Incarcerated Men: Pain Experiences Shaped by Altered Independence and Loss of Autonomy.

BACKGROUND: Individuals experiencing pain while incarcerated depend on nurses, security structures, processes, and regulations for relief. PURPOSE: The intent of this research was to understand men's experience of pain during incarceration to inform correctional nursing practice. METHOD: Interpretive description, co-positioned with relational ethics, guided this study. Twelve incarcerated men participated in a single 1-hour interview that was audio-recorded and transcribed. The resultant text was analyzed for themes. FINDINGS: The two main themes were dependence on staff and institutional processes and dependence on oneself and others who were incarcerated. Participants reported a substantial loss in their ability to access pain-relieving medications, products, and services. Unresponsive or delayed pain-relieving interventions from nurses contributed to their sense of indignity, disrespect, and injustice. The participants employed whatever was available, mainly exercise equipment and social support, to manage their pain. DISCUSSION: Nurses must engage with incarcerated patients meaningfully to understand and respond to contextual factors that influence their pain experiences. Participants identified loss of autonomy and dependence on nurses as barriers to their pain relief. CONCLUSION: Nurse engagement and responsiveness are crucial to altering incarcerated men's perceptions of injustice or helplessness while improving their pain experiences. Nurses must also foster autonomous pain-management approaches that men can use without limitations within correctional settings.

How do Registered Nurses Understand Followership?

BACKGROUND: Despite a consensus that followers and leaders are interdependent, the focus of nursing education, practice, and research has been leader centred. This has spawned calls in the nursing literature for increased scholarship on followership in nursing. PURPOSE: To develop a grounded theory of followership in nursing. METHOD: This study addressed the question - how do registered nurses understand followership? 11 registered nurses participated in online interviews that were later transcribed and analyzed following Charmaz's approach to Constructivist Grounded Theory. RESULTS: The core category of trusting informal and formal leaders was co-constructed from the data. A conceptual model, titled Followership as Trust in Acute Care Nursing Teams, illustrates that the nurses' decision to trust (and subsequently to engage in following) hinges on sharing the load (understanding one's role, accepting one's role, and working together); demonstrating knowledge (having experience, modelling, and mentoring); and connecting through communication (knowing the goal and communicating clearly). When participants fully trust formal and informal leaders, they engage in following as proactive members of the team, provide solutions to problems, and take initiative. Conversely, when they are less trusting of informal and formal leaders, they are less willing to follow. CONCLUSIONS: This study underscores the importance of trust between followers and leaders for effective team function and safe patient care. More research on the follower-leader dynamic in nursing is needed to inform education, policy, and practice so that every nurse possesses the knowledge and skill to be both a follower and a leader.

Rural Home Care Nursing During COVID-19.

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic continues to be a challenging time for the nursing profession globally. Research indicates that the care of patients with COVID-19 has caused significant psychological stress for nurses. Although much of the world's attention has been on nurses working in emergency departments and intensive care units, the pandemic also posed significant challenges for nurses providing home care services in rural communities. PURPOSE: The purpose of this work was to describe the experiences of rural Canadian home care nurses during the early stages of the COVID-19 pandemic. METHODS: The data for this analysis was derived from a study that explored the continuing education needs of rural home care nurses. Since the data collection for the primary objective occurred in the early stages of the COVID-19 pandemic, COVID-19 related themes were created using interpretive description methodology. Snowball and purposive sampling were used to recruit rural home care registered nurses who were employed in the central and southern areas of a western Canadian province. RESULTS: Six themes were constructed from the data including: Nurses Must Work, Constant State of Flux, Threatened Safety, Loss of Learning Opportunities, Fearing the Unknown, and Hindsight is Easy. CONCLUSION: The experiences of rural home care nurses during COVID-19 reflects the chaos, uncertainty, and fear that was felt globally. Based on the findings of this study, recommendations for future pandemic planning are suggested.

The Lived Experience of Human-Pet Relationships among Adult Survivors of Childhood Sexual Abuse: An Interpretative Phenomenological Analysis.

