Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis.

BACKGROUND: Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. AIM: The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. METHOD: The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. RESULTS: The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: 'Women with chronic conditions have unmet preconception health information needs', 'Women with chronic conditions want personalised preconception health information', 'Preferred sources of preconception health information', 'Learning from the experiences of other women', 'Improving preconception health discussions with health care professionals', and 'Women want holistic care'. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. CONCLUSION: To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308.

Mental health of people in Australia in the first month of COVID-19 restrictions: a national survey.

OBJECTIVES: To estimate the population prevalence of clinically significant symptoms of depression, generalised anxiety, thoughts of being better off dead, irritability, and high optimism about the future, and of direct experience of COVID-19, loss of employment caused by COVID-19 restrictions, worry about contracting COVID-19, or major disadvantage because of the restrictions; to examine the relationship between these experiences and reporting mental symptoms. DESIGN, SETTING, PARTICIPANTS: Anonymous online survey of adult Australian residents, 3 April - 2 May 2020. MAIN OUTCOME MEASURES: Self-reported psychological status during the preceding fortnight assessed with the Patient Health Questionnaire 9 (PHQ-9; symptoms of depression) and the Generalised Anxiety Disorder Scale (GAD-7). Optimism about the future was assessed with a 10-point study-specific visual analogue scale. RESULTS: 13 829 respondents contributed complete response data. The estimated prevalence of clinically significant symptoms of depression (PHQ-9 ≥ 10) was 27.6% (95% CI, 26.1-29.1%) and of clinically significant symptoms of anxiety (GAD-7 ≥ 10) 21.0% (95% CI, 19.6-22.4%); 14.6% of respondents (95% CI, 13.5-16.0%) reported thoughts of being better off dead or self-harm (PHQ-9, item 9) on at least some days and 59.2% (95% CI, 57.6-60.7%) that they were more irritable (GAD-7, item 6). An estimated 28.3% of respondents (95% CI, 27.1-29.6%) reported great optimism about the future (score ≥ 8). People who had lost jobs, were worried about contracting COVID-19, or for whom the restrictions had a highly adverse impact on daily life were more likely to report symptoms of depression or anxiety, and less likely to report high optimism than people without these experiences. CONCLUSIONS: Mental health problems were widespread among Australians during the first month of the stage two COVID-19 restrictions; in addition, about one-quarter of respondents reported mild to moderate symptoms of depression or anxiety. A public mental health response that includes universal, selective and indicated clinical interventions is needed.

Social and economic development and pregnancy mental health: secondary analyses of data from rural Vietnam.

BACKGROUND: This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. METHODS: Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. RESULTS: Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. CONCLUSIONS: Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.

Mental and social wellbeing trajectory during the pandemic for vulnerable populations.

Objectives: We investigated changes over time in mental and social wellbeing indicators for vulnerable population subgroups during the pandemic. These groups were younger people, people with disabilities, low-income groups, unemployed, culturally, and linguistically diverse communities (CaLD), and Aboriginal and Torres Strait Islander peoples. Methods: A series of four repeated population representative surveys were conducted in June 2020, September 2020, January 2022, and June 2022. Questions included items on psychological distress, financial hardship, social connection, and life satisfaction. Results: For most groups, social connection and life satisfaction improved in 2022 relative to 2020. Psychological distress and financial hardship showed the opposite pattern, with some groups having worse results in 2022 relative to 2020. People without any vulnerability had better mental health and social wellbeing outcomes at each time point relative to the vulnerable population subgroups. Conclusion: Pandemic-related policies had differential effects over time and for different population groups. Future policies and research need to closely monitor how they impact population subgroups, and the overall results clearly demonstrate the inequity in mental health and social wellbeing outcomes for vulnerable population cohorts.

Coping Self-Efficacy and Thoughts of Self-Harm Among Adolescents in Vietnam: A Longitudinal Study.

We aimed to determine the effect of coping self-efficacy on thoughts of self-harm among adolescents attending high school in Hanoi, Vietnam. Longitudinal data were collected using the Center for Epidemiologic Studies Depression Scale Revised and the Coping Self-Efficacy Scale among 552 Year 10 students. The prevalence of thoughts of death and/or self-injury on at least 1 day in the past week was 16.9% at baseline and 14.5% at 8-month follow-up. When baseline coping self-efficacy was greater by one standard deviation, the odds of having thoughts of self-harm at follow-up were reduced by 42%. Our findings suggest that school-based programs that aim to strengthen coping strategies may be useful in preventing self-harm among adolescents.

School-based universal mental health promotion intervention for adolescents in Vietnam: Two-arm, parallel, controlled trial.

