Perinatal Mental Health Services Research Articles

A systematic review of clinical psychological guidance for perinatal mental health

BackgroundGuidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input.MethodEight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined.ResultsFrom the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion.ConclusionPerinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.

How do patient and care experience data inform policy and practice? Insights from the Irish National Care Experience Programme

Abstract Issue Patient experiences are central to the delivery of quality, person-centred care and an important predictor of outcomes. Prior to 2017, there was no unified, national approach to the collection of care experience data in Ireland. Description of the problem The National Care Experience Programme is a partnership between a regulator, policy makers and the Irish public health service, with a suite of surveys of inpatient, maternity, nursing home and end of life care. The surveys aim to learn from people's feedback on health and social care services to identify areas of good experience and areas requiring improvement. Results Findings have informed national policies, including a healthcare communication programme to support staff to develop communication skills with patients and families. Survey data provide a key input to the Irish health quality indicator framework and the Health Systems Performance Assessment Framework, which assess the overall performance of the Irish health system. National Maternity Experience Survey results informed the allocation of funding for post-natal supports and new lactation consultant posts, and supported the implementation of a specialist perinatal mental health services model of care, leading to increased diagnosis and vigilance of mental health issues ante- and postnatally. National Nursing Home Experience Survey findings supported legislative amendments, including provision for the delivery of in-person advocacy awareness campaigns and the strengthening of complaints processes within nursing homes. Lessons In order to maximise the use of survey findings and ensure the voices of people using health and social care services are acted on, routine surveying of care experiences is required to track the impact of policy and practice initiatives. The programme is currently expanding to include people's experiences of cancer care and mental health services, in addition to exploring options for continuous, local care experience surveys.

'It's a girl!' Is gender disappointment a mental health or sociocultural issue?

Gender disappointment can be defined as subjective feelings of sadness when discovering that the sex/gender of a child is the opposite of what the parent had hoped or expected. Wanting a boy (or 'son preference') has long been noted in many cultures, particularly in South and East Asian communities, but it is now becoming more recognised in the UK, Europe and North America. This article aims to improve understanding of gender disappointment by exploring medical and social sciences research; it also discusses the clinical and risk implications of assessing and managing gender disappointment (or not doing so) when individuals present to perinatal and/or community mental health services.

Healthcare professionals’ views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study

BackgroundPerinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities—Black and South Asian women in particular—are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals’ views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women.MethodsSemi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis.ResultsThree main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients’ relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services.ConclusionKey insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

South Asian and East Asian Immigrant Pregnant women in Canada, United Kingdom, United States of America, Australia, and New Zealand: Prevalence of common mental health conditions and women’s lived experience with them

The goal of this review is to investigate the prevalence rates of common mental health conditions among pregnant East and South Asian immigrant women, as well as to understand their lived experiences with these conditions in 5 English-speaking countries: Canada, United Kingdom, United States of America, Australia, New Zealand. Pregnancy is a critical time in a woman's life marked by intricate physical, emotional, and psychological transitions. The mental health of pregnant women emerges as a paramount concern given its associations with poor pregnancy outcomes. This is crucial within the context of South Asian and East Asian immigrant women, who navigate unique cultural, social, and economic challenges in their host countries that may influence their emotional wellbeing. This review will investigate the prevalence rates of common mental health conditions. This review will also explore their encounters with mental health care services and interactions with perinatal mental health care providers and services. Quantitative and Qualitative studies in English language that examine East and/or South Asian immigrant women in the perinatal period will be considered for this review. Published abstracts and mixed methods studies will also be included. All languages and publication dates will be included. However, only studies with an English language translation will be considered. This review will exclude books/book chapters, editorials, commentaries, and reviews. CINAHL (EBSCO), MEDLINE ALL will be searched. Furthermore, a grey literature search will be included in the search using CINAHL and PsycINFO as well as websites such as Society of Obstetricians and Gynecologists of Canada (SOGC), Canadian Perinatal Surveillance System (CPSS), Canadian Perinatal Mental Health Collaborative (CPMHC), Centre for Addiction and Mental Health (CAMH) and the Canadian Pediatric Society. Screening, conflict resolution data extraction and aggregation will be done by two independent reviewers.

