Sara Holton

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

OBJECTIVE To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. METHODS Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. FINDINGS Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CONCLUSION CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

Postpartum emotional support: a qualitative study of women's and men's anticipated needs and preferred sources

Australian health policy emphasises prevention, early intervention and improved pathways to treatment for perinatal mental disorders. Primary care is vital to achieving these aims. The aim of this study was to understand the anticipated needs and preferred sources of mental health information and support of men and women expecting their first baby. Nulliparous English-speaking expectant parents attending childbirth education programs in public and private hospitals participated in single sex small group discussions in late pregnancy. Discussions were audio-recorded, transcribed and analysed thematically using the group as the unit of analysis. Eight groups (22 women; 16 men) encompassing diverse socioeconomic circumstances were conducted. Analyses showed idealised fantasies consistently tempered with realistic expectations about adjustment to life with a baby. However, there were diverse and gendered views about whether primary care providers should discuss mental health with parents of infants and willingness to complete written questionnaires or be referred for specialist mental health care. Men regard primary family care as mother not father inclusive. Expectant parents readily anticipate realistic postnatal adjustment and need for emotional support. Increased provision of services that meet mens needs and public understanding and acceptance of Australian integrated models of primary postnatal mental health care are needed.

Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey.

Objective: Mistimed, unexpected or unwanted pregnancies occur in Australia, despite widespread contraception use. The objective was to estimate prevalence and ascertain modifiable social factors for prevention of unintended pregnancy.

Polyvictimization among children and adolescents in low- and lower-middle-income countries: a systematic review and meta-analysis

Background: Most of the world’s children and adolescents live in low- and lower-middle-income countries (LALMIC), but there is limited evidence about polyvictimization (experiences of multiple forms of victimization) among them. The aims of this article were to systematically review the evidence from LALMIC about the overall prevalence of polyvictimization and to identify the associations between polyvictimization and health and well-being among children and adolescents. Method: A systematic search of the English-language peer-reviewed literature to identify empirical, quantitative studies conducted in LALMIC between 2005 and 2015, assessing at least four forms of victimization among young people aged up to 19 years. Where prevalence of any victimization and of polyvictimization were reported, meta-analyses were performed. Results: A total of 30/8,496 articles were included in the review. Evidence was available from 16/84 LALMIC and methodology and quality varied. Pooled prevalence of experiences of any victimization was 76.8% (95% confidence interval (CI) [64.8%, 88.9%]). Prevalence of polyvictimization ranged from 0.3% to 74.7% with an overall estimate of 38.1% (95% CI [18.3%, 57.8%]). None of the studies examined the associations between polyvictimization and physical or reproductive health or quality of life. Polyvictimization was associated with increased likelihood of mental health problems and involvement in health risk behaviors. Conclusions: Experiences of polyvictimization among children and adolescents in LALMIC are more prevalent than in high- and upper-middle-income countries and contribute to the burden of poor health among children and adolescents. Most LALMIC lack local data, and research is required to address this knowledge gap.

Poly-Victimisation among Vietnamese High School Students: Prevalence and Demographic Correlates.

Background Exposure to multiple forms of violence, including abuse and crime is termed poly-victimisation. There has been increasing research interest in poly-victimisation among children and adolescents in high income countries. However, experiences among adolescents living in low- and lower-middle-income countries are yet to be examined. Aims To establish the prevalence of lifetime exposure to poly-victimisation and demographic characteristics of victims among high school students in Vietnam. Methods A cross-sectional survey with a self-report, anonymous questionnaire was conducted in ten high schools in Hanoi, Vietnam between October 2013 and January 2014. Poly-victimisation was assessed using the Juvenile Victimisation Questionnaire Revised 2 (JVQ R2). Results A total of 1,606/1,745 (92.0%) eligible students provided data and were included in the analyses. Lifetime exposure to at least one form of victimisation was reported by 94.3% (95%CI: 92.5-95.4%) of participants and lifetime exposure to more than 10 forms by 31.1% (95%CI: 27.8-33.5%). Poly-victimisation was associated with experiencing more adverse life events, having a chronic disease or disability, living with a step-parent, experiencing family life as unhappy, being disciplined at school, and living in a rural area. Poly-victimisation experiences differed among students from the three types of high schools in Vietnam. Conclusions These data reveal the prevalence and multi-factorial risks of exposure to poly-victimisation among adolescents in Vietnam. Prevalence rates of different forms of victimisation among Vietnamese students, including those previously un-investigated, were higher than those reported in other settings. Poly-victimisation was also common among them. There were certain subgroups who were more vulnerable to poly-victimisation. Further research to understand the broader aspects of adolescence in Vietnam, including poly-victimisation, is thus recommended. Special attention should be paid to specific subgroups in the prevention of violence against children and adolescents in this setting. Education to raise awareness about poly-victimisation among the community is needed.

The childbearing concerns and related information needs and preferences of women of reproductive age with a chronic, noncommunicable health condition: a systematic review.

