Patricia Jarrett

Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation

Objectives: To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. Design: Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n = 67) or standard services (n = 64). Incremental cost analysis. Setting: 40 general practitioner practices across 2 counties in the UK. Participants: 131 vulnerable pregnant women. Intervention: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally. Main outcome measures: Mother–child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. Results: At 12 months, differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group were found. The mean incremental cost per infant of the home visiting intervention was £3246 (bootstrapped 95% CI for the difference £1645–4803). Conclusion: This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.

Pregnant women’s experience of depression care

Purpose – Up to 25 per cent of women will experience depression during their pregnancy. Perinatal mental health problems are a leading cause of maternal morbidity and mortality, however care provided to women is often a low priority. The purpose of this paper is to explore women’s perspective of care from GPs and midwives, when they experience symptoms of depression during pregnancy. Design/methodology/approach – Women, with self-reported symptoms of depression, were invited to post comments in response to a series of on-line questions posted on two discussion forums over a nine month period. The questions were related to the care women received from GPs and midwives. Data were analysed using thematic analysis. Findings – In total, 22 women responded to the on-line questions. A number of themes were identified from the data including women’s disclosure of symptoms to GPs and midwives; lack of knowledge of perinatal mental health among health providers; attitudes of staff and systemic issues as barriers to...

Response to Editorial, who can be a legitimate author on an article?

I am writing in response to a recent editorial entitled, Who can be a legitimate author on an article?. The focus of the editorial was to clarify legitimacy of authorship in the publication of academic papers in journals such as Women and Birth. Professor Sweet identified several common pitfalls with author legitimacy, for example, the use of “ghost” or “guest” authors, confusion over multiple authorship and authors who “back away” from responsibility when things go wrong. Professor Sweet went on to define authorship as involving three key concepts comprising contribution, responsibility and ethical conduct and concluded with a recommendation that publication misconduct should be addressed through contact with the Editor in Chief of the journal concerned. The process was presented as relatively straightforward with a clear strategy to resolve issues—so far so good. However, there are omissions within this editorial which render it problematic. For a start, Professor Sweet fails to recognise the context in which academia operates (often one of nepotism and bullying) or acknowledge the power dynamic that exists between junior and senior staff (rigid hierarchy). I believe it is irresponsible to advise individuals (especially those in junior or fixed term posts) that they should raise concerns about publication misconduct with those outside the institute as this would inevitably affect their employment and career, whether conducted in confidence or not.

How do women’s self-report symptoms impact on identification of perinatal mental health problems?

Purpose Perinatal depression is common and increases the risk of adverse outcomes for both the mother and child. Despite regular contact with midwives and GPs during the perinatal period less than 50 per cent of women with depression are identified and treated. A number of reasons for this have been proposed; however, failure of health professionals to recognise the symptoms women present with may contribute. The purpose of this paper is twofold: to explore women’s self-report symptoms of perinatal depression and understand how the symptoms women present with might impact on identification. Design/methodology/approach Women were invited to post their experiences of perinatal depression on one of two online discussion forums over a nine-month period. Data were analysed using a process of deductive thematic analysis informed by cognitive behavioural therapy. Findings Women’s symptoms were presented using five headings: triggers (for perinatal depression), thoughts, moods, physical reactions and behaviours. Women believed having a previous mental health problem contributed to their depression. Women’s self-report symptoms included intrusive and violent thoughts; emotional responses including fear, worry and anger; and somatic symptoms including insomnia and weight changes. Women also reported aggressive behaviour and social withdrawal as part of their depressive symptomatology. Symptoms women present with may negatively impact on identification as they often overlap with those of pregnancy; may not be included in the criteria for mental health assessment and may involve undesirable and socially unacceptable behaviour, making disclosure difficult. Practical implications A more inclusive understanding of women’s self-report symptoms of perinatal depression is called for, if identification is to improve. Originality/value This paper offers an analysis of women’s self-report symptoms of depression, in the context of identification of perinatal mental health problems.

Response to ‘Who should be an author on your academic paper?’

Dear Madam, I am responding to your editorial, Who should be an author on your academic paper? April 2014. It does not surprise me that there is misconduct with regard to authorship of academic journal papers. What does surprise me is that this has been reported as if it were a new and emerging problem. Offering authorship as a favour or incentive is a long and ongoing problem, I would suggest, of epdemic proportion. It certainly isn’t something new and it certainly isn’t going to go away. Academia is fiercely competitive and occurs within a strict hierarchy, allowing junior staff little opportunity to challenge the status quo – it is prime recipe for abuse. I don’t believe, however, your editorial addressed the complexity of the situation. I was disappointed that your editorial did not really address how a junior researcher or PhD student might challenge what they believed to be publication or academic misconduct. What do you do, if misconduct of this type is occurring? Employing assistance from organisations such as COPE and UKROI who propose to deal with academic misconduct, in my experience, is often lacking. These services are largely understaffed, overworked and generally tepid in their response and in what they can do. I am sure everyone has a horror story when they have tried to stand their ground and challenge behaviour they believe is less than optimal. Your editorial seems to imply that academic and publication misconduct is fairly easy and straightforward to challenge. I would suggest that this is far from the truth and, in fact is difficult if not impossible to achieve, especially for those in junior academic posts.