A Qualitative Exploration Of Experiences And Perceptions In Recent Parents Screening Positive For Perinatal Depression In Karachi, Pakistan.

The narrative review was planned to qualitatively analyse the experiences, factors and context of parents screening positive for perinatal depression in Karachi. Semi structured in-depth interviews were conducted to explore the experiences and perceptions of participants during pregnancy, birth and 10-12 weeks after birth. Seven men and 20 women participated in the in-depth interviews. Factors in the perinatal period that affected new parents included sleep disturbances, emotional stressors linked to preference for a male child, a lack of social support, financial burdens of perinatal care, personal frustrations caused by an inability to comprehend the signs and symptoms of perinatal depression, denial to admit challenging issues concerning mental health and social disapproval with expressing mental health issues. There is an imminent need for appropriate initiatives to raise awareness about perinatal depression, and the provision of adequate perinatal mental health services for Pakistani women and men.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India.

The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Conceptual frameworks of barriers and facilitators to perinatal mental healthcare: the MATRIx models.

Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care. To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services. Relevant literature was systematically identified, categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base and feedback from stakeholders (women and families, health professionals, commissioners and policy makers). Barriers and facilitators to PMH care were identified at seven levels: individual (e.g. beliefs about mental illness), health professional (e.g. confidence addressing perinatal mental illness), interpersonal (e.g. relationship between women and health professionals), organisational (e.g. continuity of carer), commissioner (e.g. referral pathways), political (e.g. women's economic status) and societal (e.g. stigma). The MATRIx conceptual frameworks provide pictorial representations of 66 barriers and 39 facilitators to PMH care. The MATRIx frameworks highlight the complex interplay of individual and system-level factors across different stages of the care pathway that influence women accessing PMH care and effective implementation of PMH services. Recommendations are made for health policy and practice. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to PMH care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services and quality training for health professionals, with protected time to complete it.

Evaluation of a new Perinatal Mental Health Service in a University Maternity Hospital.

Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital. Clinical charts were reviewed to collect data on allreferrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT. In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020. Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there wasincreased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.

Stakeholder views on the design of National Health Service perinatal mental health services: 360-degree survey.

At the start of a new community perinatal mental health service in Scotland we sought the opinions and aspirations of professional and lay stakeholders. A student elective project supported the creation of an anonymous 360-degree online survey of a variety of staff and people with lived experience of suffering from or managing perinatal mental health problems. The survey was designed and piloted with trainees and volunteer patients. A rich variety of opinions was gathered from the 60 responses, which came from a reasonably representative sample. Respondents provided specific answers to key questions and wrote free-text recommendations and concerns to inform service development. There is clear demand for the new expanded service, with strong support for provision of a mother and baby unit in the North of Scotland. The digital survey method could be adapted to generate future surveys to review satisfaction with service development and generate ideas for further change.

Perinatal Mental Health in Hamilton and Montreal

Mental health concerns experienced by individuals during or up to one year after pregnancy fall under the umbrella of perinatal mental health. Estimates suggest that one in five people will experience a perinatal mental illness at some point during their pregnancy or up to one year postpartum. Racialized individuals with low socioeconomic status are at an increased risk to perinatal mental health. Perinatal mental illness is becoming an incredibly relevant topic in the sphere of public health and policy. Recently, the Canadian Task Force on Preventive Health Care released a recommendation against screening individuals for depression during pregnancy and the postpartum period (up to 1 year after childbirth), stating that there is low certainty of evidence for such screening measures. This received backlash, with groups like the Canadian Perinatal Mental Health Collaborative (CPMHC) speaking out. Prime Minister Justin Trudeau and the Minister of Mental Health and Addictions aim to “ensure timely access to perinatal mental health services”, as identified in a recent mandate letter. Given its current salience, this piece seeks to explore perinatal mental health programs in Ontario and Quebec, critically analyze their effectiveness, and suggest future areas of improvement.

