Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol.

BACKGROUND: The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services. METHODS: This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM. DISCUSSION: This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care. TRIAL REGISTRATION: ChiCTR2300072559. Registered on 16 June 2023.

A Cross-National Comparison on Life Expectancy of Non-Hispanic White Americans.

Objectives: Taking the life expectancy (LE) of Non-Hispanic White (NHW) Americans as an example to provide potential references for improving LE globally. Methods: We collected complete data from the United States (US) CDC, Office for National Statistics in the United Kingdom (UK), and the OECD publications, and described LE changes of NHW Americans by cross-national comparison and Arriaga's method. Results: LE of NHW Americans was not as optimistic as European countries from 2006 to 2018. The LE annual average growth rate was 0.04% for NHW Americans, 0.19% for the UK population, and the median of 25 countries was 0.24%. Compared with the other age groups, the age group 30-34 revealed an inferior impact on the LE of NHW people, of which accidents and intentional self-harm were likely to be the top two direct causes. Conclusion: Finding out the direct causes that affect the LE growth in different age groups is conducive to making a targeted intervention or solving the LE growth bottleneck.