The mental and behavioral health crisis in youth: Strategic solutions post COVID-19 pandemic: An American Academy of Nuring consensus paper.

The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness.

Perceived Stressors and Support in Family Caregivers of Individuals With Opioid Use Disorder.

ABSTRACT: Stress experienced by family caregivers of individuals with opioid use disorder (OUD) contributes to caregiver burden. To understand the stressors experienced by family caregivers of individuals with OUD and the factors that influence their personal resiliency, data were collected from a convenience sample of family caregivers who answered two open-ended questions about sources of stress and factors that affect their personal resilience as part of an online survey. Yin's thematic analysis revealed five objective and two subjective burden themes and four resilience themes. Results indicate OUD places significant burden on families and may contribute to decreased physical and mental well-being in caregivers. Caregivers who perceived adequate support were able to use their experience and innate knowledge to cope and emerge with more resilience. Results of this study support the need for translational research to increase resilience and coping in this population of caregivers.

Predictors of Burden and Resilience in Family Caregivers of Individuals With Opioid Use Disorder.

BACKGROUND: Family caregivers are an essential resource for individuals with opioid use disorder (OUD). Overburdened caregivers often experience detrimental effects to their emotional and physical well-being. METHOD: A cross-sectional, nonexperimental, correlational study was used to identify correlates and predictors of burden and resilience in caregivers of care recipients with OUD. Pearson product-moment correlation and multiple regression analysis were used to explore the relationships between caregiver characteristics, care recipient characteristics, the caregiver-care-recipient dyad characteristics, and burden and resilience among caregivers of individuals with OUD and to determine the best predictive model. Participants ( N = 152) completed the study using an online electronic survey. RESULTS: The standardized regression coefficients indicated that supervision of care recipient behavioral problems (ß = .29), dyadic interaction (ß = .29), caregiver stress (ß = .28), and care recipient opioid use (ß = .12) were the strongest predictors of caregiver burden, whereas caregiver mental health (ß = -.31) and physical health (ß = .30) were the strongest predictors of caregiver resilience. CONCLUSIONS: Caregiver and care recipient characteristics, and their dyadic interaction, directly influence the degree of burden and resilience reported by family caregivers. Caregivers experiencing increased stress who are tasked with supervising problematic care recipient behaviors are more likely to experience higher levels of burden. In contrast, caregivers with good physical and mental health and adequate resources showed higher levels of resilience.

Intensive Perinatal Mental Health Programs in the United States: A Call to Action.

Despite the growth of intensive perinatal mental health programs in the United States, too few programs serve women with perinatal mood and anxiety disorders (PMADs). Furthermore, little is known about program operations, services, the women served, and the methods of collecting outcome data. With this Open Forum, the authors aimed to share their investigation of intensive perinatal mental health programs in the United States and offer recommendations to improve services for women with PMADs. The authors recommend forming a national consortium that can foster collaboration to expand existing services and establish a national database to inform program development, evaluation, policies, and funding.

A Stepped Care Model of Patient Navigation to Enhance Engagement with Perinatal Mental Health Care.

During the perinatal period, women are at increased risk for developing perinatal mood and anxiety disorders (PMADs). As perinatal mental health screening efforts increase, significantly more women will be identified who require mental health services. Evidence-based treatments exist, yet many women do not receive adequate care. Patient navigation (PN) offers a promising patient-centered approach to improve treatment attendance and engagement. The purpose of this study is to describe the development of a stepped care PN service at an intensive outpatient program for women with PMADs. Our experience incorporating this model of PN revealed significant features that may guide other treatment care facilities to adopt this service to increase identification and connection to care.

Mental Health Nursing.

This Special Issue, Mental Health Nursing, provides transdisciplinary readers with a glimpse into the varied interests among researchers in nursing [...].

Nursing Students' Attitudes Toward and Empathy for Patients With Substance Use Disorder Following Mentorship.