BACKGROUND Certain chronic health conditions and their treatments may compromise womens fertility; some chronic conditions are more likely to affect women of reproductive age than others, and some are heritable. All have implications for womens future childbearing and fertility management. OBJECTIVE The aim of this systematic review was to identify the concerns about childbearing and related information needs and preferences of women with a chronic, noncommunicable health condition. METHOD The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Relevant social science and medical science databases (Ovid MEDLINE, ProQuest, and CINAHL plus) were searched for peer-reviewed, English-language papers published from 1995 to August 2012 of empirical research using quantitative or qualitative methods. RESULTS Of the 5,350 articles identified, 29 met inclusion criteria and were reviewed. Despite variation in methods, the studies demonstrated consistently that women with a chronic health condition are concerned about childbearing and have questions about the reproductive implications of their condition. The evidence suggests that there is less consistency about womens preferences for the mode and timing of information about the effect of the condition and its treatment on childbearing. Most research to date has focused on the needs and experiences of women with cancer; there is almost none about other noncommunicable conditions. CONCLUSION There are serious evidence gaps about the childbearing concerns and related information needs and preferences of women with chronic, noncommunicable health conditions. Research is required to address these gaps and to inform the development of appropriate tools to assist women in this situation with their childbearing decisions.

Long-acting reversible contraception: Findings from the Understanding Fertility Management in Contemporary Australia survey

Objectives The aim of this research was to investigate awareness, perceived reliability and consideration of use of long-acting reversible contraception (LARC) among Australians of reproductive age. Methods A sample of 18- to 50-year-old women and men (N = 2235) was randomly recruited from the Australian electoral roll in 2013. Respondents completed a self-administered, anonymous questionnaire. Data were weighted to reduce non-response bias. Factors associated with perceived reliability and consideration of use of LARC were identified in multivariable analyses. Results Most respondents had heard of implants (76.5%) and intrauterine contraception (63.7%). However, most did not think implants (56.3%) or IUDs (63.9%) were reliable and would not consider using implants (71.6%) or IUDs (77.5%). Those significantly more likely to perceive LARC as reliable were younger, did not regard religion as important in fertility choices, had private health insurance, had been pregnant and had had an abortion; and women who had a partner. Those more likely to consider using LARC were younger and did not regard religion as important in fertility choices; women who had private health insurance, lived in an area of socioeconomic advantage and had had an abortion; and men without a partner, born in Australia and comfortable talking to a health care provider about contraceptive matters. Conclusions Despite high awareness of LARC among Australian adults, its perceived reliability and willingness to use it remain low in certain groups. Targeted interventions that aim to increase knowledge of the benefits and reliability of LARC and allow informed use are recommended.

Women's Health and Their Childbearing Expectations and Outcomes: A Population-Based Survey from Victoria, Australia

CONTEXT Financial and employment concerns are commonly regarded as the most important factors determining Australian womens childbearing. However, little is known about the relationship between womens health and their childbearing. METHODS We investigated the relationship between health and childbearing expectations and outcomes in a population-based sample of women living in Victoria, one Australian state (n = 569), recruited from the Australian Electoral Roll in 2005. Participants completed a self-administered, anonymous questionnaire. MAIN FINDINGS Health problems were identified by many participants as a salient factor in their childbearing, and were often an obstacle that prevented them from achieving their ideal childbearing outcomes. CONCLUSION The results challenge the prevailing view that womens childbearing is mostly voluntary, and primarily based on financial considerations or career ambitions. To assist women in achieving their childbearing preferences, appropriate health care and policies are required.

A feasibility study of the provision of a personalized interdisciplinary audiovisual summary to facilitate care transfer care at hospital discharge: Care Transfer Video (CareTV)

OBJECTIVE To assess the feasibility and patient acceptance of a personalized interdisciplinary audiovisual record to facilitate effective communication with patients, family, carers and other healthcare workers at hospital discharge. DESIGN Descriptive pilot study utilizing a study-specific patient feedback questionnaire conducted from October 2013 to June 2014. SETTING AND PARTICIPANTS Twenty General Medical inpatients being discharged from an Acute General Medical Ward in a metropolitan teaching hospital. INTERVENTION Audiovisual record of a CareTV filmed at the patients bedside by a consultant-led interdisciplinary team, within 24 h prior to discharge from the ward, provided immediately for the patient to take home. Patient surveys were completed within 2 weeks of discharge. MAIN OUTCOME MEASURES Technical quality, utilization, acceptability, patient satisfaction and recall of diagnosis, medication changes and post-discharge review arrangements. RESULTS All patients had watched their CareTV either alone or in the presence of a variety of others: close family, their GP, a medical specialist, friends or other health personnel. Participating patients had good understanding of the video content and recall of their diagnosis, medication changes and post-discharge plans. Patient feedback was overwhelmingly positive. CONCLUSIONS In the context of a General Medical Unit with extensive experience in interdisciplinary bedside rounding and teamwork, CareTV is simple to implement, inexpensive, technically feasible, requires minimal staff training and is acceptable to patients. The results of this pilot study will inform and indicate the feasibility of conducting a larger randomized control trial of the impact of CareTV on patient satisfaction, medication adherence and recall of key information, and primary healthcare provider satisfaction.

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Abstract Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia. Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use. Results: Most respondents (n = 1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p = .008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p = .026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p < .001), and not considering religion important to fertility choices (OR 0.43; 95%CI 0.31, 0.60; p < .001). A third used effective contraceptive methods (n = 534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p = .002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p < .001), and not have private health insurance (OR 0.52; 95% CI 0.38, 0.71; p < .001). Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.