How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content.

BACKGROUND: Despite elevated prevalence rates of prenatal (antenatal) anxiety across studies (13-21%), and prenatal people's use of the Internet to search for pregnancy-related information and support, research investigating prenatal people's experiences with online mental health communication, such as blogs, is lacking. This study examined blog entries focused on anxiety in pregnancy to better understand prenatal people's Internet discourse concerning their experiences with anxiety. METHODS: A Google search using the keywords "anxiety," "pregnant," and "blog" resulted in N = 18 blogs that met inclusion criteria (public blog written in English describing a personal experience with prenatal anxiety in 250 words or more). Blog content was analyzed using a thematic analytic approach based on grounded theory principles. RESULTS: Three main themes capturing prenatal people's experiences with anxiety as written in public blog content were developed from qualitative analyses: 1) etiology (subthemes: before pregnancy, during the current pregnancy, related to a previous pregnancy), 2) triggers (subthemes: uncertainty, perceived lack of control, and guilt and shame for not having a normal pregnancy), and 3) symptoms (subthemes: intertwined emotional, cognitive and physical symptoms, in addition to behavioural symptoms). CONCLUSIONS: Our findings demonstrate a need for perinatal professionals to address anxiety symptoms and triggers in pregnancy. One way to address this may be by providing credible information regarding prenatal mental and physical health to pregnant people through online mediums, such as blogs. Bloggers often discussed experiencing a combination of emotional, cognitive, physical, and behavioural symptoms, which suggests that medical and mental health professionals should work collaboratively to provide care for prenatal people experiencing anxiety. Furthermore, Cognitive Behavioural Therapy (CBT) addresses these types of symptoms, which suggests that interventions developed or adapted to meet this populations' needs could employ this therapeutic approach. Future research should explore the reasons why prenatal people experiencing anxiety engage with blogs, the characteristics of bloggers and readers, the impact of the blogging experience on both the blogger and their audience, and the information quality of blog content.

An evaluation of the quality of online perinatal depression information.

BACKGROUND: During the perinatal period (including pregnancy and up to 12 months after childbirth), expectant and new mothers are at an elevated risk of developing depression. Inadequate knowledge about perinatal depression and treatment options may contribute to the low help-seeking rates exhibited by perinatal people. The Internet can be an accessible source of information about perinatal depression; however, the quality of this information remains to be evaluated. The purpose of this study was to assess the quality of perinatal depression information websites. METHODS: After review, 37 websites were included in our sample. To assess overall website quality, we rated websites based on their reading level (Simple Measure of Gobbledegook; SMOG), information quality (DISCERN), usability (Patient Education Materials Assessment Tool; PEMAT), and visual design (Visual Aesthetics of Website Inventory; VisAWI). RESULTS: Websites often exceeded the National Institute of Health's recommended reading level of grades 6-8, with scores ranging from 6.8 to 13.5. Website information quality ratings ranged from 1.8 to 4.3 out of 5, with websites often containing insufficient information about treatment choices. Website usability ratings were negatively impacted by the lack of information summaries, visual aids, and tangible tools. Visual design ratings ranged from 3.2 to 6.6 out of 7, with a need for more creative design elements to enhance user engagement. CONCLUSIONS: This study outlines the characteristics of high-quality perinatal depression information websites. Our findings illustrate that perinatal depression websites are not meeting the needs of users in terms of reading level, information quality, usability, and visual design. Our results may be helpful in guiding healthcare providers to reliable, evidence-based online resources for their perinatal patients.

"Another Tool in Your Toolkit": Pediatric Occupational and Physical Therapists' Perspectives of Initiating Telehealth during the COVID-19 Pandemic.

AIMS: Pediatric occupational and physical therapy service delivery via telehealth increased during the COVID-19 pandemic. Real-world experience can guide service improvement. This study explored experiences, barriers, and facilitators of initial telehealth implementation from the therapist's perspective. METHODS: Qualitative descriptive approach. Semi-structured interviews were conducted with occupational therapists (n = 4) and physical therapists (n = 4) between May-June 2020. Interviews were recorded, and transcribed verbatim. Data were coded inductively to generate themes, then re-coded deductively to classify barriers and facilitators to telehealth acceptance and use using the Unified Technology Acceptance Theory. RESULTS: Participants had 16.5 [(2-35); median (range)] years of experience (3 months with telehealth) and predominantly worked with preschool children. Three themes about telehealth were identified: a practical option; requires skill development and refinement; beneficial in perpetuity. Most frequently cited barriers were the lack of opportunity for 'hands-on' assessment/intervention and the learning curve required. Most frequently cited facilitators included seeing a child in their own environment, attendance may be easier for some families, and families' perception that telehealth was useful. CONCLUSION: Despite rapid implementation, therapists largely described telehealth as a positive experience. Telehealth facilitated continued service provision and was perceived as relevant post-pandemic. Additional training and ensuring equitable access to services are priorities as telehealth delivery evolves.

Challenges, supports, and postpartum mental health symptoms among non-breastfeeding mothers.

