Management Of Perinatal Depression Research Articles

Nurse’s Knowledge, Attitudes and Practices Toward Perinatal Depression—A Study Among Nurses in Southern Ghana

Introduction Nurses in perinatal care are the initial point of interaction making them crucial for early detection of depression among pregnant or birthed women. Though prevalent, there is limited data on the knowledge levels, attitudes, and practice among nurses in Ghana toward perinatal depression. This study investigated nurse’s knowledge, attitude, and practices on perinatal depression at two hospitals in Ghana. Methodology 211 perinatal care nurses at the Korle Bu Teaching Hospital and the Greater Accra Regional Hospital were surveyed on their knowledge, attitude & practices on perinatal depression and analyzed using STATA version 15. Logistic regression was performed to determine factors associated with nurses’ and midwives’ practices toward the identification and management of perinatal depression. At a confidence interval of 95%, a p value of <.05 was considered statistically significant. Results Nearly half of the nurses (47.4%) of nurses depicted inadequate knowledge, 46.9% had an overall poor attitude toward identification and management of perinatal depression, and 79.6% depicted poor practices toward the identification and management of perinatal depression. Conclusions This study highlights knowledge gaps and suboptimal attitudes and practices regarding perinatal depression among nurses in Ghana. Addressing these gaps through targeted education and training may enhance early identification and management of perinatal depression in perinatal care settings.

Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi.

Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer Delivered, adapted for use in rural Malawi. A multi-method evaluation of feasibility and acceptability of the intervention was conducted using a one-group pretest-posttest quasi-experimental design and an exploratory qualitative study. Pre-post intervention change in depression scores (paired t-test) and recruitment, retention and session adherence rates were calculated. Qualitative data were collected through 29 in-depth interviews (22 mothers and 7 peer volunteers) and 1 Focus Group Discussion (18 mothers). Thematic analysis approach was used to analyse qualitative data. Seven (7) out of 8 peer volunteers were successfully trained to deliver the intervention. A total of 31 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) score ≥12 were offered intervention, of whom 24 were enrolled (recruitment rate 77.4%). Out of these 24 women, 22 completed the intervention (retention rate 91.6%). Mean difference between pre- and post-test EPDS scores one week after 8th session was 7.59 (95% CI 4.98 to 10.19), p<0.001. Qualitative evaluation showed that the intervention was acceptable despite some challenges including stigma and issues around incentivization of peer volunteers. The Thinking Healthy Programme-Peer Delivered, adapted for use in Malawi, was feasible to deliver and acceptable to its target population. The intervention may be useful in management of perinatal depression in primary care settings in Malawi. However, definitive trials are needed to evaluate its effectiveness.

Mom’s Good Mood: screening and management of perinatal depression within primary healthcare system in China–protocol for an effectiveness–implementation design study

IntroductionThe management of perinatal depression (PND) is challenging in China. The Thinking Healthy Programme (THP), developed under the core theory of cognitive–behavioural therapy, is an evidence-based approach that is recommended...

Understanding Healthcare Professionals’ Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study

Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.

A Review of Treatments and Clinical Guidelines for Perinatal Depression.

Perinatal depression occurs in approximately 1 in 7 women and is considered the most common complication of pregnancy and childbearing. Management of perinatal depression may include a combination of nonpharmacological and pharmacological therapies depending on the severity of symptoms, the stage of gestation, and maternal preference. Healthcare providers are recommended to review current guidelines and provide information to women during pregnancy and postpartum regarding the risks and benefits of nonpharmacological and pharmacological treatment options for perinatal depression. In addition, healthcare providers should consider common barriers to treatment including inadequate screening and social stigma. This article reviews common treatments of perinatal depression as well as the clinical guidelines provided by the American Association of Obstetricians and Gynecologists (ACOG), the American Psychiatric Association (APA), and the US Preventive Services Task Force (USPSTF). Discussion of nonpharmacological therapies includes cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Pharmacological treatments are reviewed by drug class and include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), norepinephrine/dopamine reuptake inhibitors (NDRIs), and tricyclic antidepressants (TCAs). Adjunctive treatments of severe depression, including second-generation antipsychotics (SGAs), are also discussed.

Diagnosis and Management of Perinatal Depression

Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.

