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Purpose: Postpartum depression (PPD) affects one in eight women in the United States. Women with HIV may be at higher risk for PPD. This systematic review examined factors related to PPD in those with HIV., Method: Using three databases, articles published between 2017 and 2022 were screened for eligibility, with 19 full texts reviewed and critically appraised. Ten studies from eight countries were ultimately included in the analysis., Results: Using Engel's biopsychosocial model, common themes emerged within the theoretical framework: (a) biological (e.g., HIV diagnosis in pregnancy, impact on HIV adherence); (b) psychological (e.g., pregnancy intention, intimate partner violence, fear of HIV transmission, infant illness, behavior); and (c) social (e.g., socioeconomic status, lack of social support, disclosure, stigma)., Conclusion: Living with HIV carries additional stressors for new parents that may impact mental health in the postpartum period. Nurses are in a unique position to screen for PPD early using established screening tools while paying particular attention to associated factors impacting those with HIV. [ Journal of Psychosocial Nursing and Mental Health Services, 62 (11), 19-26.].

Aim: To describe the current state of the literature on nurses' and midwives' knowledge, perceptions and experiences of managing parental postnatal depression (PPND)., Design: The Joanna Briggs Institute scoping review method and the PRISMA extension for Scoping Reviews guided the work., Data Sources: A systematic search of PubMed, CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases was conducted in January and February 2023., Review Methods: Peer-reviewed primary research articles published in English between 2012 and 2023 that involved nurses or midwives managing PPND were included. Rayyan was used to screen titles, abstracts and full-text articles. A spreadsheet was used to organize extracted data and synthesize results., Results: Twenty-nine articles met the inclusion criteria. Most study samples were of mothers, and few were from middle- and lower-income countries. Nurses and midwives lacked knowledge about PPND, yet they felt responsible for its management. Nurses and midwives faced significant organizational and systems-level challenges in managing PPND. However, nurses and midwives facilitated PPND care in collaboration with other healthcare providers., Conclusion: The review highlights significant gaps in the nurses' and midwives' care of PPND. Educational programmes are necessary to increase nurse and midwife knowledge of PPND and strategies for its management, including facilitating collaboration across the healthcare system and eliminating organizational and systemic-related barriers. Additional focused research is needed on nurses' and midwives' knowledge, perception of and experience with PPND beyond mothers, such as with fathers, sexually and gender-minoritized parents and surrogate mothers. Finally, additional research is needed in middle- and lower-income countries where nurses and midwives may face a higher burden of and unique cultural considerations in managing PPND., Impact: PPND can affect the parent's mental and physical health and relationship with their child. If left untreated, PPND can lead to long-term consequences, including child developmental delays, behavioural problems and difficulties with parental-child attachment., Reporting Method: This scoping review adheres to PRISMA Extension for Scoping Review guidelines and the Joanna Briggs Institute scoping review method., Patient or Public Contribution: This research is a scoping review of published peer-reviewed studies., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: A silent health crisis in the United States is the underdiagnosed and undertreated mental health of women related to childbirth. This discussion paper describes the Postpartum Depression Screening Scale (PDSS) with its scoring and interpretation along with its psychometric testing and translations., Method: In addition to the studies conducted by the instrument developers, databases were searched for studies where other researchers used the PDSS to assess postpartum depressive symptoms. Studies were included that measured the psychometrics of the scale and studies that reported the translation of the PDSS into other languages., Results: Evidence is presented that the PDSS is a reliable and valid screening scale for use by psychiatric mental health nurses and other health care providers. The scale also has been translated into 14 languages, so it is available to screen non-English speaking mothers., Conclusion: Childbirth is one of the most powerful triggers of psychiatric illness in a woman's life. Postpartum depression is a treatable mental health condition, but first, women need to be screened so they can be identified and referrals made. Screening for this devastating mood disorder in new mothers is an essential role of psychiatric mental health nurses and other clinicians so that treatment can be started as early as possible to avoid harmful consequences., Competing Interests: Declaration of Conflicting InterestsThe author declares no conflicts of interest with the writing of this paper.

Purpose: Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences., Study Design and Methods: This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity., Results: Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU., Clinical Implications: For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

The FDA has approved brexanolone specifically for treatment of adults with postpartum depression (PPD). Administered I.V., it can relieve severe signs and symptoms of PPD within days rather than weeks. This article discusses the benefits and risks of brexanolone as a treatment for PPD, including nursing considerations and patient teaching.

