were in place in the UK (1 unit per 2.8 million people). A total of 19 units were in England, 2 in Scotland, 1 in Wales, offering a total of 168 beds. No perinatal-psychiatric unit was in place in Northern Ireland. This report suggested that there is a national deficit of about 50 beds for inpatient mother-baby treatment. 50% of the UK perinatal-psychiat- ric units work closely with 11 specialised perinatal com- munity teams, less than 50% of all mental health trusts in the UK provide perinatal mental health services and large areas of the country have no specialised facilities. Due to this fact, women need to travel long distances to the next available perinatal-psychiatric unit or are admitted to psy- chiatric general wards without their babies.
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Perinatal mental health : preparing the future nursing workforce

Perinatal mental health : preparing the future nursing workforce

Introduction Perinatal mental health problems are those which occur during pregnancy or in the first year post-partum, and affect up to 20% of women. If left untreated it can have significant and lasting effects on the mother and her family as well as affecting the child’s emotional, social and cognitive development. The NHS 5 Year Forward View for Mental health: One Year On (NHS England, 2017) sets out a clear commitment that specialist perinatal services will be available to all women and their families who need them by 2020/21. To achieve this ambition a significant amount of financial and human resource is required.
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Perinatal Mental Health Care in New Zealand: The Promise of Beginnings

Perinatal Mental Health Care in New Zealand: The Promise of Beginnings

Perinatal Mental Health Care in New Zealand: The Promise of Beginnings Carol Cornsweet Barber, University of Waikato Pregnancy and the postnatal year represent a critical time in the health and development of families, and a time when psychologists can play an important role in the primary health care team. This paper discusses some key issues of interest in perinatal mental health care, encouraging clinicians and researchers to broaden the focus beyond postnatal depression to perinatal emotional disorders, and to become informed and involved in promoting recognition of, and appropriate treatment for, parents who are struggling with psychological distress.
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An Exploration of the Strong Black Woman Schema and Perinatal Mental Health

An Exploration of the Strong Black Woman Schema and Perinatal Mental Health

phenomenon in clinical social work and even less prevalent in perinatal mental health, continued research in this area appears to be indicated. Strengths and Limitations The most significant strength of this review is that the status of perinatal mental health care for Black and African American women is presented. This manuscript is contribution to a small but growing body of research. As a group that is typically underrepresented in perinatal mental health care, it was important to call attention to the needs of Black and African American women. This review sought to disentangle the broad grouping of women of color and focused primarily on Black and African American women. Intended to highlight the cultural nuances of Black womanhood and as a limitation of this review, this did not materialize. Another limitation is the possibility that articles may have been missed in the preliminary search because there was only one investigator even though the PRISMA guidelines were consulted. With the addition of a second or third investigator, the rigor of this systematic review could be enhanced.
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Perinatal mental health among young women in urban China

Perinatal mental health among young women in urban China

2 RATIONAL OF THE THESIS Perinatal mental health disorders are common and affect every 10th woman. They have long- term consequences for both mother and child, yet recognition and treatment in China is limited. Perinatal mental health disorders are therefore of importance for public health outcomes and long-term health of societies. Currently, there are no national guidelines for perinatal mental health screening and no national requirements for perinatal mental health interventions in China. In 2016 China legislated a new child policy, allowing couples to have two children, to counterbalance the ageing populations. The two-child policy has significant impact on multiple levels of society and health care infrastructure. To date, it is still not known how different groups view mental health problems, where women would seek help for perinatal mental health problems, and who they would trust and turn to. To improve long-term health outcomes of young women in urban China, it is essential to gain information from both professionals and women during the perinatal period regarding mental health care and suggestions to reduce the treatment gap.
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Computer- or web-based interventions for perinatal mental health: A systematic review

Computer- or web-based interventions for perinatal mental health: A systematic review

Abstract Background: Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women’s perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy.
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Family physicians perceived role in perinatal mental health: an integrative review

Family physicians perceived role in perinatal mental health: an integrative review

