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Objective: To understand the experiences and perceptions of mental health providers about palliative care. Background: Little attention is paid to the experience of people with chronic persistent mental illness (CPMI) and life-threatening diseases and how their dying experience might differ from those without a CPMI. Methods: Interpretive description informed the project. Sixteen mental health care providers were interviewed using a semi-structured interview template. The interviews were recorded, transcribed, and analyzed using a reflexive, inductive-deductive thematic approach, guided by Braun & Clarke's framework for thematic analysis. Results: Four themes were identified from the data: intersectionality, limited collaboration, misconceptions about palliative care, and relationships. Mental health providers identified gaps in their knowledge of palliative care practices along with their knowledge of death and dying.

Objective: Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. Method: Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. Results: The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. Conclusions: Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.

Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms. Nurses' workplace stress is also linked to increased absenteeism and decreased job satisfaction., Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms., Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses' workplace stress, coping strategies, and depressive symptoms., Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items., Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses' work experiences and the unique contribution that workplace stressors have on their physical and mental health., Competing Interests: The authors have no conflict of interest to declare., (© The Author(s) 2022.)

Although there is literature that describes coping strategies of women who experience intimate partner violence (IPV), the definitions of common coping strategies and the two-dimensional model of coping styles (emotion-or problem-focused) may not fully delineate how these women manage their day-to-day lives. Using an Interpretive Description method and feminist standpoint principles, in-depth interviews were conducted with 40 Thai women regarding how they managed living in the context of IPV. Data were analyzed using an iterative thematic analysis procedure. In this study, the highly changeable and adaptive strategies use by participants could not be easily categorized into emotion-or action/problem-focused. Indeed, the strategies used by Thai women in this study were better described as survival focused. Based on our analysis, the process of managing their day-to-day life in the context of IPV revealed six major themes: keeping silent, disconnect between the fantasy of love and reality, seeking emotional support, ambivalence surrounding leaving, living with negative emotions, and despair and suicide. An undercurrent that was woven throughout multiple themes was the dominant lens of motherhood through which women made day-to-day decisions. These data also highlight the specific impacts that Thai society and religious beliefs have on increasing the risk of IPV and maintaining its duration. All levels of government, religious leaders, and public policy makers must engage in intersectoral initiatives to make public what is now private. Social and health service providers must create safe spaces where women can disclose IPV and where they can get funded multilevel supports to help them live independent of violence. The participants' stories give voice to why Thai health professionals need to fully engage with women to understand the past and current contexts of women's lives and how their experiences impact their health.

This project evaluates the acceptability and utilityof a storybook, entitled Unexpected: Parents' Experience of Preterm Birth , as an educational resource for parents in the neonatal intensive care unit (NICU). Forty-nine parents were recruited from Level II and Level III NICUs and completed several questionnaires; a subset of 11 parents also participated in focused qualitative interviews. Almost all parents experienced the characters as believable and agreed/strongly agreed that the stories accurately portray what it is like to be a parent in the NICU. The multiple narrators offer different perspectives of the NICU experience, which helped to normalize their experience and reminded them that they were not alone. Participants reported learning something new from the storybook and would recommend it to others.

People with a mental illness often encounter stigma and discrimination from a variety of sources, reinforcing negative self-perceptions and influencing their health and well-being. Even though support systems and attitudes of the general public act as powerful sources of stigma, views and perceptions held by people with mental illness also influence their sensitivity to the experiences they encounter. The aim of the present qualitative study was to examine perceptions of stigma and discrimination and self-stigma in individuals diagnosed with a mental illness. This study adopted a narrative, descriptive method, using a semistructured interview guide to elicit participant perceptions regarding sources of stigma, discrimination, and personal factors that might influence their experiences. Twelve outpatients attending a clinic in Ghana were interviewed. Thematic content analysis was completed and augmented by field notes. Participants' perceptions about personal impacts of stigma were found to be influenced by self-stigma, anticipated stigma and discrimination, perceived discrimination, and their knowledge about their illness. For many participants, their views served to augment societal views, and thus reinforce negative self-perceptions and their future. However, for other participants, their views served as a buffer in the face of environmental situations that reflect stigma and discrimination. Stigma is a complex, socially-sanctioned phenomenon that can seriously affect the health of people with mental illness. As such, it requires coordinated strategies among public policy makers, governmental bodies, and health-care providers to address stigma on a societal level, and to address its potential impacts on broad health outcomes for individuals with mental illness., (© 2017 Australian College of Mental Health Nurses Inc.)