Given the high prevalence and severe consequences of childhood sexual abuse, it is essential to identify ways to support adult survivors. One potential and relatively unexplored resource available to survivors is the human-pet relationship. In the literature, the human-pet relationship is linked to many positive benefits to physiological regulation, mental health, physical health, and social support - areas of functioning where survivors of childhood sexual abuse may be particularly at risk. Despite existing evidence, there is little research on human-pet relationships among survivors of childhood sexual abuse. To help address this gap, this qualitative study explored the lived experience of human-pet relationships among adult survivors of childhood sexual abuse. Utilizing data collection and analysis methods from Interpretative Phenomenological Analysis, semi-structured interviews were conducted with 10 adult survivors of childhood sexual abuse. The following themes were developed from the data: (a) close bond with pet; (b) idiosyncrasies within the human-pet relationship; (c) moral responsibility; (d) fundamental differences between pets and humans; (e) safety in the human-pet relationship; (f) resource for coping with painful experience; (g) positive impact on well-being; (h) buttress for human-human social interaction; (i) medium for skill and knowledge development; and (j) shortcomings of the human-pet relationship. Findings are discussed in the context of the existing literature, along with considerations for practice and future research with childhood sexual abuse survivors.

A Scoping Review of Followership in Nursing.

Although the concept of followership has existed for several decades and is related to effective leadership, the concept is poorly understood and not well integrated into nursing education, practice and research. This paper reports the findings of a scoping review of 21 articles on followership in nursing. The literature discloses that followership and leadership roles are co-constructed, interdependent and synergistic and influence organizational success and patient safety. The lack of scholarship on followership in nursing is notable and points to the need for a greater understanding of the follower-leader dynamic and effective follower behaviours in the healthcare context.

Domestic Violence and Immigrant Women: A Glimpse Behind a Veiled Door.

Domestic violence (DV) experienced by immigrant women is a public health concern. In collaboration with a community agency, researchers undertook a retrospective review of 1,763 client files from 2006-2014. The three aims were to document the incidence of DV, service needs associated with DV, and identification of risk factors associated with DV in the extracted file data. About 41% reported DV and required multiple services. Separated and divorced women, and women on visitor/temporary visas showed the highest risk. The results underscore the value of research partnerships with community-based service agencies in increasing our understanding of DV among immigrant women.

Comparison of Urdu Versions of the Resilience Scale and the Resilience Scale for Adults.

BACKGROUND AND PURPOSE: Several methodological challenges are associated with measuring resilience in women. This study compares the 14-item Resilience Scale (RS-14) and the Resilience Scale for Adults (RSA) in a community sample of women. METHODS: Data were collected from 120 women residing in low socioeconomic areas of Karachi, Pakistan. Construct validity, internal consistency, and responsiveness were calculated. RESULTS: Both scales demonstrated satisfactory psychometric characteristics. The total RS-14 score was significantly associated with all subscales of the RSA. However, two items of the RS-14 did not show any association with any of the subscales of the RSA. Medium effect size was noted on the "structured style"subscale of the RSA. CONCLUSION: Differences between the scales concluded that the Urdu version the of RSA yielded improved results in this sample.

Social support intervention to promote resilience and quality of life in women living in Karachi, Pakistan: a randomized controlled trial.

OBJECTIVES: This study tested the efficacy of a 6-week social support intervention for enhancing resilience and quality of life among women living in low socioeconomic areas of Karachi, Pakistan. METHODS: One hundred and twenty women were randomly allocated to the intervention (n = 60) or control group (n = 60). Women in the intervention group attended a 6-week social support program, while those in the control group attended a single mental health awareness session. Outcome variables were measured via the resilience scale-14 item (RS-14), the resilience scale for adults (RSA), and World Health Organization quality of life brief scale (WHOQOL-BREF). RESULTS: Compared to participants in the control group, women in the intervention group reported improvements in resilience measured by RS-14 (p = 0.022) and the structured style subscale of the RSA (p = 0.043). A medium effect size was also measured on the structured style subscale (d = 0.6, 95% CI = 0.62874, 2.57126). No significant findings were noted on QOL scores. CONCLUSIONS: Community-based social support interventions are a gender-sensitive-, culturally appropriate-, and resource-sparing approach to promote women's resilience and improve their mental health.

The State of Knowledge Regarding the Use of Simulation in Pre-Licensure Nursing Education: A Mixed Methods Systematic Review.

This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.

The determinants of meaning of pain following an acute traumatic injury.

RATIONALE AND AIMS: Meaning is an integral aspect of life that drives behaviours, actions and emotions. Perception of pain is believed to be affected by the meaning of pain. Our primary aim was to investigate and discuss the determinants of meaning in acute pain following a traumatic injury. METHODOLOGICAL DESIGN: Using the Interpretive Description approach, a method of qualitative inquiry, 13 adults hospitalised due to their accidental injuries were recruited. Semi-structured interviews that were digitally recorded were used to collect the data. Ethical approval was received by our local Health Research Ethics Board, and all relevant ethical standards were followed as outlined in the approved ethics proposal. FINDINGS: The three primary determinants of meaning during an acute pain event, or the experience of acute pain include permanence of injuries, incongruence of care quality, and personal responses to the injury and care received. Although the permanence of an injury is lasting, we did not find any emotional response to this fact while the participants were hospitalised. The emotion characterising the personal response to the perceived poor quality of hospital care received was anxiety. CONCLUSION: Both the technical and personal components of healthcare quality have the potential to increase the perception of pain. Meanings in an acute pain event are primarily related to the determinants of incongruent care and the personal response to that determinant: anxiety.