Objective: Before January 2019, no established solutions regarding the screening, assessment, and treatment of patients suffering from perinatal depression existed in Poland. From 2019, a new standard of perinatal care has imposed the obligation to monitor the mental state of women during pregnancy and in the postpartum period on the healthcare providers (mainly on midwives). Thus, our study aimed to evaluate midwives' knowledge about prenatal and postnatal mental health disorders in the first six months of implementing the new standard of perinatal care in Poland., Design: Polish midwives completed a survey consisting of the Test of Antenatal and Postpartum Depression Knowledge by Jones, Creedy, and Gamble (2001) and questions related to a hypothetical case study of a depressed woman named "Mary", developed by Buist and colleagues (2006). The midwives also rated their perceived knowledge and skills in assessing women' mental health condition., Setting: The study was conducted in four Polish cities: Gdansk, Olsztyn, Szczecin, Wroclaw, and the surrounding rural areas., Participants: 111 Polish midwives with varied professional experience and socio-demographic characteristics participated in the study., Measurements and Findings: Among all of their professional responsibilities, the midwives self-rated their knowledge and skills in assessing the mental state of patients as the lowest ones. A subsequent objective assessment revealed their insufficient knowledge about antenatal and postnatal depression and the ways of treatment of these disorders., Key Conclusions: Midwives are not properly prepared for the new tasks resulting from the Polish standard of perinatal care: specifically, for the assessment of a woman's mental state., Implications for Practice: Further trainings are required to ensure midwives' competency and knowledge about the assessment and dealing with mental disorders of patients who experience prenatal and postpartum depression., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: Although postpartum depression (PPD) affects 1 in 5 women, just 15% receive treatment. Cognitive Behavioural Therapy (CBT) is a first-line treatment for PPD. The objective of this pilot study was to determine the feasibility and acceptability of public health nurse (PHN)-delivered group CBT for PPD and to determine preliminary estimates of effect., Design: A pre-posttest design was used. Participants provided data before and after the CBT groups., Sample: Seven women who were over the age of 18 and had given birth in the past year participated., Measurements: Feasibility and acceptability focused on PHN training, recruitment, retention, and adherence to the intervention. Participants provided data on depression, worry, health care utilization and mother-infant relations. Women and their partners reported on infant temperament., Intervention: Participants attended a 9-week CBT group delivered by two PHNs., Results: The PHN training, CBT intervention and our study protocol were found to be feasible and acceptable to participants. Reductions were seen in depression and worry. The number of health care visits decreased; mother-infant relations improved., Conclusions: These findings highlight the feasibility of PHN-delivered group CBT for PPD and suggest that it could reduce the burden of PPD on women and their children., (© 2019 Wiley Periodicals, Inc.)

Background: Postpartum depression (PPD) affects one in seven women in the United States. Korean Americans are one of the six largest Asian American (AA) subgroups, representing 9% of the AA population in the United States. Women of Asian descent have not always been represented in studies of PPD., Purpose: The purpose of this study was to understand postpartum experiences, perceptions of PPD, and mental health help-seeking among Korean women living in the United States., Methods: Individual, face-to-face, semistructured interviews of Korean immigrant women, over age 18, who were able to read, write, and speak English or Korean, and who had given birth to a live infant within the past 12 months, were conducted using a qualitative exploratory design. Thematic analysis approach was used to analyze qualitative data The Edinburgh Postnatal Depression Screening Scale (EPDS) was used to assess frequency of depressive symptoms over the past week., Results: Eleven women participated. Total EPDS scores ranged from 2 to 17 (mean 6.5, SD = 3.2); three women had scores indicating a high risk for developing PPD. Two overall themes, postpartum experiences and perceptions of PPD and professional help-seeking, along with several subthemes were identified. They included postpartum challenges, importance of keeping Korean postpartum traditions, desire for professional Korean postpartum care, "Sanhoo-Joeri" postpartum support and social networking, normalization of PPD symptoms, family first for health seeking attitude and behavior, and stigma attached to mental health care., Clinical Implications: Nurses working with Korean women during postpartum can provide culturally competent care by assessing postpartum care needs, respecting cultural practices, and providing resources such as Korean postpartum care centers Sanhoo-Joeriwon, which can be found in major U.S. cities with large Korean communities (e.g., Los Angeles), and in-home postpartum care providers, Sanhoo-Joerisa. Nurses should be comfortable educating women about normal signs and symptoms of PPD and those requiring immediate medical follow-up.

