Using Prenatal Advocates to Implement a Psychosocial Education Intervention for Posttraumatic Stress Disorder during Pregnancy: Feasibility, Care Engagement, and Predelivery Behavioral Outcomes.
Upshur CC1, Wenz-Gross M2, Weinreb L2, Moffitt JJ3.
Womens Health Issues. 2016 Jul 29. pii: S1049-3867(16)30059-7. doi: 10.1016/j.whi.2016.06.003.
Pregnant women with posttraumatic stress disorder (PTSD) engage in more high-risk behavior and use less prenatal care. Although treating depression in pregnancy is becoming widespread, options for addressing PTSD are few. This study was designed to test the feasibility of implementing a manualized psychosocial PTSD intervention, Seeking Safety, delivered by prenatal advocates.
All women entering prenatal care at two federally qualified health centers were screened for current symptoms of PTSD. One site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women that indicated clinical or subclinical PTSD symptoms. Baseline and predelivery interviews were conducted and collected background characteristics and assessed PTSD severity and coping skills. Medical records were collected to document care visits. Documentation of participation rates, fidelity to the treatment, and qualitative feedback from advocates and participants was collected.
More than one-half (57.3%) of the intervention women received all Seeking Safety sessions and fidelity ratings of the session showed acceptable quality. Using an intent-to-treat analysis, intervention women participated in significantly more prenatal care visits (M = 11.7 versus 8.9; p < .001), and had a significantly higher rate of achieving adequate prenatal care (72.4% vs. 42.9%; p < .001). Although not significant when accounting for baseline differences, intervention women also reduced negative coping skills but not PTSD symptoms.
Using prenatal care advocates to deliver Seeking Safety sessions to women screening positive for PTSD symptoms at entry to prenatal care is a promising intervention that seems to increase prenatal care participation and may reduce negative coping strategies.
Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey.
Gökçe İsbİr G1, İncİ F1, Bektaş M2, Dikmen Yıldız P3, Ayers S4.
Midwifery. 2016 Aug 1;41:96-103. doi: 10.1016/j.midw.2016.07.016.
this study examined factors associated with symptoms of post-traumatic stress (PTS) following childbirth in women with normal, low-risk pregnancies in Nigde, Turkey.
a prospective longitudinal design where women completed questionnaire measures at 20+ weeks’ gestation and 6-8 weeks after birth.
eligible pregnant women were recruited from nine family healthcare centres in Nigde between September 2013 and July 2014.
a total of 242 women completed questionnaires at both time points.
PTS symptoms were measured using the Impact of Event Scale-Revised (IES-R) 6-8 weeks after birth. Potential protective or risk factors of childbirth self-efficacy, fear of childbirth, adaptation to pregnancy/motherhood, and perceived social support were measured in pregnancy and after birth. Perceived support and control during birth was measured after birth. Demographic and obstetric information was collected in pregnancy using standard self-report questions.
PTS symptoms were associated with being multiparous, having a planned pregnancy, poor psychological adaptation to pregnancy, higher outcome expectancy but lower efficacy expectancy during pregnancy, urinary catheterization during labour, less support and perceived control in birth, less satisfaction with hospital care, poor psychological adaptation to motherhood and increased fear of birth post partum. Regression analyses showed the strongest correlates of PTS symptoms were high outcome and low efficacy expectancies in pregnancy, urinary catheterization in labour, poor psychological adaptation to motherhood and increased fear of birth post partum. This model accounted for 29% of the variance in PTS symptoms.
this study suggests women in this province in Turkey report PTS symptoms after birth and this is associated with childbirth self-efficacy in pregnancy, birth factors, and poor adaptation to motherhood and increased fear of birth post partum.
IMPLICATIONS FOR PRACTICE:
maternity care services in Turkey need to recognise the potential impact of birth experiences on women’s mental health and adaptation after birth. The importance of self-efficacy in pregnancy suggests antenatal education or support may protect women against developing post partum PTS, but this needs to be examined further.
Impact of holding the baby following stillbirth on maternal mental health and well-being: findings from a national survey.
Redshaw M1, Hennegan JM1, Henderson J1.
BMJ Open. 2016 Aug 18;6(8):e010996. doi: 10.1136/bmjopen-2015-010996.
To compare mental health and well-being outcomes at 3 and 9 months after the stillbirth among women who held or did not hold their baby, adjusting for demographic and clinical differences.
