Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review.

BACKGROUND: Despite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0-6 years; and (2) explore how frontline workers are included in the program process. METHODS: This scoping review was completed using the Arksey and O'Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990-2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis. RESULTS: Forty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation. CONCLUSION: Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.

Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes.

BACKGROUND: Antenatal women experience an increased level of mood and anxiety symptoms, which have negative effects on mothers' mental and physical health as well as the health of their newborns. The relation of maternal depression and anxiety in pregnancy with neonate outcomes is well-studied with inconsistent findings. However, the association between antenatal mood instability (MI) and neonatal outcomes has not been investigated even though antenatal women experience an elevated level of MI. We sought to address this gap and to contribute to the literature about pregnancy neonate outcomes by examining the relationship among antenatal MI, depression, and anxiety and neonatal outcomes. METHODS: A prospective cohort of women (n = 555) participated in this study at early pregnancy (T1, 17.4 ± 4.9 weeks) and late pregnancy (T2, 30.6 ± 2.7 weeks). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal depressive symptoms, anxiety was measured by the EPDS anxiety subscale, and mood instability was measured by a visual analogue scale with five questions. These mood states together with stress, social support, as well as lifestyle were also examined in relation to neonatal outcomes using chi-square tests and logistic regression models. RESULTS: Mood instability, depression, and anxiety were unrelated to adverse neonatal outcomes. Only primiparous status was associated with small for gestational age after Bonferroni correction. CONCLUSIONS: We report no associations between antenatal mood symptoms including MI, depression, and anxiety and neonatal outcomes. More studies are required to further explore the relationship between antenatal mood instability, depression, and anxiety and neonatal outcomes.

Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women.

BACKGROUND: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.

Mood instability during pregnancy and postpartum: a systematic review.

Perinatal mood instability (MI) is a common clinical observation in perinatal women, and existing research indicates that MI is strongly associated with a variety of mental disorders. The purpose of this study is to review the evidence of perinatal MI systematically, with a focus on perinatal MI, its relation to perinatal depression, and its effects on children. A systematic search of the literature using PRISMA guidelines was conducted on seven academic health databases to identify any peer-reviewed articles published in English from 1985 to July 2017. Studies were screened, data were extracted, and quality of the selected studies was assessed. A total of 1927 abstracts were returned from the search, with 1063 remaining for abstract screening after duplicate removal, and 4 quantitative studies were selected for final analysis. The selected studies addressed perinatal MI (n = 2), the relation of perinatal MI to perinatal depression (n = 1), and the effects of perinatal MI on children (n = 1). The selected studies identified that perinatal women experienced a significantly higher level of MI than non-perinatal women, MI is a prominent feature in perinatal women with and without depression, mood lability during the early postpartum predicts psychopathology up to 14 months postpartum, and maternal emotion dysregulation, rather than maternal psychopathology, increases the risk of heightened facial affect synchrony in mother-infant interaction. The study reveals a significant gap in the literature of perinatal MI.

Exploring National Nursing Readiness for a Radiological or Nuclear Incident: A Cross-Sectional Study.

INTRODUCTION: As the largest component of the United States health care workforce, nurses will play a critical role in radiological or nuclear disaster medical response. Despite this, the United States' schools of nursing are not currently providing radiation content (75% teach zero or <1 hour), and much of the current nursing workforce may not have received adequate response education and training. Nurses working in emergency departments and those who work at hospitals within the Radiation Injury Treatment Network will be relied on heavily, but little is known about whether these nurses possess the knowledge and skills needed to care for and protect patients after a radiation emergency. Current federal and state radiological/nuclear preparedness plans may be built on false assumptions of readiness, which would have serious implications for national preparedness and the National Health Security Strategy. The purpose of this study was to assess nurses' knowledge and skill in emergency radiological or nuclear response and determine their willingness to use mobile technology for education and training in response to a large-scale radiation event. METHODS: Descriptive cross-sectional survey of registered nurse members of the Emergency Nurses Association and/or those employed at Radiation Injury Treatment Network centers. RESULTS: Knowledge scores were low for all respondents. Prior attendance at a Radiation Emergency Medical Management course, use of online resources, and having a preparedness plan were associated with higher scores. Experience with a radiation emergency was associated with the highest score. Nurses are willing to use mobile technology during a radiological or nuclear disaster response. DISCUSSION: Key nurses may not possess adequate knowledge or clinical competence to participate in radiation response activities. The results of this assessment identified educational gaps and areas to strengthen nursing education and clinical skills.

Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpartum and their prenatal predictors.

BACKGROUND: Maternal depression and anxiety have distinct constellations of symptom trajectories, which are associated with factors that may vary between different groups of women. The aim of this study was to identify subgroups of women who exhibit unique longitudinal trajectory patterns of depressive and anxiety symptoms from pregnancy to 5 years postpartum and the antenatal predictors associated with these maternal groups. METHODS: The study used a longitudinal data collected from 615 women in Saskatchewan from pregnancy to 5 years postpartum. Semiparametric group-based models were used to identify latent maternal depressive and anxiety trajectory groups. Multinomial logit models were then used to assess the association between maternal characteristics and the identified latent trajectory groups. RESULTS: We identified four trajectory groups of maternal depressive symptoms: low-stable (35%); moderate-stable (54%); moderate-increasing (5%); and high-decreasing (6%), and three trajectory groups of maternal anxiety symptoms: very low-stable (13%); low-stable (58%); and moderate-stable (29%). We also identified several risk factors, most notably history of depression and stress, that were significantly associated with these trajectories. CONCLUSION: History of depression and increased stress are significant risk factors that can be identified during regular perinatal visits; therefore, clinicians should inquire about these risk factors to identify women at high risk of ongoing depression or anxiety.

Correlation Between Paramedic Disaster Triage Accuracy in Screen-Based Simulations and Immersive Simulations.

Background: Disaster triage is an infrequent, high-stakes skill set used by emergency medical services (EMS) personnel. Screen-based simulation (SBS) provides easy access to asynchronous disaster triage education. However, it is unclear if the performance during a SBS correlates with immersive simulation performance. Methods: This was a nested cohort study within a randomized controlled trial (RCT). The RCT compared triage accuracy of paramedics and emergency medical technicians (EMTs) who completed an immersive simulation of a school shooting, interacted with an SBS for 13 weeks, and then completed the immersive simulation again. The participants were divided into two groups: those exposed vs. those not exposed to 60 Seconds to Survival© (60S), a disaster triage SBS. The aim of the study was to measure the correlation between SBS triage accuracy and immersive simulation triage accuracy. Improvements in triage accuracy were compared among participants in the nested study before and after interacting with 60S, and with improvements in triage accuracy in a previous study in which immersive simulations were used as an educational intervention. Results: Thirty-nine participants completed the SBS; 26 (67%) completed at least three game plays and were included in the evaluation of outcomes of interest. The mean number of plays was 8.5 (SD =7.4). Subjects correctly triaged 12.4% more patients in the immersive simulation at study completion (73.1% before, 85.8% after, P = 0.004). There was no correlation between the amount of improvement in overall SBS triage accuracy, instances of overtriage (P = 0.101), instances of undertriage (P = 0.523), and improvement in the second immersive simulation. A comparison of the pooled data from a previous immersive simulation study with the nested cohort data showed similar improvement in triage accuracy (P = 0.079). Conclusions: SBS education was associated with a significant increase in triage accuracy in an immersive simulation, although triage accuracy demonstrated in the SBS did not correlate with the performance in the immersive simulation. This improvement in accuracy was similar to the improvement seen when immersive simulation was used as the educational intervention in a previous study.

A Review of the Effects of Physical Therapy on Self-Esteem in Postpartum Women With Lumbopelvic Dysfunction.

This study sought to determine the impact of physical therapy for lumbopelvic dysfunction on self-esteem in postpartum women. Systematic searches were carried out in CINAHL, Embase, PsycINFO, Medline (OVID), Cochrane, and Web of Science by a health sciences librarian using various combinations of subject headings and key words. A dual review process was used first to assess titles and abstracts and then to examine the full text. Conflicts were resolved through discussion or a third reviewer as needed. Dual data extraction was completed using a standardized collection form. Pairs of reviewers met to discuss conflicts. Data quality was assessed using the Cochrane Collaboration's Risk of Bias Tool, the Joanna Briggs Critical Appraisal Tool, and the Critical Appraisal Skills Programme Checklist. Thirteen articles were included in the review. None of the articles assessed self-esteem specifically; however, each article assessed aspects of self-esteem (self-concept, self-efficacy, self-worth, depression, quality of life, general well-being, or physical function). All articles reported improvements in the selected outcome measures compared with baseline; two studies that compared two different physical therapy interventions found no significant differences between the interventions. To our knowledge, there is no literature explicitly evaluating self-esteem in postpartum women following physical therapy intervention for lumbopelvic dysfunction. Low self-esteem is shown to predict depression and anxiety; therefore, interventions that increase self-esteem may be useful in reducing the risk of depression.