A scoping review of the literature was conducted to compile existing evidence and identify gaps on detection methods and practices of antepartum and postpartum anxiety and depression symptoms and disorders in immigrant women. With the assistance of a health science librarian, four databases were searched between January and March 2016. Thirteen articles met the inclusion criteria and their findings were compiled using numerical summary and thematic analysis. No articles specifically addressing the screening of anxiety disorders or symptoms in antepartum or postpartum immigrant women were found. Some studies showed positive results for using translated tools. Other studies showed similarities in immigrant and non-immigrant assessment. However, several challenges in detection existed. Some of these challenges include cultural appropriateness of some questions and the accuracy of interpretive services and instrument translation. Limited literature was found, indicating a need to design and test targeted strategies to ensure that immigrant women are provided with appropriate antepartum and postpartum emotional support and mental health services based on appropriate policies and practices., (© 2017 Australian College of Mental Health Nurses Inc.)

Objective: To establish global research priorities for interpersonal violence prevention using a systematic approach., Methods: Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2., Findings: In round 2, "developing, implementing and evaluating interventions" was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, "scaling up interventions and evaluating their cost-effectiveness" was ranked lowest for all types of violence. In round 3, research into "developing, implementing and evaluating interventions" that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises., Conclusion: These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.

Background: Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening. However, few studies to date have identified barriers and facilitators that affect pregnant women's responses to mental health screening. The objective was to identify barriers and facilitators that influence pregnant women's responses to the screening process and factors associated with their identification., Methods: This multi-site, cross-sectional survey recruited pregnant women >16 years of age who spoke/read English in Alberta, Canada. Main outcomes were barriers and facilitators of mental health screening. Descriptive statistics were generated to identify the most common barriers and facilitators and multivariable logistic regression models were conducted to determine factors associated with barriers and facilitators., Results: Study participation rate was 92% (460/500). Women's most common barriers were: significant others normalizing their emotional difficulties; desiring to handle mental health problems on their own; preferring to discuss feelings with significant others; and not knowing what emotions were 'normal'. Women who identified these barriers were more likely not to have been treated previously for mental illness, were primiparous, and could not be completely honest with their provider. Main facilitators were provider characteristics (sensitive, interested), reassurance that mental healthcare is a part of routine prenatal care, hearing that other women have emotional problems during pregnancy and knowing that help was available., Limitations: The sample comprised largely Caucasian, well-educated, and partnered women, which limits generalizability of the findings., Conclusions: Personal and stigma-related barriers influence pregnant women's responses to mental health screening. Efforts to minimize barriers and enhance facilitators should be explored as potential strategies for optimizing prenatal mental health screening., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Introduction: The process of mental health screening can influence disclosure, uptake of referral, and treatment; however, no studies have explored pregnant women's views of methods of mental health screening. The objectives of this study are to determine pregnant women's comfort and preferences regarding mental health screening., Methods: Pregnant women were recruited (May-December 2013) for this cross-sectional descriptive survey from prenatal classes and maternity clinics in Alberta, Canada, if they were aged >16 years and spoke/read English. Descriptive statistics summarized acceptability of screening, and multivariable logistic regression identified factors associated with women's comfort with screening methods. Analysis was conducted in January-December 2014., Results: The participation rate was 92% (N=460/500). Overall, 97.6% of women reported that they were very (74.8%) or somewhat (22.8%) comfortable with mental health screening in pregnancy. Women were most comfortable with completing paper- (>90%) and computer-based (>82%) screening in a clinic or at home, with fewest reporting comfort with telephone-based screening (62%). The majority of women were very/somewhat comfortable with provider-initiated (97.4%) versus self-initiated (68.7%) approaches. Women's ability to be honest with their provider about emotional health was most strongly associated with comfort with each method of screening., Conclusions: The majority of pregnant women viewed prenatal mental health screening favorably and were comfortable with a variety of screening methods. These findings provide evidence of high acceptability of screening--a key criterion for implementation of universal screening--and suggest that providers can select from a variety of screening methods best suited for their clinical setting., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

