Julie Jomeen

Assessment and relationship of sleep quality to depression in early pregnancy

Sleep quality is integral to optimal physical functioning and mental health during pregnancy. There has, however, been little work conducted to determine the most appropriate measure of sleep quality in this clinical group, a surprising observation given the complex and dynamic psychobiology of pregnancy. The Pittsburgh Sleep Quality Index (PSQI) was evaluated to determine the usefulness of this measure in early pregnancy. The psychometric properties of the PSQI were evaluated in women at 14 weeks of pregnancy and revealed the instrument to have good internal consistency and convergent and divergent reliability properties. Confirmatory factor analysis suggested that the removal of the PSQI sleeping medications sub‐scale from the global sleep quality total score calculation would improve the utility of this measure in early pregnancy. Women classified as depressed on the basis of Edinburgh Postnatal Depression Scale (EPDS) scores were found to have significantly poorer sleep quality scores on the majority of PSQI sub‐scales. The relationship between sleep quality and depression was found to be statistically significant and clinically relevant during early pregnancy and the PSQI would appear to be an appropriate measure to assess sleep quality in this group.

Is the hospital anxiety and depression scale (HADS) a reliable screening tool in early pregnancy

The factor structure and internal reliability of the Hospital Anxiety and Depression Scale (HADS) was investigated to determine the suitability of the instrument for screening during early pregnancy. The study used a cross-sectional design with all observations taken at the antenatal booking clinic. Confirmatory factor analysis (CFA) of the HADS revealed that a three-factor solution offered the most parsimonious account of the data. However, the CFA further revealed that none of the factor models tested provided a consistent and good fit to the data. It was concluded that the HADS does not reliably assess distinct domains of anxiety and depression in early pregnancy. These findings suggest that the HADS is not a suitable screening tool for symptoms of anxiety and depression in this clinical group.

Assessing women’s perinatal psychological health: exploring the experiences of health visitors

Objective: This study aimed to explore health visitors’ (HVs) experiences of the assessment of women with psychological distress and mental health problems across the perinatal period in clinical practice. Background: In international contexts, there is now a firm policy remit for the assessment of psychological and mental health disorder across the perinatal period. Women are in regular contact with health professionals across this time and consultations intuitively create an ideal and appropriate context in which to assess women’s psychological health. National reports and academic literature highlight that to prevent the escalation of perinatal mental illness, significant change is needed to support health professionals in detecting, discussing and dealing with mental illnesses. Methods: In a qualitative aspect of a larger mixed-method study, data were collected from two Focus Group Discussions with HVs pre and post a training session related to assessing and managing perinatal mental health problems in practice. For the purposes of this paper, the data were explicitly examined for references to recognition and assessment. Results: Four themes emerged from the data: recognising the problem; questioning and identification; so what do I do now; the importance of support to promote effective identification and assessment. Conclusion: Findings elucidate the complexities that practitioners face in assessing women’s psychological health in real world settings. HVs’ experiences highlight that the implementation of measures into practice needs to be workable and accompanied by contemporary and appropriately contextualised knowledge, adequate service provision and clear referral pathways to ensure effective assessment of women’s psychological health.

Maternal–fetal relationships and psychological health: emerging research directions

Maternal representations of, and relationships with, the unborn baby appear to be associated with psychological health in pregnancy and beyond, and might play an important role in identifying women who need additional support, as well as providing an arena to develop positive pregnancy experiences. The mechanisms and pathways linking maternal–fetal relationships, psychological health and important outcomes are complex. This article provides an overview of some of the key findings in this area and identifies some important emerging directions for future research: the nature and form of maternal–fetal relationships and how best to measure them, the mediating and moderating factors linking maternal–fetal relationships with psychological health and other outcomes in pregnancy and beyond, and the importance and acceptability of the concept of maternal–fetal relationships to women.

Sexual health information seeking: a survey of adolescent practices.

AIMS AND OBJECTIVES To identify sources of information and support preferred by young people to understand adolescent practices as adolescents develop a sexual health knowledge base. BACKGROUND Statistics suggest that adolescents are not always making safe sexual health decisions. It is essential to develop an understanding of preferred sources of information and support to structure health and education services so that adolescents develop skills and knowledge to make safer choices. DESIGN A cross-sectional survey design. METHODS A wide-ranging questionnaire was developed using validated questions, drawn from similar adolescent lifestyle surveys and adapted with guidance from an advisory group; 2036 13-16-year-olds responded. Two questions, reporting information sources adolescents find useful and sources of approachable support, are considered here. RESULTS Adolescents find informal sources more useful and experience higher levels of comfort accessing informal support especially from their best friends and mothers. Of formal provision, school-based sources are preferred; however, sexual health information seeking is gendered and changes across year groups. The range of sexual health information sources adolescents access increases with age, and how they access these information sources changes as sexual activity increases and the information becomes more relevant. CONCLUSIONS The findings support the targeting of sexual health provision in relation to age and gender and suggest a youth-focused approach to formal provision, including outreach working and a collaborative relationship with adolescents and parents. RELEVANCE TO CLINICAL PRACTICE The findings contribute to an understanding of sources of information and support preferred by adolescents. In particular, they need to reconsider how services external to the school may be developed so they are youth-focused and approachable. Nurses need to consider how best to work in partnership with adolescents and their families to disseminate accurate information and develop relevant services.