BACKGROUND: Previous studies have shown that nurses have negative attitudes toward caring for patients with substance use disorder (SUD); these negative attitudes also have been noted with nursing students. This study examined nursing students' attitudes toward and empathy for patients with SUD to determine whether there were differences across practice settings. METHOD: Fifty-three students were surveyed before and after a 120-hour mentor-ship practicum; 25 students participated in focus groups. RESULTS: Students' empathy scores improved significantly across all practice settings, and students' attitudes improved significantly in all settings except maternal child health. Qualitative analysis revealed themes related to perceived lack of educational preparation, observing generational differences in nursing care, transitioning from fear to empathy, familial exposure, and feelings of helplessness and blame. CONCLUSION: Findings support the need for educational interventions in both academic and professional practice settings. [J Nurs Educ. 2020;59(3):149-153.].

Introducing mother-baby interaction therapy for mothers with postpartum depression and their infants.

Postpartum depression (PPD) and other perinatal mental health disorders have profound adverse effects on maternal-infant interaction and child health. However, standard psychiatric treatment does not necessarily improve the quality of mother-infant interaction. The purpose of this article is to describe the evidence-based CARE intervention and its translation to practice as Mother-Baby Interaction (MBI) Therapy to promote infant outcomes by supporting mothers' sensitive, responsive, and contingent interactions with their infants. Two vignettes illustrate MBI. We advocate that MBI needs to be a requisite adjunct treatment for PPD, and other perinatal mental health disorders, to promote maternal functioning, and positive long-term infant health outcomes.

Introducing Mother Baby Connections: a model of intensive perinatal mental health outpatient programming.

Perinatal mental health problems, experienced by 15-20% of women, are a significant public health issue associated with adverse effects among childbearing women; yet only 20-25% receive adequate treatment. There has been a recent proliferation of intensive perinatal day treatment programs in the United States. To meet this need in the greater Philadelphia area, we introduce Mother Baby Connections (MBC), an innovative interdisciplinary, attachment-focused, intensive, outpatient perinatal mental health program recently launched at Drexel University. The purpose of this paper is to (1) present an overview of MBC, its theoretical framework for services, and its evidence-based components, highlighting the unique factors that differentiate this program from traditional outpatient treatment, and (2) present clinical outcome data utilizing scores from reliable and valid scales, including enrollment to discharge outcomes from 20 months of MBC operation. In sum, outcomes for 20 predominantly minority women with complete measures showed significant improvements in maternal depression symptom severity, maternal functioning, birth trauma symptoms, perceived stress, parenting stress, and emotional regulation. Effect sizes were medium to large (i.e., 0.42-2.00). We conclude that MBC is a viable model for tailored intensive outpatient treatment to foster maternal mental health and functioning during the perinatal period.

Inflammatory Markers and Preeclampsia: A Systematic Review.

BACKGROUND: Preeclampsia (PE), a serious and variable pregnancy complication affecting 5%-10% of the obstetric population, has an undetermined etiology, yet inflammation is concomitant with its development, particularly in relation to endothelial dysfunction. OBJECTIVE: The purpose of this systematic review was to examine the published evidence concerning an association between PE and inflammatory markers for their usefulness in the prediction or early identification of women with PE in antepartum clinical settings. METHODS: In this systematic review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cumulative Index for Nursing and Allied Health and MEDLINE/OVID were the electronic databases used for identifying published articles. We placed no time limit on the publication year. RESULTS: The search generated 798 articles. After removing duplicates, screening abstracts, and conducting full-text reviews, we retained 73 articles and examined 57 unique markers. This review shows that C-reactive protein and the cytokines, specifically the proinflammatory markers IL-6, IL-8, and tumor necrosis factor alpha, garner the most support as potential inflammatory markers for clinical surveillance of PE, particularly during the second and third trimesters. DISCUSSION: Based on this review, we cannot recommend any single inflammatory marker for routine clinical use to predict/identify PE onset or progression. Research is recommended to examine a combination panel of these four inflammatory markers both with and without clinical risk factors toward the goal of translation to practice.

Tasks and communication as an avenue to enhance parenting of children birth-5 years: an integrative review.