Women's experiences of perinatal depression: Symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family

ObjectiveNearly half of all cases of perinatal depression are not detected, despite routine appointments with healthcare professionals (HCP) during pregnancy and after childbirth. Early identification of perinatal depression is crucial to provide the required support and offer timely treatment. This study aimed to explore women's experiences of perinatal depression to help identification and management of perinatal depression by HCPs. DesignTheoretical perspective of symbolic interactionism and methodological design of ethnography was adopted. Face-to-face individual interviews were used. Thematic analysis was conducted to analyse interview data. ParticipantsFifteen women who had experienced perinatal depression in the last five years were interviewed. FindingsThree themes were identified: 1) Getting closer to the perinatal depression; 2) Decision to disclose or hide real feelings; 3) Hidden face of perinatal depression. Key conclusions and implications for practiceFindings demonstrate the importance of HCPs’ attitudes towards women, as if women perceive they being dismissed or neglected by HCPs, may have an impact on women refraining from disclosing their feelings.

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

BackgroundImmigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.MethodsWe recruited 13 women ages 18–35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants’ age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.ResultsFour themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while “doing the month”, the perceived gap between the ideal of “perfect moms” and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.ConclusionThe recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

A qualitative study on the use of mobile-based intervention for perinatal depression among perinatal mothers in rural Bihar, India.

Perinatal depression (PND) is one of the most common psychiatric illnesses in women, with a prevalence around 22% in India. Leveraging mobile-based technologies could help in the prevention and treatment of perinatal depression even in remote places. Understanding the experiences and barriers of using such technology interventions by perinatal mothers could help in the better design and in delivery of these interventions. We aimed to study the experiences of the perinatal women using a mobile phone-based intervention, Interactive Voice Response System (IVRS), for the prevention and management of perinatal depression in a rural district of Bihar, India. A total of 12 in-depth interviews (IDIs) and one focus group discussion (FGD) with eight participants were conducted with perinatal mothers using the mobile-based IVRS to explore the experiences and perspectives of women receiving mobile phone-based interventions for the treatment of PND. Thematic analysis was done to identify major themes. Five major themes emerged from the study around accessibility, usability, community participation, cost and preference to either intervention. Women found the mobile-based intervention useful as it made them feel lighter. They considered mental health as a health issue and wanted help to address their problems. They became familiar with terms like anxiety, depression, helplessness and burden and bean using them in their conversations. The patients used therapeutic strategies such as breathing, coping and relaxation. They even agreed to take up sessions for their peer group. Women in rural Bihar seemed satisfied with the technology-based intervention. It has made mental health issues more visible and acceptable even in the rural hinterlands of Bihar.

MHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature

Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review of the literature pertaining to the use of mobile phone technologies for perinatal depression in low-and middle-income countries. PubMed CINHAL, and Google Scholar databases were searched, generating 423 results. 12 articles met our inclusion criteria. Two of the 12 articles reviewed mobile phone applications. The remaining 9 articles were study protocols or descriptive/intervention studies. Our results reveal that minimal literature is currently available on the use of mobile health for perinatal depression in low- and middle-income countries. We found four articles that present the results of an intervention that were delivered through mobile phones for the treatment of perinatal depressive symptoms and an additional qualitative study describing the perceptions of mothers receiving cognitive behavioral therapy via telephones. These studies demonstrated that depressive symptoms improved after the interventions. There is potential to improve the quality of mHealth interventions, specifically mobile phone applications for perinatal depressive symptoms and depression, through meaningful collaborative work between healthcare professionals and application developers.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria

BackgroundDepression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.MethodsFocus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.ResultsA total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.ConclusionsParticipants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.

Identification and Management of Perinatal Depression: Differences between Healthcare Providers

Objective: Pilot data was collected to examine providers’ beliefs, knowledge, self-efficacy, barriers, and practices related to perinatal depression and how they may differ across provider types. Background: High prevalence and detrimental impact of depression during pregnancy and the first year postpartum (i.e. perinatal period) on maternal and child health outcomes highlights the need for improving diagnosis and treatment during this critical period. Healthcare providers play a significant role in helping to identify and manage perinatal depression. Methods: Ninety-nine providers (e.g. physicians, nurses, mental health workers, public health practitioners) who provide care to pregnant women in Colorado completed a 64-item online survey. Results: Although 94% of providers reported it was their responsibility to recognize perinatal depression, variations across specialties with regards to responsibility to treat were found. Most providers (91%) reported use of a screening tool for depression, 60% of providers provide counseling on perinatal depression, and 80% of providers refer patients for treatment of perinatal depression on at least a monthly basis. Significant differences in knowledge, self-efficacy, current practices, and perceived patient barriers were found across provider specialties. Conclusion: These findings highlight the need for expansion of online training programs to increase awareness of mental health resources in the community, improve confidence related to diagnosis and treatment of perinatal mood disorders, and to enhance communication between mental health specialists and healthcare providers in order to effectively identify and manage maternal depression.

A Call to Action: Screening Fathers for Perinatal Depression.

