The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

Dominiek Coates; Maralyn Foureur

doi:10.1111/hsc.12740

Proof-of-concept support for the development and implementation of a digital assessment for perinatal mental health: a mixed methods study (Preprint)

10.2196/preprints.27132 ◽

2021 ◽

Author(s):

Nayra Anna Martin-Key ◽

Benedetta Spadaro ◽

Thea Sofie Schei ◽

Sabine Bahn

Keyword(s):

Mental Health ◽

Health Assessment ◽

Mental Healthcare ◽

Perinatal Period ◽

Perinatal Mental Health ◽

Health Concerns ◽

Mental Health Assessment ◽

Digital Assessment ◽

Mental Health Concerns ◽

The Uk

BACKGROUND Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the UK, with outbreaks of disease, like the coronavirus (COVID-19) pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. OBJECTIVE To conduct a mixed methods evaluation of the current state of perinatal mental healthcare provision in the UK, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. METHODS Eight hundred and twenty-nine women, 103 partners, and 90 midwives participated in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) and summarized using descriptive statistics. RESULTS The provision of adequate perinatal mental healthcare support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The digital assessment was seen to be well placed within maternity healthcare settings, with in-person only and blended care (i.e., in-person and remote support) approaches being preferred by women and partners in the event of further care being advised. Identified benefits and barriers mainly related to physical opportunity (e.g., accessibility), psychological capability (e.g., cognitive skills) and automatic motivation (e.g., emotions). CONCLUSIONS This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision-making in the assessment of perinatal mental health concerns in the UK.

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A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America

BMC Public Health ◽

10.1186/s12889-019-7661-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Mara Mihailescu ◽

Elena Neiterman

Keyword(s):

Mental Health ◽

North America ◽

Scoping Review ◽

Mental Wellbeing ◽

Review Of The Literature ◽

Eligibility Criteria ◽

Health Concerns ◽

General Mental Health ◽

Psychological Harm ◽

Mental Health Concerns

Abstract Background This scoping review summarizes the existing literature regarding the mental health of physicians and physicians-in-training and explores what types of mental health concerns are discussed in the literature, what is their prevalence among physicians, what are the causes of mental health concerns in physicians, what effects mental health concerns have on physicians and their patients, what interventions can be used to address them, and what are the barriers to seeking and providing care for physicians. This review aims to improve the understanding of physicians’ mental health, identify gaps in research, and propose evidence-based solutions. Methods A scoping review of the literature was conducted using Arksey and O’Malley’s framework, which examined peer-reviewed articles published in English during 2008–2018 with a focus on North America. Data were summarized quantitatively and thematically. Results A total of 91 articles meeting eligibility criteria were reviewed. Most of the literature was specific to burnout (n = 69), followed by depression and suicidal ideation (n = 28), psychological harm and distress (n = 9), wellbeing and wellness (n = 8), and general mental health (n = 3). The literature had a strong focus on interventions, but had less to say about barriers for seeking help and the effects of mental health concerns among physicians on patient care. Conclusions More research is needed to examine a broader variety of mental health concerns in physicians and to explore barriers to seeking care. The implication of poor physician mental health on patients should also be examined more closely. Finally, the reviewed literature lacks intersectional and longitudinal studies, as well as evaluations of interventions offered to improve mental wellbeing of physicians.

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Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment

Military Medicine ◽

10.1093/milmed/usz171 ◽

2019 ◽

Vol 185 (1-2) ◽

pp. e105-e111 ◽

Cited By ~ 1

Author(s):

Mercedes J Szpunar ◽

Jennifer N Crawford ◽

Selena A Baca ◽

Ariel J Lang

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Suicidal Ideation ◽

Longitudinal Research ◽

Women Veterans ◽

Perinatal Period ◽

Health Concerns ◽

Time Points ◽

Pregnancy And Postpartum ◽

Mental Health Concerns

Abstract Introduction Pregnancy and postpartum, or the perinatal period, are times when women are particularly vulnerable to mental health concerns, including suicidal ideation. Risk factors for suicidal ideation during this period of a woman’s life are depression and exposure to trauma, the latter of which may occur during military operations. The number of women veterans in the United States continues to rise, as does their use of maternity benefits. In this pilot study, we examined the feasibility of recruiting pregnant veterans for longitudinal research. We hypothesized that hopelessness and depressive symptoms would be related to suicidal ideation during the perinatal period, and we investigated a possible relationship between post-traumatic stress symptoms (PTSS) and suicidal ideation. Materials and Methods Using the designated Veterans Affairs (VA) maternity care coordinator’s census, we contacted pregnant women veterans for assessment during the 3rd trimester of pregnancy and 6 weeks postpartum at the San Diego VA. Between September 2017 and October 2018, 28 women volunteers completed the following measures: the Columbia-Suicide Severity Rating Scale (C-SSRS); the Beck Hopelessness Scale (BHS); the Edinburgh Postnatal Depression Scale (EPDS); and the PTSD Checklist for DSM-5 (PCL-5). We used correlational analyses and descriptive statistics to determine associations among the measures. Results As gathered from the C-SSRS, over 30% of the veteran women had past lifetime suicide attempts, and over 10% of the veterans had suicidal ideation in the perinatal period. Both depression and PTSS rates neared 30% during pregnancy and postpartum. Hopelessness and depressive symptoms were positively correlated at both time points. While the intensity of lifetime suicidal ideation was correlated with postpartum depressive symptoms, there was no correlation with current suicidal ideation and depressive symptoms. PTSS correlated with both depressive symptoms and hopelessness, but not suicidal ideation, at both time points. There was no correlation between hopelessness and suicidal ideation during the perinatal period in this cohort. Conclusions It is important to understand the mental health needs of perinatal veterans given their vulnerability to develop mental health concerns, including suicidal ideation. The unpredicted pattern of correlations determined in this study implies the need for multifaceted measures for safety-related mental health assessment of perinatal veterans, including assessment for PTSS. Strengths of this study include its longitudinal assessment and a sampling from a general population of veterans. Limitations include small sample size, a single gestational time point, and loss of participants who did not return for their postpartum assessment. We demonstrated the feasibility of longitudinal research with pregnant and postpartum veterans, but additional assessment points during the perinatal period could help identify critical times for mental health intervention in this population.

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