Mental Health Services For Women Research Articles

Implementing Guidelines to Manage Perinatal Depression: Exploration of the Healthcare Provider’s Perceptions

Perinatal mental health guidelines are still lacking in more than 80% of low- and middle-income countries. World Health Organization has outlined the importance of an evidence-informed approach for developing and sustaining high-quality integrated mental health services for women during the perinatal period. Method: The study explored healthcare providers' perceptions of implementing guidelines to manage perinatal depression in primary healthcare settings in Namibia. A qualitative, explorative, descriptive, and contextual design was applied to collect data from a purposively selected sample of 12 healthcare providers. This involved two focus groups with healthcare providers. Thematic analysis of the interview transcripts was conducted simultaneously with data collection. Findings: The study highlighted three major themes for successfully implementing the guidelines to manage perinatal depression: the significance of implementing the guidelines, integration of the guidelines into perinatal care settings, and barriers to implementing the guidelines. Conclusion: Healthcare providers were aware of poor maternal mental health provision within perinatal care settings and were ready to implement the guidelines to manage perinatal depression. Professional training and continuous education on perinatal depression are fundamental components in fostering quality of care and community awareness, as well as improving stigma within the community and healthcare providers.

Prevalence and predictors of depression among women in Afghanistan: a cross-sectional study

Depression is a very common mental health illness characterized by a cluster of signs and symptoms ranging from mood disturbances and sleep or appetite disorders to physical manifestations of the body. The purpose of the present study was to estimate the prevalence of depression and its related factors among Afghan women. A cross-sectional study was conducted among women between July 14, 2021, to August 15, 2021, in Kabul, Mazar-e-Sharif and Samangan provinces (Afghanistan). A total of 664 Afghan women participated in the study (mean age = 28.85 years; SD ± 11.57). In order to assess depression among participants, the 19-item validated Dari version of the Center for Epidemiological Studies–Depression Scale was used. Approximately four-fifths of the sample had depression symptoms (79.1%). Participants with depression symptoms were significantly more likely to (i) be aged over 30 years, (ii) live in rural areas, (iii) have a low-income level, (iv) not have an occupation, (v) have any disease/illness, and (vi) have experienced an event that had mentally affected them in the past month. Considering the high prevalence of depression symptoms among Afghan women, there is a need to integrate mental health services for women in Afghanistan. The use of interventions including regular screening for depression symptoms, and educating women and girls concerning the symptoms of depression for early self-diagnosis are essential.

The COVID-19 pandemic and mental health in pregnant women: A review article.

A rapid spreading of the COVID-19 virus in recent years had a great impact on every single aspect of live and the world faced with unexpected and unpredictable crisis in both physical and mental condition. As with any crisis, vulnerable individuals like pregnant women were the concern of societies. Several physiological and psychological changes occur during pregnancy which put individuals in a risk of mental health problems. During the outbreak of the COVID-19, pregnant women have experienced more psychological stresses, fear, anxiety, and depression. The prenatal mental distresses and psychiatric disorders may cause poor compliance, reduce help-seeking behaviors, and neglect to take the follow up screening visits and risk of harm for mother and others. Addressing the mental health in pregnant women is crucial to prevent the consequences. The purpose of this narrative review was to investigate the available literature on the impact of the COVID-19 pandemic on mental health in pregnant women and provide some recommendations to improve mental health in them. It also shed some light on providing mental health services for women during pregnancy and can be used by health professionals and policymakers.

Evidence of Effectiveness of a Psychotherapy Protocol for Women with a History of Intimate Partner Violence: Follow-up Study

This study aims to evaluate the therapeutic effects of the cognitive behavioral psychotherapy protocol for women with a history of intimate partner violence 6 months after the end of the intervention. The study employed a mixed method with pre-experimental design. Fifteen women (M = 36.67 years; SD = 11.89; 22 to 60 years) who had completed the intervention participated in the study. The majority of the participants were white, divorced, with complete higher education, and employed. Data collection was carried out from May 2019 to September 2020 in person at Psychology Practice and Research Service (Serviço de Atendimento e Pesquisa em Psicologia—SAPP) of the university with 7 participants, and online with 8 participants. Instruments applied aim to assess levels of self-esteem, life satisfaction, anxiety, depression, post-traumatic stress disorder, post-traumatic beliefs, and complex trauma. The instruments were applied at pretest, post-test, and follow-up. A structured interview was applied only at the follow-up. Descriptive analyses of frequencies were carried out, Friedman’s test to verify differences between the evaluation times, analyses with JT method to evaluate individual differences, and clinical significance. Content analysis was also carried out from the structured interviews. The intervention reduced symptoms of depression (Cohen’s d = 0.45), post-traumatic stress disorder (Cohen’s d = 0.33), and complex trauma (Cohen’s d = 0.57), which were maintained at follow-up. Participants showed higher levels of self-esteem and life satisfaction after the intervention, when comparing pretest and follow-up evaluations (p < 0.005). In the interviews, participants indicated that the psychotherapy process contributed to better quality of life. The study results indicate the potential of the intervention for the replication in mental health services for women with a history of intimate partner violence. Cognitive-behavioral therapy is an effective approach and it can be a tool to reduce negative mental health outcomes in long-term process.