Latent trajectory groups of perinatal depressive and anxiety symptoms from pregnancy to early postpartum and their antenatal risk factors.

The aim of this study is to identify subgroups of women who exhibit distinct trajectory patterns of depressive and anxiety disorders from pregnancy to early postpartum and the risk factors associated with the latent trajectory group memberships. Women (n = 615) from the Feelings in Pregnancy and Motherhood (FIP) longitudinal study were followed from early pregnancy to early postpartum for a 7-month period in 2006-2007. The semi-parametric group-based trajectory modeling approach was used to identify the latent trajectory groups. Multinomial logit models were then used to explore the association between latent trajectory group membership and antenatal characteristics. We identified four latent trajectory groups of perinatal depressive symptoms: "low-stable" (49.6%), "moderate-stable" (42.3%), "postpartum" (3.6%), and "antepartum" (4.6%). Significant risk factors associated with these trajectory group memberships were past depression, stress level, ethnicity, the mother's age, and relationship satisfaction. Three latent trajectory groups of perinatal anxiety symptoms were identified: "very low-stable" (8.9%); "low-stable" (60.7%); and "moderate-stable" (30.4%). Significant risk factor associated with these trajectories were past depression, stress level, and income level. Latent trajectory groups of perinatal depressive and anxiety symptoms were identified to uncover potential heterogeneity in populations. Our findings support the need for multiple assessments starting from early pregnancy to the postpartum, which can give some important insights on the characteristics of the women at high symptom burden trajectories for early interventions that may alter the progress of their mental symptoms.

Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study.

BACKGROUND: Refugee women are almost five times more likely to develop postpartum depression than Canadian-born women. This can be attributed to various difficulties they faced before coming to Canada as well as during resettlement. Moreover, refugee women usually face many obstacles when accessing health services, including language and cultural barriers, as well as unique help-seeking behaviors that are influenced by various cultural and practical factors. There has been a recent, rapid influx of Syrian refugees to Canada, and many of them are childbearing women. However, little is known about the experiences that these women have encountered pre- and post-resettlement, and their perceptions of mental health issues. Thus, there is an urgent need to understand refugee women's experiences of having a baby in Canada from a mental health perspective. METHODS: A mixed methods research design included 12 Syrian refugee women who migrated to Saskatoon in 2015-16 and who were either pregnant or 1 year postpartum. The data were collected during a single focus group discussion and a structured questionnaire. RESULTS: Our results showed that more than half of participants have depressive symptoms, half of them have anxiety symptoms, and one sixth have PTSD symptoms. Three major themes emerged from the qualitative data: 1) Understanding of maternal depression; 2) Protective factors for mental health; and 3) Barriers to mental health services. CONCLUSIONS: Maternal depression is an important feature in Syrian refugee women recently resettled in Canada. Reuniting these women with their families and engaging them in culturally appropriate support programs may improve their mental health outcomes.

Approaches to health-care provider education and professional development in perinatal depression: a systematic review.

BACKGROUND: Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. METHODS: A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. RESULTS: Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. CONCLUSIONS: This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers. TRIAL REGISTRATION: A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701 ), June 21, 2015.

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond.

OBJECTIVES: To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle. OUTCOMES: Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter. EVIDENCE: Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document. VALUES: The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.

Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà.

