Rhonda Small

Generating best evidence from qualitative research : the role of data analysis

Objective: To outline the importance of the clarity of data analysis in the doing and reporting of interview‐based qualitative research.

Association between depression and abuse by partners of women attending general practice: descriptive, cross sectional survey

Abstract Objective To explore the association between depression and physical, emotional, and sexual abuse by partners or ex-partners of women attending general practice. Design Descriptive, cross sectional survey. Setting 30 general practitioners in Victoria, Australia. Participants 1257 consecutive female patients. Main outcome measures Some type of abuse in an adult intimate relationship (composite abuse scale), depression (Beck depression inventory or Edinburgh postnatal depression scale), and physical health (SF-36). Results 18.0% (218/1213) of women scored as currently probably depressed and 24.1% (277/1147) had experienced some type of abuse in an adult intimate relationship. Depressed women were significantly more likely to have experienced severe combined abuse than women who were not depressed after adjusting for other significant sociodemographic variables (odds ratio 5.8, 95% confidence interval 2.8 to 12.0). These variables included not being married, having a poor education, being on a low income, being unemployed or receiving a pension, pregnancy status, or being abused as a child. Conclusion Physical, emotional, and sexual abuse are strongly associated with depression in women attending general practice. Doctors should sensitively ask depressed women about their experiences of violence and abuse in intimate relationships. Research into depression should include measures of partner abuse in longitudinal and intervention studies.

Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth

Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

Objective  This study aimed to investigate pregnancy outcomes in Somali‐born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden.

Cross-cultural experiences of maternal depression: associations and contributing factors for Vietnamese, Turkish and Filipino immigrant women in Victoria, Australia

Objectives. To investigate in an Australian study of immigrant women conducted 6–9 months following childbirth (a) the associations of a range of demographic, obstetric, health and social context variables with maternal depression, and (b) womens views of contributing factors in their experiences of depression. Design. Three hundred and eighteen Vietnamese, Turkish and Filipino women participated in personal interviews conducted by three bicultural interviewers in the language of the womens choice. Utilising three approaches to the assessment of maternal depression, the consistency of associations on the different measures is examined. Womens views of contributing factors are compared with previous research with largely English-speaking Australian-born women. Results. Analysis of the associations of maternal depression revealed considerable consistency in associations among the three approaches to assessing depression. Significant associations with depression on at least two of the measures were seen for: mothers under 25 years, shorter residence in Australia, speaking little or no English, migrating for marriage, having no relatives in Melbourne, or no friends to confide in, physical health problems, or a baby with feeding problems. There were no consistent associations found with family income or maternal education, method of delivery and a range of other birth events, or womens views about maternity care. The issues most commonly identified by women in this study as contributing to depression are similar to those found previously for Australian-born women: isolation (in this study, including being homesick)—29%; lack of support and marital issues—25%; physical ill-health and exhaustion—23%; family problems—19%, and baby-related issues—17%. There were some differences in the importance of these among the three country-of-birth groups, but all except family issues were in the top four contributing factors mentioned by women in all groups. Conclusions. These findings support the evidence for quite marked cross-cultural similarity in the associations of maternal depression and in womens views about their experiences.

Stillbirths and infant deaths among migrants in industrialized countries

Introduction. The relation of migration to infant outcomes is unclear. There are studies which show that some migrant groups have similar or even better outcomes than those from the receiving country. Equally, raised risk of adverse outcomes for other migrant groups has been reported. Objective. We sought to determine (1) if migrants in western industrialized countries have consistently higher risks of stillbirth, neonatal mortality, or infant mortality, (2) if there are migrant sub‐groups at potentially higher risk, and (3) what might be the explanations for any risk differences found. Design and Setting. Systematic review of the literature on perinatal health outcomes among migrants in western industrialized countries. Methods and Main outcome measures. Drawing on a larger systematic review of perinatal outcomes and migration, we reviewed studies including mortality outcomes (stillbirths and infant deaths). Results. Eligible studies gave conflicting results. Half (53%) reported worse mortality outcomes, one third (35%) reported no differences and a few (13%) reported better outcomes for births to migrants compared to the receiving country population. Refugees were the most vulnerable group. For non‐refugees, non‐European migrants in Europe and foreign‐born blacks in the United States had the highest excess mortality. In general, adjustment of background factors did not explain the increased mortality rate among migrants. Regarding causes of death, higher preterm birth rates explained the increased mortality figures among some migrant groups. The increased mortality from congenital anomalies may be related to restricted access to screening, but also to differing attitudes to screening and termination of pregnancy. Conclusions. Mortality risk among babies born to migrants is not consistently higher, but appears to be greatest among refugees, non‐European migrants to Europe, and foreign‐born blacks in the US. To understand this variation better, more information is needed about migrant background, such as length of time in receiving country and receiving country language fluency. Additional data on demographic, health care, biological, medical, and socioeconomic risk factors should be gathered and analyzed in greater detail.