The aim of this study was to evaluate the effects of Happy House, a universal school-based programme, in reducing adolescents' depressive symptoms and improving their mental well-being, coping self-efficacy and school connectedness. This was a school-based, two-arm parallel controlled trial. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale. Data were collected at recruitment, and at 2 weeks and 6 months post-intervention. Mixed-effect models were conducted to estimate the effects of the intervention on the outcomes. A total of 1,084 students were recruited. At 2 weeks post-intervention, the effect size on depressive symptoms was 0.11 (p = 0.011) and the odds of having clinically significant depressive symptoms were lower in the intervention compared to the control (0.56, p = 0.027). Both of these were no longer significant at 6 months post-intervention. Psychological well-being mean scores in the intervention were significantly higher than in the control at 2 weeks post-intervention (effect size 0.13). Coping self-efficacy mean scores were significantly higher in the intervention group at both 2-week and 6-month post-intervention (effect sizes from 0.17 to 0.26). Data support the potential of Happy House to reduce the prevalence of adolescent mental health problems and to promote positive mental health in the school context in Vietnam.

Adaptation of a school-based mental health program for adolescents in Vietnam.

INTRODUCTION: Cultural adaptation of a school-based mental health intervention developed in a high-income country is a cost-effective method to address the mental health needs of adolescents in resource-constrained settings. The aim of this study was to translate and culturally adapt the Resourceful Adolescent Program for Adolescents (RAP-A) for adolescents attending high school in Vietnam. METHODS: The translation and adaptation were conducted using a five-step process including (1) initial stakeholder consultation, (2) forward translation, (3) backward translation, (4) adaptation, and (5) finalising the adapted version. An adaptation panel was established, including the RAP-A authors and mental health and public health experts from Australia, and psychology and public health experts from Vietnam. The panel collaborated closely with a group of stakeholders, including bilingual psychologists and psychiatrists, high school (grades 10-12) students and teachers throughout the adaptation process. RESULTS: The adapted version of RAP-A was named 'Happy House'. Happy House was adapted to be delivered in larger groups and in longer sessions than the RAP-A. The 11 sessions in RAP-A were restructured to 6 sessions in Happy House. Major changes were not required for any of the materials. However, some content, illustrations and videos were adapted to be more feasible for the school context and to enhance the comprehensibility, acceptability and appropriateness. CONCLUSION: Happy House has great potential to be relevant, comprehensible and acceptable for Vietnamese adolescents. Further research is warranted to examine the relevance, comprehensibility, acceptability, and effectiveness of this program on adolescents' mental health before advocating for scaling up program delivery in high schools throughout Vietnam.

Validation of the coping self-efficacy scale: Vietnamese version for adolescents.

BACKGROUND: This study aimed to examine the construct validity of the Coping Self-Efficacy Scale-Vietnamese Version (CSES-V) among Vietnamese adolescents. METHODS: This study selected Grade 10 students from eight schools in Hanoi using a multiple-stage sampling method. Multiple aspects of the construct validity were examined including: factorial structure (evaluated using exploratory factor analysis); internal consistency (tested using Cronbach's alpha coefficient); measurement invariance between male and female participants and longitudinal measurement invariance (tested by employing multiple group confirmatory factor analysis) and external aspect (tested using Pearson's correlation coefficients between CSES-V and the Depression Anxiety and Stress Subscales of Depression (DASS21-D), Anxiety (DASS21-A), and Stress (DASS21-S) and a measure of mental well-being, Mental Health Continuum Short Form (MHC-SF)). RESULTS: A total of 1082 adolescents (aged 14-16 years) was included in this study. Data supported a three-factor structure (comprising 24 items) that explained 97.6% of the total variance of the CSES-V. Cronbach's alpha coefficients of all three factors were acceptable. All levels of measurement invariance between male and female participants and longitudinal measurement invariance were well-supported. The three factors of the CSES-V were positively correlated with MHC-SF and were negatively correlated with the DASS21 subscales at a low or moderate level, supporting the external aspect of the construct validity. CONCLUSIONS: CSES-V is recommended to assess coping self-efficacy among Vietnamese adolescents who are attending school.

Validation of the Behavioral Anger Response Questionnaire for Children (BARQ-C) in a large community sample of Vietnamese middle adolescents in Hanoi.