OBJECTIFS: Doter les professionnels de la santé du Canada de connaissances et d'outils de base, afin qu'ils puissent prodiguer des conseils nutritionnels aux femmes tout au long de leur cycle de vie. RéSULTATS: L'alimentation optimale a fait l'objet d'une évaluation tout au long du cycle de vie de la femme. Elle a porté en particulier sur l'adolescence, la préconception, la grossesse, la période post-partum, la ménopause et au-delà. Le présent guide fournit d'abord des directives abrégées à l'intention de toutes les femmes. Elles sont suivies de chapitres proposant un examen des données probantes, ainsi que des recommandations sur la promotion d'une alimentation saine et d'un poids santé à chaque étape de la vie. Par ailleurs, tous les chapitres présentent une analyse de nutriments d'intérêt particulier, ainsi que d'autres aspects uniques à chaque étape de la vie. DONNéES PROBANTES: Des documents publiés, des rapports d'organismes gouvernementaux et de santé, des lignes directrices de pratique clinique, de la documentation parallèle et des extraits de manuels ont servi à étayer les recommandations formulées dans le présent document. VALEURS: L'évaluation de la qualité des données probantes repose sur les critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. CHAPITRE 2 : CONSEILS GéNéRAUX SUR L'ALIMENTATION FéMININE: Déclarations Sommaires Recommandations CHAPITRE 3 : ALIMENTATION DE L'ADOLESCENTE: Déclarations Sommaires Recommandations CHAPITRE 4 : ALIMENTATION PRéCONCEPTIONNELLE: Déclarations Sommaires Recommandations CHAPITRE 5 : ALIMENTATION PENDANT LA GROSSESSE: Déclarations Sommaires Recommandations CHAPITRE 6 : ALIMENTATION ET LACTATION POST-PARTUM: Déclarations Sommaires Recommandations CHAPITRE 7 : ALIMENTATION PENDANT LA MéNOPAUSE ET AU-DELà: Déclarations Sommaires Recommandations.

Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study.

Postpartum depression (PPD) afflicts up to 15 % of women following childbirth and negatively impacts both mother and child. Therapist-assisted internet cognitive behavior therapy (TAICBT) is a promising intervention for the treatment of PPD; however, women's perceptions of TAICBT have not been examined. Responses to 10 open-ended questions from 24 women who received TAICBT for PPD were thematically analyzed. The majority of women expressed that the TAICBT program afforded flexibility, accessibility, and convenience, as well as anonymity and privacy. Some participants described the program as helping them take a step in the right direction and enhance their self-awareness and parenting skills. Participants also described having the internet therapist individualize their treatment. Challenges related to the TAICBT program were also identified by a minority of participants including managing time to log onto the program, the fast pace, completion of homework around childcare duties, and challenges of not having a face-to-face therapist. Participants also made suggestions for future programming. The large majority of participants consistently described their internet therapist favorably; however, challenges related to the internet therapy were also identified. Results should be integrated in the development of future programming.

Patterns of depression and treatment in pregnant and postpartum women.

OBJECTIVE: To determine the course of depression and the effects of treatment during pregnancy and into the postpartum period. METHOD: This is a longitudinal study of a community sample of 649 pregnant women who were assessed in early pregnancy (17.4 ± 4.9 weeks), late pregnancy (30.6 ± 2.7 weeks), and postpartum (4.2 ± 2.1 weeks) with the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were encouraged to seek assessment and treatment. We used generalized estimating equation modelling to determine the predicted mean depression scores, taking age, ethnicity, history of depression, and previous and present treatment status into account. RESULTS: The unadjusted prevalence of depression (EPDS ≥ 12) was 14.1% (n = 91) in early pregnancy, 10.4% (n = 62) in late pregnancy, and 8.1% (n = 48) postpartum. Twelve per cent of women were engaged in treatment. The predicted mean EPDS score decreased over the course of the pregnancy into the postpartum period, most significantly when women were engaged in counselling or taking psychotropic medication. Counselling was the more common method of treatment during pregnancy and medication in the postpartum period. Women who were depressed and untreated were more likely to be younger, more stressed, have less support, have a history of depression, and use alcohol. CONCLUSIONS: We confirm that depressive symptoms improve over the course of the pregnancy into the postpartum period, particularly for women who receive treatment. Our study is unique as it takes the history of depression, present and past treatment status, and the longitudinal nature of the data into account.

Are pregnant and postpartum women moodier? Understanding perinatal mood instability.