We examined the stories of 12 women mothering growing children at the intersection of personal history (childhood violence experiences) and symbolic, structural, and ideological forces and conditions. Women revealed their determination to reweave a self and a world, that is, to continually reconstruct and reconfigure their lives to change the story for themselves and their children. Women's ability to reweave, however, was facilitated or challenged through intersections with family, networks, single stories, and prescribed rules and routines. We propose that reweaving work is a significant phenomenon to consider as deeper understandings of the dynamic experience of adult resilience are sought.

A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.

Background: Stress, depression, and anxiety affect 15 to 25% of pregnant women. However, fewer than 20% of prenatal care providers assess and treat mental health problems and fewer than 20% of pregnant women seek mental healthcare. For those who seek treatment, the lack of health system integration and existing barriers frequently prevent treatment access. Without treatment, poor prenatal mental health can persist for years and impact future maternal, child, and family well-being., Methods/design: The purpose of this randomized controlled trial is to evaluate the effectiveness of an integrated process of online psychosocial assessment, referral, and cognitive behavior therapy (CBT) for pregnant women compared to usual prenatal care (no formal screening or specialized care). The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6 to 8 weeks postrandomization. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. Pregnant women are eligible if they: 1) are <28 weeks gestation; 2) speak/read English; 3) are willing to complete email questionnaires; 4) have no, low, or moderate psychosocial risk on screening at recruitment; and 5) are eligible for CBT. A sample of 816 women will be recruited from large, urban primary care clinics and allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment, and those with mild or moderate depression, anxiety, or stress symptoms then complete six interactive cognitive behavior therapy modules. All women will complete email questionnaires at 6 to 8 weeks postrandomization and at 3, 6, and 12 months postpartum. Clinic-based providers and researchers conducting chart abstraction and analysis are blinded. Qualitative interviews with 8 to 10 healthcare providers and 15 to 30 intervention group women will provide data on feasibility and acceptability of the intervention. Results of this trial will determine the feasibility and effectiveness of an integrated approach to prenatal mental healthcare and the use of highly accessible computer-based psychosocial assessment and CBT on maternal, infant, and family-based outcomes., Trial Registration: ClinicalTrials.gov Identifier: NCT01901796.

Background: We used population-based data to determine the public's views of prenatal and postnatal mental health and to identify predictors of those views., Methods: A computer-assisted telephone survey was conducted by the Population Health Laboratory (University of Alberta) with a random sample of participants from the province of Alberta, Canada. Respondents were eligible to participate if they were: 1) ≥18 years; and 2) contacted by direct dialing. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Descriptive and multivariable regression analyses were conducted., Results: Among the 1207 respondents, 74.7% had post-secondary education, 16.3% were in childbearing years, and over half (57.4%) reported knowing a woman who had experienced postpartum depression. Significantly more respondents had high levels of knowledge of postnatal (87.4%) than prenatal (70.5%) mental health (p < .01). Only 26.6% of respondents accurately identified that prenatal anxiety/depression could negatively impact child development. Personal knowledge of a woman with postpartum depression was a significant predictor of prenatal and postnatal mental health knowledge., Conclusions: While the public's knowledge of postnatal mental health is high, knowledge regarding prenatal mental health and its influence on child development is limited. Strategies for improving perinatal mental health literacy should target these knowledge deficits.

