Health services research into postnatal depression: results from a preliminary cross-cultural study (original) (raw)
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Postnatal depression: Use of health services and satisfaction with health-care providers
Journal of Quality in Clinical Practice, 2001
Abstract The objective of this study was to compare health-care use and satisfaction with health-care providers between depressed and non-depressed women in the first 4 months after childbirth. Sixteen weeks after delivery a questionnaire, which included the Edinburgh Postnatal Depression Scale (EPDS) and items about health-care use and satisfaction, was mailed to women who attended the antenatal clinic, Royal Women’s Hospital, Brisbane. Completed questionnaires were returned by 574 (86.4%) of the 664 women surveyed. During the study period most women (91%) visited a general practitioner at least once and 117 (12%) saw their doctor on five or more occasions. A total of 118 (20.7%) scored above 12 on the EPDS. Depressed women were more likely to visit a psychiatrist (OR, 9.2; 95% CI, 4.3–19.6), social worker (OR, 6.1; 95% CI, 3.3–11.1), postnatal depression group (OR, 4.0; 95% CI, 1.3–12.6), paediatrician (OR, 2.5; 95% CI, 1.6–3.9), or a general practitioner (OR, 2.1; 95% CI, 1.4–3.2) than non-depressed women. Twenty-two (18.5%) of the depressed women had contact with a psychiatrist. Compared with non-depressed women, those scoring above 12 on the EPDS were less satisfied with the services of general practitioners (P = < 0.000), paediatricians (P = 0.002), Nursing Mothers’ Associations of Australia (P = 0.043) and obstetricians (P = 0.045). Postpartum depression leads to an increase use of health-care services and has a negative effect on satisfaction with some services.
Inequity in provision of and access to health visiting postnatal depression services
Journal of Advanced Nursing, 2011
Aim. This paper is a report of a study of equity in the provision of a public health nursing postnatal depression service. Background. Postnatal depression is a global public health concern. Health visitors are nurses involved in the early detection and treatment of postnatal depression. However, research has revealed that all women are not assessed for postnatal depression particularly women in minority ethnic groups. Methods. A case study was conducted involving 21 observations of health visitors visiting postnatal women, interviews with 20 health visitors, 6 managers, 12 English women, 9 Bangladeshi women and 3 other personnel. Data were collected between 2003 and 2005 and analysis was completed in 2008. Findings. The organization had a policy to create equitable postnatal depression services, but practitioners were not clear whether it was to be implemented, and it did not address the needs of a diverse population. All health visitors received specialized training and were consequently expected to assess and treat all women. The training based on the policy had not equipped health visitors with knowledge and skills to assess and treat women in minority ethnic groups. Conclusion. While a policy was in place, equity in care was not achieved. An analysis of women's needs is recommended prior to policy development and policy implementation should be planned. To achieve equity, training should include knowledge and skills for cultural competency. Research is needed to illuminate the characteristics of equitable nursing services.
Predictors of postpartum depression service use: A theory-informed, integrative systematic review
Women and Birth, 2019
Postpartum depression affects many women globally, yet rates of treatment use are low. A comprehensive view of factors associated with treatment use, from women's and providers' perspectives, based on a theoretical model is lacking. Background: Several studies examined various factors associated with postpartum depression service use; however, each study focused on a small number of factors. Aim: This study describes a systematic literature review based on the Behavioral Model of Health Service Use. The purpose of this article is to review and synthesize the available literature regarding factors associated with women's mental health service use for postpartum depression from women's and healthcare providers' perspectives, and provide a comprehensive integrative view of the subject. Methods: Three electronic databases were searched, and 35 studies published up to 2018 in English language journals met inclusion criteria for review. Factors associated with postpartum depression service use were classified according to the Behavioral Model of Health Service Use's constructs. Findings: Service use for postpartum depression is a function of a woman's predisposition to use mental health services; individual, familial, and communal factors which enable or pose barriers to use of mental health services; and the woman's perceived or evaluated need for treatment. In addition, societal determinants impact the woman's decision to seek help directly or through impacting the health and mental health care service system's resources and organization. Conclusion: This review illustrates key factors for researchers and practitioners to consider when treating postpartum women and developing interventions to enhance postpartum depression treatment use.