* Abbreviations: AAP — : American Academy of Pediatrics PPD — : postpartum depression In early 2019, the American Academy of Pediatrics (AAP) released a policy statement1 recognizing that “maternal depression affects the whole family” and urging pediatric providers to “incorporate recognition and management of perinatal depression into pediatric practice.” Soon after, the US Preventive Services Task Force issued new recommendations on interventions to prevent perinatal depression.2 The convergence of these 2 statements from nationally recognized bodies of experts in evidence-based medicine underscores the urgency of a heightened focus on screening and making referrals for perinatal depression in pediatric practice. The new recommendations do not go far enough and risk being out of touch with contemporary American families. The US Preventive Services Task Force evidence review and recommendations are focused exclusively on interventions to prevent maternal depression. The AAP statement acknowledged paternal postpartum depression (PPD) as an established clinical problem yet called for pediatricians to screen solely mothers at the 1-, 2-, 4-, and 6-month well-child visits and “consider screening the partner as well” at the 6-month visit. We believe it is inadequate to treat the recognition and management of paternal depression as extra or optional. To promote optimal outcomes for children, pediatric providers must assess the mental health and adjustment to parenting of all new parents, regardless of gender or marital status, and make appropriate referrals for needed care. Fathers’ time spent with children has nearly tripled since 19653; even among unmarried couples, fathers typically want to be and are involved with their children. … Address correspondence to Tova B. Walsh, PhD, School of Social Work, University of Wisconsin, 1350 University Ave, Madison, WI 53706. E-mail: tbwalsh{at}wisc.edu

Impact of an On-site Perinatal Mood Disorders Clinic in the Diagnosis and Management of Perinatal Depression [15A

INTRODUCTION: Perinatal mood disorders are a widespread complication of pregnancy and the postpartum period, with negative effects for mother and child if left untreated. This study assessed health outcomes of women seen in an onsite Perinatal Mood Disorder Clinic (PMDC) intended to improve access to timely evaluation and treatment. METHODS: A retrospective chart review was performed of 120 patients seen at the PMDC between March 1, 2017 and June 1, 2018. The primary outcome was participants' Edinburgh Postnatal Depression Scale (EPDS) score at final visit, where score >12 indicated postpartum depression. Two-tailed t-tests compared initial and final EPDS scores. A multivariable linear regression model with robust standard errors estimated the relationship between patient characteristics and final EPDS score for patients with greater than one score, controlling for initial score, mood disorder history, treatment type, and demographics. RESULTS: Mean final EPDS score (11.04) was lower than mean initial score (16.54; P<.001), among n=57 with greater than one score. There was a significant decrease between initial and final score for those receiving pharmacotherapy (P<.001) and those receiving combination pharmacotherapy/counseling (P<.01), but not those receiving counseling only (P=.137). Initial to final EPDS score decreased significantly for those in ongoing treatment at study period end (P<.01) and those referred back to primary physicians (P<.001), but not for those referred to psychiatry (P=.256) or lost to follow-up (P=.540). CONCLUSION: Women treated at the PMDC showed improved EPDS scores. Therefore, the PMDC may be filling a gap in access to timely care for perinatal mood disorders.

Management of perinatal depression by non-health specialist workers in Indonesia

Perinatal depression has become a public health concern because of the burden of the disease for mother and children as well as the community in large. The management of perinatal depression is needed, yet there is a low-resource of mental health specialist in Indonesia. Psychotherapy interventions by non-health specialist workers in some developing countries have shown benefits for perinatal depression. The study aims to analyze the interventions for perinatal depression by non-health specialist workers based on studies from other developing countries. The type of the study is an in-depth study using secondary data. Data were obtained from online databases, including PubMed, Global Health Cochrane Library, PsycINFO and additional search. The total number of studies found was 743, 705 studies were available for assessment after removing the duplicate, 55 abstracts were reviewed, and 42 studies included. A conceptual framework developed by the author was used to guide data collection and analysis. Psychotherapy interventions implemented in Pakistan, Turkey, China, and India were analyzed using Assessment of Applicability and Transferability criteria. The most applicable and transferable interventions for the management of perinatal depression in Indonesia were Cognitive Behavioural Therapy and participatory women group. This study indicates that interventions by non-health specialist workers could reduce the interventions gap for perinatal depression. The stakeholders are recommended to adapt the interventions into a cultural context and integrate it into existing maternal and child health program.

Management of Perinatal Depression By Non-health Specialist Workers in Indonesia

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Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients.

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review

Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices.

Making decisions in the management of perinatal depression and anxiety

SummaryThe care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk-benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.LEARNING OBJECTIVES•Understand the potential risks and benefits of treating, or not treating, maternal mental illness at various stages in the perinatal period.•Understand the limitations of the literature in this field.•Be able to use different frameworks for deciding with patients about the management of mental illness in the perinatal period.