Background: At a prevalence rate of 13-25%, mental health problems are among the most common morbidities of the prenatal and postnatal periods. They have been associated with increased risk of preterm birth and low birthweight, child developmental delay, and poor child mental health. However, very few pregnant and postpartum women proactively seek help or engage in treatment and less than 15% receive needed mental healthcare. While system-related barriers limit accessibility and availability of mental health services, personal barriers, such as views of mental health and its treatment, are also cited as significant deterrents of obtaining mental healthcare. The purposes of this population-based study were to identify the public's views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views., Methods: A computer-assisted telephone survey was conducted by the Population Research Laboratory with a random sample of adults in Alberta, Canada. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Interviews were conducted in English and were less than 30 minutes in duration. Descriptive and multivariable regression analyses were conducted., Results: Among the 1207 respondents, 74.8% had post-secondary education, 16.3% were 18-34 years old, and two-thirds (66.1%) did not have children <18 years living at home. The majority of respondents strongly agreed/agreed that all women should be screened in the prenatal (63.0%) and postpartum periods (72.7%). Respondents reported that when seeking help and support their first choice would be a family doctor. Preferred treatments were talking to a doctor or midwife and counseling. Knowledge of perinatal mental health was the main factor associated with different treatment preferences., Conclusions: The high acceptability of universal perinatal mental health screening among the public provides a strong message regarding the public value for routine screening during pregnancy and postpartum periods. Perinatal mental health literacy is the most prominent determinant of screening and treatment acceptability and preference. Efforts to enhance population literacy as part of a multifaceted perinatal mental health strategy may optimize pregnant and postpartum women's mental health.

Background: Stress, depression, and anxiety affect 15% to 25% of pregnant women. However, substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. Moreover, pregnant women are often reluctant to disclose their mental health concerns to a healthcare provider. Identifying screening and assessment tools and procedures that are acceptable to both women and service providers, cost-effective, and clinically useful is needed., Methods/design: The primary objective of this randomized, parallel-group, superiority trial is to evaluate the feasibility and acceptability of a computer tablet-based prenatal psychosocial assessment (e-screening) compared to paper-based screening. Secondary objectives are to compare the two modes of screening on: (1) the level of detection of prenatal depression and anxiety symptoms and psychosocial risk; (2) the level of disclosure of symptoms; (3) the factors associated with feasibility, acceptability, and disclosure; (4) the psychometric properties of the e-version of the assessment tools; and (5) cost-effectiveness. A sample of 542 women will be recruited from large, primary care maternity clinics and a high-risk antenatal unit in an urban Canadian city. Pregnant women are eligible to participate if they: (1) receive care at one of the recruitment sites; (2) are able to speak/read English; (3) are willing to be randomized to e-screening; and (4) are willing to participate in a follow-up diagnostic interview within 1 week of recruitment. Allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment on a computer tablet, while those in the control group will complete the same assessment in paper-based form. All women will complete baseline questionnaires at the time of recruitment and will participate in a diagnostic interview within 1 week of recruitment. Research assistants conducting diagnostic interviews and physicians will be blinded. A qualitative descriptive study involving healthcare providers from the recruitment sites and women will provide data on feasibility and acceptability of the intervention. We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening., Trial Registration: ClinicalTrials.gov Identifier: NCT01899534.

Critical feminist narrative inquiry is informed by the theoretical triangulation of critical, feminist, and symbolic interactionist perspectives. We first locate this approach within narrative research and identify the epistemological underpinnings and assumptions supporting this innovative methodology. The analytic and interpretive objectives and processes involved to achieve a double-hermeneutic narrative analysis are detailed. We conclude by proposing that this novel approach is suitable to advance knowledge about the nature and context of individual experiences, to expose circumstances leading to social injustice and health inequities, and ultimately to contribute to improved health outcomes for traditionally silenced, marginalized, or vulnerable populations.

Background: Research has shown that exposure to interpersonal violence is associated with poorer mental health outcomes. Understanding the impact of interpersonal violence on mental health in the early postpartum period has important implications for parenting, child development, and delivery of health services. The objective of the present study was to determine the impact of interpersonal violence on depression, anxiety, stress, and parenting morale in the early postpartum., Methods: Women participating in a community-based prospective cohort study (n = 1319) completed questionnaires prior to 25 weeks gestation, between 34-36 weeks gestation, and at 4 months postpartum. Women were asked about current and past abuse at the late pregnancy data collection time point. Postpartum depression, anxiety, stress, and parenting morale were assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Index, the Cohen Perceived Stress Scale, and the Parenting Morale Index, respectively. The relationship between interpersonal violence and postpartum psychosocial health status was examined using Chi-square analysis (p < 0.05) and multivariable logistic regression., Results: Approximately 30% of women reported one or more experience of interpersonal violence. Sixteen percent of women reported exposure to child maltreatment, 12% reported intimate partner violence, and 12% reported other abuse. Multivariable logistic regression analysis found that a history of child maltreatment had an independent effect on depression in the postpartum, while both child maltreatment and intimate partner violence were associated with low parenting morale. Interpersonal violence did not have an independent effect on anxiety or stress in the postpartum., Conclusion: The most robust relationships were seen for the influence of child maltreatment on postpartum depression and low parenting morale. By identifying women at risk for depression and low parenting morale, screening and treatment in the prenatal period could have far-reaching effects on postpartum mental health thus benefiting new mothers and their families in the long term.