Women face a high degree of pressure to breastfeed. However, some women are not able to breastfeed, or choose not to. Few studies have examined the experiences of non-breastfeeding mothers, including their challenges, supports, and mental health sequelae. We sought to identify women's experiences with breastfeeding, specifically their reasons for not breastfeeding, challenges faced, and supports received, and the association between breastfeeding and postpartum mental health. Self-identified postpartum women (N = 70) completed a questionnaire investigating perinatal health. Open-ended responses were analyzed using thematic analysis and quantitative measures were analyzed using descriptive statistics and multivariate analysis of variance (MANOVA). Qualitative analysis identified two main themes reflecting reasons for not breastfeeding (maternal factors and infant factors) and three primary challenges associated with not breastfeeding (emotional health, physical health, and perceived lack of support). Authors identified two main themes categorizing non-breastfeeding mothers' experiences with support (sources of support and type of support). A MANOVA revealed significantly greater levels of distress, anxiety, and depression, and lower levels of social support, among non-breastfeeding, relative to breastfeeding mothers. Findings reveal limitations in the availability of information and resources for non-breastfeeding mothers. It is possible that the pressure women may experience regarding breastfeeding may contribute to increased psychological distress for mothers who cannot or choose not to breastfeed. Based on our findings, future research and applied action should target the development and evaluation of informational resources and supports for non-breastfeeding women.

Unmet Parental Mental Health Service Needs in Neonatal Follow-Up Programs: Parent and Service Provider Perspectives.

Parental mental health services in neonatal follow-up programs (NFUPs) are lacking though needed. This study aimed to determine (1) the unmet mental health needs of parents and (2) the parent and provider perspectives on barriers and opportunities to increase mental health service access. Study 1: Parents in a central Canadian NFUP (N = 49) completed a mixed-method online survey (analyzed descriptively and by content analysis) to elucidate their mental health, related service use, barriers to service use, and service preferences. Study 2: Virtual focus groups with NFUP service providers (N = 5) were run to inform service improvements (analyzed by reflexive thematic analysis). The results show that parents endorsed a 2-4 times higher prevalence of clinically significant depression (59.2%), anxiety (51.0%), and PTSD (26.5%) than the general postpartum population. Most parents were not using mental health services (55.1%) due to resource insecurity among parents (e.g., time, cost) and the organization (e.g., staffing, training, referrals). Consolidating parents' and service providers' perspectives revealed four opportunities for service improvements: bridging services, mental health screening, online psychoeducation, and peer support. Findings clarify how a central Canadian NFUP can address parental mental health in ways that are desired by parents and feasible for service providers.

Paternal Perinatal Experiences during the COVID-19 Pandemic: A Framework Analysis of the Reddit Forum Predaddit.

During the COVID-19 pandemic, new parents were disproportionately affected by public health restrictions changing service accessibility and increasing stressors. However, minimal research has examined pandemic-related stressors and experiences of perinatal fathers in naturalistic anonymous settings. An important and novel way parents seek connection and information is through online forums, which increased during COVID-19. The current study qualitatively analyzed the experiences of perinatal fathers from September to December 2020 through the Framework Analytic Approach to identify unmet support needs during COVID-19 using the online forum predaddit on reddit. Five main themes in the thematic framework included forum use, COVID-19, psychosocial distress, family functioning, and child health and development, each with related subthemes. Findings highlight the utility of predaddit as a source of information for, and interactions of, fathers to inform mental health services. Overall, fathers used the forum to engage with other fathers during a time of social isolation and for support during the transition to parenthood. This manuscript highlights the unmet support needs of fathers during the perinatal period and the importance of including fathers in perinatal care, implementing routine perinatal mood screening for both parents, and developing programs to support fathers during this transition to promote family wellbeing.

Cognitive functioning before and after repetitive transcranial magnetic stimulation (rTMS): A quantitative meta-analysis in healthy adults.

Repetitive transcranial magnetic stimulation (rTMS) is thought to modulate brain function through methods of electromagnetic induction. Over the last few decades, a large body of studies have investigated the clinical applications of rTMS in a variety of patient populations for a diverse range of symptoms from depressive symptomology to post-stroke motor functioning. There is still no clear consensus, however, on how rTMS influences cognitive functioning in the healthy brain. We conducted a quantitative meta-analysis in order to evaluate whether offline rTMS (the delivery of rTMS when not actively engaged in a cognitive task) influences cognition in healthy adults. More specifically, we examined studies that applied rTMS to the dorsal lateral prefrontal cortex (DLFPC) and that tracked cognitive outcomes both before and after a prescribed period of rTMS. Fifteen studies met our inclusion criteria. Cognitive performance was pooled and examined across studies for four cognitive domains (working memory, executive functioning, episodic memory, and visual perception) and under two types of stimulation conditions (excitatory and inhibitory rTMS). Whereas excitatory rTMS was associated with statistically reliable effects for improving executive functioning, inhibitory rTMS was associated with statistically reliable effects for improving episodic memory and visual perception. However, the magnitude of these effects was small and no other significant effects were observed. Though future studies are still needed, our findings suggest that offline forms of rTMS may have limited utility in affecting cognitive functioning when applied to the DLPFC in healthy adults, irrespective of cognitive domain or stimulation type.