scholarly journals The Role of Maternity Services in Reducing the Prevalence and Cost of Perinatal Depression and Anxiety during COVID-19 in England

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Rachael Maree Hunter

In 2020 the novel coronavirus outbreak (COVID-19) was declared a global pandemic. Pregnant women have been recognised as a group specifically at risk during this time due to the impact that the COVID-19 infection may have on the health of the birthing person and the unknown impact of vertical transmission to the fetus. Pregnant women also have a recognised risk of perinatal mental health problems including depression and anxiety. The aim of this paper is to summarise the impact of the COVID-19 pandemic and associated infection control measures on perinatal depression and anxiety in England, the cost of the additional impact and the role of English National Health Service (NHS) trusts and maternity services in reducing the impact and cost. Studies including systematic reviews and meta-analyses have found a 3 to 5 fold increase in perinatal depression and anxiety during the COVID-19 pandemic compared to non-pandemic times. This increased prevalence, if also seen in England, is at a potential cost to society of £10.6 billion for depression and £6.9 billion for anxiety, including a cost to the health care sector of £649 million and £1.7 billion respectively. Health care Trusts and maternity services have an important role to play in reducing this cost, not just in providing maternity care, but also in monitoring the health of the population and referring onwards where needed. Modest improvements in the availability of social support including improved partner involvement during pregnancy and labour and support given by health care staff during maternity care have the potential to reduce the risk of perinatal depression and anxiety. Signposting to and provision of perinatal mental health services, particularly for women at risk, is also likely improve outcomes for birthing people and their infants and hence to reduce the total cost to society of perinatal mental health problems.

2016 ◽  
Vol 3 (1) ◽  
pp. e11 ◽  
Author(s):  
Amit Baumel ◽  
Stephen M Schueller

Background Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services. Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient’s feedback on the resultant program. Methods This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results In response to clinicians’ feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood disorders. Further research should focus on the benefits accrued from such a service. However, this article highlights how a publicly available eHealth product can be leveraged to create new services in a health care setting.


2021 ◽  
Author(s):  
Clare Evans ◽  
Jana Kreppner ◽  
Peter J Lawrence

Background: Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. Method: We followed PRISMA guidance (PROSPERO: 42019143369 ), estimated weighted effect sizes and tested possible moderators: timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. Results: 14 studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r= 0.32 (95% Confidence Interval = 0.23 to 0.41). In sub-group analyses, perfectionistic concerns were associated with depression (r=.35, 95% CI = 0.26 – 0.43). We found no evidence of significant moderation of associations. Limitations: Included studies had methodological and conceptual limitations. Studies inconsistently examined both perfectionistic concerns and strivings, nor anxiety as well as depression. Conclusions: Perfectionism, especially perfectionistic concerns, appears to be an important feature of common maternal perinatal mental health problems. While further research is warranted, screening and identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.


2020 ◽  
Author(s):  
Steven Gillard ◽  
Ceri Dare ◽  
Jackie Hardy ◽  
Patrick Nyikavaranda ◽  
Rachel Rowan Olive ◽  
...  

AbstractPurposeResearch is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time.MethodsWe used qualitative interviews (N=49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team.ResultsExisting mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health.ConclusionThere is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.


Pained ◽  
2020 ◽  
pp. 69-72
Author(s):  
Michael D. Stein ◽  
Sandro Galea

This chapter studies the health of veterans and the military. Since the first Gulf War in 1990, veterans have had worse mortality than the general population. Aside from mortality, mental health problems are a particular concern. More soldiers kill themselves than are killed on the battlefield. Beyond suicide, key mental health concerns among veterans include posttraumatic stress disorder (PTSD). Itself disruptive, PTSD foreshadows increased risks of physical health problems, substance use/misuse, homelessness, and violence. Less studied, but equally important, are high rates of depression and anxiety among veterans. Rates of chronic pain and physical disability are also high. These challenges make the Veterans Health Administration’s unique expertise in mental health care provision and rehabilitation services all the more crucial. For these reasons, moves to privatize veterans’ health care and narrow access to these services do veterans a disservice, shortchanging a fundamental social contract. The health of soldiers is the public’s health.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
D C Fuhr ◽  
C Ataturk ◽  
M McGrath ◽  
Z Ilkkursun ◽  
A Woodward ◽  
...  

Abstract Introduction Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey. Methods A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. Results The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported. Conclusions To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness. Key messages This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.