Every day, normative functions of parenting and their significance are under-investigated. An integrative review of tasks and communication involved in parenting young children informed by Horowitz (1995) and Blumer (1969) was conducted.Research articles consistent with inclusion criteria were published from 1995 to 2013 and focused on parenting tasks and communication. Themes consistent with Horowitz and Blumer were identified. Nurses are reminded about the significance of attending to the everyday, normative work of parenting young children, the potential meaning derived from this work, and the importance of assessing parental development as well as the importance of continuing research in this area.

Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression.

OBJECTIVE: To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. DESIGN: Randomized clinical trial (RCT) with three phases. METHODS: In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants. SETTING: Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes. PARTICIPANTS: Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol. RESULTS: Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups. CONCLUSIONS: Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.

A community-based screening initiative to identify mothers at risk for postpartum depression.

OBJECTIVES: To conduct a community-based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices. DESIGN: Descriptive correlational. SETTINGS: Two academic medical centers, a university research office, and participants' homes. PARTICIPANTS: Five thousand one hundred and sixty-nine postpartum women age 14 to 49 years. METHODS: The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4 to 6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ≥10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD. RESULTS: Six hundred and seventy-four (13%) women had EPDS scores ≥10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self-administered and mailed in the EPDS than women who were screened via telephone had scores ≥10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White and having less than high school education were associated with higher PPD scores. CONCLUSIONS: The AHRQ framework was effective in guiding a large-scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation.

Best practices: community-based postpartum depression screening: results from the CARE study.

This column describes findings and best-practice recommendations from CARE (Communicating and Relating Effectively), a prospective randomized study in which 5,169 mothers were screened for postpartum depression. The prevalence rate was 13%. Results support use of the Edinburgh Postnatal Depression Screening Scale and a diagnostic assessment for those who screen positive. Of the 674 mothers with positive screens, 26% were not asked about their emotional state by clinicians. Screening must be linked to treatment options via referral and follow-up. Best-practice strategies for implementing screening include educating clinicians and postpartum women.

The inextricable nature of mental and physical health: implications for integrative care.

There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.

Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum.

OBJECTIVE: To examine differences in depression symptom rates and severity and factors associated with depression ratings. PARTICIPANTS: Cross-sectional sample of 1,359 American women who had delivered a single, live infant within the previous 2 years. DESIGN: Data were collected using the Edinburgh Postnatal Depression Scale online to screen for depression symptoms as part of Listening to Mothers, a national survey sponsored by Childbirth Connection of New York City and administered by Harris Interactive between May and June 2002. RESULTS: Evidence of continued mild and moderate-to-severe depression symptom rates throughout the first 2 years postpartum was found. Age, income, education, and employment had significant negative associations with depression symptom severity, and parity had a significant positive association with depression symptom severity. Race was not associated with depression symptom severity. CONCLUSIONS: Long-term screening for childbearing women is justified based on the study findings. The ease in survey administration suggests potential for online depression screening by health care providers and researchers. Furthermore, risk factors identified from this large-scale national survey, specifically young maternal age, low income, low education, not being employed full time, and multiparity, merit evaluation in clinical practice and future research.

How does postpartum depression affect breastfeeding?

PURPOSE: To examine patterns of exclusive breastfeeding, combination feeding, and exclusive bottle-feeding among a sample of women identified at 2-4 weeks postpartum with positive PPD symptoms. STUDY DESIGN AND METHODS: The sample included 122 women who were part of a larger study testing an intervention for promoting maternal-infant interaction among women with elevated PPD symptoms. Data were collected during three postpartum home visits. Demographic and feeding pattern data were described. Variables related to and predictors of feeding pattern were analyzed. The sample was compared to a random sample of postpartum women in New England. RESULTS: Severity of depression was not significantly related to breastfeeding. Older maternal age, living with a partner, and higher income were positively related to breastfeeding. Compared to a random sample, the level of exclusive breastfeeding was significantly lower in this sample than the level of combination feeding. CLINICAL IMPLICATIONS: Nurses should be involved in screening all prenatal and postpartum women for PPD symptoms, particularly when they present with breastfeeding difficulties, and refer for treatment when appropriate. For breastfeeding mothers, PPD treatment must include consideration of therapeutic options as well as implications for the breastfeeding relationship. When appropriate treatment for PPD is being considered, thought should be given to the importance and value of breastfeeding to the mother.