scholarly journals Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Jessica K Jensen ◽  
Jody D Ciolino ◽  
Alicia Diebold ◽  
Melissa Segovia ◽  
Aria Degillio ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Postpartum Depression ◽  
Low Income ◽  
Health Professionals ◽  
Group Intervention ◽  
Cluster Randomized Trial ◽  
The United States ◽  
Home Visitors ◽  
Cluster Randomized

BACKGROUND Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. OBJECTIVE This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. METHODS A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. RESULTS We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. CONCLUSIONS There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. CLINICALTRIAL ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11624

scholarly journals Optimal Well-Being After Major Depression

2019 ◽  
Vol 7 (3) ◽  
pp. 621-627 ◽  
Author(s):  
Jonathan Rottenberg ◽  
Andrew R. Devendorf ◽  
Vanessa Panaite ◽  
David J. Disabato ◽  
Todd B. Kashdan
Keyword(s):  
Mental Health ◽  
United States ◽  
Major Depression ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Well Being ◽  
The United States ◽  
Global Burden ◽  
Leverage Points ◽  
Midlife Development

Can people achieve optimal well-being and thrive after major depression? Contemporary epidemiology dismisses this possibility, viewing depression as a recurrent, burdensome condition with a bleak prognosis. To estimate the prevalence of thriving after depression in United States adults, we used data from the Midlife Development in the United States study. To count as thriving after depression, a person had to exhibit no evidence of major depression and had to exceed cutoffs across nine facets of psychological well-being that characterize the top 25% of U.S. nondepressed adults. Overall, nearly 10% of adults with study-documented depression were thriving 10 years later. The phenomenon of thriving after depression has implications for how the prognosis of depression is conceptualized and for how mental health professionals communicate with patients. Knowing what makes thriving outcomes possible offers new leverage points to help reduce the global burden of depression.

scholarly journals Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis

2020 ◽  
Author(s):  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jessica K. Johnson ◽  
Aria Degillio ◽  
Dana Zakieh ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Intervention ◽  
Home Visiting ◽  
Perinatal Depression ◽  
The United States ◽  
Health Concern ◽  
Preventive Interventions

Abstract Background: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A current cluster-randomized controlled trial is examining the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. Methods: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. Results: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. Trial Registration: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444).

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Peyote Effect ◽  
2018 ◽  
pp. 11-22
Author(s):  
Alexander S. Dawson
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
The United States ◽  
Washington Dc ◽  
German Scientist ◽  
The United Kingdom ◽  
First Americans ◽  
The Moment

In this chapter, we consider the moment when European and American scientists “discovered” peyote. John Briggs was one of the first Americans to write about peyote (in 1887), followed shortly by James Mooney, who recounted his experiences among the Kiowa of Oklahoma at the Anthropological Association in Washington DC in 1891. Around this time, the German scientist Louis Lewin encountered peyote while on a trip to the United States. Americans proved less adept at unlocking the chemistry of the cactus than their German counterparts, who identified four different alkaloids in the cactus by the mid-1890s. This period also saw notable studies of peyote by investigators in the United Kingdom, including some fairly dramatic self-experimentation among English intellectuals overseen by Havelock Ellis. Though their work did not yield widely accepted breakthroughs, these researchers were early pioneers in the exploration of the use of peyote and then mescaline as a tool for mental health professionals.

Associative stigma experienced by mental health professionals in China and the United States

2018 ◽  
Vol 54 (6) ◽  
pp. 745-753 ◽  
Author(s):  
Xiaoming Lin ◽  
Robert Rosenheck ◽  
Bin Sun ◽  
Guojun Xie ◽  
Guhua Zhong ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
The United States ◽  
Associative Stigma

Breaking Out of the Mainstream: The Evolution of Peer Support Alternatives to the Mental Health System

2008 ◽  
Vol 10 (3) ◽  
pp. 146-162 ◽  
Author(s):  
Alexandra L. Adame ◽  
Larry M. Leitner
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Illness ◽  
Peer Support ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health System ◽  
Medical Model ◽  
The United States

The consumer/survivor/ex-patient (c/s/x) movement has been instrumental in the development of a variety of peer-support alternatives to traditional mental health services in both the United States in Canada. This article explores the role of the c/s/x movement in the creation of such alternatives and discusses the various ways peer support is defined and has been put into practice. We also discuss the potential for future alliances and dialogues between progressive mental health professionals and the c/s/x movement as both groups seek ways to reconceptualize mental illness and recovery outside of the medical model paradigm.

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