Staff Satisfaction in the Functionalisation of Psychiatric In-patient Care.

In many UK mental health services, in-patient psychiatric care is being separated from community care by having dedicated in-patient medical team. We evaluated staff satisfaction in this functionalised in-patient care. A survey was conducted amongst multidisciplinary staff from various teams using a questionnaire survey. On an average 14.3% of staff returned a satisfactory response for functionalisation, 57.3% had unsatisfactory response and others were undecided or perceived no change. There was no difference in responses amongst age, gender and professional groups. Mean scores of all groups were within unsatisfactory domain; however community staff compared to in-patient staff and staff with more than 5 years of experience compared to those with 1-5 years of experience returned significantly more unsatisfactory responses regarding functionalisation. Many positive and negative aspects of functionalisation were raised. The results of this evaluation suggest the need for further studies on the effectiveness of in-patient functionalisation. Short and long term clinical outcomes and the satisfaction of the patients should also be studied.

A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu.

OBJECTIVES: To measure the prevalence of depression amongst postpartum and non-postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. METHODS: We screened 100 women 2-3 months post-delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM-IV criteria. RESULTS: Predictive errors were minimized by using an EPDS score > or =13 to define depression. Using this threshold, there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fisher's exact test, P > 0.05). Compared with DSM-IV, the sensitivity, specificity and positive predictive values were 100, 92.6 and 41.6%, respectively. CONCLUSIONS: The prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions, PPD is no more common than the background depression rate amongst Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries.