Pediatricians’ and health visitors’ views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study (original) (raw)
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Child Care Health and Development, 2007
Objectives To assess paediatricians' beliefs about discussing maternal depressive symptoms during a paediatric visit, and methods paediatricians use to identify mothers with depressive symptoms. Methods In-depth telephone interviews were conducted with 23 primary care paediatricians from a practice-based research network. We asked a series of previously developed questions about discussing maternal depressive symptoms during a paediatric visit; methods used to identify mothers at risk; barriers encountered, and potential strategies to improve recognition and treatment of maternal depression. Interviews were audiotaped and transcribed. Data were codified and analysed using standard qualitative data techniques. Results All paediatricians agreed that it is appropriate to ask mothers about their own health during a well-child visit, because a mother's well-being affects her children. Paediatricians relied on observational cues to identify a mother with depressive symptoms, especially mother-child interactions. Few used direct questions or a checklist. Almost all paediatricians felt that lack of time was the barrier most often faced in addressing maternal depression. Lack of training, inadequate knowledge of resources and distractions encountered in the primary care setting were additional barriers cited. One-third of paediatricians acknowledged the fear of judgement and stigma that a mother may face when discussing maternal stresses. Paediatricians desired better ability to refer mothers to social workers for help. Conclusions Observational cues are used more often than direct questions or screening tools to identify mothers at risk of depression. This may under-identify mothers at risk. Paediatricians prefer to rely on other professionals, particularly social services, to address maternal depression, yet mothers may be hesitant or ambivalent about such assistance because of fear of judgement. Paediatricians, in fact, may be the professional mothers most want to communicate with. Thus, appreciation of mothers' perspectives, empathetic communication skills and knowledge of community resources can enhance paediatricians' abilities to assist mothers at risk for depression.
In the Moment: Attitudinal Measure of Pediatrician Management of Maternal Depression
Ambulatory Pediatrics, 2007
Objective.-Pediatricians are in a good position to identify women who struggle with depression, but studies show low rates of pediatrician identification and management. It is likely that pediatricians' management of maternal depression may vary on the basis of their attitudes, but no instrument has been developed to measure these attitudes. We sought to develop a measure of pediatricians' attitudes about managing maternal depression and to identify characteristics associated with pediatricians' attitudes about managing maternal depression. Methods.-We conducted a cross-sectional analysis of data provided by 651 practicing, nontrainee pediatricians (response rate 57.5%) surveyed through an American Academy of Pediatrics 2004 Periodic Survey. An exploratory principal components analysis was used to investigate the interrelationships among the attitudinal items. Multivariable linear regression was used to assess the adjusted associations between physician and practice characteristics and attitudes. Results.-The attitudinal measure consisted of 3 subscales: acknowledging maternal depression, perceptions of mothers' beliefs, and treating maternal depression. Clinical approaches (eg, interest in further education on identifying or treating maternal depression) and training and work characteristics were significantly related to pediatricians' attitudes; patient characteristics (eg, type of insurance and ethnicity/race) were not significantly associated with pediatricians' attitudes. Conclusions.-We developed a measure to assess pediatricians' attitudes about managing maternal depression. The findings from this study can be used to develop and assess interventions that improve pediatricians' attitudes about acknowledging maternal depression, perceptions of mothers' beliefs, and treating maternal depression.
PLOS ONE, 2021
The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-struct...
Families, Systems, & Health, 2012
Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.
Beyond Screening: A Review of Pediatric Primary Care Models to Address Maternal Depression
Pediatric Research, 2015
Review nature publishing group Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.
Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study
Family Medicine
Background and Objectives: Untreated maternal depression negatively impacts both the mother and her children’s health and development. We sought to assess family medicine program directors’ (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder. Methods: Data were gathered through the Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018. Results: Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4%...
General Hospital Psychiatry, 2013
Objectives: The objectives were to examine patients' perspectives on patient-, provider-and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals. Method: Four 90-min focus groups were conducted with women 3-36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach. Results: Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/ skills among professionals. Facilitators included psychoeducation, peer support and training for professionals. Conclusions: Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals' perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
General hospital psychiatry, 2015
Best practices for addressing women's mental health and screening for depression in public health clinics are not available. Clinic staff are often responsible for screening for depression; however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. During December 2012, we conducted four focus groups using a semistructured interview guide with public health clinic staff of varying disciplines (n=25) in a Special Supplemental Nutrition Program for Women, Infants, and Children. All interviews were audio recorded and analyzed using thematic analysis. We found five descriptive themes related to acceptability and feasibility of screening for perinatal depression in a public health clinic. The main themes include (1) literacy barriers, (2) need for referrals and follow-up with outside services, (3) training and capacity needs, (4) stigma of depression, and (5) location and...