Association between maternal mental health-related hospitalisation in the 5 years prior to or during pregnancy and adverse birth outcomes: a population-based retrospective cohort data linkage study in the Northern Territory of Australia.

Background: Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes. Methods: We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations. Findings: From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births. Interpretation: Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services. Funding: The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.

Recreational cannabis policy reform-What mental health nurses need to know about minimising harm and contributing to the reform debate.

The recently rapidly evolving legal status of recreational cannabis in various countries has triggered international debate, particularly around measures required to minimise resulting harms. The present article argues that mental health nurses should have a key role in promoting safe and appropriate use of recreational cannabis, and minimising harm based on the extant evidence. The article summarises the factors driving legalisation, outlines the evident medicinal benefits of cannabis, and appraises the evidence on the negative mental health impacts associated with use. We go on to discuss research findings on the potentially deleterious mental health effects resulting from legalising recreational cannabis and strategies to minimise these harms, including directions for future research and evaluation. Further, we consider the importance of the implementation of harm minimisation measures that are context-specific, using Thailand as an example. Finally, we present the key health promotion messages that mental health nurses should aim to convey to people who use or consider using recreational cannabis. Ultimately, we aim to provide a summary of the existing evidence that mental health nurses can draw upon to promote mental health and engage with the policy reform debate.

Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers.

BACKGROUND: Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. METHOD: We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. RESULTS: At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying". LIMITATIONS: While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. CONCLUSIONS: Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review.

Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.

La meta de Navegación del Paciente (PN) es mejorar el acceso a tiempo a servicios de cuidado de salud por medio de ayudar a los pacientes a "navegar" los complejos esquemas de provisión de servicios. Los modelos PN han sido aplicados en diversos escenarios de cuidados de salud incluyendo la salud mental perinatal (PMH). Sin embargo, los modelos de la práctica e implementación de programas PN varían ampliamente, y su impacto en la participación de los servicios PMH no ha sido sistemáticamente investigada. Este estudio de revisión narrativa sistemática se propuso 1) identificar y describir modelos PMH PN existentes, 2) comprender su eficacia para mejorar la participación en el servicio y resultados clínicos, 3) examinar las percepciones de pacientes y proveedores, y 4) explorar factores facilitadores y barreras al éxito del programa. Se llevó a cabo una sistemática investigación de artículos/reportes publicados que describen modelos que proveen programas/servicios de PMH PN con enfoque en los padres en el período desde la concepción hasta los 5 años posteriores al parto. En total, se identificaron 19 artículos que describían 13 programas. Los análisis dieron como resultado un número de puntos comunes y diferencias a través de la composición de los programas, la población a la cual se dirigían, y el ámbito del papel del navegador. A pesar de que se observó una evidencia prometedora para apoyar la efectividad clínica y el impacto sobre la utilización del servicio de programas PN para PMH, la base actual de la evidencia es escasa. Es necesaria una posterior investigación para evaluar la efectividad de tales servicios, y puntos que los faciliten o barreras al éxito de éstos.

La Navigation du Patient (abrégé ici NP en français) a pour but d'améliorer l'accès rapide aux soins de santé en aidant les patients à « naviguer ¼ un paysage complexe d'offre de services. Les modèles NP ont été appliqués dans divers contextes de soins de santé y compris la santé mentale périnatale (SMP en français ici). Cependant les modèles de pratique et de mises en place de programmes NP varient grandement, et leur impact sur l'engagement avec des services SMP n'a pas encore été examiné systématiquement. Cette étude narrative systématique s'est donnée pour but de 1) identifier et décrire les modèles NP existants, 2) comprendre leur efficacité à améliorer d'engagement du service et ses résultats cliniques, 3) passer en revue les perceptions du patient et du prestataire, et 4) explorer ce qui facilite et fait obstacle au succès du programme. Une recherche systématique d'articles/rapports publiés décrivant des modèles de prestation de NP SMP visant des parents dans la période de la conception à 5 ans postpartum a été faite. En tout 19 articles décrivant 13 programmes ont été identifiés. L'analyse a produit un nombre de points communs et de différences au travers des contextes des programmes, des populations ciblées et de la portée du rôle de navigateur. Bien qu'il y ait des preuves promettantes soutenant l'efficacité clinique et l'impact de l'utilisation de services des programmes NP pour la SMP la base de preuves actuelle est éparse. Des recherches supplémentaires évaluant l'efficacité de tels services ainsi que les facteurs de facilitation et les barrières au succès sont nécessaires.

Perinatal depression screening in Australia: A position paper.

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review.

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.

Los trastornos mentales maternos pueden impactar significativamente el desarrollo sicosocial y sicológico de los niños lo cual conlleva considerables continuos costos económicos y personales. Un mecanismo mediador clave es la calidad de la relación madre-infante (MIRQ). Los estudios investigativos y las iniciativas de exámenes de salud mental perinatales predominantemente se enfocan en los síntomas depresivos y la depresión perinatal como factores de predicción de MIRQ. Mientras que la depresión materna se asocia con una MIRQ inferior al nivel óptimo, los resultados no son consistentes. Las características de la personalidad se asocian con la crianza y la tendencia a la depresión, lo cual presenta un posible punto adicional a la evaluación de salud mental prenatal. Llevamos a cabo una revisión sistemática de estudios que examinaron la conexión entre síntomas depresivos prenatales y/o características de la personalidad con MIRQ postnatal. Nuestros resultados sugieren que tanto las características maternas de la personalidad como los síntomas depresivos medidos durante el temprano embarazo se asocian con MIRQ postnatal. Una medición de las características de la personalidad pudiera mejorar la evaluación de salud mental prenatal lo cual permitiría oportunidades para la intervención enfocada a partir del embarazo con miras a mejorar MIRQ, la crianza, los resultados de salud mental maternos, así como el desarrollo sicosocial y sicológico del infante, contribuyendo así a reducir la carga humana y económica.

Les troubles mentaux maternels peuvent avoir un impact important sur le développement psychosocial et psychologique des enfants menant à des coûts personnels et économiques continus et importants. Un mécanisme de médiation clé est la qualité de la relation mère-nourrisson (ici abrégé en français QRMN). Les études de recherché et les initiatives de dépistage en santé mentale périnatale ont surtout porté sur les symptômes dépressifs et la dépression périnatale en tant que prédicteurs de la QRMN. Mais alors que la dépression maternelle est liée à une QRMN sous-optimale, les résultats ne sont pas uniformes et constants. Les caractéristiques de personnalité sont liées au parentage et à la propension à la dépression, présentant un ajout potentiel à l'évaluation de santé mentale prénatale. Nous avons passé en revue systématiquement toutes les études ayant examiné le lien entre les symptômes dépressifs périnataux et / ou les caractéristiques de personnalité avec une QRMN postnatale. Nos recherches suggèrent que les traits de personnalité maternelle et les symptômes dépressifs mesurés durant le début de la grossesse sont à la fois liés à la QRMN postnatale. Une mesure de caractéristiques de personnalité pourrait améliorer l'évaluation de la santé mentale prénatale et offrir des possibilités d'intervention ciblée commençant durant la grossesse, afin d'améliorer la QRMN, le parentage et les résultats de santé mentale maternelle, ainsi que le développement psychosocial et psychologique du nourrisson, contribuant donc à la réduction de la charge du coût humain et économique.

Prenatal maternal personality as an early predictor of vulnerable parenting style.

Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.