Experiences of women with autistic spectrum condition accessing the Brighton and Hove Specialist Perinatal Mental Health Service

PurposeThis study aims to describe the experiences and barriers to care for women with autistic spectrum condition (ASC) under the care of the Brighton and Hove Specialist Perinatal Mental Health Service (BHSPMHS) and provide recommendations to improve the service.Design/methodology/approachPatients with an ASC diagnosis or suspected diagnosis and awaiting assessment under the care of BHSPMHS were offered to take part in the study. Five patients were interviewed to explore their experiences.FindingsParticipants had a mix of positive and negative experiences of services. Positives included the continuous support and allowing flexibility around appointments. Dialectical behavioural therapy groups running online instead of in-person was highlighted as a universal negative as well as delays in diagnosing ASC.Practical implicationsThose likely to meet the criteria for ASC but are awaiting formal diagnosis should be treated with appropriate adjustments to service provision as those who have received a diagnosis. Recommendations for service improvements include the provision of smaller, in-person therapy groups. Adjustments to treatments may include flexibility around appointment times and location.Originality/valueThere is little research into the experiences of people with ASC under the care of perinatal mental health teams. As specialist perinatal services expand, it is important to understand the experiences of women with ASC being cared for by these services, to ensure they are accessible and inclusive. The results of this study will be used to guide service development and act as a model for other services, with the intention of improving care for this patient group.

Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK.

In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.

Feasibility and impact of a mental health chatbot on postpartum mental health: a randomized controlled trial

Perinatal mood disorders are common yet underdiagnosed and un- or undertreated. Barriers exist to accessing perinatal mental health services, including limited availability, time, and cost. Automated conversational agents (chatbots) can deliver evidence-based cognitive behavioral therapy content through text message-based conversations and reduce depression and anxiety symptoms in select populations. Such digital mental health technologies are poised to overcome barriers to mental health care access but need to be evaluated for efficacy, as well as for preliminary feasibility and acceptability among perinatal populations. To evaluate the acceptability and preliminary efficacy of a mental health chatbot for mood management in a general postpartum population. An unblinded randomized controlled trial was conducted at a tertiary academic center. English-speaking postpartum women aged 18 years or above with a live birth and access to a smartphone were eligible for enrollment prior to discharge from delivery hospitalization. Baseline surveys were administered to all participants prior to randomization to a mental health chatbot intervention or to usual care only. The intervention group downloaded the mental health chatbot smartphone application with perinatal-specific content, in addition to continuing usual care. Usual care consisted of routine postpartum follow up and mental health care as dictated by the patient's obstetric provider. Surveys were administered during delivery hospitalization (baseline) and at 2-, 4-, and 6-weeks postpartum to assess depression and anxiety symptoms. The primary outcome was a change in depression symptoms at 6-weeks as measured using two depression screening tools: Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale. Secondary outcomes included anxiety symptoms measured using Generalized Anxiety Disorder-7, and satisfaction and acceptability using validated scales. Based on a prior study, we estimated a sample size of 130 would have sufficient (80%) power to detect a moderate effect size (d=.4) in between group difference on the Patient Health Questionnaire-9. A total of 192 women were randomized equally 1:1 to the chatbot or usual care; of these, 152 women completed the 6-week survey (n=68 chatbot, n=84 usual care) and were included in the final analysis. Mean baseline mental health assessment scores were below positive screening thresholds. At 6-weeks, there was a greater decrease in Patient Health Questionnaire-9 scores among the chatbot group compared to the usual care group (mean decrease=1.32, standard deviation=3.4 vs mean decrease=0.13, standard deviation=3.01, respectively). 6-week mean Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 scores did not differ between groups and were similar to baseline. 91% (n=62) of the chatbot users were satisfied or highly satisfied with the chatbot, and 74% (n=50) of the intervention group reported use of the chatbot at least once in 2 weeks prior to the 6-week survey. 80% of study participants reported being comfortable with the use of a mobile smartphone application for mood management. Use of a chatbot was acceptable to women in the early postpartum period. The sample did not screen positive for depression at baseline and thus the potential of the chatbot to reduce depressive symptoms in this population was limited. This study was conducted in a general obstetric population. Future studies of longer duration in high-risk postpartum populations who screen positive for depression are needed to further understand the utility and efficacy of such digital therapeutics for that population.