The purpose of this study is to present an understanding of the experience of Brazilian homemakers with type 2 diabetes mellitus (DM2). A descriptive exploratory design was used and semi-structured interviews were conducted with 25 Brazilian homemakers concerning their experience. The interviews were recorded, transcribed, and the resulting text was analyzed using the sequential step method. Data converged to one dominant category, "constructing one's identity in the family context", which is comprised of three categories: gender differences; day-to-day concerns; and incongruity between knowledge and behavior related to DM2. These findings suggest that participants construct their identities within the family context and that their experience of living with DM2 is integral to their self-identification as wives and mothers. This, in turn, has implications for the design and implementation of programs to assist women in managing DM2 effectively.

Objective: Peritraumatic dissociative responses have been identified as strong predictors of subsequent posttraumatic stress disorder development. We aimed to clarify the mechanism by which peritraumatic dissociation is related to PTSD development by exploring the neural correlates of peritraumatic dissociation during posttraumatic adjustment., Method: We combined a prospective questionnaire study with a neuroimaging paradigm in an acutely traumatized sample recruited from the emergency department from 2004 until 2009. 121 acutely traumatized subjects were assessed for acute stress disorder, PTSD, and dissociative symptoms at 3 time points within the first 3 months post trauma. A subsample of 21 subjects underwent a script-driven 4-Tesla functional magnetic resonance imaging scan 2 to 4 months post trauma., Results: Peritraumatic dissociation predicted PTSD diagnostic status at 5-6 weeks and 3 months over and above childhood trauma (Wald = 4.035, P = .045; Wald = 4.793, P = .029, respectively). Peritraumatic dissociation scores were positively correlated with activation in the right occipital lobe, ie, the lingual (Brodmann area [BA] 18, z = 3.37), fusiform (BA 19, z = 3.64), and parahippocampal (BA 19, z = 3.25) gyri. After covariation of dissociation at the time of the scan, peritraumatic dissociation remained positively correlated with activation in the right lingual (BA 18, z = 3.21) and fusiform (BA 19, z = 3.55) gyri., Conclusions: The neuroimaging findings indicate that peritraumatic dissociation is associated with greater activation of the right occipital lobe (BAs 18 and 19), a region previously implicated in vivid autobiographical memory recall of highly emotional events. These results suggest that peritraumatic dissociation directly leads to the formation of intrusive memories. Peritraumatic dissociation and childhood trauma emerged as valuable predictors of PTSD development and therefore can guide the identification of individuals at risk., (© Copyright 2012 Physicians Postgraduate Press, Inc.)

Objective: Resilience refers to the ability to thrive despite adversity and is defined as a multidimensional phenomenon, spanning internal locus of control, sense of meaning, social problem-solving skills, and self-esteem. We aimed to investigate the predictive value of resilience for the development of posttraumatic stress disorder (PTSD) and to examine the neural correlates mediating the relationship between resilience and recovery from a traumatic event in acutely traumatized subjects. We hypothesized that resilience would mediate the relationship between childhood trauma and posttraumatic recovery., Method: We conducted a prospective study with 70 acutely traumatized subjects with DSM-IV PTSD recruited at the emergency department, assessing PTSD symptom severity at 3 time points within the first 3 months posttrauma. Scores for childhood trauma as assessed with the Childhood Trauma Questionnaire and trait resilience as assessed with the Connor-Davidson Resilience Scale were used as predictors of symptom severity. A subsample of 12 subjects additionally underwent a functional 4 Tesla magnetic resonance imaging scan 2 to 4 months posttrauma. We employed the traumatic script-driven imagery paradigm to assess the correlations between trait resilience and blood oxygen level-dependent (BOLD) response. The study was conducted from 2003 to 2007., Results: Resilience predicted PTSD symptom severity at 5 to 6 weeks (β = -0.326, P = .01) as well as at 3 months (β = -0.423, P = .003) posttrauma better than childhood trauma. Resilience essentially mediated the relationship between childhood trauma and posttraumatic adjustment. Resilience scores were positively correlated with BOLD signal strength in the right thalamus as well as the inferior and middle frontal gyri (Brodmann area 47)., Conclusions: This pilot investigation revealed a significant relationship between resilience and emotion regulation areas during trauma recall in an acutely traumatized sample. Resilience was established as a significant predictor of PTSD symptom severity and mediated the influence of childhood trauma on posttraumatic adjustment., (© Copyright 2012 Physicians Postgraduate Press, Inc.)