Aim: To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress., Background: Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk., Design: Randomized controlled trial (RCT) with three conditions., Methods: Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured., Results: Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF., Conclusion: The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness., Impact: Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women., Trial Registration Number: ClinicalTrials.gov NCT02843022., (© 2019 John Wiley & Sons Ltd.)

Purpose: Stress and anxiety are prevalent during pregnancy and postpartum with adverse effects on mothers and newborns, yet women's psychological and emotional needs are often given a lower priority than their physical wellbeing. The purpose of this study was to assess feasibility of implementing a bedside music therapy intervention to alleviate stress and anxiety, provide emotional support, and facilitate mother-baby bonding for women during antepartum and postpartum hospitalization at a large urban medical center., Study Design and Methods: Over 15 months, women on three units who were hospitalized during antepartum or postpartum were referred for music therapy and received a single bedside session from a credentialed music therapist (MT-BC), including tailored interventions and education in relaxation techniques. A retrospective analysis of postintervention feedback questionnaires and process notes was conducted to assess participant receptivity and satisfaction, and the feasibility of implementing the program on the units., Results: Music therapy was provided to 223 postpartum and 97 antepartum patients. The program was found to be feasible and well received, including high satisfaction, positive effects on participants' relaxation and sense of connection with their baby, and enthusiastic reception from providers and staff. Qualitative feedback revealed salient themes including the effect of the intervention on mothers' mental, emotional and physical states, and the soothing effect of music on their newborns., Clinical Implications: Hospitals are in a unique position to provide support services and self-care education for women during their antepartum and postpartum hospitalization. Music therapy can be integrated successfully into inpatient care as a nurturing and patient-centered form of psychosocial support.

Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD., (© 2018 Wiley Periodicals, Inc.)

The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence-based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment., Background: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making., Design: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment., Methods: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment., Results: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information., Conclusion: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care., Relevance to Clinical Practice: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring., (© 2018 John Wiley & Sons Ltd.)

According to the World Health Organization, 10% to 13% of postpartum women develop a mental disorder, mainly depression. This number is higher in developing countries. This percentage increases in adolescents and symptoms in adolescents tend to be overlooked. These disorders can be treated successfully if detected early, which will in turn prevent more severe symptoms from developing. This article provides evidence-based clinical best practices for the assessment and early recognition of postpartum depression, specifically in adolescents. In addition, suggestions for integration into practice and recommendations for interprofessional collaboration are discussed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore public health nurses' engagement, competence and education needs in relation to perinatal mental health care in Ireland., Background: It is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support women's mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses' knowledge, skills and current practices in perinatal mental health and establish their education needs., Design: The research used a descriptive design., Method: A total of 186 public health nurses completed an anonymous, online survey, designed by the research team., Results: While public health nurses are positive about their role in supporting women's mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without., Conclusion: Public health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period., Relevance to Clinical Practice: Without knowledge and skill among nurses in all aspects of perinatal mental health, women with significant mental health needs may be left to cope alone and lack the necessary prompt evidence-based interventions and supports., (© 2017 John Wiley & Sons Ltd.)

Aim and Objective: To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women., Background: Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality., Design: This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth., Methods: Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis., Results: All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms., Conclusion: Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution., Relevance to Clinical Practice: The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post-traumatic stress symptoms during pregnancy., (© 2016 John Wiley & Sons Ltd.)

Background and Purpose: The Edinburgh Postnatal Depression Scale (EPDS) was created specifically to screen for perinatal depression. The purpose of this study was to assess the psychometric properties of the EPDS for use in a population of pregnant and postpartum 14- to 24-year-olds in Canada., Methods: The Standards for Educational and Psychological Testing was used as the psychometric framework to assess the validity, reliability, and acceptability of responses obtained using the EPDS with pregnant and postpartum adolescents and young adults., Results: There were 102 young women who were surveyed. Principal component analysis supported the EPDS as a 2-dimensional instrument. Test scores also showed the EPDS to be reliable and acceptable., Conclusions: The EPDS was found to be a psychometrically sound tool for use in this population of young childbearing women.

