Mental Health Care For Women Research Articles

Women's mental health and COVID-19: increased vulnerability and inequalities.

The impact of COVID-19 on mental health has become a relevant object of research. Studies have demonstrated that women have experienced greater mental health challenges, highlighting the importance of public health systems to address women's specific needs. This literature review explores the effects of the coronavirus pandemic on psychological distress among women, aiming to provide a comprehensive understanding of the subject and to explore how these research findings can guide public mental health care responses in crisis settings. A total of 131 studies were analyzed and four dimensions were discussed: study characteristics, factors impacting women's mental health in the pandemic setting, particularities of pregnancy and the postpartum period, and proposed interventions. Most studies exclusively addressed populations of adult women, predominantly during pregnancy and the postpartum period. Anxiety, depression, and stress were the most common outcomes. Lower education and income, preexisting mental health problems, and living alone or with children were risk factors for higher levels of anxiety and depression. A comprehensive care approach supported by public health policies and focused on intersectional factors, including race, socioeconomic status, and access to resources, is necessary to improve women's mental health care response in future crises.

Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID‐19 pandemic

AbstractObjective/BackgroundUnmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID‐19 pandemic but data on the extent of this problem are needed.AimThe aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare.MethodWomen in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup‐PPD‐COVID‐19 cross‐sectional study, reported on sociodemographic, social support health‐related factors, and COVID‐19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD‐7]) using self‐report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD‐7 ≥ 10 for anxiety. Mental healthcare was defined as self‐reported current mental health treatment.ResultsOf the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD‐7 ⟨ 10), anxiety (n = 848; 7.2%; GAD‐7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD‐7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59‐0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41‐7.01), were more likely to receive mental healthcare.ConclusionThere are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID‐19 pandemic. Studies beyond the COVID‐19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period

ObjectiveTo identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DesignSecondary analysis of data from the population-based Listening to Mothers in California survey. ParticipantsThe sample included 194 non-Latina Black women in the postpartum period. MethodsWe used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. ResultsMost respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. ConclusionOur results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.

Women's desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study

ObjectiveWe report on women's mental health care desires following a miscarriage, medical termination, or abortion. Method689 women completed a questionnaire on reproductive history, health care following miscarriage/medical termination/abortion, and current mental health. Descriptive statistics and logistic regression analyses examined: miscarriage/termination/abortion incidence, desires for mental health support following miscarriages/terminations/abortions, and current mental health. ResultsOf 365 women with a pregnancy history, 37% reported ≥1 miscarriage, 9% ≥1 medical termination, 16% ≥1 abortion, and 3% endorsed all three. Current mental health did not differ between women with a history of miscarriage/termination/abortion and those with only live births (p = 0.82). Following miscarriage, 68% of women discussed options for the medical management of pregnancy loss with their provider, 32% discussed grief/loss, and 25% received mental health care recommendations. Engagement in mental health services was reported by 16% of women with a history of miscarriage, 38% after medical termination, and 19% following an abortion. Of women who became pregnant after their most recent miscarriage/termination/abortion and did not receive mental health care, 55% wished they had received services during the subsequent pregnancy. ConclusionsWomen desire mental health care after miscarriages, medical terminations, or abortions, warranting improved access to mental health care for these individuals.

Translating Research Evidence Into Marketplace Application: Cohort Study of Internet-Based Intervention Platforms for Perinatal Depression.