Women's experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support

ObjectiveTo explore the experiences of women during pregnancy with mild to moderate mental health problems and describe the barriers to receiving support in relation to their mental health. Research design and participantsThis paper reports part of a larger project which recruited women and midwives in one hospital in Wales. Participants completed questionnaires in early pregnancy in an antenatal clinic, and the characteristics of women with and without symptoms of anxiety and depression compared. All women were invited to express interest in a follow up interview in late pregnancy. Women identified to have depression and anxiety in early pregnancy, but not under the care of perinatal mental health services, were eligible for interview. Interviews were conducted with 20 women using a visual timeline to aid discussion and were thematically analysed. FindingsIn late pregnancy mental health disorders were reported by nine women, of which five were diagnosed during adulthood. EPDS scores found 15 women had symptoms of mild to moderate depression and GAD-7 scores indicating 15 women with mild to moderate anxiety. Three themes were identified: moods and emotions - past, present and future; expectations and control; knowledge and conversations. Key conclusions and implications for practiceDue to limited access to specialist perinatal mental health services women relied on support networks and self-care to maintain their mental health. More time and better continuity at antenatal appointments along with improved mental health literacy may increase discussions regarding women's mental health during pregnancy. In addition investment is required to develop strategies and improve access to mental health services for women with mild to moderate mental health problems.

Stressful events as correlates of depressive and PTSD symptoms in Hong Kong women during social unrest and COVID-19 pandemic

BackgroundStressors at the population level affect women more than men. The influence of prolonged stressors on mental disorders in women is yet unknown, especially when social movements and pandemics coexist. MethodsThis study analysed data from an online mental health self-help service for women in Hong Kong between May and September 2020. We collected demographic data, PTSD symptoms, and exposure to social unrest-related traumatic events (TEs), pandemic-related traumatic events (PEs), and personal stressful life experiences (SLEs). Multiple logistic regression was performed to examine the links between TEs, PEs, and SLEs and PTSD. ResultsThe study found that 38.4% of 751 women had moderate-to-severe depressive symptoms and 23.8% had probable PTSD. The most common TEs, PEs, and SLEs were violence via media, major physical health concerns, and plans thwarted due to COVID-19, respectively. Younger age, less education, unemployment, and more stressors (individually or collectively, except for high TEs and PEs) were linked to increased odds of moderate-to-severe depressive symptoms. TEs and PEs increased the risk of probable PTSD only when SLEs were present. LimitationThe non-random samplinging procedure reduced the generalisability to the entire women population. ConclusionsExposure to social conflicts and pandemics may increase depressive and PTSD symptoms in women. Developing mental health services for women should consider the impact of concurrent major events.

Examination of the Predictability of Psychological and Sociodemographic Variables among Early Emerging Adulthood and Late Emerging Adulthood Seeking Mental Health Treatment

In this study, the relationship between psychiatric symptoms and the use of mental services among 18-29-year-old adults was examined. Data were collected from the 18-29 aged men and women whos participated in the TURBAHAR study. Psychological symptoms, attachment, alexithymia, personal well-being, and positive-negative mood levels of the participants were examined for the research. According to the regression analysis, it was found that smoking and alcohol use, depression, personal well-being, and hostility levels significantly predicted the psychiatric status of both women and men. In addition, it was found that negative self-esteem and somatization levels predicted the use of mental health services among women. The results showed that more psychological factors were affecting the use of mental health services for women compared to men. The findings are expected to contribute to the structuring of services for men and women in terms of the utilization of mental health services based on gender differences.