We explored the experiences of 12 women who mothered their children while they encountered challenges stemming from the legacy of childhood violence experiences. We examined the participants' narratives through critical, feminist, and symbolic interaction lenses to locate the forces and conditions facilitating and constraining women's mothering choices and decisions. Women's stories revealed their agency in the face of enduring distrust experiences. Women were determined to "change the story." They met pervasive self-doubt with a "search for anchors" and "constant comparisons." Persistent distrust of others meant women relied on "hypervigilance" and "gatekeeping." Implications for knowledge development, research, and practice are discussed.

Background: Imaging studies of pain processing in primary psychiatric disorders are just emerging. This study explored the neural correlates of stress-induced analgesia in individuals with posttraumatic stress disorder (PTSD). It combined functional magnetic resonance imaging (fMRI) and the traumatic script-driven imagery symptom provocation paradigm to examine the effects of trauma-related cues on pain perception in individuals with PTSD., Methods: The study included 17 patients with PTSD and 26 healthy, trauma-exposed controls. Participants received warm (nonpainful) or hot (painful) thermal stimuli after listening to a neutral or a traumatic script while they were undergoing an fMRI scan at a 4.0 T field strength., Results: Between-group analyses revealed that after exposure to the traumatic scripts, the blood oxygen level-dependent (BOLD) signal during pain perception was greater in the PTSD group than the control group in the head of the caudate. In the PTSD group, strong positive correlations resulted between BOLD signal and symptom severity in a number of brain regions previously implicated in stress-induced analgesia, such as the thalamus and the head of the caudate nucleus. Trait dissociation as measured by the Dissociative Experiences Scale correlated negatively with the right amygdala and the left putamen., Limitations: This study included heterogeneous traumatic experiences, a different proportion of military trauma in the PTSD versus the control group and medicated patients with PTSD., Conclusion: These data indicate that in patients with PTSD trauma recall will lead in a state-dependent manner to greater activation in brain regions implicated in stress-induced analgesia. Correlational analyses lend support to cortical hyperinhibition of the amygdala as a function of dissociation.

Background: Preterm birth is the leading cause of perinatal morbidity and mortality. Risk factors for preterm birth include a personal or familial history of preterm delivery, ethnicity and low socioeconomic status yet the ability to predict preterm delivery before the onset of preterm labour evades clinical practice. Evidence suggests that genetics may play a role in the multi-factorial pathophysiology of preterm birth. The All Our Babies Study is an on-going community based longitudinal cohort study that was designed to establish a cohort of women to investigate how a women's genetics and environment contribute to the pathophysiology of preterm birth. Specifically this study will examine the predictive potential of maternal leukocytes for predicting preterm birth in non-labouring women through the examination of gene expression profiles and gene-environment interactions., Methods/design: Collaborations have been established between clinical lab services, the provincial health service provider and researchers to create an interdisciplinary study design for the All Our Babies Study. A birth cohort of 2000 women has been established to address this research question. Women provide informed consent for blood sample collection, linkage to medical records and complete questionnaires related to prenatal health, service utilization, social support, emotional and physical health, demographics, and breast and infant feeding. Maternal blood samples are collected in PAXgene™ RNA tubes between 18-22 and 28-32 weeks gestation for transcriptomic analyses., Discussion: The All Our Babies Study is an example of how investment in clinical-academic-community partnerships can improve research efficiency and accelerate the recruitment and data collection phases of a study. Establishing these partnerships during the study design phase and maintaining these relationships through the duration of the study provides the unique opportunity to investigate the multi-causal factors of preterm birth. The overall All Our Babies Study results can potentially lead to healthier pregnancies, mothers, infants and children.