Examining the gaps in perinatal mental health care: A qualitative study of the perceptions of perinatal service providers in Canada.

In Canada, access to perinatal mental health services is disparate across districts, regions, provinces, and territories. Questions remain as to how gaps in service are being experienced by Canadian service providers and clinicians. This paper examines three key questions: 1) What are the experiences of care providers with respect to the screening, identifying, and managing perinatal mental health disorders? 2) What gaps in perinatal mental health care have been identified? and 3) What approaches have been taken by providers, communities, and regions in addressing the needs of their populations? To address these questions, 435 participants from across Canada were surveyed using an online survey constructed by the research members of the CPMHC. A qualitative analysis of the data revealed three key themes: groups marginalized by the current perinatal mental health system, gaps and supports identified by communities; and systemic and policy issues. From these three themes we have identified the key components of changes required in the national approach to perinatal mental health disorders. We identify key resources that could be utilized to create policy change and provide recommendations for change.

The COSI trial: a study protocol for a multi-centre, randomised controlled trial to explore the clinical and cost-effectiveness of the Circle of Security-Parenting Intervention in community perinatal mental health services in England

BackgroundPerinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and parent-infant interventions. One intervention showing preliminary efficacious findings and user acceptability is Circle of Security-Parenting (COS-P), which is a brief, weekly, group programme. However, these studies were underpowered and predominantly non-randomised, and there has never been a research trial in England or with birthing parents experiencing severe and complex perinatal mental health difficulties. The aim of the research is to conduct a randomised control trial to test whether COS-P will reduce perinatal mental health symptoms in birthing parents accessing NHS perinatal mental health services, compared to treatment as usual (TAU). Secondary objectives include exploring whether the intervention improves parenting sensitivity, emotion regulation skills, attachment security and infant development. Additionally, the project aims to examine whether the intervention is acceptable to parents and NHS staff, and whether it is cost-effective.MethodsCOSI is an individually randomised, single-blind parallel arm controlled trial with an embedded internal pilot aiming to recruit 369 participants in a 2:1 ratio (intervention: TAU). Participants will be recruited from ten NHS community perinatal mental health services in England and screened based on clinical levels of both mental health symptoms (average CORE-OM score ≥ 1.1) and postnatal bonding difficulties (total PBQ score ≥ 12). This trial has 90% power to detect a MCID of 5 points on the CORE-OM. Primary and secondary outcomes will be measured at baseline, 3, 7 and 12 months after baseline. Service use and quality of life measures will also be collected alongside a process evaluation of parents’ and interveners’ views and experiences.DiscussionThis will be the first large pragmatic trial to test whether COS-P is effective for birthing parents with severe and complex perinatal mental health difficulties in improving their mental health symptoms. If shown to be effective, the intervention could be delivered widely across the NHS and other similar services globally.Trial registrationISRCTN, ISRCTN18308962. Registered 18 February 2022.

Developing Specialist Perinatal Mental Health Services: the door of opportunity.

The development of Specialist Perinatal Mental Health Services in Ireland in recent years (2018-2021) is described. The paper highlights the role of unexpected opportunity in advancing this much needed service for women, infants and their families. It also emphasises the need for funding combined with an implementation mechanism to ensure that the service emerging is true to the Model of Care designed and is available in a uniform manner to women nationally.

Suicidal ideation and depressive symptoms in an urban post-partum maternity setting: a retrospective cohort study.