Black and south asian women’s pathways to accessing community and inpatient perinatal mental health services: An analysis of local service data from the paam study

IntroductionWomen from ethnic minorities who experience mental health problems during the perinatal period are disproportionately represented in involuntary care. They have poorer access to community care but have higher engagement with services once accessed. Their pathways to accessing perinatal mental health care remain underexplored.ObjectivesTo investigate the pathways to perinatal mental health services for women across different ethnic groups, including number of caregivers encountered and time elapsed between referrals.MethodsAnalysis of patient records and routine service data from community and inpatient perinatal mental health services in the United Kingdom. Use of an adaptation of the WHO’s pathway encounter form.ResultsWomen from ethnic minority groups experience increased levels of complexity on their journey to accessing perinatal mental health care. We will present a detailed analysis of patient and service characteristics.ConclusionsReferral pathways to perinatal mental health services need to be optimised for women from underrepresented groups.

In search of 'community': a critical review of community mental health services for women in African settings.

Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.

761 Improving access to maternal mental health services for women with a positive postpartum depression screen

Because perinatal depression can be detrimental to both women and their families, depression screening with adequate referral resources is an important access to care. We aimed to evaluate the utilization of mental health services (MHS) in an urban inner-city hospital following implementation of co-located MHS across ten community clinics serving a medically-underserved population. We hypothesized that integrating co-located MHS would improve referral rates following positive postpartum depression screening compared to before these services were deployed. This was a retrospective cohort study of women undergoing postpartum depression screening with deliveries from January 2017 to December 2019 compared to a historical cohort of referrals from the same population from June 2008 to March 2010. The Edinburgh Postnatal Depression Scale (EPDS) was universally administered to women at their postpartum visit and an MHS referral was offered for a score of greater than or equal to 13. The primary outcome was a comparison of completed MHS referrals between those with and without co-located MHS following a positive EPDS screen. Statistical analysis included chi-square with P<0.05 considered significant. In the study period, 25,425 women completed postpartum EPDS screening and 978 (4%) women had a +EPDS. The historical cohort consisted of 17,648 EPDS screened women with 1,106 (6%) with a +EPDS. Of those with a +EPDS that accepted referral, 238 (22%) in the historical cohort kept their referral visit compared to the contemporary cohort with 504 (52%) evaluations (P<0.001). Twenty-six percent of evaluations in the contemporary cohort were scheduled as virtual encounters with a 71% completion rate. Utilization of MHS following depression screening more than doubled following implementation of co-located services and implementation of virtual visits within the community clinic setting.

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study.

Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.

A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.

This article explores mental health services in Norway and their availability for women subjected to female genital mutilation/cutting (FGM/C). The article focus on the system of communication and referrals from the perspective of health workers, and aims to identify bottlenecks in the system, what and where they are to be found, and analyze how different mental health services deal with Sub Saharan African (SSA) women in general, but in particular with respect to FGM/C. The study was conducted in Oslo, Norway, using a qualitative fieldwork research design, with the use of purposeful sampling, and a semi-structural guideline. One hundred interviews were done with general practitioners (GPs), gynecologists, psychologists, psychiatrists, midwives and nurses. A system analysis is applied using socio-cybernetics as a tool to identify the flow of communication and referrals of patients. The study shows that borders of subsystems, silencing mechanisms, regulations and "attitudes" of the system can lead to women with SSA background having difficulty getting access to the specialist services. High standards for referral letters, waiting lists, out pushing to the lower levels, insecurities around treatment and deference rules silencing mental health issues during consultancies, have a negative impact on the accessibility of services. Consequences are that mental health problems due to FGM/C are under-investigated, under-referred, and under-treated and a silenced problem within the mental health services for women. A better integration of subsystems at the specialist level with the GP scheme is necessary, as well as providing competence on FGM/C to the different levels. It is also important to strengthen and integrating the services at the Municipal level and provide information to SSA women about the low threshold services.

Improving access to cognitive behavioural therapy groups for postnatal women following partnership work: a service evaluation