Evaluation of a Storybook Resource for Parents in the Neonatal Intensive Care Unit.

This project evaluates the acceptability and utilityof a storybook, entitled Unexpected: Parents' Experience of Preterm Birth, as an educational resource for parents in the neonatal intensive care unit (NICU). Forty-nine parents were recruited from Level II and Level III NICUs and completed several questionnaires; a subset of 11 parents also participated in focused qualitative interviews. Almost all parents experienced the characters as believable and agreed/strongly agreed that the stories accurately portray what it is like to be a parent in the NICU. The multiple narrators offer different perspectives of the NICU experience, which helped to normalize their experience and reminded them that they were not alone. Participants reported learning something new from the storybook and would recommend it to others.

An exploration of addiction in adults experiencing early-life stress: a metasynthesis.

OBJECTIVE: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. METHOD: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. RESULTS: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. CONCLUSION: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime.

Scoping Review of the Mental Health of Parents of Infants in the NICU.

OBJECTIVE: To synthesize and summarize evidence regarding the mental health of parents of infants in the NICU. DATA SOURCES: Thirteen electronic databases were searched in October 2014 using the following terms individually and in combination: postpartum woman, mother, NICU, preterm birth, depression, anxiety, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and parental stress. STUDY SELECTION: We examined the published research regarding the experiences of parents who have infants admitted to the NICU, the mental health problems that parents may develop, the tools that have been used to identify such problems, and factors related to parental mental health. DATA EXTRACTION: After the exclusion of articles according to preset criteria, we included 66 articles in the full review. DATA SYNTHESIS: Mental health issues are common in parents of infants in the NICU across diverse ethnocultural groups and countries. Parents report feelings of guilt and shame, high levels of stress, mood and anxiety symptoms, and the positive influence of specific coping strategies and social support. The ethnocultural meanings of these experience and thus nursing interventions may differ widely. CONCLUSION: Ongoing assessments of the mental health of parents should be part of routine NICU care. Identification of mood and anxiety symptoms and testing innovative interventions to address at-risk or affected parents is imperative to ensure that there are culturally appropriate policies and services in place to respond to the mental health needs of NICU families.

Pregnant Women's Views on the Feasibility and Acceptability of Web-Based Mental Health E-Screening Versus Paper-Based Screening: A Randomized Controlled Trial.

BACKGROUND: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. OBJECTIVE: The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women's preferences for e-screening and disclosure of mental health concerns. METHODS: Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin's tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs. RESULTS: Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women's disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure. CONCLUSIONS: The findings suggest that mental health e-screening is feasible and acceptable to pregnant women. TRIAL REGISTRATION: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).

Sexual orientation and depression in Canada.

OBJECTIVES: Depression is a global concern and it is well known that certain segments of the population are at greater risk. Sexual minorities are recognized as being more likely to suffer from depression due to social stigma and prejudice. The aim of this study was to describe the relationship between sexual orientation and depression in the Canadian population. METHODS: The study used the 2012 Canadian Community Health Survey - Mental Health data. The sample comprised 24,788 Canadians living in the ten provinces. Logistic regression analyses were used to examine the relationship of depression and sexual orientation. RESULTS: After adjusting for known risk factors for depression, there was no difference in prevalence of past 12-month or lifetime major depressive episode between sexual minorities and heterosexuals. Bisexuals did have a near significant trend towards higher prevalence of both past 12-month and lifetime depression as a combined group, but there were not clear differences when stratified by sex. CONCLUSION: This study supports important emerging trends in the relationship between sexual orientation and depression. Research on the mental health of sexual minority people must take into account differences between sexual minority groups and avoid aggregating mental health disorders into broad categories. These findings have implications for public health planning and clinical recommendations.

An exploration of addiction in adults experiencing early-life stress: a metasynthesis / Uma investigação sobre o vício em adultos com estresse no início da vida: uma metassíntese / Una exploración de la adicción en adultos que han sufrido estrés durante los primeros años de su vida: una metasíntesis

ABSTRACT Objective: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. Method: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. Results: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. Conclusion: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime.