Postnatal depression across countries and cultures: a qualitative study
The British Journal of Psychiatry, 2004
Background Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. Aims To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people's perceptions of remedies and services for morbid states of unhappiness within the context of local services. Method The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interview swith fathers and grandmothers, and interviews with health professionals. Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. Results All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness r...
Influence of depressive symptomatology on maternal health service utilization and general health
Archives of Women?s Mental Health, 2004
Background: While postpartum depression is a well-established affective condition, information about its influence on health service utilization is scant. The objective of this study was to examine the influence of maternal mood on health service utilization and general health within the first 2 months postpartum. Methods: As part of a population-based postpartum depression study, a cohort of 594 women from British Columbia completed postal questionnaires at 1, 4, and 8 weeks postpartum. Results: Women with depressive symptomatology had a significantly higher number of contacts with a health professional than those with non-depressive symptomatology. Furthermore, over 50% of high utilizers of family physician and public health nursing services in the first month postpartum exhibited depressive symptomatology. Women with depressive symptomatology were also significantly more likely to have lower scores on the SF-36 and to indicate the care they received from family physicians to be unhelpful. Conclusion: Health professionals who discover a woman frequently using health services should closely examine the motivation for the visits and consider screening for postpartum depression. Future research should examine whether screening women with high utilization patterns reduces unnecessary health care visits and facilitates early diagnosis and treatment of postpartum depression.
Objective: to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). Methods: prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Results: a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusion: it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.
Frequency of Postnatal Depression in a Tertiary Care Hospital : A Cross Sectional Study
2018
Background: Postnatal depression can affect health of among many mothers. Objective: To assess the frequency of depression among postnatal women in a tertiary care setting of Pakistan. Methodology: Study Design: Cross Sectional Study. Two hundred and fifty Postnatal women were recruited voluntarily through Gynecology and Obstetrics ward Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. A structured Proforma was prepared and later screened through 10-item Edinburgh Postnatal Depression Scale (EPDS). The results were analyzed through SPSS version 21. Frequency of depression was presented as percentage. Results: The mean age of the postnatal recruited women was 27.5 years. It was noted that 75 (30%) of the Postnatal women were depressed; among Primigravida (28%) and Multigravida (30%) have depression. Poverty, lack of social support, female children only and birth of female child were enlisted as common among the risk factors. Conclusion: The study showed that one third the mothers have...
Assessing the Utilization of Postnatal Services Among Mothers: A Cross-Sectional Study
Cureus, 2023
Background: Women in the postnatal period are a special group with a high risk to health. Providing good quality postnatal care can help reduce maternal morbidity and mortality and improve the quality of life. The objective of the study was to assess the utilization of the postnatal services provided to mothers and to find the factors affecting the utilization of these services. Materials and methods: A cross-sectional study where 154 mothers from Patiala were interviewed regarding postnatal services using a pretested semi-structured questionnaire. Results: A total of 92.9% of mothers (95%CI=88.76-97.04) availed postnatal care with a multipurpose health worker-female (MPHW-F) and an accredited social health activist (ASHA (U)) as the main providers. Only 47.4% of mothers (95%CI=39.35-55.45) had visited a doctor for a postnatal checkup. Mother's education, type of family, place, and type of delivery were significantly associated with the number of visits to the doctor during the postnatal period. Thirty-nine (25.3%) mothers (95%CI=18.3-32.3) reported a health problem in the period, out of which only 32 mothers had taken treatment for their health problems. Mothers who were visited by MPHW-F in the postnatal period had fewer morbidities as compared to those who were not visited by MPHW-F (χ 2 =7.697; df=2; p value=0.02). Conclusions: Working women with cesarean section delivery in the private sector reported more utilization of postnatal services. These women had higher education levels and belonged to joint families. More visits by MPHW-F were associated with fewer health problems. A multi-pronged approach, targeting individuals, families, and communities, may be necessary to improve postnatal care service utilization rates.
Postnatal Depression Is a Public Health Nursing Issue: Perspectives from Norway and Ireland
Nursing Research and Practice, 2013
The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.