In this second article in a two-part series, we call for the integration of strengths-based and trauma-informed care into services for teen mothers. Nurses working with teen mothers in health clinics, schools and home visiting programs can play a pivotal role in promoting their mental health. Many teen mothers have high levels of psychological distress and histories of adverse experiences that cannot be ignored, and cannot solely be addressed by referral to mental health services. Nurses must be prepared to assess for trauma and be open to listening to teen mothers' experiences. Principles of strengths-based and trauma-informed care are complementary and can be integrated in clinical services so that teen mothers' distress is addressed and their strengths and aspirations are supported. Potential screening tools, interviewing skills and basic strategies to alleviate teen mothers' distress are discussed.

Purpose: To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum., Study Design and Methods: Forty-two healthy mother-infant dyads completed a home-based study at infant age 32 weeks. Maternal measures included Patient Reported Outcomes Measurement Information System (PROMIS) sleep and wake disturbance, depression, and fatigue scales. Home regularity was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Infant sleep and regulation were measured respectively by the Brief Infant Sleep Questionnaire (BISQ) and Infant-Toddler Symptom Checklist (ITSC)., Results: Significant correlations among maternal sleep and wake disturbance, fatigue, and depression were detected (r = .519 to .746, p < .01), but not with infant variables. Home regularity was significantly related with maternal variables (r = .597 to .653, p < .01)., Clinical Implications: Regularity of the home environment appears to contribute to maternal sleep, depression, and fatigue. Implications for intervention include establishment of daily routines and household management to improve regularity and consequently improve maternal outcomes.

Background and Purpose: The purpose of this research was to evaluate the psychometric properties of a new instrument to measure mother-infant togetherness, Mother-Infant Togetherness Survey (MITS)., Methods: Stage 1 examined content validity. Stage 2 pretested the readability and understandability and further examined content validity. Stage 3 examined women's ability to accurately self-report on the Delivery Events subscale. Stages 4 and 5 examined construct validity., Results: Good content validity was obtained at the scale/subscale level (CVI = .91-1.00). Internal consistency reliability was evaluated at the scale/subscale level (α = .62-.89). Construct validity was supported with known groups testing and factor analysis., Conclusion: Study findings provide support for the reliability and validity of the MITS. Future research should be done to improve the internal consistency reliability of the Postpartum Events subscale.

Background: Mothers with postpartum stress have increased maternal/infant morbidity and mortality. Haitians, a growing minority excluded from most studies because of the lack of instruments in Creole. The Perceived Stress Scale (PSS) and the Daily Hassles Scale (DHS) measuring stress are not available in Creole., Purpose: To test the psychometrics of the newly translated Creole instruments., Methods: A convenience sample of 85 Haitian mothers completed 2 instruments in Creole and English, 2 weeks apart using the process of cross-cultural adaptation., Result: Internal consistency reliability and stability were strong for both instruments (.80-.94). Reliability and validity support the translated Creole with this sample of Creole speaking mothers., Conclusion: Psychometric findings suggest the newly translated versions are good representations of the English versions and are ready for use.

Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centered maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD? This review includes a description of key variables associated with P-PTSD. Socioeconomic, environmental and genetic determinants are discussed, as are evidence-based prevention and treatment approaches., (© 2015 AWHONN.)

To assess parenting stress and major difficulties experienced in early motherhood among immigrant and Taiwanese women in Pingtung, southern Taiwan. A comparative, descriptive, cohort study of parenting stress and maternal psychological health, using the Child Care Stress Checklist and Edinburgh Postpartum Depression Scale. A purposive sample of 26 foreign-born Vietnamese and 162 Taiwanese mothers were surveyed at 6 weeks' postpartum. Both groups of mothers experienced similar parenting difficulties including the establishment of a regular sleeping schedule for the infant, consoling a crying infant, awareness of infant's needs, conflict with family members, and difficulties managing household chores. Curtailment of social activities was reported more often by Taiwanese mothers, whereas inaccessibility to other experienced mothers and poor maternal-infant bonding were experienced more by immigrant mothers. There were significant differences between groups, with high levels of child care stress and postpartum depression symptoms reported more often by immigrant mothers. Nurses-midwives and community child health nurses need to be sensitive to the particular difficulties and stresses of parenting in mothers from different backgrounds and provide effective interventions and support activities.

Poor mental health accounts for 23% of all ill health in the UK, with the cost of treating it expected to double in the next 20 years. In addition, postnatal depression (PND) in both mothers and fathers can have a detrimental long-term impact on a child's cognitive, social and behavioural development. This paper discusses the development process of an innovative evidence-based resource which involved professional expertise and parent involvement. This unique resource helps to recognise PND in both mothers and fathers and will support health visitors in making a real impact in improving outcomes for children and families.

