Carla J. Groh

The effect of natural environments upon agitation and aggression in late stage dementia patients

Agitated aggressive behavior in late stage dementia occurs in 30 to 50 percent of patients. This behavior often results in the use of chemical and physical restraints (which have a high degree of untoward side effects) and caregiver burnout. Interventions for agitated aggressive behavior are needed that do not have these side effects, which are readily available in nursing homes and are effective and acceptable to caregivers. Environmental psychologists have proposed that natural elements within the environment decrease agitation in the nondemented as well as the demented Since the shower bath is often a time of great agitation in dementia patients, natural elements were used to modify care during the shower bath (n = 31). There was a significant decrease in mean difference scores from baseline to treatments one and two, with the treatment group demonstrating an overall decline in agitated aggressive behavior Additional randomized trials of the effects of natural environments upon agitation and aggression in dementia are needed.

Poverty, Mental Health, and Women: Implications for Psychiatric Nurses in Primary Care Settings:

Poverty is one of the most consistent correlates of depression as well as other mental health disorders. Although poverty has negative health outcomes for men and women, the greater burden falls to women. Thus, the focus of this article is on the experiences of women and the complex intersection between the social and economic correlates of poverty and mental illness. A case study is presented that illustrates these intersections. The article concludes with suggestions to improve the mental health of poor women. J Am Psychiatr Nurses Assoc, 2007; 13(5), 267-274. DOI: 10.1177/1078390307308310

Vitamin D and Depression Is There a Relationship in Young Women

Background: Depression is emerging as a leading cause of morbidity and mortality in young adults. New biological assessment strategies such as biological markers are needed to more accurately assess for depression in this age group. Vitamin D may present such an opportunity. Objective: A descriptive correlational design with convenience sampling was used to address the research question: Is there a relationship between vitamin D serum levels and depression scores in young adult women? Design: One hundred thirty-nine participants completed a health questionnaire, Beck Depression Inventory, and had serum vitamin D, 25(OH)D, levels drawn. Results: No statistically significant correlation between vitamin D level and depression was identified. Statistically significant differences between African American and Caucasian women were detected on vitamin D levels but not on the Beck Depression Inventory. Conclusion: Based on the results of this study, vitamin D cannot be used as a biomarker for depression in women aged 18 to 24 years. Clinical implications of no relationship between vitamin D and depression will be explored and the cut-point for serum 25(OH)D levels will be discussed.

Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States

ABSTRACT Transition into motherhood is generally a joyful life event; for some women, however, it is marked by emotional turmoil. Lack of support can be associated with postpartum depression and can compromise both the mother and infant. A descriptive, cross-sectional study (N = 61) was conducted to explore the relationship between social support and postpartum depression and to determine whether mothers overwhelmed with childcare, or overwhelmed with life in general since becoming a mother, sought professional help. The results revealed that screening for depression alone may not be sufficient, that mothers are willing to contact a professional for help in the postpartum period, and that assessments after birth should include a broader assessment of life’s difficulties rather than focusing on childcare responsibilities alone.

Development of a doula intervention for postpartum depressive symptoms: participants' recommendations.

PROBLEM About 10-15% of women experience postpartum depression (PPD). Doulas provide support and education about PPD. METHODS This qualitative study used focus groups with mothers, doulas, and doula trainers to develop educational materials for doulas to help mothers identify symptoms of depression and seek treatment. FINDINGS All participants preferred materials that use simple language and avoid psychiatric jargon. Three themes emerged: someone to talk to, flexibility, and interactivity. Materials developed include tri-fold brochure and content for an application for smartphones and digital tablets. CONCLUSIONS Doulas can use these interactive materials to provide supportive, relationship-based care that complements nursing care.

Depression in rural women: Implications for nurse practitioners in primary care settings

Purpose The purpose of this study was threefold: (a) to determine what percent of rural women self‐report as currently depressed when asked; (b) to explore the congruence between self‐report of depression and Center for Epidemiologic Studies‐Depression Scale (CES‐D) score; and (c) to identify factors associated with congruence between self‐report of depression and CES‐D score. Data source Self‐report data were collected from 140 women who lived in a rural community in the Midwest. The convenience sample was recruited at a Federally Qualified Health Center. Conclusions The percent of rural women who self‐reported as currently depressed was 36.4%. Congruence between self‐report of depression and CES‐D score was 76.8%, indicating the majority of women were able to identify if they were depressed or not. Women in the incongruent group were significantly more likely to be diagnosed with diabetes, reported more headaches, and received treatment for depression in the past. Implications for practice Dependence on primary care providers to identify and treat depression is the current standard of care for the vast majority of rural women. As more advanced practice registered nurses work in rural areas, they need to be cognizant of the high rates of depression in women and the most effective strategies for identifying and treating.