Background: Recent evidence emphasizes the importance of maintaining normoglycemia in critically ill patients to reduce morbidity and mortality. Different analytical methods of varying accuracy exist for obtaining and measuring blood glucose in critically ill patients. The purpose of this study was to determine if there were differences in blood glucose values measured by whole blood capillary and arterial samples using three different bedside blood glucose meters and a blood gas analyzer as compared to a reference blood glucose analyzer., Methods: Sixty subjects were recruited from a university hospital medical/surgical intensive care unit. Matching capillary and arterial samples were analyzed by a clinical blood glucose reference analyzer (YSI, Yellow Springs Instrument, Yellow Springs, OH) and three blood glucose meters (Lifescan [Milpitas, CA] SureStepFlexx, Roche [Indianapolis, IN] Accu-Chek Inform, and Abbott [Alameda, CA] FreeStyle). Additionally, the arterial samples were analyzed by a point-of-care blood gas analyzer (Chiron 865, Bayer, Tarrytown, NY)., Results: Data analysis included repeated-measures analysis of variance, Consensus Error Grid analysis, Bland-Altman plots, and numerical estimates of inaccuracy. With capillary samples there were high numbers of errors as compared to the reference instrument. Measurement of blood glucose with arterial samples demonstrates a higher degree of accuracy. With arterial samples, the Abbott FreeStyle blood glucose meter and the blood gas analyzer glucose exhibited the lowest median and mean relative absolute deviation., Conclusion: In critically ill adult patients, measurement of blood glucose using arterial samples is recommended. Using arterial blood, the Abbott FreeStyle blood glucose meter and the point-of-care blood gas analyzer (Bayer Chiron 865) were shown to be highly accurate instruments to measure arterial blood glucose.

Objective: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression., Design: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression., Participants and Setting: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6)., Results: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.

Integrative approaches to understanding complex health issues can transcend disciplinary and knowledge boundaries and provide opportunities to view phenomena from diverse perspectives. These broad approaches to understanding phenomena of interest to nursing might provide new directions for nursing research and be a requisite for delivering safe, responsible, and holistic nursing care. The relationship between stress and illness is a strong example of a field of study that can be understood more fully from an integrative perspective. The potential of an integrative approach to contribute to improvements in human health and well-being outweigh historical biases that have been associated with an integrative science approach.

Numerous epidemiological studies report increased prevalence rates for women as compared to men for stress-related disorders such as acute stress disorder, post-traumatic stress disorder, and major depressive disorder. Stress disorders disrupt work and home life and pose a high risk for suicide. Multiple factors contribute to the increased vulnerability in women. Physiological differences account for some of the differential. Other factors that make a significant contribution to the overall risk for health problems in response to stressors or trauma include the nature and meaning of the trauma, accessibility of resources, and restrictive diagnostic categories. Increasing our knowledge of the individual impact of each factor as well as the interactions among the factors is central to understanding the development of stress disorders. Comprehensive sex- and gender-sensitive middle-range theory, which explores the role of key factors identified in qualitative and quantitative research, is required. The authors discuss structural equation modelling as one method of theory testing.

Stress as a stimulus is integral to dynamic homeostatic functioning. However, evidence of its potentially deleterious effects on health is mounting. The impetus to understand the mechanisms that underlie stress-related negative health outcomes and prevent the development of stress-related disorders has never been greater. Symptom severity and subjective levels of stress, although frequently assessed in studies of stress in nursing research, may not provide adequate data to fully understand the pervasive effects of chronic or overwhelming stress associated with stress disorders. The measurement of stress hormones such as cortisol can help identify bodily changes that are stressor specific, people at risk for development of stress-related disorders, and the efficacy of interventions aimed at stress reduction. Cortisol, as the peripheral output of one of the major stress response systems, possesses several properties that make its measurement highly useful for investigations of stress. This article discusses some of the biological mechanisms involved in the stress response, why cortisol is commonly measured, and issues and approaches in cortisol measurement.