Purpose: To explore Asian Indian mothers' perspectives of postpartum depression (PPD) and mental health help-seeking behavior., Study Design: Qualitative exploratory design., Methods: Using convenience sampling, postpartum mothers were recruited through flyers posted in public places and on social media sites. Postpartum depression risk was assessed with the Edinburgh Postnatal Depression Scale (EPDS) prior to qualitative interviews. Content analysis methods were used to extract themes from participant narratives., Results: Twelve self-identified, married, Asian Indian mothers, aged between 29 and 40 years, living in Northern California, who gave birth to a healthy infant within the last 12 months, took part in this study. Scores on the EPDS indicated two participants were at an increased risk for developing PPD. Content analysis revealed two emerging themes: (1) Culture-specific postpartum practices and ceremonies and their role in maternal-infant postpartum recovery; and (2) Maternal mental health help-seeking behavior., Clinical Implications: Nurses taking care of women during the extended prenatal and postpartum period have the unique opportunity to build rapport with their patients which can offer a window of opportunity to educate and help dispel myths about PPD symptoms and treatment. To promote successful maternal-infant outcomes, PPD education should be initiated at the first prenatal appointment, continue during the pregnancy, and be incorporated into well-baby visits through the first postpartum year. Education should include signs and symptoms of PPD as well as importance of timely mental-health help-seeking.

Objective: to investigate immigrant Afghan women's emotional well-being and experiences of postnatal depression after childbirth and their use of health services., Design: telephone interviews were conducted at four months after birth, using a semi-structured questionnaire; and a further in-depth face-to-face interview with a small number of women approximately one year after the birth. Women's emotional health was assessed at four months using the Edinburgh Postnatal Depression Scale (EPDS), as well as women's own descriptions of their emotional well-being since the birth., Setting: women were recruited from four hospital antenatal clinics or postnatal wards in Melbourne, Australia, between October 2006 and May 2007., Participants: Immigrant women who were born in Afghanistan, spoke Dari/Persian or English, and had given birth to a live and healthy baby., Findings: Thirty nine women were interviewed at four months after birth; 41% reported feeling depressed or very unhappy since the birth and 31% scored as probably depressed on the EPDS. Ten women participated in further in-depth face-to-face interviews. Isolation, lack of support and being overwhelmed by life events were the most frequently reported contributing factors to women's emotional distress, and for many being a migrant appeared to intensify their experiences. The themes that emerged from both the telephone and face-to-face interviews revealed that some women were reluctant to discuss their emotional difficulties with health professionals and did not expect that health professionals could necessarily provide assistance., Key Conclusions and Implications for Practice: in this study a significant proportion of immigrant Afghan women experienced emotional distress after childbirth. Women's experiences of emotional distress and help-seeking were at times affected by their status as immigrants and their perceptions of possible causes and treatment for their emotional health problems. Understanding the effects of migration on women's lives and paying careful attention to individual needs and preferences are critically important in providing care for immigrant Afghan women., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to determine which of the four common approaches to coding maternal-infant interaction best discriminates between mothers with and without postpartum depression., Methods: After extensive training, four research assistants coded 83 three minute videotapes of maternal infant interaction at 12month postpartum visits. Four theoretical approaches to coding (Maternal Behavior Q-Sort, the Dyadic Mini Code, Ainsworth Maternal Sensitivity Scale, and the Child-Caregiver Mutual Regulation Scale) were used. Twelve month data were chosen to allow the maximum possible exposure of the infant to maternal depression during the first postpartum year. The videotapes were created in a laboratory with standard procedures. Inter-rater reliabilities for each coding method ranged from .7 to .9. The coders were blind to depression status of the mother., Results: Twenty-seven of the women had major depressive disorder during the 12month postpartum period. Receiver operating characteristics analysis indicated that none of the four methods of analyzing maternal infant interaction discriminated between mothers with and without major depressive disorder., Conclusion: Limitations of the study include the cross-sectional design and the low number of women with major depressive disorder. Further analysis should include data from videotapes at earlier postpartum time periods, and alternative coding approaches should be considered. Nurses should continue to examine culturally appropriate ways in which new mothers can be supported in how to best nurture their babies., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The most extensively researched form of psychotherapy over the last 10 years, cognitive behavioural therapy (CBT), has recently been promoted in health visiting practice. Health visitors, frontline practitioners for the majority of women with postnatal depression (PND), stand between the use of antidepressants for PND on the one hand where compliance is not good and the potential to offer a practical alternative using cognitive behavioural techniques on the other. The aim of this study was to examine how health visitors understand the concept of CBT and envisage its implementation in practice with regard to the treatment and management of PND. A qualitative research methodology using a phenomenological approach was adopted to analyse transcripts from two semi-structured focus group interviews with nine health visitors about their work with PND and CBT. The findings demonstrated that health visitors do not want to be known as 'frontline' professionals in the delivery of CBT to treat PND as this would imply 'counsellor'--a diversion from their professional identity and unique role. However, they wanted to be equipped with more than just introductory basic assessment and treatment techniques in CBT to deliver a pragmatic, psycho-educational approach to PND in four to eight home sessions.