Secondary analyses of data from a postal population survey.
Women with a registered stillbirth in England in 2012.
468 eligible responses were compared. Differences in demographic, clinical and care characteristics between those who held or did not hold their infant were described and adjusted for in subsequent analysis. Mental health and well-being outcomes were compared, and subgroup comparisons tested hypothesised moderating factors.
Self-reported depression, anxiety, post-traumatic stress disorder (PTSD) symptoms and relationship difficulties.
There was a 30.2% response rate to the survey. Most women saw (97%, n=434) and held (84%, n=394) their baby after stillbirth. There were some demographic differences with migrant women, women who had a multiple birth and those whose pregnancy resulted from fertility treatment being less likely to hold their baby. Women who held their stillborn baby consistently reported higher rates of mental health and relationship difficulties. After adjustment, women who held their baby had 2.12 times higher odds (95% CI 1.11 to 4.04) of reporting anxiety at 9 months and 5.33 times higher odds (95% CI 1.26 to 22.53) of reporting relationship difficulties with family. Some evidence for proposed moderators was observed with poorer mental health reported by women who had held a stillborn baby of <33 weeks’ gestation, and those pregnant at outcome assessment.
This study supports concern about the negative impact of holding the infant after stillbirth. Results are limited by the observational nature of the study, survey response rate and inability to adjust for women’s baseline anxiety. Findings add important evidence to a mixed body of literature.
Posttraumatic Growth in Parents After Infants’ NICU Hospitalization.
Aftyka A1, Rozalska-Walaszek I1, Rosa W2, Rybojad B1, Karakuła-Juchnowicz H1.
J Clin Nurs. 2016 Aug 18. doi: 10.1111/jocn.13518.
AIMS AND OBJECTIVES:
We aimed to determine the incidence and severity of Post-traumatic Growth (PTG) in a group of parents of children hospitalized in the intensive care unit in the past.
A premature birth or a birth with life-threating conditions is a traumatic event for the parents and may lead to a number of changes, some of which are positive, known as PTG.
The survey covered 106 parents of 67 infants aged 3 to 12 months. An original questionnaire and standardized research tools were used in the study: Impact Event Scale – Revised, Perceived Stress Scale, COPE Inventory: Positive Reinterpretation and Growth, Coping Inventory for Stressful Situations, Post-traumatic Growth Inventory and Parent and Infant Characteristic Questionnaire.
Due to a stepwise backward variables selection, we found three main factors that explain PTG: post-traumatic stress symptoms, positive reinterpretation and growth and dichotomic variable infants’ survival. This model explained 29% of the PTG variation. Similar models that were considered separately for mothers and fathers showed no significantly better properties.
PTG was related to a lesser extent to sociodemographic variables or the stressor itself, and related to a far greater extent to psychological factors.
Who is distressed? A comparison of psychosocial stress in pregnancy across seven ethnicities.
Robinson AM1, Benzies KM2, Cairns SL1, Fung T3, Tough SC4.
BMC Pregnancy Childbirth. 2016 Aug 11;16(1):215. doi: 10.1186/s12884-016-1015-8.
Calgary, Alberta has the fourth highest immigrant population in Canada and ethnic minorities comprise 28 % of its total population. Previous studies have found correlations between minority status and poor pregnancy outcomes. One explanation for this phenomenon is that minority status increases the levels of stress experienced during pregnancy. The aim of the present study was to identify specific types of maternal psychosocial stress experienced by women of an ethnic minority (Asian, Arab, Other Asian, African, First Nations and Latin American).
A secondary analysis of variables that may contribute to maternal psychosocial stress was conducted using data from the All Our Babies prospective pregnancy cohort (N = 3,552) where questionnaires were completed at < 24 weeks of gestation and between 34 and 36 weeks of gestation. Questionnaires included standardized measures of perceived stress, anxiety, depression, physical and emotional health, and social support. Socio-demographic data included immigration status, language proficiency in English, ethnicity, age, and socio-economic status.
Findings from this study indicate that women who identify with an ethnic minority were more likely to report symptoms of depression, anxiety, inadequate social support, and problems with emotional and physical health during pregnancy than women who identified with the White reference group.
This study has identified that women of an ethic minority experience greater psychosocial stress in pregnancy compared to the White reference group.
Understanding the Experience of Miscarriage in the Emergency Department.
MacWilliams K1, Hughes J2, Aston M2, Field S2, Moffatt FW2.