Service user involvement in decisions GPs reported low usage of guidelines in practice due to lack of time and the volume of available guidelines. GPs acknowledged that guidelines provide best practice advice, a professional reference point and can be used as a defence against litigation in case of adverse reactions however, guidelines were also identified as generic, lacked specific and clear direction on treatment in the perinatal period, were restrictive and may inhibit flexibility and knowledge resulting in patient need not being met. GPs relied on their own professional experience and knowledge of the individual woman to make complex risk-benefit treatment deci- sions. Individualised information provision communicated using lay language in both written and verbal formats encouraged women to be involved in the decision –making process. Lack of specific or accurate guidance was described as a barrier to information provision and led to under treatment of pregnant women in general practice. Professional experience was used to determine the level of involvement that women wanted in the decision-making process. Treatment decisions involved balancing the impact of the severity of symptoms with the possibility of adverse ef- fects of antidepressants on the foetus and timing of treatment. Female GPs ac- knowledged that their personal experience of pregnancy affected decisions. Lack of consultation with GPs by women led to abrupt stopping of antidepressants. GPs ac- knowledged the support available from the local mental health team and voluntary organisations. However, a lack of available resources, specialists ’ perinatal mental health services, delays in response due to lengthy appointment waiting lists and in- creasing workloads were identified as barriers to complicated treatment decisions.
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Moving beyond mother and baby : perinatal mental health and the couple relationship

Moving beyond mother and baby : perinatal mental health and the couple relationship

In doing so, I have been aware of the political nature of sharing research findings. As MBUs are not widespread across the UK, the professional community is relatively small. In some ways conducting this research felt like a risk: if participants were highly critical of MBUs this could have implications in an already under resourced area. Whilst participants did note difficulties in their engagement with services, they identified many positive aspects of MBU care. It feels important to highlight this, along with areas for improvement, particularly given the potential pressures on service staff explored previously. The recent public attention being paid to perinatal mental health services means it is an ideal time to conduct and share research in this area. In contrast to my earlier feelings of powerlessness, it seems there is currently an avenue to voice the participants’ support and concerns for these services.
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Engagement with perinatal mental health services: a cross sectional questionnaire survey

Engagement with perinatal mental health services: a cross sectional questionnaire survey

WDNA: Women offered referral to the PMHS who did not attend; WNOR: Women not offered referral to the PMHS Acknowledgements The authors would like to thank all the women who participated in this study for sharing their experiences with us. The authors also thank: the Redcliffe Hospital Maternity Department; the Metro North Perinatal Mental Health Service; Joel Dulhunty, Director of Research at Redcliffe Hospital; and Satomi Okano at the Queensland Institute of Medical Research for statistical support. The project was carried out as a part of the RANZCP Fellowship requirement.
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Family physicians perceived role in perinatal mental health: an integrative review

Family physicians perceived role in perinatal mental health: an integrative review

Service user involvement in decisions GPs reported low usage of guidelines in practice due to lack of time and the volume of available guidelines. GPs acknowledged that guidelines provide best practice advice, a professional reference point and can be used as a defence against litigation in case of adverse reactions however, guidelines were also identified as generic, lacked specific and clear direction on treatment in the perinatal period, were restrictive and may inhibit flexibility and knowledge resulting in patient need not being met. GPs relied on their own professional experience and knowledge of the individual woman to make complex risk-benefit treatment deci- sions. Individualised information provision communicated using lay language in both written and verbal formats encouraged women to be involved in the decision –making process. Lack of specific or accurate guidance was described as a barrier to information provision and led to under treatment of pregnant women in general practice. Professional experience was used to determine the level of involvement that women wanted in the decision-making process. Treatment decisions involved balancing the impact of the severity of symptoms with the possibility of adverse ef- fects of antidepressants on the foetus and timing of treatment. Female GPs ac- knowledged that their personal experience of pregnancy affected decisions. Lack of consultation with GPs by women led to abrupt stopping of antidepressants. GPs ac- knowledged the support available from the local mental health team and voluntary organisations. However, a lack of available resources, specialists ’ perinatal mental health services, delays in response due to lengthy appointment waiting lists and in- creasing workloads were identified as barriers to complicated treatment decisions.
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Computer- or web-based interventions for perinatal mental health: A systematic review

