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• There is a drive in policy and practice for perinatal health services to provide trauma-informed care. • The current review synthesised eight recommendations for trauma-informed approaches within maternal mental health care settings in the context of pregnancy or childbirth-related loss or trauma. • This review is timely given the increasing development, delivery, and evaluation of maternal mental health services, particularly in the United Kingdom. The National Health Service (NHS) in England plans to increase accessibility to evidence-based, trauma-informed psychological care for women in the perinatal period. Therefore, this systematic review aimed to 1) synthesise current guidance from clinical guidelines, policy documents, and care standards on trauma-informed approaches to care in maternal mental health settings within the context of pregnancy-related trauma and 2) to offer recommendations informing the implementation and evaluation of this type of care. Nine electronic databases were searched and screened. Data were extracted and analysed using narrative synthesis. Included records were quality-assessed. After screening 1095 identified records, 11 records were included. The findings were synthesised into eight recommendations: 1) screening for trauma, 2) access to care, 3) clear and sensitive communication, 4) consistency and continuity of care, 5) offering individualised care whilst recognising diversity, 6) collaboration between women, families, and services, 7) care provider training to enhance skills and knowledge, and 8) supervision and peer support for care providers. The findings of this review are highly relevant given the current development, delivery, and evaluation of specific maternal mental health services, particularly in the United Kingdom, but also with the increase in perinatal mental health provision more globally. [ABSTRACT FROM AUTHOR]

The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations. [ABSTRACT FROM AUTHOR]

Despite differences between Mother and Baby Units (MBUs) and other inpatient psychiatric settings, research has not yet explored the nature and value of compassionate care offered by MBU staff despite the increasing importance of compassion in healthcare. This novel study investigated the experience of compassionate care by fifteen mothers admitted to a MBU in England using the Repertory Grid Technique. Our findings indicated that these women perceived their MBU care as compassionate. Compassion was central to nursing care and clearly implicated in women's recovery from mental illness. Additionally, other staff characteristics were important to mothers, including how effectively MBU staff coped with stressful situations, staff flexibility in their care approach and how they adhered to professional boundaries. It is important to facilitate the expression of compassion which partially depends on the personalities and training of staff and the cooperation of service managers in fostering compassionate care. [ABSTRACT FROM AUTHOR]

Objectives Weight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18–30 kg/m 2 . This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs. Participants Ten pregnant women with a BMI≥30 kg/m 2 and 11 midwives and from an inner city maternity service were recruited. Intervention Participants provided information that allowed for the creation of a repertory grid; generating psychological constructs (perceptions or attitudes) identifying similarities and differences between pregnant women and midwives across a BMI range. Findings Midwives were extremely conscious of being perceived as judgemental. They construed all pregnant women as anxious and vulnerable, but attributed characteristics such as “less health-conscious” and “complacent” to those with a raised BMI. The ideal pregnant woman and ideal midwife were typically construed as more likely to have a BMI of 18–30 kg/m 2 . Pregnant women with a BMI≤18 kg/m 2 were construed as lacking warmth. While midwives differentiated between the elements based on role, the pregnant women construed the elements according to their BMI. Similarly, they construed those with a BMI≤18 kg/m 2 as having an undesirable personality, and acknowledged weight-related stereotypes for those with a raised BMI. Clinical Implications It is possible these constructs impact on the way midwives care for and interact with women. Midwives may be supported through reflective clinical supervision and communication skills training to reduce the perceptions of stigma experienced by women with a raised BMI. It may be beneficial to involve pregnant women with a raised BMI in service development to ensure services meet their needs. [ABSTRACT FROM AUTHOR]

Background Experiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices. Aim The aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress. Methods Four electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013. Findings Of 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth. Conclusion Complex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants. [ABSTRACT FROM AUTHOR]

Objective: to systematically review qualitative research that explores the experience of maternal antenatal psychological distress, such as depression, anxiety and stress during pregnancy. Method: a meta-synthesis was conducted to integrate the findings of qualitative studies. Eight final eligible studies were scrutinised, recurring themes were extracted and compared across studies, and core themes were identified. Findings: five core themes of the experience of pregnancy distress were identified: Recognising that things are not right, Dealing with stigma, Negotiating the transformation, Spiralling down, and Regaining control. In the interpretation of these concepts the experience of maternal antenatal distress was depicted as a process similar to the one of grief and loss, as a result of women's inability to situate their experience within the 'perfect mother' discourse. Key conclusions: women who experience psychological distress undergo a specific process of transformation towards motherhood that begins during pregnancy. This process is exacerbated by their interpretation of their experience as deviant and often as inadequate. Implications for practice: this review will assist health professionals in translating and negotiating the transformation towards motherhood for women experiencing pregnancy distress, in a timely and meaningful manner. [ABSTRACT FROM AUTHOR]