To synthesize existing qualitative literature on the first-hand experiences of women suffering from postpartum depression (PPD), to uncover potential common themes, a meta-synthesis of 12 qualitative studies using Noblit and Hare's 7-phase model of meta-ethnography was used. Four themes were discovered: crushed maternal role expectation, going into hiding, loss of sense of self, intense feelings of vulnerability, plus practical life concerns. A preliminary theory of PPD as a 4-step process is proposed, based on the relationships between the themes in this meta-synthesis. This 4-step process is compared and contrasted with Cheryl Tatano Beck's 4-stage theory of PPD "Teetering on the Edge". This meta-synthesis and theory offers a significant contribution to the literature in helping identify PPD distinctly from depression outside of the postpartum period, and deserves further study.

The purpose of this study is to understand mental health literacy (MHL) (Jorm, 2000) in lower income women postpartum and share participant experiences of recognizing and seeking help for depressive symptoms. Focus group textual data were received from 25 participants who completed a weight and psychosocial health longitudinal study. Iterative content data analysis using Jorm's framework provided thematic understandings descriptive of MHL. Women recognized behavioral changes indicating mental distress, but fears prevented them from seeking help, and some resorted to risky behaviors. This framework could guide providers to identify women who may benefit from early intervention for postpartum depressive symptoms., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aims and Objectives: To assess the effectiveness of application of health locus of control in pregnant women for prevention of postpartum depression in Iran., Background: Nearly 10-15% of women suffer postnatal depression by the end of the second week after delivery, which creates problems in caring for the child that may affect child's future learning and concentration., Design: Pre-post experimental design., Methods: Two hundred and thirty volunteer women were randomly divided into experimental and control groups. The data collection tools included a demographic questionnaire, the Multidimensional Health Locus of Control Scale and the Edinburg Depression Scale. Based on the associations found in the pretest, intervention programme was planned and carried out in the focused group discussion method. Data were collected after the end of scheduled sessions, immediately and one month later. The data were analysed with SPSS-16 using statistical methods including anova, chi-square test, Student's t-test and paired t-test., Results: Chance health locus of control significantly reduced and internal health locus of control significantly increased, immediately after intervention. Also, a month after intervention, a significant difference was observed between the two groups in reducing postpartum depression., Conclusions: The planned participatory intervention led to empowerment and increased awareness and internalisation of health control beliefs and less tendency towards external health control beliefs, especially chance, improvement in general health leading to improved psychological health for prevention of postpartum depression in mothers., Relevance to Clinical Practice: Clinicians might assess chance and internal health locus of control to identify the women at risk of developing depression during their pregnancy and to develop prevention and treatment plans., (© 2013 John Wiley & Sons Ltd.)

This study examined pregnancy risk for developing, and protective factors for preventing, Postpartum Depression (PPD). The object of this study was to (a) examine previously identified pregnancy stressors to learn which stressors put women more at risk for PPD and (b) to identify possible buffers for women who are at risk for developing PPD. A secondary data set was used for two analyses. Women were invited to participate in the study while still in the hospital, within 24-48 hours after delivery of a singleton, term (≥37 weeks) live-born infant. The data were collected in four large urban hospitals in Utah from 2005-2007. A total of 1,568 women participated in the study. Women who report experiencing less stress in their couple relationship are less likely to report PPD symptoms even when they have a personal history of depression and or PPD. The results of these analyses illustrate that a couple's relationship, depending on the stress level experienced in the relationship, can be both a risk and protective factor for pregnant women.

