Erin J. Henshaw

Patient perspectives on improving the depression referral processes in obstetrics settings: A qualitative study

OBJECTIVES Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement. METHODS A stratified purposeful sampling based on pregnancy, socioeconomic status and depression severity was used to identify 23 women who completed semistructured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes and identifying themes. RESULTS Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma. CONCLUSIONS This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.

A PILOT RANDOMIZED CONTROLLED TRIAL OF COGNITIVE BEHAVIORAL THERAPY FOR PERINATAL DEPRESSION ADAPTED FOR WOMEN WITH LOW INCOMES

Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression‐specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low‐income women with Major Depressive Disorder (MDD).

Patient Preferences for Clinician Interactional Style in Treatment of Perinatal Depression

Most women with depression around the time of childbearing are not treated adequately, or at all. Clinical practice guidelines focus primarily on provision of information rather than on interaction factors. In this study, we explored clinician interactional style characteristics contributing to patient response to perinatal depression referral and treatment. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences with and preferences for clinician interactional style characteristics in the context of obstetrics-setting referral and delivery of depression treatment. Thematic analysis revealed a central theme related to interactional cues that influence women’s reactions to clinical encounters, summarized by the question, “Can this person help me?” Women evaluated this question in four domains: feeling heard, developing trust in the clinician, perceiving technical competence in the clinician, and feeling that the intervention focus is effectively chosen and communicated. Our results imply that, in addition to informational factors, the way in which clinicians interact with patients about depression might strongly influence patient responses.

Breastfeeding Self-Efficacy, Mood, and Breastfeeding Outcomes among Primiparous Women:

Background: A link between postpartum mood and breastfeeding has been established in the literature, but little is known about the relationship of breastfeeding self-efficacy (BSE) to breastfeeding and mood outcomes, particularly in primiparous women. Objectives: The purpose of this study was to prospectively evaluate the relationship among BSE, mood, and breastfeeding outcomes in primiparous women. A secondary purpose was to explore self-reported reasons for difficult emotional adjustment during the transition to motherhood. Methods: Primiparous women who initiated breastfeeding were surveyed at 2 days, 6 weeks, and 6 months postpartum. Breastfeeding self-efficacy, depressive symptoms, work status, breastfeeding difficulties, partner support, and use of lactation services were included in a hierarchical multiple regression analysis. Women who identified as emotionally distressed provided open-ended responses identifying the main cause of their stress. Results: High BSE at 2 days postpartum predicted positive emotional adjustment and fewer depressive symptoms at 6 weeks postpartum, as well as more exclusive breastfeeding at 6 months postpartum. Among distressed mothers, breastfeeding concerns were among the most commonly named reasons for stress, along with lack of sleep, lack of social support, and overwhelming learning demands involved with being a new parent. Conclusion: Breastfeeding perceptions are associated with emotional health and breastfeeding outcomes. Bolstering women’s early BSE may be an important goal for multiple dimensions of postpartum health.

OB CARES — The Obstetric Clinics and Resources Study: providers' perceptions of addressing perinatal depression — a qualitative study

OBJECTIVE We conducted a qualitative study to understand how prenatal care providers perceive influences on their delivery of perinatal depression care. Given that depression screening protocols were in place at the clinics where we sampled providers, we hypothesized that clinic- and system-level factors such as resources, training opportunities and coordination would be dominant in influencing provider decisions. METHODS We conducted semistructured interviews with 20 prenatal care providers from six obstetric clinics. We performed a thematic analysis, including within-case and cross-case comparisons, and built a conceptual model of provider decision making from the data. RESULTS Although depression screening protocols were in place at our study clinics, we found that decisions to address perinatal depression were largely made at the level of the individual provider and were undefined on a clinic level, resulting in highly variable practice patterns. In addition, while providers acknowledged externally derived influences, such as logistical resources and coordination of care, they spoke of internally derived influences, including familiarity with consultants, personal engagement styles and perceptions of role identity, as more directly relevant to their decision making. CONCLUSION Our results highlight the pivotal role of internal factors in decisions to deliver perinatal depression care. Future interventions in obstetric settings should target the intrinsic motivations of providers.

Maternal expectations and postpartum emotional adjustment in first-time mothers: results of a questionnaire survey

Abstract Objective: Several predictors of postpartum mood have been identified in the literature, but the role of maternal expectations in postpartum mental health remains unclear. The aim of this study was to identify whether maternal expectations during the postpartum hospital stay predict adjustment and depressive symptoms at 6 weeks postpartum. Methods: The sample included 233 first-time mothers recruited from the postpartum unit of a Midwestern hospital. Participants completed measures of maternal expectations and depressive symptoms (EPDS) at Time 1 (2 d postpartum) and completed EPDS and an Emotional Adjustment Scale (BaM-13) at Time 2 (6 weeks postpartum). Results: A conditional relationship between the expectation that an infant’s behavior will reflect maternal skill and Time 2 outcomes (BaM-13 and EPDS) was found, such that endorsing this belief predicted increased depression and poorer adjustment in those with higher (but not lower) Time 1 EPDS scores. Time 2 BaM-13 scores were also negatively predicted by expectations of self-sacrifice and positively predicted by expectations that parenthood would be naturally fulfilling. Conclusions: The expectations that new mothers hold about parenting soon after delivery are predictive of emotional adjustment in the early postpartum period, suggesting a role for discussion of expectations in future preventive strategies.

Stigma and Depression During Pregnancy: Does Race Matter?

Rates of depression treatment are low in pregnant women, particularly Black women. Stigma is an important barrier to treatment, but little research has examined how depression stigma differs in Blacks and Whites; a key purpose of this study. Participants were 532 pregnant women recruited in obstetrics settings, who responded to measures of stigma and mood. Black women reported more depression stigma than White women, regardless of their depression status, and were more likely to endorse the view that depression should be kept secret, than White women. In White women, stigma increased as a function of depression status (current, past, never). White womens perceptions of depression stigma were positively correlated with their beliefs about keeping depression secret. Secrecy and depression stigma were uncorrelated in Black women. There are important racial differences in the way depression stigma functions in pregnant women. Implications for engaging women in mental health treatment are discussed.

Faith-based sex education programs: what they look like and who uses them.

The purpose of this study was to explore the kinds of sex education programs for youth available in mainline churches. This research project sought to identify the kinds of programs developed, the ages of the youth involved, the reasons for implementing the programs, the goals of the programs, the topics covered, and the perceived youth response to these programs as identified by youth ministers and leaders. The sample included 92 churches/synagogues with memberships over 300 that were within a 25-mile radius of our small, urban area in southeast Michigan. Findings from this study lay the groundwork for exploring whether these programs have an impact on adolescents’ sexual behaviors.

Too sick, not sick enough? Effects of treatment type and timing on depression stigma.

Abstract A case vignette survey design was used to explore effects of treatment timing (early, delayed, or untreated) and depression treatment type (pharmacological or psychological) on components of depression stigma. The survey was distributed to two samples, 116 undergraduates (UGs) and 301 participants from the online service Amazon Mechanical Turk. As expected, extended untreated depression was associated with greater social distance and negative character evaluation than treated depression, and early treatment was associated with higher illness invalidity stigma (both samples) and illness responsibility stigma (UG sample only). Interaction effects suggested that pharmacotherapy, in comparison with psychotherapy, was more sensitive to the effects of treatment timing on stigma. Taken together, the pattern of results suggests that separate facets of stigma are associated with early depression treatment and prolonged untreated depression. Evidence for separate stigmatization of early treatment and extended illness holds important implications for antistigma campaigns.