ABSTRACT Objective: Postnatal depression (PND) can adversely impact the wellbeing of the mother and child. However, accessing mental health support is a challenge for the perinatal population. While most studies have focused on the effectiveness of stand-alone interventions in treating PND, recent studies have highlighted the need for collaboration and inter-agency working. This study evaluated the impact of partnership working on the effectiveness of cognitive behavioural therapy (CBT) groups for women with PND and anxiety in an Improving Access to Psychological Therapies (IAPT) service. Method: This study is a service evaluation conducted within a primary care setting. It compares engagement and outcomes from pre-partnership groups that were delivered before the development of local partnership working arrangements with post-partnership groups developed in collaboration with a secondary care perinatal mental health service (PNMHS). Participants attended either pre-partnership (N = 26) or post-partnership (N = 19) CBT groups. Results: Following developments in partnership working arrangements, the diversity and number of referrals to CBT groups significantly increased, with a 50% increase in self-referrals. Retention from referral to start of treatment was high, with an increase to 100% following partnership working arrangements (88.5% vs. 100%). Completion rates were also higher following partnership working arrangements (84.2% vs. 61.5%). However, these differences and differences in recovery outcomes did not reach statistical significance. Discussion: Overall this study has found promising results for the effectiveness of partnership working on perinatal care, particularly when improving access to mental health services for women with PND and anxiety.

Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers’ Experiences

ObjectiveThe American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. MethodsSemistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. ResultsTwenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. ConclusionsPostpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.

Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK

ObjectiveLack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in...

Barriers and Facilitators to the Use of Mental Health Services by Women With Elevated Symptoms of Depression and Their Partners

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.

Economic Hardship and Depression Among Women in Latino Farmworker Families.

Farmworker family members risk poor mental health due to stressors including poverty, relocation, and documentation status. This paper explores the relationship between farm-work related stressors and depressive symptoms in women of Latino farmworker families. 248 mothers of young children completed fixed-response interviews in Spanish. Measures included the Center for Epidemiologic Studies-Depression Scale, Migrant Farmworker Stress Inventory, and USDA Household Food Security Survey Module. Bivariate analyses indicated greater depressive symptoms with more economic hardship, more farm work-related stressors, greater age, and being unmarried. In multivariable logistic regression, economic hardship remained the only factor associated with depressive symptoms. Greater economic hardship, but not general farm work-related stress, is a main factor associated with depression in women of Latino farmworker families. Maternal depression can have consequences for both mothers and families. Mental health services for women in farmworker families should be targeted to those with the greatest economic challenges.

Key Informant's Perspective On Barriers and Facilitators in Access to Mental Health Services for Women with Depression in Urban Area of a Low-income Country

Purpose Studies from Pakistan reveal a high prevalence of depression in women. Evidence based and effective treatments are available, yet there is a significant gap between the number of women in need of treatment for depression and those who receive the services. This qualitative study identifies the barriers in access to mental health services for women with depression in Karachi from key informants' perspectives. Method 19 key-informant interviews were conducted with psychiatrists, psychologists, general health practitioners, pharmaceutical representatives, a government health department official and NGO workers working on women health issues. Results Key-informants reported lack of awareness, misconceptions, self-medication, being young and unmarried and financial status as barriers for women in accessing mental health services. In addition, provider's lack of medical education about depression, mismanagement of cases by GPs, opposing mental health care and lack of referral system are also considered barriers to mental health services. Larger societal issues are stigma, gender bias, as well as poor resource allocation and management. Key-informants considered women's education, mental health literacy and referrals as facilitators for women. Conclusion The study highlights the need for multipronged and multi-sector approach for increasing the access to mental health services for women in an urban context of developing country where mental health services are present but not accessed by women.

Patient-centered mental health care for female veterans.

Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women's needs and priorities is essential to guide the implementation of patient-centered behavioral health services. In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women's mental health services for each of the mental health services that emerged as key priorities. Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women's key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women's mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women's services. Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women's mental health care in the VHA.

EPA-1000 – No one ever asked about it! barriers in access to mental health services for women accessing treatment from primary care in Karachi

Studies conducted in Pakistan reveal a high prevalence of depression, particularly in women. Evidence based and effective treatments are available, yet there is a significant gap between the numbers of women in need of treatment and those who receive services. This qualitative study identifies the barriers in access to mental health services for women screened for depression from primary care clinics in Karachi. In-depth interviews were conducted with 30 women screened for depression from three purpose fully selected primary care sites in Karachi. Interviewees reported that they mostly did not share their depressive symptoms and suicidal attempts with health care providers due to perception of these being their personal problems and health care providers also not asking about it. Interviewees perceived health care providers too busy, overburdened and not interested in their emotional problems. Those who shared their symptoms also did not receive proper diagnoses, treatment or referral from their health care providers. The study highlights the need to increase mental health literacy about depression through mass media, community engagement, and educational institutions so that women can recognize the depression in themselves and other women around them and be able to share their symptoms with their health care providers. Religious scholars needs to be involved in raising awareness on depression as an illness for which women should seek medical treatment besides taking support from religion. It also indicates the need for a referral system to help women reach to the required mental health services.