BACKGROUND: Depression and other forms of psychological distress are common among Vietnamese adolescents and increase the risk of mental health problems in adulthood. As anger coping is a robust predictor of adolescent mental health difficulties, and there appear to be cultural variations in anger coping, a measure of adolescent anger coping styles that has been validated using a non-Western adolescent sample is required to inform and support early intervention to prevent or treat mental health difficulties in Vietnamese adolescents. This study examined the construct validity (structural and external) of the Behavioral Anger Response Questionnaire for Children in Vietnam (BARQC-V). METHODS: Baseline data sourced from a recent randomised control trial conducted with Grade 10 Vietnamese adolescents aged 14 to 16 (N = 1084) were used to examine multiple aspects of construct validity: factorial structure (evaluated using factor analysis); internal consistency (tested using Cronbach's alpha coefficient); and external aspect (assessed using Pearson's correlation coefficients between the BARQC-V and Vietnamese translations of the Coping Self-Efficacy Scale, Centre for Epidemiologic Studies Depression Scale Revised, Mental Health Continuum Short Form, and the Depression Anxiety and Stress Scale). RESULTS: Evaluating factorial structure using confirmatory factor analysis failed to converge on a solution. Exploratory factor analysis yielded a 5-factor structure model that explained 49.32% of the BARQC-V's total variance and was deemed to be a good fit by the final confirmatory factor analysis. Cronbach's alpha coefficients of the 5 factors demonstrated acceptable internal reliability for the BARQC-V's sub-scales. Concerning concurrent validity, three sub-scales predicted well-being and mental health difficulties: the maladaptive anger coping styles Rumination and Direct Anger-out were positively associated with depression and distress, and negatively associated with coping self-efficacy and mental well-being; and the adaptive anger coping style Assertion was positively associated with coping self-efficacy and mental well-being, and negatively associated with depression. CONCLUSIONS: The BARQC-V provides a validated measure of three anger coping strategies used by adolescents in Vietnam (Rumination, Direct Anger-out, and Assertion) that can be used to improve detection and treatment of mental health difficulties in this population, and as a starting point by future research to develop a much-needed gold standard measure of anger coping for adults, adolescents and children world-wide.

Evaluation of an online learning module to improve nurses' and midwives' capacity to promote preconception health in primary healthcare settings.

Optimal parental preconception health improves the likelihood of a successful pregnancy and a healthy child. Although primary healthcare professionals believe that it is within their role to promote preconception health to people of reproductive age, few do this routinely, in part because they lack knowledge on the topic and confidence to discuss it with their patients. The aim of this study was to evaluate the efficacy and acceptability of a free online learning module to assist nurses and midwives in primary health care to promote preconception health in their practice. A repeat online survey was administered before and after completion of the online learning module. The survey included questions gauging knowledge about and attitudes towards promoting preconception health. In all, 121 nurses/midwives completed the two surveys and the learning module. There were statistically significant improvements in the knowledge scores (from 6.42 to 8.31; P < 0.001) and in the proportion of participants who reported feeling confident in their knowledge about preconception health (from 15% to 53%). Almost all (95%) were satisfied with the duration and content of the learning module. The findings of this study suggest that the learning module is acceptable and improves nurses' and midwives' capacity to promote preconception health in their practice.

Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia.

While the Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) are frequently used in mental health research, few studies have reported comprehensive data on these measures from population or community samples. The PHQ-9 and GAD-7 were used as indicators of symptoms of depression and anxiety in a national online anonymous survey to assess the mental health of adults in Australia during the COVID-19 restrictions. The aim of this study was to describe gender- and age-specific PHQ-9 and GAD-7 item and summary data contributed by those who completed this survey. Data were analysed descriptively. Complete survey responses were contributed by 13,829 people. For both measures, item-by-item results, summary statistics (mean, standard deviation, minimum, maximum, median and interquartile range) and prevalence of severity categories are reported for the whole sample, and disaggregated by gender and age groups. These comprehensive data provide a useful point of comparison for future COVID-19-related or other research among population or community samples. Other researchers are encouraged to report detailed PHQ-9 and GAD-7 data in the future, to enable and promote relevant between-group comparisons.

Intimate partner violence and health outcomes experienced by women who are pregnant: a cross-sectional survey in Sanma Province, Vanuatu.