RESUMO Objetivo: revisar e sintetizar pesquisas qualitativas sobre os vínculos entre o estresse no início da vida e os comportamentos de dependência na idade adulta. Método: metassíntese para revisar resultados de pesquisa qualitativa com base em procedimentos que descrevem como identificar temas ou construtos através de estudos em uma área específica. Foram realizadas pesquisas abrangentes em múltiplas bases de dados eletrônicas. A pesquisa inicial produziu 1.050 artigos, cujos títulos e resumos foram selecionados para inclusão com base em critérios predeterminados. Trinta e oito textos completos de artigos revisados por pares foram recuperados e avaliados por três revisores independentes. Doze artigos foram elegíveis para revisão completa e avaliados usando as ferramentas do Programa de Competências de Avaliação Crítica (Critical Appraisal Skills Programme, CASP). Resultados: os achados revelaram que existem associações claras entre o estresse no início da vida e comportamentos aditivos na idade adulta, como entre trauma na infância, violência e comportamentos aditivos. Um tema comum nas descobertas indica que os participantes se voltam para substâncias aditivas como uma maneira de lidar estrategicamente com experiências estressantes da infância, independentemente dos efeitos colaterais deletérios ou resultados sociais prejudiciais. Conclusão: pode-se inferir que o vício pode ser visto como uma forma de lidar com a adversidade na infância e que existe uma inter-relação entre vício, violência doméstica e crime.

RESUMEN Objetivo: revisar y sintetizar la investigación cualitativa referida a la relación entre el estrés durante la infancia y las conductas adictivas en la adultez. Método: metasíntesis que examina los resultados de investigaciones cualitativas basadas en procedimientos orientados a identificar temas o constructos en diferentes estudios en un área específica. Se realizaron búsquedas exhaustivas en múltiples bases de datos electrónicas. La búsqueda inicial arrojó 1.050 artículos. Sus títulos y resúmenes fueron analizados para determinar si debían incluirse en este estudio en base a criterios predeterminados. Se obtuvieron treinta y ocho artículos completos revisados por expertos que fueron evaluados por tres revisores independientes. Entre ellos, doce fueron seleccionados para una revisión detallada y evaluados mediante las herramientas del Programa de Habilidades de Evaluación Crítica (CASP por sus siglas en inglés). Resultados: los resultados revelaron que existe una asociación clara entre el estrés de la infancia y las conductas adictivas en la edad adulta, al igual que entre los traumas infantiles, la violencia y las conductas adictivas. Un aspecto común encontrado en los resultados es que los participantes recurren a las sustancias adictivas como una estrategia para lidiar con experiencias estresantes de su niñez, independientemente de sus efectos secundarios dañinos o de sus resultados sociales perjudiciales. Conclusión: se concluye que la adicción puede ser vista como una forma de lidiar con la adversidad en la niñez y que existe una interrelación entre la adicción, la violencia doméstica y la delincuencia.

Depression in Lesbian, Gay, and Bisexual Members of the Canadian Armed Forces.

PURPOSE: Lesbians, gay men, and bisexuals have been shown to have different risks for mood and anxiety disorders than heterosexuals in population studies, but there is a paucity of research in this area in military populations. This study examined the relationship between sexual orientation and depression in the Canadian Armed Forces (CAF). METHODS: Data were drawn from the Canadian Forces Mental Health Survey 2013 (n = 8165), a representative sample of Regular and Reserve members of the Canadian military. Binomial logistic regression was used to predict 12-month and lifetime odds ratios for major depressive episode (MDE) stratified by sexual orientation and sex. RESULTS: Gay male members had higher risk (AOR = 3.80, 95% CI 1.60-9.05) for lifetime MDE, but not for past 12-month MDE compared to heterosexual males. There was no significant difference in risk for lesbians or bisexuals compared to heterosexuals. CONCLUSIONS: The results suggest that gay male members of the CAF are at higher risk for a history of MDE, but not current MDE. This may be a result of ongoing discrimination and stigma faced by gay men in the military or may reflect MDE that occurred before military service. The lack of difference in MDE risk for lesbian and bisexual members compared to heterosexual members is an important positive finding.

The relationship between sexual orientation and depression in a national population sample.

