Megan Hebdon

Maternal Postadoption Depression, Unmet Expectations, and Personality Traits

Background: There are approximately 2 million adoptive parents in the United States and some struggle with depressive symptoms postplacement. We know little about personality traits that may be associated with depression in adoptive parents. Objectives: This study describes the relationships between personality traits, unmet expectations, and maternal postadoption depression. Design: Adoptive mothers (N = 136) were surveyed for depressive symptoms using the Center for Epidemiologic Studies–Depression Scale (CES-D) and the Edinburgh Postnatal Depression Scale (EPDS). Analyses included correlations and a regression analysis between depressive symptoms and unmet expectations with the Five-Factor Model personality traits (extraversion, agreeableness, conscientiousness, emotional stability, openness to experience) as measured by the Ten-Item Personality Inventory. Results: Both the CES-D and EPDS were significantly, negatively correlated with all five personality dimensions. Mothers whose expectations of themselves as parents matched pre- and postplacement were more likely to be emotionally stable and extraverted. Approximately 36% of the variance in depressive symptoms was explained by personality traits (emotional stability: p < .0001). Conclusions: The postadoption period is a crucial time of transition for mothers and their children. Maternal emotional stability, depressive symptoms, and unmet expectations may affect this period. Mothers who are lower in emotional stability may be at risk for postadoptive depressive symptoms. In planning and providing innovative care that promotes positive mother–child relationships, nurses should assess adoptive mothers for depressive symptoms, emotional stability, and unmet expectations.

Shared mental models of patients, oncology providers, and primary care providers regarding roles in cancer survivorship care.

In 2009, the United States had an estimated 12.5 million cancer survivors, and an increase to 18 million by 2022 is projected. This volume places a great burden on the health care system, but little consensus exists regarding who should be responsible for providing follow-up care for cancer survivors. A shared care model between oncology providers and primary care providers (PCPs) is a survivorship care model recommended by the Institute of Medicine. Quantitative and qualitative studies have evaluated oncology and PCP roles, but no systematic review has been completed. The purpose of this review is to analyze the convergent and divergent views of provider roles in survivorship care from the perspective of cancer survivors, PCPs, and oncology providers using the conceptual framework of shared mental models, because a shared understanding of goals, roles, and coordination may enhance outcomes. A search using CINAHL, PubMed, and the Cochrane Database yielded 1,995 potential articles. Twenty-two studies fit inclusion criteria of primary research, conducted in the United States, written in English, and addressed views and perceptions of cancer survivors, PCPs, and oncologists regarding general survivorship care. Both PCPs and oncologists reported that they participate in survivorship care, with some expressing confidence in a shared care model. PCPs were identified as the providers of wellness care and oncologists as the providers of specialized cancer care for cancer survivors. Care continuity and the need for psychosocial support during the transition from active treatment to follow-up care were themes noted by all groups. The survivorship care plan was cited as a means to promote care continuity, improve communication, and prepare PCPs to make follow-up care decisions. Cancer survivors require ongoing support as they transition to survivorship care. PCPs and oncologists share this support through their roles in wellness and specialized cancer care, respectively. The survivorship care plan can guide decision making in shared care between PCPs and oncologists, 540099WJNXXX10.1177/0193945914540099Western Journal of Nursing Research research-article2014

Transitions of Adoptive Parents: A Longitudinal Mixed Methods Analysis

ABSTRACT As adoptive parents create a new family, they face myriad changes both pre‐and post‐placement of their child. The aim of this study was to describe parent perceptions and depressive symptoms during this transition via reports collected with an online survey. Using content analysis, we analyzed a total of 110 responses from 64 parents at three time points: 4–6 weeks pre‐placement, and 4–6 weeks and 5–6 months post‐placement. Five main themes were revealed: Transition from uncertainty to a new normal; unique experiences related to adoption; rest/fatigue: out of balance; life stressors; and faith/spirituality. Two subthemes were also identified: previous losses (pre‐placement) and joy and love (post‐placement). During the transition from pre‐to post‐placement, adoptive parents experience a unique passage, with both challenges and strengths exclusive to this group of parents. While acknowledging the commonalities of some parenting experiences, healthcare and adoption professionals should recognize the unique dynamics that adoption brings to families. HIGHLIGHTSIn addition to stressors experienced in life and due to the transition to a parenting role, adoptive parents encounter unique challenges.Psychiatric nurses should be aware of opportunities to therapeutically interact with parents before and after a child is placed in the home.Nurses’ awareness of the uncertainties prior to placement and post‐placement adoption circumstances is needed to optimize parental functioning.Resiliency factors, such as spirituality, may strengthen individuals as they transition to the role of being adoptive parents.

Personality traits, unmet expectations, and depressive symptoms in adoptive mothers.

There are two million adoptive parents in the United States with data suggesting some parents struggle with depression during the postadoption period. The purpose of this study was to explore maternal characteristics during this transition to parenthood by examining the association of personality traits with maternal expectations and depressive symptoms in newly adoptive mothers. Foli’s Mid-Range Theory of Parental Expectations was used as the Conceptual Framework, where the dissonance between met and unmet expectations may predict parental depressive symptoms. Findings are reported from a cross-sectional study of newly adoptive mothers who were recruited through an online adoption organization. Participants (N = 136) completed a survey that included specific maternal expectations, the Ten-Item Personality Inventory (TIPI), Center for Epidemiological Studies–Depression (CES-D) scale, Edinburgh Postnatal Depression Scale (EPDS), and measures of mother-to-child bonding. Depressive symptom rates in adoptive parents were 29% and 21% as measured by the CES-D and EPDS, respectively. The CES-D and EPDS were significantly negatively correlated with each dimension of the TIPI scale (extraversion, emotional stability, agreeableness, conscientiousness, and openness). Unmet maternal expectations of themselves and their children were significantly negatively associated with emotional stability, and mother-to-infant bonding was significantly positively associated with emotional stability. Almost one third of adoptive mothers in the sample met threshold levels for depressive symptoms, a finding with implications for the entire family. Emotional stability was significantly associated with depressive symptoms, maternal expectations, and maternal bonding. The postadoption period is a crucial time of transition and bonding for mothers and their children. Maternal emotional stability, depressive symptoms, and unmet expectations may affect this period. In planning and providing innovative care that promotes positive mother–child relationships, nurses

Shared mental models of cancer survivorship care

Quality cancer survivorship care relies on care continuity within the healthcare team. The purpose of this study was to explore the perspectives of healthcare team members regarding cancer survivorship care using the framework of shared mental models. Semi-structured interviews of cancer survivors, primary support individuals, oncology providers, primary care providers and registered nurses were completed. Data were extrapolated to seven primary themes with associated secondary themes. Primary themes included survivor definition and identity, care setting, team member roles, care gaps, survivor needs, barriers to care and facilitators of care. Through these themes, participants emphasised the individuality of the survivorship experience, acknowledged care gaps and described ongoing needs of cancer survivors. Information provision and communication were noted as care facilitators. Through clarification of team member roles, healthcare providers will be equipped to promote cancer survivor transition by focusing on care continuity, communication and collaboration.