Objective: to explore the lived experience of postnatal depression (PND) in West African mothers living in the United Kingdom (UK). Design: using a qualitative design, semi-structured interviews were undertaken. Interpretative Phenomenological Analysis (IPA) was used to explore and analyse the data. Setting: community health services within inner-city suburbs in Manchester, England. Participants: six West African mothers (Nigeria = 3; Ghana = 3), who were experiencing low mood in the postnatal period. Findings: five overarching themes emerged: (1) conceptualising PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Women exhibited symptoms of PND but did not regard it as an illness. In their view, postnatal depression and distress resulted from social stress. Participants stated that their cultural background made it dif cult to disclose feelings of depression thus adversely influencing their help-seeking behaviour. Key conclusions: this is the first study to investigate the experiences of West African mothers with PND who live in the UK, and how they perceive and make sense of their experiences. The themes generated add to the body of existing research on PND in Black and ethnic minority populations and offer insight into the lived experience of West African women residing in England. Such insights are vital in order to deliver effective, culturally sensitive care. Implications for practice: these findings have implications on how services should be designed to increase their accessibility to African women, by using a community psychology approach alongside systemic and group interventions. Challenges to help seeking and language used to describe experiences are considered. [ABSTRACT FROM AUTHOR]

Objective: to examine perceptions of mothers experiencing postpartum depression utilising the revised Illness Perception Questionnaire (IPQ-R), to explore relationships between illness perceptions, depression severity and perceptions of maternal bonding, and to assess the psychometric properties within this population. Design: longitudinal correlational design. Setting: North West of England, UK. Participants: 43 mothers, who screened positive for postpartum depression (mean age 29.36 years) with babies whose mean age was 4 months. Methods: participants were recruited through health services. Participants completed the IPQ-R and measures of depression severity and maternal bonding. Illness perceptions and depression severity were assessed at 2 time points, 4 weeks apart. Findings: mothers endorsed IPQ-R subscales of cyclical timeline, consequences, emotional representations, treatment and personal control. IPQ-R subscale scores and depression severity correlated significantly at Time 1. Initial IPQ-R subscale scores, however, were not associated with and accounted for little variation in depression severity at Time 2. IPQ-R identity and consequence subscales positively correlated with perceived bonding difficulties. Key conclusions and clinical implications: the IPQ-R was shown to be a reliable measure of illness perceptions in mothers experiencing postpartum depression. The maternal illness perceptions endorsed in this study have implications for clinical practice. Interventions aimed at developing a more coherent understanding of depression may enhance beliefs of personal control over symptoms, reduce the number of perceived symptoms and associated emotional distress. Educating mothers regarding the benefits of interventions may be important in increasing the number of mothers accessing support for postpartum depression. [ABSTRACT FROM AUTHOR]