J Emerg Nurs. 2016 Aug 6. pii: S0099-1767(16)30079-4. doi: 10.1016/j.jen.2016.05.011.
Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women.
Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis.
Five themes emerged: “Pregnant/Life: Miscarriage/Death”; “Deciding to go to the emergency department: Something’s wrong”; “Not an illness: A different kind of trauma”; “Need for acknowledgement”; and “Leaving the emergency department: What now?”. Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization.
This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization.
Effect of Parent Presence During Multidisciplinary Rounds on Neonatal Intensive Care Unit-Related Parental Stress.
Gustafson KW, LaBrecque MA, Graham DA, Tella NM, Curley MA.
J Obstet Gynecol Neonatal Nurs. 2016 Aug 3. pii: S0884-2175(16)30227-1. doi: 10.1016/j.jogn.2016.04.012.
To evaluate the effect of parent presence during multidisciplinary rounds on NICU-related parental stress.
University-affiliated, 24-bed NICU located within a children’s hospital that admits infants from birth to 6 months of age.
One hundred thirty-two parents of infants admitted to the NICU for the first time.
All parents completed the Parent Stressor Scale: NICU (PSS:NICU) on Study Days 0 and 3. In addition to usual family communication practices, parents in the experimental group were offered the opportunity to participate in multidisciplinary rounds on their infants.
A total of 132 parents completed the study; the first 46 parents were enrolled in the control group, and the subsequent 86 parents in the experimental group. Overall PSS:NICU scores decreased significantly in the experimental group between Study Days 0 and 3 (mean ± standard error (SE) = -0.24 ± 0.07, p < .001), but the change was not significantly different between the control and experimental groups (mean ± SE = -0.12 ± 0.10, p = .25). The PSS:NICU Parental Role Alteration subscale decreased by the largest margin in the experimental group (mean ± SE = -0.42 ± 0.09, p < .0001), but the change was not significantly different between groups (mean ± SE = -0.26 ± 0.14, p = .06). Overall PSS:NICU stress scores were higher in mothers than fathers (mothers, mean ± SE = 3.4 ± 0.81; fathers, mean ± SE = 2.7 ± 0.67; p < .001).
Providing parents with the opportunity to participate in multidisciplinary rounds did not affect NICU-related parental stress. Mothers reported higher levels of stress than fathers.
Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth.
Schrøder K; Larsen PV; Jørgensen JS; Hjelmborg JV; Lamont RF; Hvidt NC;
Midwifery [Midwifery] 2016 Aug 2; Vol. 41, pp. 45-53. Date of Electronic Publication: 2016 Aug 2.
Objective: this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth. Material and Methods: a 2012 national survey of all Danish obstetricians and midwives (n=2098). The response rate was 59% of which 85% (n=1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen Psychosocial Questionnaire (COPSOQII). Responses were assessed on six scales: burnout, sleep disorders, general stress, depressive symptoms, somatic stress and cognitive stress. Associations between COPSOQII scales and participant characteristics were analysed using linear regression. Results: midwives reported significantly higher scores than obstetricians, to a minor extent during the most recent four weeks and to a greater extent immediately following a traumatic childbirth scale, indicating higher levels of self-reported psychosocial health problems. Sub-group analyses showed that this difference might be gender related. Respondents who had left the labour ward partly or primarily because they felt that the responsibility was too great a burden to carry reported significantly higher scores on all scales in the aftermath of the traumatic birth than did the group who still worked on the labour ward. None of the scales were associated with age or seniority in the time after the traumatic birth indicating that both junior and senior staff may experience similar levels of psychosocial health and well-being in the aftermath. Key Conclusions and Implications: this study shows an association between profession (midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by gender. This knowledge may lead to better awareness of the possibility of differences related to profession and gender when conducting debriefings and offering support to HCPs in the aftermath of traumatic childbirth. As many as 85% of the respondents in this national study stated that they had been involved in at least one traumatic childbirth, suggesting that the handling of the aftermath of these events is important when caring for the psychosocial health and well-being of obstetric and midwifery staff.
Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment.
Oh W; Muzik M; McGinnis EW; Hamilton L; Menke RA; Rosenblum KL
Journal Of Affective Disorders [J Affect Disord] 2016 Aug; Vol. 200, pp. 133-41.
Background: Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history. Methods: 177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors. Results: Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors. Limitations: Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk. Conclusions: The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.