Objective: To examine the specific barriers to mothers' realization of social support during the first-year postpartum., Design: A qualitative approach in which social support data were analyzed thematically., Setting: An urban medical center in Pittsburgh, Pennsylvania., Participants: Thirty-one women who had given birth in the year prior to study enrollment were recruited through posted flyers at multiple community sites., Methods: Data were collected during three focus groups. The data that related to social support were extracted from a larger qualitative data set and analyzed separately for prominent social support inhibitors., Results: Major themes that emerged were availability of trustworthy child care, cost of child care, demands of infant care, changing priorities, a transient population, and availability of family., Conclusions: Emergent barriers to social support such as the demands of infant care and changing priorities are likely challenges for women regardless of socioeconomic status. However, the volume of text related to availability (proximity) of family, availability of trustworthy child care, and the consequences of a transient lifestyle may be attributed to the composition of the study sample., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

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 difficult 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., (© 2013 Elsevier Ltd. All rights reserved.)

Postpartum women often suffer clinically significant depressive symptoms, a problem addressed by nurse-delivered screening programs. In the past, success of these identification programs was measured in terms of screening rates; however, merely evaluating the screening rate does little to inform how to implement depression screening in clinical practice. This article describes the experiences of nurses in implementing depression screening on a maternity unit. We evaluate the practice qualitatively, by asking nurses to describe their screening strategies and their views about implementation, as well as quantitatively by assessing their screening rates and the number of women identified. Utilizing a framework of program evaluation, 20 maternity unit nurses completed qualitative assessments investigating their day-to-day experiences with this practice. To include the perspectives of nurses that declined to participate in qualitative assessments, 14 additional maternity unit nurses completed a brief survey assessing their views. We also assessed screening rates, defined as the number of women screened divided by the number eligible for screening. Maternity unit nurses viewed depression screening positively and were able to screen patients in relatively few steps, which they implemented using strategies they had developed themselves. Despite nurses' ongoing concern about finding time to screen, they achieved high screening rates and, with one exception, indicated they would opt to continue voluntarily. Depression screening on the maternity unit is feasible and embraced by attending nurses. The clinical strategies used to implement screening are extensively described and provide a basis for implementation in other settings that serve perinatal women.

Posttraumatic stress disorder (PTSD) following childbirth may be diagnosed as postpartum depression. With a thorough assessment, women with this condition can be diagnosed correctly and receive appropriate treatment, promoting a better outcome for both mother and baby.

Objective: to investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth., Design: prospective pregnancy cohort study., Setting: Melbourne, Victoria, Australia., Population: 1507 nulliparous women., Methods: women were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum., Outcome Measures: Edinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems., Results: overall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0-2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0-15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6-12 months post partum (Adjusted OR=3.43, 95% CI 2.1-5.5)., Conclusions: poor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

In 2011 a national children's charity led a campaign that identified why help with postnatal depression (PND) needed to improve; however PND remains a huge problem. Numerous cases are still coming to light where a mother has not sought help or has not been given adequate support, with disastrous consequences. Why is this still happening and what can health professionals do? Former practising midwife and specialist PND counsellor at a charity supporting women and families suffering from PND, Joanne Morton discusses why increasing awareness, education and understanding of perinatal illness are vital to limit the devastating effects of antenatal depression (AND) and PND and how standards of care must improve to help mothers in need.

Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred.

The Healthy Child Programme (HCP) focuses on the care offered to pregnant women and children in the first five years of life. It is delivered by a range of professionals, with the health visitor as lead. Effective delivery of the HCP depends on services for children and families being fully integrated, and partnership working between different agencies on a local level seems to be the key to success. This article focuses on how effective implementation of the HCP facilitates the recognition and care of women with anxiety, mild to moderate depression and other perinatal mental disorders during both the antenatal period and after the birth.

There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. One hundred, thirty-five mothers of preterm infants born at 26-34 weeks of gestation completed three self-report measures: the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory (2nd ed.), and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Maternal sociodemographic measures, including race, ethnicity, age, maternal pregnancy history, and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety, and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant's medical severity.

Mental health is an integral part of health and a state of wellbeing. The concept of 'parity of esteem' increases awareness that mental health needs to be treated as seriously as physical health. During the childbirth continuum, women and their partners can be at increased risk of mental health problems; therefore it is important to embrace the 'parity of esteem' concept. This article highlights links between mental and physical health problems and discusses the vital role that midwives can play in promoting better maternal mental health. It considers the challenges this can present to midwives and maternity services.