The Effective Use of Psychiatric Mental Health Nurses in Integrated Care: Policy Implications for Increasing Quality and Access to Care

In the last ten years primary care providers have been encouraged to implement integrated models of care where individuals’ medical and mental health needs are addressed holistically. Many integrated models use Psychiatric Mental Health (PMH) nurses as case managers and select exemplars use PMH Advanced Practice Nurses (APNs) as providers. However, the potential value of PMH nurses in integrated health care remains unrealized by health care planners and payers, limiting access to services for the populations most in need of comprehensive care approaches. This current situation is partially fueled by insufficient knowledge of the roles and skill sets of PMH nurses. In this paper, the PMH RN and APN skill sets are detailed, demonstrating how effective use of these nurses can further the aims of integrated care models. Finally, outlined are barriers and enabling factors to effective use of PMH RNs and APNs and attendant policy implications.In the last ten years primary care providers have been encouraged to implement integrated models of care where individuals’ medical and mental health needs are addressed holistically. Many integrated models use Psychiatric Mental Health (PMH) nurses as case managers and select exemplars use PMH Advanced Practice Nurses (APNs) as providers. However, the potential value of PMH nurses in integrated health care remains unrealized by health care planners and payers, limiting access to services for the populations most in need of comprehensive care approaches. This current situation is partially fueled by insufficient knowledge of the roles and skill sets of PMH nurses. In this paper, the PMH RN and APN skill sets are detailed, demonstrating how effective use of these nurses can further the aims of integrated care models. Finally, outlined are barriers and enabling factors to effective use of PMH RNs and APNs and attendant policy implications.

Vitamin d, depression and coping self-efficacy in young women: longitudinal study.

Depression is a significant health issue in young women with few assessment strategies for early detection. It has been suggested that self-efficacy and vitamin D levels can predict and prevent depression. The authors examined the relationship between vitamin D levels, coping self-efficacy and depression in 77 college age women over three seasons. The results of the repeated measures analysis showed that a strong, inverse relationship existed between self-efficacy and depression but not vitamin D levels. These findings were consistent across the three data collection points. The results implied that strengthening perceived coping self-efficacy may be useful in order to maintain the mental health of young college age women.

Practice Methods Among Nurse Practitioners Treating Depressed Women

Objective To determine practice methods and beliefs about degree of competence in the assessment, diagnosis, and treatment of depressive symp‐toms in women by nurse practitioners (NPs). Data Sources A survey about the diagnosis and treatment of depressive symptoms in women was mailed to 3,000 NPs randomly selected from the mem‐bership of the American Academy of Nurse Practitioners. Family, adult, womens and gerontological NPs were included; 1,647 surveys were returned (55%). Conclusions Assessment and treatment protocols used by NPs were consistent with the AHCPR guidelines and similar to the protocols used by psychiatrists and non‐psychiatric physicians, yet only 65% believed their education had adequately prepared them to assess/diagnose depression and only 52% believed they had been adequately prepared to treat depression. Implications for Practice Findings suggest areas for improvement in the formal education and continuing education of NPs.

Depression Screening and Treatment in Uninsured Urban Patients

Background: Depression has been widely studied in primary care settings, yet studies of medically uninsured populations are lacking. We sought to determine whether depression screening and treatment improved depression scores of a medically uninsured, mostly African American primary care population. Methods: The study was a prospective repeated-measures design that recruited uninsured patients. Patients were screened for depression, and the rate of depression diagnosis was compared with baseline. Patients who were diagnosed and accepted treatment were randomized to 1 of 4 treatment arms: (1) usual care; (2) usual care and psychotherapy; (3) usual care and education and psychotherapy; and (4) usual care and education. Patients were then reevaluated at 8, 12, and 24 weeks. Results: A total of 674 patients participated. Depression prevalence was significantly higher among those screened (38%) than at baseline (16%). All treatment groups showed a significant reduction in depression scores over a 6-month period, from a mean score of 15 at baseline to 8.3 at 24 weeks (P < .005). All treatment interventions were equally effective. Conclusion: Screening improves the rate of diagnosis of depression in an uninsured, primarily African American population, and subsequent treatment significantly reduces the burden of depression.