Effectiveness and cost-effectiveness of an electronic mindfulness-based intervention to improve maternal mental health in the peripartum: study protocol for a randomised controlled trial.

BACKGROUND: Perinatal women are highly vulnerable to developing mental health issues and particularly susceptible to a recurrence of psychiatric illness. Poor mental health during the perinatal period can have long-term impacts on the physical and psychiatric health of both mother and child. A potentially useful strategy to improve women's mental health is through a mobile application teaching mindfulness, an evidence-based technique helping individuals focus on the present moment. METHODS: A mixed method, prospective randomised controlled trial. The study group comprise women aged 18 years and over, who are attending the public and private maternity clinics at Mater Mothers' Hospital. A sample of 360 prenatal women will be randomised into the intervention group (with the use of the mindfulness app) or usual care. Participants will remain in the study for 11 months and will be assessed at four timepoints for changes in postnatal depression, mother-infant bonding, and quality of life. A cost-effectiveness evaluation will also be conducted using quality-adjusted life year (QALY) calculations. A random selection of intervention participants will be invited to attend focus groups to give feedback on the mindfulness app. DISCUSSION: Previous studies have found mindfulness interventions can reduce stress, anxiety, depression, and sleep disturbances in a prenatal population. The risks of the intervention are low, but could be of significant benefit for women who are unable to attend face-to-face appointments due to geographical, financial, or time barriers; during endemic or pandemic scenarios; or due to health or mobility issues. TRIAL REGISTRATION: This study was approved by the Mater Misericordiae Human Research Ethics Committee (83,589). Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001581752 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385107&isReview=true ). Registered on 22 Dec. 2022.

Understanding care plans in a psychiatric mother-baby unit.

INTRODUCTION: Care plans outline collaborative goals and strategies for recovery. While care planning is recommended across international mental health guidelines, scant attention has examined the unique nature of care planning within psychiatric mother-baby units. This retrospective audit aims to explore the content of care planning goals, compare against the World Health Organisation's (WHO) International Classification of Functioning, Disability, and Health (ICF), and devise a care plan framework to support development of admission goals. METHODOLOGY: A total of 63 care plans across admission, mid-admission and discharge were analysed. Using deductive content analysis, care plan goals were compared to the WHO ICF codes. Inductive content analysis was used to generate a framework for care plans. RESULTS: When compared to the WHO ICF codes, care plans were most commonly coded against d570 (looking after one's health) and d7600 (parent-child relationships). Care plans covered six main themes: mental health recovery, physical health, connecting with baby, caring for baby, relationships, and community supports. DISCUSSION: This study is the first to examine the nature of recovery goals in care plans within a mother-baby unit. The results inform a framework to support care planning and thereby facilitate holistic well-being and recovery for a mother with mental illness.

Red flags and gut feelings-Midwives' perceptions of domestic and family violence screening and detection in a maternity department.

BACKGROUND: Domestic and family violence (DFV) is known to escalate during pregnancy. Routine screening for DFV in maternity departments is a widely acceptable practice according to staff and women. This study is part of a 3-year follow-up of an organisational intervention evaluation and aimed to identify clinicians' perceptions of current practices, as well as barriers and enablers to DFV antenatal screening. METHOD: Semi-structured interviews were conducted with ten midwives about conducting DFV screening within the maternity department of a large tertiary public hospital in Queensland, Australia. Interview transcripts were read and thematically analysed by two independent researchers. RESULTS: Four main themes emerged from the data: uncertainty despite education and training; fear of opening Pandora's Box; working with 'red flags' and 'gut feelings'; and it's all about the relationship. CONCLUSION: Although clinicians identified the importance of guidelines for managing DFV and knowledge of resources and services, confidence varied. Ongoing, formal, mandatory training in the area of DFV was highlighted. Managing partner presence in the room, building rapport with the woman, and time constraints continue to be challenging barriers to DFV detection. Routine screening, continuity of care, and staff knowledge and experience were major enablers to successful detection and response.