Internet-based intervention platforms may improve access to mental health care for women with perinatal depression (PND). Though the majority of platforms in the market lack an evidence base, a small number of them are supported by research evidence. This study aims to assess the current status of internet-based PND intervention platforms supported by published evidence, understand the reasons behind the disappearance of any of these previously accessible platforms, examine adjustments made by those active platforms between research trials and market implementation, and evaluate their current quality. A cohort of internet-based PND intervention platforms was first identified by systematic searches in multiple academic databases from database inception until March 26, 2021. We searched on the World Wide Web and the iOS and Android app stores to assess which of these were available in the marketplace between April and May 2021. The basic characteristics of all platforms were collected. For inaccessible platforms, inquiries were made via email to the authors of publications to determine the reasons for their unavailability. We compared the intervention-related information of accessible platforms in the marketplace with that reported in original publications and conducted quality assessments using the App Evaluation Model of the American Psychiatric Association. Fisher exact tests were used to compare the functional characteristics in publications of available and unavailable platforms and to investigate potential associations between functional adjustments or quality indices and platform survival time. Out of 35 platforms supported by research evidence, only 19 (54%) were still accessible in the marketplace. The main reason for platforms disappearing was the termination of research projects. No statistically significant differences were found in functional characteristics between available and unavailable platforms. A total of 18 (95%) platforms adapted their core functions from what was reported in related publications. The adjustments included changes to intervention methods (11/19, 58%), target population (10/19, 53%), human resources for intervention support (9/19, 47%), mood assessment and monitoring (8/19, 42%), communication modality (4/19, 21%), and platform type (2/19, 11%). Quality issues across platforms included low frequency of update, lack of crisis management mechanism, poor user interactivity, and weak evidence base or absence of citation of supporting evidence. Platforms that survived longer than 10 years had a higher tendency to use external resources from third parties compared to those that survived less than 10 years (P=.04). No significant differences were found for functional adjustments or other quality indices. Internet-based platforms supported by evidence were not effectively translated into real-world practice. It is unclear if adjustments to accessible platforms made during actual operation may undermine the proven validity of the original research. Future research to explore the reasons behind the success of the implementation of evidence-based platforms in the marketplace is warranted.

Understanding Stress and Coping Among Women of Color in the United States in the Age of COVID-19

This study was conducted to identify processes of coping with COVID-19 and determine their impact on emotional well-being for women of color in the United States. Data were collected from 368 women between May and July 2020 using an online survey guided by the Transactional Model of Stress and Coping, which included an assessment of COVID-19 stressors, Brief Encounter Psychosocial Instrument (BEPSI), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Ways of Coping Questionnaire (WCQ), and Center for Epidemiologic Studies Depression Scale (CES-D). Over half of the women were depressed (59.0%) and felt ill (69.3%) from the stress of COVID-19. Planful problem solving (M = 4.58, SD = 2.70) was the primary way to cope with COVID-19. A small, positive correlation existed between COVID-19 stressors and depressive symptoms (r = 0.27, p < .001). COVID-19 had a significant impact on the increase of stress (MI = 0.53, p < .001) and depressive symptoms (MI = 5.90, p < .001) as well as the decrease of resilience (MD = 2.17, p < .001) for women of color in the United States. These results can be translated into actionable care plans for clinicians and public health professionals that inform the development of tailored, culturally appropriate, equitable, and gender-specific mental health care for women of color in the age of COVID-19.

The physical-mental health interface during pregnancy planning

IntroductionThe physical and mental health of women prior to conception can have a significant impact on pregnancy and child outcomes. Given the rising burden of non-communicable diseases, the aim of this analysis was to explore the relationship between mental health, physical health and health behaviour in women planning a pregnancy.ObjectivesTo investigate the association between indices of physical and mental health in a large population of women in the UK planning a pregnancy.MethodsResponses to a preconception health digital education tool provided data on the physical and mental health and health behaviour of 131,182 women planning pregnancy. Logistic regression was used to explore associations between mental health and physical health variables. Multiple imputation by chained equations was implemented to handle missing data.Results There was evidence for an association between physical and mental health conditions (OR 2.22; 95% CI 2.14, 2.3). There was also an association between having a mental disorder and physical inactivity (OR 1.14; 95% CI 1.11, 1.18), substance misuse (OR 2.4; 95% CI 2.25, 2.55) and less folic acid use (OR 0.89; 95% CI 0.86,0.92).ConclusionsThere is a need for greater integration of physical and mental healthcare for women in the preconception period, which could support women, including those who wish to conceive, to optimise their health during this time.DisclosureNo significant relationships.