Fifteen percent of women worldwide experience depression in the perinatal period. Suicide is now one of the leading causes of maternal mortality in developed countries. Internationally, many healthcare systems screen post-natal women for depressive symptoms and suicidal ideation to facilitate early assessment and intervention. To our knowledge, no Irish data exists on the prevalence of suicidal ideation in this cohort. To evaluate the prevalence of suicidal ideation and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) in post-natal women attending a large Dublin maternity hospital. A retrospective cohort study was conducted. Women were randomly selected by delivery date over a 6 month period. Demographic and medical information was collected from their booking visit and discharge summary data. EPDS results at discharge post-partum were examined. Data was collected on 643 women. Post-partum, 19 women (3.4%) had experienced suicidal ideation in the previous 7 days. Just over half of these women also had high EPDS scores (>12). Overall, 29 women (5.2%) screened positive for depression (EPDS score > 12). The rate of suicidal ideation is in line with the published international data and emphasises the need for all clinicians to inquire about such thoughts. Training of midwifery and obstetric staff is required. Maternity units should have a policy on the management of suicidal ideation and risk. The prevalence of depressive symptoms post-partum was comparatively low in our study. This could suggest that antenatal screening and early intervention, which are integral parts of the perinatal mental health service, are effective. However, due to limitations of the study, it could also reflect an under-representation of depressive symptom burden in this cohort.

Best practice in perinatal mental healthcare

Journal of Health VisitingVol. 11, No. 3 EditorialBest practice in perinatal mental healthcarePolly MoffatPolly MoffatE-mail Address: [email protected]Editor, JHVSearch for more papers by this authorPolly MoffatPublished Online:13 Mar 2023https://doi.org/10.12968/johv.2023.11.3.93AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Institute of Health Visiting, Maternal Mental Health Alliance (2023) Supporting High-Quality Perinatal Mental Health Care. https://maternalmentalhealthalliance.org/news/ihv-mmha-resource-inform-high-quality-perinatal-mental-health-care (accessed 7 March 2023) Google ScholarNHS England, NHS Improvement (2021) Involving and Supporting Partners and Other Family Members in Specialist Perinatal Mental Health Services.’ Good Practice Guide. www.england.nhs.uk/wp-content/uploads/2021/03/Good-practice-guide-March-2021.pdf (accessed 7 March 2023) Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 11Issue 3ISSN (print): 2050-8719ISSN (online): 2052-2908 Metrics History Published online 13 March 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Screening and early therapeutic intervention of bonding disorders at first six months of life: An alternative to prevent disorganised attachment and severe mental disorder

IntroductionDisorganized attachment has been described as an important risk factor for developing serious mental disorders in childhood, adolescence and adulthood, such as borderline personality disorder, psychoses, afective disorders, and a higher suicide risk, for instance. Bonding disorders (BD) in parents are related to insecure and disorganized attachment in children. BD can be early diagnosed at 4 to 6 weeks after birth.ObjectivesDetermine if there is a significant difference between the results of the prevalence of affective disorders, disorganized attachment, and suicidal risk five years after the birth of the offspring of parents with and without attachment disorders detected in the first year postpartum during the covid-19 pandemic.MethodsDescribe a pilot project of an analytical prospective study following a cohort of parents from the cohort SAMPECO/PEMHSCO (Perinatal Mental Health in Spain during the Covid-19 pandemic). The cohort is planned to be divided into two groups: with bonding disorders an without bonding disorders, which was established using the Postpartum Bonding Questionnaire (Brockington, 2006). Follow the offspring of both groups for 5 years and compare the results of disorganized attachment, affective disorders and suicide risk.ResultsThe cohort SAMPECO/PEMHSCO was recruited between March 2021 and June 2022. There was measured postpartum depression in mothers and fathers using the EPDS and bonding disorders in parents using the PBQ validated to the Spaniard population. More than 1500 families were involved at the beginning and around 450 families finished the follow-up six months after birth. Around 500 families were lost because of non-right contact information.ConclusionsThe covid-19 pandemic has seriously affected the mental health of the general population. Consequently, there is a higher demand for mental health assistance by public and private sanity sectors. Currently, the youth population is suffering very much from the consequences of isolation and other social factors, and many families who had babies in this period haven’t had enough support to breed and look after both their babies and themselves. Some papers suggest that the prevalence of perinatal mental disorders in parents has increased since the covid-19 pandemic because of several factors. Paradoxically, despite the high preventive potential of early intervention in the perinatal period, there are not yet exist well-equipped perinatal mental health units to solve this problem. It is urgent to boost the development of Perinatal Mental Health Services to prevent a major worsening of the situation and to prevent the increasing rate of severe mental disorders in children, adolescents and adults.Disclosure of InterestNone Declared