AIMS AND OBJECTIVES: The aim of this study was to examine the relationship between sexual orientation and depression in a nationally representative population to determine if sexual minorities report higher levels of depression than the remainder of the population. BACKGROUND: Depression is a highly prevalent and disabling chronic disorder worldwide. Prior research utilizing national population samples have reported that members of sexual minorities are at higher risk for depression when compared to heterosexual people. More recent studies have revealed differences in depression risk based on sexual orientation, sexual activity and sex. There have been significant shifts in societal attitudes towards sexual minorities in recent decades. Continuing research into predictors for reporting depression amongst sexual minorities is needed. METHODS: National Health and Nutrition Examination Survey cycles 2005-2012 were used to identify sexual minority status based on declared sexual orientation and presence of same-sex sexual activity. Complex samples logistic and multivariate regression models were used to predict depression adjusted for sexual orientation, sexual activity, age, sex, marital status, education, income, race/ethnicity, employment and health status. RESULTS: Sexual orientation was not a significant independent predictor of depressive symptoms overall. Gay men reported lower levels of depressive symptoms than heterosexual men. In the sex stratified analyses, men who reported having sex with men were five times more likely to report depressive symptomatology compared to men who reported opposite sex partners (2005-2008 adjusted odds ratios: 5·00; 95% confidence interval: 1·44-17·38; 2009-2012 adjusted odds ratios: 5·10; 95% confidence interval: 1·33-19·54) after controlling for sexual orientation. CONCLUSIONS: Results of our analyses indicate that homosexually experienced heterosexual men appear to be at highest risk for depression. Furthermore, reported physical health status was a significant independent predictor of depression in all models, suggesting a strong link between physical and mental health. RELEVANCE TO CLINICAL PRACTICE: Health care providers should inquire about sexual orientation and sexual behaviour as part of a routine health history and be familiar with the unique health needs of sexual minorities to tailor clinical practice and foster safe, inclusive, health care environments.

Pregnant Women's Perceptions of Harms and Benefits of Mental Health Screening.

BACKGROUND: A widely held concern of screening is that its psychological harms may outweigh the benefits of early detection and treatment. This study describes pregnant women's perceptions of possible harms and benefits of mental health screening and factors associated with identifying screening as harmful or beneficial. METHODS: This study analyzed a subgroup of women who had undergone formal or informal mental health screening from our larger multi-site, cross-sectional study. Pregnant women >16 years of age who spoke/read English were recruited (May-December 2013) from prenatal classes and maternity clinics in Alberta, Canada. Descriptive statistics were generated to summarize harms and benefits of screening and multivariable logistic regression identified factors associated with reporting at least one harm or affirming screening as a positive experience (January-December 2014). RESULTS: Overall study participation rate was 92% (N = 460/500). Among women screened for mental health concerns (n = 238), 63% viewed screening as positive, 69% were glad to be asked, and 87% took it as evidence their provider cared about them. Only one woman identified screening as a negative experience. Of the 6 harms, none was endorsed by >7% of women, with embarrassment being most cited. Women who were very comfortable (vs somewhat/not comfortable) with screening were more likely to report it as a positive experience. LIMITATIONS: Women were largely Caucasian, well-educated, partnered women; thus, findings may not be generalizable to women with socioeconomic risk. CONCLUSIONS: Most women perceived prenatal mental health screening as having high benefit and low harm. These findings dispel popular concerns that mental health screening is psychologically harmful.

Disclosure during prenatal mental health screening.

BACKGROUND: While women and healthcare providers have generally viewed perinatal mental health screening favorably, some qualitative studies suggest that some women intentionally decide not to reveal their symptoms during screening. PURPOSE: The purpose of this study was to describe women's reported willingness to disclose mental health concerns during screening and factors associated with this. METHODS: This cross-sectional study included pregnant women who were >16 years of age and could speak/read English. Women were recruited from five maternity clinics and two community hospitals in Alberta, Canada (May-December, 2013). Eligible women completed the online Barriers and Facilitators of Mental Health Screening Questionnaire on recruitment. The primary outcome for this analysis was women's level of honesty about mental health concerns (completely vs somewhat/not at all honest) during screening. Analyses included descriptive statistics and multivariable logistic regressions to identify factors associated with honesty. RESULTS: Participation rate was 92% (460/500). Seventy-nine percent of women indicated that they could be 'completely honest' during screening. Women who feared their provider would view them as bad mothers were less likely to be honest. We found a significant association between 'less anonymous' modes of screening and honesty. LIMITATIONS: Over eighty percent of women in this study were well-educated, partnered, Caucasian women. As such, generalizability of the study findings may be limited. CONCLUSIONS: Most women indicated they could be honest during screening. Stigma-related factors and screening mode influenced women's willingness to disclose. Strategies to reduce stigma during screening are warranted to enhance early detection of prenatal mental illness.