Background: stress in pregnancy is common and impacts negatively on women, infants and families. A number of factors contribute to high levels of stress in pregnancy, including financial concerns, marital discord, low support systems and low socio-economic status., Objectives: the aim of this study was to evaluate stress anxiety levels and depressive symptoms among low risk women in an area in Ireland that was particularly impacted by the 2008 economic crisis., Design: a quantitative descriptive cross-sectional design was used. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the Perceived Stress Scale and the State Trait Anxiety Inventory (STAI). Data was collected at a single time during the second trimester., Setting: this paper reports a case study of one maternity service in Ireland. Participants included low risk pregnant women who were attending the hospital clinic for routine antenatal care., Results: of 150 questionnaires distributed, 74 completed questionnaires were returned indicating a 49.3% return rate. Findings indicated high levels of stress, anxiety and depressive symptomatology among participants. There were no significant difference in mean EPDS score for different age groups (F4,69=2.48, P=0.052), living arrangements (F4,68=0.90, P=0.5) or usual occupation (F4,69=1.45, P=0.2). A score of ≥ 12 was taken as indicative of probable antenatal depression and 86.5% of participants responded with a score of 12 or above. PSS scores were also high and more than three quarters of respondents scored ≥ 15 (75.6%) and more than a third had scores ≥ 20 (35.1%), out of a total score of 40. There was a significant difference in mean PSS score between the different age groups (F4,69=3.60, P=0.010) but not for living arrangements or usual occupation. A STAI score of ≥ 39 was taken as indicative of antenatal anxiety, and 74.3% of participants responded with a score of 39 or above. There were no significant differences in mean STAI score between the different age groups (F4,68=1.68, P=0.16), living arrangements (F4,67=2.30, P=0.068) or usual occupations (F4,68=1.25, P=0.3)., Key Conclusions and Implications for Practice: this study found high levels of antenatal stress, anxiety, and depressive symptoms in a low risk pregnant population, in an economically impacted region in Ireland. These findings have implications for fetal development and maternal health during pregnancy and in the post partum. Further studies are important to confirm rates and should be conducted over a longer time frame with data collected at more than one point in time, such as mid and late pregnancy. If findings are confirmed, early recognition and treatment of stress, anxiety and depressive symptoms is important to ameliorate some of the harmful effects of these conditions., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: this study evaluates how an internet-based intervention affects mothers' parenting satisfaction, infant centrality and depressive symptoms., Design: a quasi-experimental design and repeated measures were used., Settings: this study was conducted in two Finnish public maternity hospitals (intervention/control)., Participants: a convenience sample (N=1300) of primiparous and multiparous Finnish-speaking mothers were invited to participate. Multiple-birth and early discharge mothers receiving home visits were excluded. The analysis included 760 mothers., Intervention: the intervention offered online support for parenting, breast feeding and infant care beginning from the middle of pregnancy. It consisted of an information database, a peer discussion forum and expert advice., Measurements: Outcomes were measured by the Evaluation and Infant Centrality subscales of the What Being the Parent of a New Baby is Like-Revised, and the Edinburgh Postnatal Depression Scale after childbirth, and six weeks, six months and 12 months post partum. Age, parity, parenting self-efficacy, and perception of infant and family functioning were used as the covariates., Findings: during the first postpartum year, mothers' parenting satisfaction increased significantly, whereas infant centrality and depressive symptoms decreased within groups. However, these changes were not linear. The mean difference between groups in parenting satisfaction and depressive symptoms was not significant within any of the four assessments. The mean difference in infant centrality between control and intervention mothers was significant only at six weeks post partum. Primiparas scored significantly higher in infant centrality and significantly lower in depressive symptoms than multiparas., Key Conclusion and Implications for Practice: an internet-based intervention did not significantly affect mothers' perceptions of parenting satisfaction and depressive symptoms, but intervention mothers experienced higher infant centrality compared with control mothers at six weeks. Parenting self-efficacy was a significant covariate for all measures. Parity needs to be taken into account when infant centrality and depressive symptoms are used as outcome variables in intervention studies. More research is needed to study the potential of information data bank, professional, and peer online support. This study also highlights the need to pay more attention to the selection of the target population, the selection of outcome measures, and implementation issues in intervention research., (Copyright © 2013 Elsevier Ltd. All rights reserved.)