Measuring psychological health in the perinatal period: Workshop consensus statement, 19 March 2013

This consensus statement is the result of an invited workshop funded by the Society for Reproductive and Infant Psychology on Measuring Psychological Health in the Perinatal Period which was held in Oxford on the 19th March 2013. The details of those who participated in the workshop can be found at the end of the consensus statement. The workshop evolved out of recognition that a major limitation to research and practice in the perinatal period is identifying valid, reliable and clinically relevant measures of psychological health. Work Shop Aims: To explore the definition and measurement of key components of psychological health and related constructs, in maternity care research. To discuss design and reporting standards of measures in the perinatal period to support measurement development and appropriate use.

Ethnic minority women's experience of maternity services in England

Objectives. Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding womens interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) womens experiences of contemporary maternity care in England. Design. A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis. Results. Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to ‘feeling cared for,’ with subthemes of ‘expectations of care’ and ‘policies, rules and organisational pressures’; ‘staff attitudes and communication’ with sub-themes of ‘please believe me,’ ‘hospital as a safe place,’ ‘choices denied’ and ‘being sensitive and supportive would help,’ and ‘ethnicity and culture’ with sub-themes of ‘stereotyping’ and ‘improving the quality of care.’ Conclusion. The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services.

A psychometric evaluation of form C of the Multi-dimensional Health Locus of Control (MHLC-C) Scale during early pregnancy

The concept of locus of control (LOC) is an important psychological dimension within health research and the issue of personal control has become of increasing salience within the clinical domain of pregnancy, both psychologically and in relation to government policy. The current study sought to establish the psychometric properties of the Multidimensional Health Locus of Control scale form C (MHLC-C) in early pregnancy to assess the potential usefulness of this measure within this clinical population. Contrary to previous research, confirmatory factor analysis revealed the MHLC-C to be comprised of three distinct and correlated factors of “internal”, “chance” and “powerful others” LOC. A fourth sub-scale “doctors” was observed to be sensitive to the non-depressed/depressed status of participants. However, the “doctors” sub-scale lacked acceptable internal reliability in this clinical group. Further research is recommended to determine if developing the “doctors” sub-scale into a longer measure could enhance the potential utility of this measure.

Puerperal psychosis – a qualitative study of women’s experiences

Objective: This study explored women’s experience of puerperal psychosis (PP) and their perceptions of its cause, in order to contribute to an increased understanding of PP and promote consideration of new management perspectives. Background: Out of every 1000 live births, approximately one to two women will develop PP. The numbers are relatively small, yet the consequences can be devastating. Key theoretical explanations for the aetiology of PP are genetic, biochemical and endocrine. A small and relatively tenuous evidence base considers PP from a psychological perspective, despite acknowledgement of the need for broader understanding. A stress–vulnerability model has offered a contemporary explanation of psychotic symptoms in other contexts and non-clinical populations and may offer useful insight in relation to a psychobiological model of PP. Methods: In a qualitative study, seven women who had been diagnosed with PP previously were interviewed and the data subjected to an inductive thematic analysis. Trustworthiness and rigour of the study was assured by careful monitoring of the research process and data checking. Results: Four themes were identified – The path to PP; Unspeakable thoughts and unacceptable self; ‘Snap out of it’; and Perceived causes. While women attributed their PP to the physiological changes associated with childbirth, their accounts of PP began before and during pregnancy. Women highlighted stressful pregnancies characterised by significant challenges and emotions, difficult births and unsupportive family relationships postnatally. The experience of PP was extremely distressing. Conclusion: Findings add to the debate about a more multifaceted explanation of PP and potentially offer a psychobiological model of understanding.

Reimagining the General Health Questionnaire as a measure of emotional wellbeing: a study of postpartum women in Malta.

BACKGROUND Postpartum health has been subject to a focus on psychological morbidity, despite positive associations between postpartum recovery and maternal emotional wellbeing. There are currently many validated tools to measure wellbeing and related concepts, including non-psychiatric morbidity. The General Health Questionnaire, 12 items (GHQ-12) is one such instrument, widely used and validated in several languages. Its use in postpartum settings has been documented with disagreement about the instruments utility in this population, particularly in relation to scoring method and threshold. The GHQ-12 has never been translated into Maltese. This study explored the psychometric properties of the GHQ-12 in a Maltese postpartum population to consider if the use of a different scoring method (visual analogue scale) in the GHQ-12 can determine postpartum wellbeing. METHODS One hundred and twenty-four postpartum women recruited from one hospital in Malta completed the translated and adapted GHQ-12 as a wellbeing measure (GHQ-12(WB)) at four postpartum time points. The psychometric properties of the GHQ-12(WB) were explored using confirmatory factor analysis, discriminant and divergent validity and reliability analysis. RESULTS The GHQ-12(WB) demonstrated good divergent and known-groups validity and internal consistency. No models offered a good fit to the data. The overall consistent best-fit to the data was an eight item, two factor model (GHQ-8). Model fit improved across all models in terms of CFI at 13 weeks. CONCLUSION Findings generally support the reliability and validity of the Maltese version of the GHQ-12(WB). Model fit changes over time reflect the dynamic nature of postpartum recovery. Further evaluation of the GHQ-8(WB) is recommended.