Missing voices: What women say and do about depression after childbirth

Abstract Women who had participated in a population based survey at 8–9 months after childbirth and who had scored as depressed at that time on a well-validated self report instrument, the Edinburgh Postnatal Depression Scale (EPDS), were followed up 12–18 months later when the babies were around 2 years of age. Home interviews were conducted with this case group (n = 45, EPDS score > 12) and with a randomly selected control group (comprising women who had not scored as depressed at the time of the survey, n = 45, EPDS score < 9). Although most women who had scored as depressed also perceived themselves as having been depressed, a third did not want to label this experience postnatal depression. Women who reported feeling depressed believed the contributing factors to be lack of support, isolation, fatigue and physical ill health. Only two in five women in the case group had sought any form of professional assistance. Half die women in the case group had sought help from non-professional sources, mainly f...

Mothers' AdvocateS In the Community (MOSAIC)- non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care

AbstractBackgroundEffective interventions to increase safety and wellbeing of mothers experiencing intimate partner violence (IPV) are scarce. As much attention is focussed on professional intervention, this study aimed to determine the effectiveness of non-professional mentor support in reducing IPV and depression among pregnant and recent mothers experiencing, or at risk of IPV.MethodsMOSAIC was a cluster randomised trial in 106 primary care (maternal and child health nurse and general practitioner) clinics in Melbourne, Australia. 63/106 clinics referred 215 eligible culturally and linguistically diverse women between January 2006 and December 2007. 167 in the intervention (I) arm, and 91 in the comparison (C) arm. 174 (80.9%) were recruited. 133 (76.4%) women (90 I and 43 C) completed follow-up at 12 months. Intervention: 12 months of weekly home visiting from trained and supervised local mothers, (English & Vietnamese speaking) offering non-professional befriending, advocacy, parenting support and referrals. Main outcome measures: Primary outcomes; IPV (Composite Abuse Scale CAS) and depression (Edinburgh Postnatal Depression Scale EPDS); secondary measures included wellbeing (SF-36), parenting stress (PSI-SF) and social support (MOS-SF) at baseline and follow-up. Analysis: Intention-to-treat using multivariable logistic regression and propensity scoring.ResultsThere was evidence of a true difference in mean abuse scores at follow-up in the intervention compared with the comparison arm (15.9 vs 21.8, AdjDiff -8.67, CI -16.2 to -1.15). There was weak evidence for other outcomes, but a trend was evident favouring the intervention: proportions of women with CAS scores ≥7, 51/88 (58.4%) vs 27/42 (64.3%) AdjOR 0.47, CI 0.21 to 1.05); depression (EPDS score ≥13) (19/85, 22% (I) vs 14/43, 33% (C); AdjOR 0.42, CI 0.17 to 1.06); physical wellbeing mean scores (PCS-SF36: AdjDiff 2.79; CI -0.40 to 5.99); mental wellbeing mean scores (MCS-SF36: AdjDiff 2.26; CI -1.48 to 6.00). There was no observed effect on parenting stress. 82% of women mentored would recommend mentors to friends in similar situations.ConclusionNon-professional mentor mother support appears promising for improving safety and enhancing physical and mental wellbeing among mothers experiencing intimate partner violence referred from primary care.Trial registrationACTRN12607000010493http://www.anzctr.org.au

Cross-cultural research: trying to do it better. 2. Enhancing data quality.

Objective: To discuss a range of strategies to address the methodological and practical challenges in designing cross‐cultural public health studies.

Support, sensitivity, satisfaction: Filipino, Turkish and Vietnamese women's experiences of postnatal hospital stay

OBJECTIVE To assess Filipino, Turkish and Vietnamese womens views about their care during the postnatal hospital stay. DESIGN Interviews were conducted with recent mothers in the language of the womens choice, 6-9 months after birth, by three bilingual interviewers. PARTICIPANTS Three hundred and eighteen women born in the Philippines (107), Turkey (107) and Vietnam (104) who had migrated to Australia. SETTING Women were recruited from the postnatal wards of three maternity teaching hospitals in Melbourne, Australia, and interviewed at home. FINDINGS Overall satisfaction with care was low, and one in three women left hospital feeling that they required more support and assistance with both baby care and their own personal needs. The method of baby feeding varied between the groups, with women giving some insight into the reason for their choice. A significant minority wanted more help with feeding, irrespective of the method. The need for rest was a recurrent theme, with women stating that staffs attitudes to individual preferences, coupled with lack of assistance, made this difficult. The majority of comments women made regarding their postnatal stay focused on the attitude and behaviour of staff and about routine aspects of care. Issues related to culture and cultural practices were not of primary concern to women. CONCLUSION Maternity services need to consider ways in which care can focus on the individual needs and preferences of women.