Objective: to explore illness beliefs in women with postnatal depression and suggest an appropriate health belief model. About 10% of recently delivered mothers suffer from depression. Postnatal depression may differ from depression occurring at other times in an individual's life not only symptomatically but also experiences, perceptions and beliefs about the illness differ because of the individual's specific role as a carer for a newborn baby. Whilst illness beliefs have been extensively examined using models from physical health, recent studies have pointed out that physical health models may not provide an appropriate framework to explore mental health difficulties and require adapting. Design: qualitative study using face-to-face interviews for data collection. Setting: Greater Manchester, England. Methods: as illness beliefs have not yet been formally assessed using established questionnaires, the present study employed qualitative methodology to explore illness beliefs in mothers with postnatal depression (PND). Semi-structured interviews were conducted with 11 participants who were depressed following the birth of their child. Interview transcripts were analysed using grounded theory methodology. The point of theoretical sufficiency was reached with this sample size. Findings: the rich data allowed for a theory of illness beliefs in PND to be developed encompassing six core categories: ;unmet expectations', 'identifying stressors in their life context', 'conflict over label', 'antidepressants: the lesser of two evils', 'loss of time' and 'uncertain futures.' Key conclusions and implications for practice: participants made multiple appraisals of their PND in light of their initial difficulties, their improvements and consequences, the future and subsequent service involvement. Participants' narratives were conflicting and uncertain with internal struggles evident as mothers were torn between their desire to be good mothers and their perceptions that PND meant that they were not good enough mothers. Thus, the themes identified in this study did not match onto the key dimensions postulated by Leventhal's self-regulation model of illness beliefs. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to provide a methodologically robust and in-depth exploration of maternal expectations and beliefs in a non-clinical sample of Bulgarian mothers who described their ideas about motherhood postnatally. Design: qualitative study using face to face interviews for data collection. Setting: the cities of Sofia and Varna, Bulgaria. Participants: 10 women, 7 primiparae and 3 multipara, aged 28–32 years, who gave birth within the last 18 months. Methods: interviews were carried out using a semi-structured schedule. Discussions were audio-recorded with participants'' consent, translated and transcribed. Thematic analysis was used under the contextualist theoretical framework. Findings: four general themes of women''s expectations about motherhood were identified, concerning expectations of motherhood, parenting self-confidence, beliefs about the mother–infant dyad and anticipated social support. Findings suggest that there was a substantial discrepancy between expectations and the reality of motherhood, for primiparae and multipara mothers. Unrealistic expectations about motherhood were related to a more difficult postnatal adjustment, lowered self-esteem and feelings of inadequacy. Key conclusions and implications for practice: the way in which women view themselves as mothers during pregnancy can have a significant impact on their emotional well-being following birth. The implications of these findings are discussed with particular reference to promoting a successful adjustment to motherhood through appropriate antenatal care, focussing on maternal expectations about their new role. [Copyright &y& Elsevier]

Objective: The aim of the study was to assess the influence of general and dermatitis-specific psychological and clinical factors on quality of life in adults with atopic dermatitis (AD).Method: A total of 125 adults recruited through the National Eczema Society of U.K. (NES) completed a number of psychological and dermatological questionnaires, including the Dermatology Life Quality Index (DLQI), the Stigmatisation and Eczema Questionnaire (SEQ), the Hospital Anxiety and Depression Scale (HADS), the Fear of Negative Evaluation Scale (FNE) and the Rosenberg Self-Esteem Scale (RSE).Results: Pearson''s correlational analyses suggested that perceptions of stigma were significantly associated with psychological factors as well as quality of life (Ps<.01). An association was also found between perceived stigma and disease severity (-.28, P<.01). Almost 46% of participants were identified as having probable mood disorder. Regression analysis indicated that perceptions of stigma and depression accounted for 44.5% of the variance in quality of life in this sample [F(3,121)=34.18, P<.001], when disease severity was controlled for.Conclusion: Psychological factors and disease severity were strong predictors of quality of life in adults with AD. AD-related perceptions of stigma were of particular importance in predicting AD-related quality of life over and above more general psychological factors, such as depression. These findings have important implications for the psychological and clinical management of AD. [Copyright &y& Elsevier]

Self-harm behavior can begin in early adolescence, with the highest rates of self-harm, between 1990 and 2000 in England, being among adolescents aged 16 to 24 years and there being considerable risk of fatal and non-fatal repetition. Previous systematic reviews have identified risk factors for self-harm in adolescents, but not for the repetition of this behavior. The aim of this review was to synthesise the psychological, psychosocial and sociodemographic risk factors for self-harm repetition in adolescents. By searching four databases, 27 studies were identified and included in the review. Several psychological (e.g., psychiatric morbidity, features of previous self-harm, psychological distress), psychosocial (e.g., alcohol misuse, poor family and peer relationships) and sociodemographic (e.g., age, gender and ethnicity) risk factors were identified for self-harm repetition in adolescents. Several risk factors across all categories for self-harm overlapped with that of self-harm repetition, such as depression, alcohol misuse and female gender. The clinical implications of these findings for practitioners were discussed. As was the case with prior reviews in this area, comparability between studies was limited and a meta-analysis was not possible due to considerable heterogeneity in outcome definitions, measures and methodologies. • This review examined risk factors for self-harm repetition risk among adolescents. • Many psychological, psychosocial and sociodemographic risk factors were identified. • Multiple risk factors for self-harm overlapped with self-harm repetition. • Most evidence: psychological, followed by psychosocial and sociodemographic factors. • Most studies measured risk factors through identifying prospective predictors. [ABSTRACT FROM AUTHOR]