Leidraad voor de screening en detectie van perinatale depressieve en angststoornissen tijdens de zwangerschap tot 1 jaar na de bevalling

A protocol for the screening, detection and treatment of perinatal anxiety and depressive disorders Importance. With a prevalence of 20%, mental health problems are considered as one of the most frequent complications during pregnancy and the postnatal period. Despite their high prevalence, these mental health problems often remain underdiagnosed and undertreated. Objective. The protocol aims to offer perinatal health care workers (health care and mental health care workers) a framework helping them to detect and discuss depressive and anxiety complaints of women during the perinatal period (up to 1 year after childbirth) and to refer them for treatment. Evidence acquisition. The protocol, which was based on international guidelines and recent scientific evidence, was developed by an interdisciplinary task force taking into account concerns about its daily practicability and current perinatal health care. Results. The protocol guides staff through a psychosocial assessment, a stepped screening, a clinical assessment and treatment steps. It is currently being implemented throughout Flanders (Belgium) with support of the Flemish Ministry of Welfare, Public Health and Family. Conclusion. Integrating mental health screening and treatment in standard perinatal care will improve the mental health care for women, their partners and their offspring.

The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression

ObjectivesThis study aimed to describe the experience of healthcare professionals in providing mental health services to women with postpartum depression (PPD).MethodsIn 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.ResultsData 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.ConclusionAlthough 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.

Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India-Challenges and Potential Solutions Based on Two Case Reports.

The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in triggering a psychotic episode in women with vulnerabilities; difficulties faced by women with postpartum psychosis in accessing perinatal psychiatry services; and the challenges of admission into an inpatient Mother-Baby Unit (MBU). Further, we have discussed potential solutions from the perspectives of Lower and Middle-income (LAMI) countries that need to be extended beyond the pandemic. They include offering video consultations, reviewing hospital policies, and evolving strategies to mitigate traumatic experiences for pregnant and postpartum women with severe mental illnesses in both obstetric and psychiatric care.

Contraception for Women With Psychiatric Disorders.

Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices. A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.

Experiences of perinatal women and public healthcare providers in a community affected by the great east Japan earthquake and tsunami: Concerns that must be considered for the mental healthcare of perinatal women in postdisaster settings

Particular support needs of perinatal women in a disaster have been difficult to grasp through preexisting quantitative epidemiological studies. This study aimed to extract concerns that must be considered for perinatal women's mental healthcare in postdisaster settings based on lessons from the Great East Japan Earthquake. Narrative messages regarding protective and risk factors for mothers' mental health from a representative population of mothers who had given birth and all official maternal caregivers, in a coastal town devastated by the catastrophe were subjected to qualitative analyses. Eight concerns were extracted as specific support needs: (1) improve information pathways, (2) maintain access to medical services, (3) sufficiently equip necessary items for perinatal women and children, (4) implement hygienic facilities, (5) prevent mothers from feeling diffidence, (6) encourage mothers to focus on positive aspects of being pregnant or taking care of their babies, (7) provide dedicated paths for relief supply distribution and dedicated rooms for mothers and children in shelters, and (8) resume usual healthcare activities as soon as possible. The comprehensive survey of the affected community presented concerns that needed to be considered for perinatal women's mental health in postdisaster settings.

A qualitative investigation of models of community mental health care for women with perinatal mental health problems

Background Specialist community perinatal mental health teams support women diagnosed with moderate to severe psychiatric difficulties in pregnancy or postnatally. These teams are being expanded across the UK, and there is considerable international interest in this model of care. However, not all women access these teams, and many are instead supported by community mental health services that do not specialise in the perinatal period. Aims To explore perinatal women’s experiences of specialist perinatal versus generic non-perinatal community mental health support. Methods Semi-structured interviews were conducted with 36 women diagnosed with perinatal mental health difficulties who were supported in the community either by a specialist perinatal or general non-perinatal mental health service. Data were analysed thematically. Results Women felt that specialist perinatal and non-perinatal services alike were under-resourced and somewhat too narrow in their remit, but reported positive experiences across both settings. They particularly valued the specialist expertise offered by perinatal teams, but also valued greater continuity of care over a longer period, which some non-perinatal teams provided. Conclusions The findings suggest that women who experience perinatal mental health difficulties value specialist perinatal expertise, but that general, non-perinatal teams may also have advantages for some. Further research into optimal care arrangements is merited.

A qualitative study of healthcare professionals' perceptions of men and women's mental healthcare seeking in Rwanda.

This study aimed to explore health care professionals (HCP') perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme "Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects" illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: "Gender differences in health care seeking patterns," "Gender roles and stigma affect adherence to counselling and treatment," and "Gender roles exert an influence on family support" and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.