Computer- or web-based interventions for perinatal mental health: A systematic review

Abstract Background: Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women’s perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy.
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Approach to perinatal mental health and child abuse prevention in Japanese prefectural health centers

Approach to perinatal mental health and child abuse prevention in Japanese prefectural health centers

Previous studies have revealed that child abuse pre- vention is very important for the community. However, an effective approach to the prevention of child abuse that incorporates perinatal mental health, unwanted preg- nancies, and postpartum depression has not been devel- oped. The aims of the present study were: 1) to clarify the present situation regarding support in Japanese pre- fectural health centers for improving perinatal mental health in order to prevent child abuse; 2) to explore the association between the degree of consultation during unwanted pregnancies and support for high-risk mothers;
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Public health nurses'  perinatal mental health training needs: a cross sectional survey

Public health nurses' perinatal mental health training needs: a cross sectional survey

Accepted Article Discussion To our knowledge this is the first study that has examined PHNs’ attitudes to women with PMHPs and findings suggest that while PHNs reported positive attitudes, further education is required which includes an attitude component to prepare PHNs to undertake an effective role in perinatal mental health care. Most PHNs reported high levels of knowledge and confidence in identifying women with stress, anxiety and depression in the perinatal period. However, 63.8% of PHNs reported the need for additional skills development for assessment of perinatal mental health. Symptoms of perinatal depression and anxiety have the potential to overlap with those of perinatal transitions making accurate detection a challenge (Legere et al., 2017). Further training can support the contextualisation and use of existing knowledge and experience to underpin effective clinical decision making (Jones et al., 2015). Most PHNs (92.8%) reported screening for perinatal mental health issues using screening tools which is consistent with recommendations (NICE, 2014, Higgins et al., 2017a,). Moreover, rigorous and systematic implementation of assessment questions and screening tools may reduce detection disparities that exist for women from ethnic minority groups (Prady et al., 2016).
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Experiences of social work intervention among mothers with perinatal mental health needs

Experiences of social work intervention among mothers with perinatal mental health needs

vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. The current study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi-structured interviews were carried out with 18 women with 6-9 month old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children’s social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother’s own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened.
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The Development and Initial Validation of the Perinatal Mental Health Awareness Scale in Student Midwives

The Development and Initial Validation of the Perinatal Mental Health Awareness Scale in Student Midwives

An important tenet to the development of the PMHA was the elimination of hubris with a central desire to focus specifically and without ambiguity on specific elements of knowledge, identification and management in relation to perinatal mental health issues. Learning disability represents a highly neglected area within the realm of perinatal mental health evidence and practice. The utility of the PMHA is to enable a comparison of this area with respect to perinatal mental health issues more generally and physical/medical issues associated with the perinatal period with which midwives may be more familiar. Similarly, given the parity agenda between mental health and physical health and the prima face focus of providing holistic woman-centred care, the inclusion of a physical/medical sub-scale within the PMHA allows a direct comparison between physical/medical and mental health domains to determine if the holistic ideal is being realised in education and practice.
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Factors affecting implementation of perinatal mental health screening in women of refugee background

Factors affecting implementation of perinatal mental health screening in women of refugee background

Conclusions While clinical guidelines recommend integrating screen- ing into routine antenatal care, this formative research is the first to clarify how integration might be achieved for women of refugee background. This study reveals a prevailing attitude amongst stakeholders that perinatal mental health and PTSD screening is necessary in this population. Findings emphasise the importance of adopting an inter-disciplinary approach to implementa- tion and facilitating effective communication with women and between and within health services. This research provides clear evidence around barriers and en- ablers, and theory-based recommendations to inform implementation of perinatal mental health screening and referral for women of refugee background and ultimately improve provision of recommended antenatal care.
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