BACKGROUND: We aimed to describe the association between ni-Vanuatu women's experiences of violence perpetrated by their intimate partner (IPV) during pregnancy, and health outcomes, including self-reported general health, antenatal care attendance, psychological distress and suicidal thoughts/behaviours. METHODS: A cross-sectional survey of a consecutive cohort of women attending the antenatal clinic at Northern Provincial Hospital, Vanuatu from May to July 2019. Psychological, physical and sexual IPV were measured using the WHO Violence Against Women Instrument. Psychological distress was measured using the 20-item WHO Self-Reporting Questionnaire. Data were collected in confidential individual interviews with a trained local interviewer. Logistic regression models were used to investigate the relationship between IPV and health outcomes while controlling for confounding variables. FINDINGS: 192 women contributed data, among whom 188 answered the questions about IPV. Of these, 80 women had experienced any form of IPV during the current pregnancy. Women who experienced IPV were more likely than those who did not to report poorer general health (aOR:2.97, 95%CI:1•42-6•22), higher levels of psychological distress (aOR:4.77, 95%CI:2•02-11.24) and suicidal thoughts (aOR:3•78, 95%CI:1•71-8.33) and/or behaviours (aOR:1.98, 95%CI:0•69-5.64) in the previous four weeks. Late antenatal attendance was widespread, but not related to IPV. INTERPRETATION: IPV perpetrated against women who are pregnant is a serious public health problem in Vanuatu and is related to worse antenatal physical and psychological health. FUNDING: JF is supported by the Finkel Professorial Fellowship, funded by the Finkel Family Foundation; TT is supported by a Monash Strategic Bridging Fellowship. Monash University provided a student research grant to SMcK. Soroptimist International Gippsland provided a grant to fund small gifts for the participants.

Quantifying the mental health burden of the most severe covid-19 restrictions: A natural experiment.

BACKGROUND: The COVID-19 pandemic, and the restrictions required to halt spread of the infection, are associated with increased population burden of moderate to severe symptoms of depression and anxiety. The aim was to quantify the mental health burden of the most severe COVID-19 related restrictions. METHODS: A natural experiment in which differences between Australian states and territories in the severity of restrictions for pandemic control, divided the population. People in Victoria experienced the most severe, and people in all other states and territories less severe or negligible restrictions. Data were collected in national, anonymously completed, online surveys (in April and in July / August 2020) of adults in Australia. Outcomes were, in the previous fortnight, experiencing clinically significant depressive symptoms (Patient Health Questionnaire 9 score ≥10); or symptoms of generalised anxiety (Generalised Anxiety Disorder Scale 7 score ≥10). RESULTS: In total, 23,749 eligible respondents contributed complete data. There were no differences in the population burden of mental health problems between Victoria and the other states and territories at Survey One. By Survey Two prevalence rates of clinically significant depressive (Adjusted Odds Ratio (aOR) 1.96; 95% CI 1.62; 2.37) and anxiety (aOR 1.87; 95%CI 1.53; 2.29) symptoms were substantially and significantly higher in Victoria than in other states and territories. LIMITATIONS: Online surveys are less accessible to some groups of people. The data are self-report and not diagnostic. CONCLUSIONS: The most severe COVID-19 restrictions are associated with near double the population prevalence of moderate to severe depressive and generalised anxiety symptoms.

School-based, two-arm, parallel, controlled trial of a culturally adapted resilience intervention to improve adolescent mental health in Vietnam: study protocol.

INTRODUCTION: The Resourceful Adolescent Program (RAP) is an evidence-based resilience intervention for adolescents. Operating in a strength-focused paradigm, the programme uses an integration of cognitive behavioural therapy and interpersonal psychotherapy to improve coping skills and build resilience. This study aims to establish whether a culturally and linguistically adapted intervention informed by RAP principles is effective in increasing resilience, enhancing coping skills and preventing symptoms of depression and anxiety. METHODS AND ANALYSIS: We will translate, back-translate and culturally adapt the RAP for adolescents and training materials for facilitators, and the adapted intervention will be called Happy House. A two-arm parallel controlled trial will be conducted in eight high schools in the north of Vietnam. In each of the selected schools, all students from four randomly selected grade 10 classes (an estimation of about 1204 students) will be invited to participate. The control group will receive the usual curriculum. The intervention group will receive six weekly 90 min school-based group sessions of Happy House in addition to the usual curriculum. The primary outcome, depressive symptoms, will be measured using a locally validated version of the Centre for Epidemiologic Studies Depression Scale Revised. Secondary outcomes are mental well-being, coping self-efficacy, school connectedness, anger management and health risk behaviours. Data will be collected at recruitment, and at two weeks and six months post intervention. Mixed-effect logistic regression for the main outcome and mixed-effect linear and logistic regression models for the secondary outcomes will be conducted to estimate the effects of the intervention on the outcomes. ETHICS AND DISSEMINATION: This trial has been approved by Monash University Human Research Ethics Committee (No. 21455) and the Institutional Review Board of the Hanoi School of Public Health (488/2019/YTCC-HD3). Dissemination of findings will include peer-reviewed publications, international and national conferences, seminar and media presentations, national policy briefings in Vietnam, local language reports and lay language summaries for participants. TRIAL REGISTRATION NUMBERS: Registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12620000088943 (3/2/2020).WHO Universal Trial Number: U1111-1246-4079.