2010 ◽  
Vol 3 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Anne Joice ◽  
Stewart W. Mercer

AbstractLarge psycho-education groups are being increasingly used in mental-health promotion and the treatment of common mental-health problems. In individual therapy there is a well-established link between therapist empathy, therapeutic relationship and patient outcome but the role of empathy within large psycho-educational groups is unknown. This service evaluation investigated the impact of a 6-week large psycho-education group on patient outcome and the role of perceived therapist empathy on outcome. Within a before–after experimental design, 66 participants completed baseline and endpoint measures; Clinical Outcome Routine Evaluation (CORE), Patient Enablement Instrument (PEI), and the modified Consultation and Relational Empathy (CARE) measure. The results showed that the intervention had a positive impact on patient outcome; the CORE score reduced significantly over the 6 weeks by 0.63 (95% CI 0.82–1.14) (t= 9.18, d.f. = 55,p= <0.001) and attendees felt highly enabled. Attendees perceived the course leader as highly empathetic. However, the relationship between perceived empathy and attendee outcome was less clear; no significant relationship was found with the main outcome measure (the change in CORE score). Factors that influenced the main outcome included age, symptom severity at baseline, having a long-term illness or disability, and whether attendees tried the techniques at home (homework). These findings suggest that large group psycho-education is an effective treatment for mild to moderate mental-health problems, at least in the short term. The role of therapist empathy remains ambiguous but may be important for some patient outcomes.


Author(s):  
Emma Carlin ◽  
David Atkinson ◽  
Julia V Marley

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.


1999 ◽  
Vol 16 (3) ◽  
pp. 84-89 ◽  
Author(s):  
Elizabeth A Dunn ◽  
Aine C Fitzpatric

AbstractObjectives: Changes in healthcare policy over the last decade emphasise care in the community over residential care. Self-help organisations may play a useful role in these circumstances. Against this background, the objective of this study was to obtain the views of members of the main mental health professions on the place of self-help groups in mental health care.Method: A postal survey of 255 mental health professionals from two health boards was carried out, using a semi-structured questionnaire that contained both open and closed questions. The responses obtained were analysed using descriptive statistics and content analysis as appropriate.Results: The response rate was 35% so results must be interpreted cautiously. Self-help groups are used particularly in the management of addictive behaviours, and are also considered useful in cases of mood disorder. In general, self-help organisations are seen as providing support to patients and their families; information on mental illness/health to the general public; and lobbying for services relevant to the needs of their members. Respondents were concerned that the philosophy and programme of a group should not conflict with established models of mental health. The impact of the organisational structure of the multi-disciplinary team on the referral pattern of the different mental health professions, and the role of group availability and accessibility on the decision to refer a patient to a self-help group is commented upon.Conclusions: While some professionals see a role for self-help organisations in the mental health care system, reservations expressed about a possible clash between selfhelp groups' approach and professional mental healthcare practice need to be addressed so that the potential of both positions can be realised.


2021 ◽  
Author(s):  
Esther O Okogbenin ◽  
Omonefe J Seb-Akahomen ◽  
Osahogie I. Edeawe ◽  
Mary Ehimigbai ◽  
Helen Eboreime ◽  
...  

Objective The Coronavirus Disease 2019 (COVID-19) has had devastating effects globally. These effects are likely to result in mental health problems at different levels. Although studies have reported the mental health burden of the pandemic on the general population and frontline health workers, the impact of the disease on the mental health of patients in COVID-19 treatment and isolation centres have been understudied in Africa. We estimated the prevalence of depression and anxiety and associated risk factors in hospitalized persons with COVID-19. Methods A cross-sectional survey was conducted among 489 patients with COVID-19 at the three government-designated treatment and isolation centres in Edo State, Nigeria. The 9-item Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) tool were used to assess depression and anxiety respectively. Binary logistic regression was applied to determine risk factors of depression and anxiety. Results Of the 489 participants, 49.1% and 38.0% had depressive and anxiety symptoms respectively. The prevalence of depression, anxiety, and combination of both were 16.2%, 12.9% and 9.0% respectively. Moderate-severe symptoms of COVID-19, ≥14 days in isolation, worrying about the outcome of infection and stigma increased the risk of having depression and anxiety. Additionally, being separated/divorced increased the risk of having depression and having comorbidity increased the risk of having anxiety. Conclusion A substantial proportion of our participants experienced depression, anxiety and a combination of both especially in those who had the risk factors we identified. The findings underscore the need to address these risk factors early in the course of the disease and integrate mental health interventions into COVID-19 management guidelines.


Author(s):  
M. Silva ◽  
D. M. Resurrección ◽  
A. Antunes ◽  
D. Frasquilho ◽  
G. Cardoso

Abstract Aims Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Methods Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Conclusions Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.


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