The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome

BackgroundBoth physical and mental health care for women with polycystic ovary syndrome (PCOS) require a multidisciplinary approach. We evaluated the effects of continuous (CAT) and intermittent (IAT) aerobic training in different protocols that measure body image, anxiety, depression and sexual dysfunction in women with PCOS. MethodsIn this controlled clinical trial, women with PCOS were randomly allocated for 16 weeks to 1 out of 3 groups: CAT (n = 28), IAT (n = 29), or control group (CG, n = 30). For data collection, we used the Body Shape Questionnaire (BSQ), Figure Rating Scale (FRS), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Measurement Scales (HADS). ResultsNo effects of CAT, IAT or CG groups were identified in the perceptual dimension of body image. The dis(satisfaction) grade improved after exercise in the CAT group (p ≤ 0.01) compared to the CG, as well as improved within CAT and IAT groups. Total FSFI, and HADS-A and HADS-D scores improved after exercise in the both groups. At baseline and after the study period, there were positive correlations between scores for dis(satisfaction), HADS-A and HADS-D scores. HADS-A and HADS-D scores had a negative correlation with FSFI total in the IAT (p = =0.02) group compared to the CG, as well as within CAT and IAT groups. LimitationsThe participants were not matched for body mass index (normal, overweight and obese) which may interfere on body image dimensions. ConclusionAerobic exercise improves sexual function and indices related to anxiety and depression. Likewise, it interferes in cognitive-affective dimension of the body image.

The current status of gender-sensitive mental health services for women-findings from a global survey of experts.

Integrating gender in all aspects of health services is important and mental health is no exception. Despite several recommendations regarding the need for gender-sensitive mental health services, the actual availability of these is not clear, both in high and low-income countries. We sought to understand what aspects of gender-sensitive mental health care were considered a priority by global experts in women's mental health and how satisfied they were with the current availability of these services in their own place of work. A survey with 43 items under 7 domains of gender-sensitive mental health care for women was sent to 150 experts in women's mental health across the world, of whom 73 responded. Rating on each item was from 0 to 5. While majority of the experts rated most of the items as being very important (median score of 4 and above), some areas that were considered most important included training of mental health professionals in gender sensitivity, having private spaces for examination, using a life course approach to service planning and delivery, and assisting women who find it difficult to navigate the system and mother-baby units. However, satisfaction rates with available services were quite low overall and much lower among experts in low-income countries compared with those from high-income countries. Even in high-income countries, only 6 of the top 20 items were scored as satisfactory by at least 50% of experts. This expert survey method to arrive at consensus on top priorities for improving delivery of gender-sensitive mental health care indicates that at least 72% of the items provided in the survey were considered extremely important. Poor satisfaction of experts in both high- and low-income countries with availability of gender-sensitive services indicates the need for local and global strategic action and multilevel stakeholder engagement.

The women’s liberation movement, activism and therapy at the grassroots, 1968–1985

ABSTRACTThe women’s liberation movement was the impetus for the founding of new institutions of psychological and mental health care for women in the late 1970s and 1980s. This article draws upon the archive of one such site, based in Islington, North London, to explore the ways that members of the movement interacted with local politics and were attentive to racial and economic oppression. It demonstrates that consciousness-raising groups and feminist magazines made women’s distress visible and that this visibility led to the development of feminist critiques of mainstream psychiatric care. The critiques of mainstream provision laid the ground for grassroots interventions into women’s mental healthcare in the community.

Improving perinatal mental health care for women, children, and families

This article aims to explore the services and support available to women experiencing mental health conditions during the perinatal period, from the perspective of a third-year student mental health nurse. Through critical appraisal of the literature and evidence available on this subject, the author aims to provide knowledge and understanding of different approaches and services available to support vulnerable women. Recommendations for practice development are also discussed with a focus on the development of interprofessional working between health care professionals.

Mental health measurement among women veterans receiving co-located, collaborative care services

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration’s electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.

Women: Mental Health Care Needs

Women mental health needs arise from the biological differences, life situations of women, the stresses of changing society, decreasing social support from family and community and related issues. The broader aspects of meet the needs of women mental health care must need to be strengthen the family support, increase the mental health professional interest on these issues and also sensitize the writers, media, law, policy makers regarding women’s mental health care needs.