OBJECTIVE: To better understand mood changes in pregnancy and postpartum, we studied mood instability in a group of perinatal women and in a group of normally menstruating non-pregnant women. METHODS: Perinatal women (n = 45) completed the Edinburgh Postnatal Depression Scale at 16 weeks' and 30 weeks' gestation and again at four weeks postpartum. Immediately after completing the Edinburgh Postnatal Depression Scale, participants also completed mood diaries with separate visual analogue scales for depressed, irritable, anxious, and euphoric/activated moods. This was done twice daily for one week. A comparison group of 31 non-perinatal women without depression or premenstrual symptoms completed identical mood diaries for seven consecutive weeks. Mood instability was represented by the mean square successive difference statistic. RESULTS: Perinatal women showed higher mean levels of depressed, irritable, anxious, and high mood instability than the non-perinatal women. The findings held when pregnant women who were depressed were removed from the comparison, except that the difference in depressed mood instability was no longer significant. CONCLUSION: Wider fluctuation in mood in pregnant and postnatal women is consistent with the common belief that perinatal women are moodier than non-perinatal women.

Negative impact of non-evidence-based information received by women taking antidepressants during pregnancy from health care providers and others.

OBJECTIVES: The use of antidepressants by women during pregnancy continues to be a controversial subject, with conflicting information regarding the safety of this group of drugs. We sought (1) to determine the impact of information, advice, and comments women received from health care providers, family, and media about use of antidepressants during pregnancy, and (2) to compare experiences regarding the psychosocial impact of women who continued and discontinued antidepressant therapy during pregnancy. METHODS: Women who had taken an antidepressant at some point during pregnancy were interviewed. The responses of women who continued antidepressant therapy throughout pregnancy were compared with those of women who discontinued therapy at some point in the pregnancy. A questionnaire with questions pertaining to information women had received from various individuals regarding the use of an antidepressant while pregnant was administered to both groups. RESULTS: Ninety-four interviews were completed; 78 were with women who continued antidepressant therapy throughout pregnancy, and 16 were with women who discontinued therapy. The small number of women in the discontinuation group was a result of many women declining to participate. More than one half of the women who continued the medication throughout pregnancy had frequently considered discontinuing, despite reassurance that continuation would cause no harm to their baby. Negative information was recalled far more often than reassuring information. CONCLUSION: Information from friends, family, and health care providers can have a negative impact on decision-making regarding pharmacotherapy for depression during pregnancy. Health care providers should be cognizant of this when counselling patients who require antidepressant therapy during pregnancy.

Stigma and attitudes towards antenatal depression and antidepressant use during pregnancy in healthcare students.

Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare professionals hold stigma against patients who experience mental health conditions, including depression. The public, as well as healthcare professionals may have negative attitudes towards antidepressant use during pregnancy, despite evidence that many antidepressants are relatively safe for use in pregnancy. The objective of this project was to determine what knowledge and opinions healthcare students may hold towards antenatal depression and its treatment, and whether further knowledge and experience lessened the stigma. Medical, pharmacy, and nursing students (n = 309) were given a scenario regarding a woman with AD based on Corrigan's Attribution Questionnaire and asked seven questions based on the scenario that assessed their level of stigma and questions related to treatment. Each student group demonstrated some stigma towards the woman and all groups lacked knowledge regarding treatment of AD. Overall, the nursing students were the most stigmatizing of the three groups. The study demonstrates that healthcare students hold stigma towards people with mental health problems, including pregnant depressed women. It points to a need to increase education about antenatal depression and its treatment.

Mood instability in women with premenstrual syndrome.

OBJECTIVE: Most women of reproductive age experience premenstrual symptoms. Mood swings within a day and from day to day are a common complaint of people with mood problems (mood instability). We investigated whether mood instability was higher in women with premenstrual syndrome (PMS) than in a control group with no PMS. METHODS: We prospectively studied mood and physical symptoms over two menstrual periods in 29 women with self-identified PMS and 31 women without PMS. We excluded women on hormonal birth control or with a history of past or current diagnoses of depression. We used the mean square successive difference derived from twice daily visual analogue scale ratings of mood as the measure of mood instability. RESULTS: The women with PMS showed more irritable and depressed mood instability than the women without PMS. These differences were present whether or not the late luteal phase (seven days before the start of menstruation) was included in the data. On visual inspection of mood ratings, typically irritable and depressed moods increased in the late luteal phase. However, women with self-identified PMS showed a variety of mood patterns throughout the cycle. CONCLUSION: Women with PMS have increased mood instability within the seven day premenstrual phase and at other times as well. This supports the premise that PMS may represent a manifestation of an underlying problem of mood dysregulation in common with other mood disorders.