Detection of perinatal depression by healthcare providers remain an important barrier to receiving treatment. This study reports on the detection of perinatal depression by frontline non-physician primary healthcare workers (PHCWs) as well as the feasibility, effectiveness and acceptability of routine screening using the 2-item patient health questionnaire (PHQ-2) during antenatal care. Twenty-seven primary healthcare facilities were assigned to screening (n = 11) and non-screening (n = 16) arms. All PHCWs in both arms were trained to diagnose and treat perinatal depression using the WHO mental health gap action intervention guide (mhGAP-IG) while those in the screening arm were trained to routinely screen with PHQ-2 first to determine need for further mhGAP-IG assessment. Perceived usefulness, feasibility and acceptability of routine screening for perinatal depression was explored in key informant interviews on a purposive sample of PHCWs (n = 20) and study participants (n = 22). In the first 6-months following training, the detection rate of perinatal depression was 4.6% at the clinics where PHCW were not routinely screening with the PHQ-2 compared to 11% at the screening clinics. Over the next six months, with refresher training for PHCW in the screening arm and the introduction of monthly supportive supervision for PHCW in both arms, detection rates increased from 4.6 to 7.6% at non-screening clinics and from 11 to 40% at the screening clinics. Over the entire study period only 81 (15.7%) out of the 517 cases of perinatal depression were detected by the PHCWs. Detection of depression by PHCWs was associated with the severity of depression symptoms and routine screening with PHQ-2. The introduction of routine screening was acceptable to both PHCWs and perinatal women. PHCWs reported that the PHQ-2 was useful, easy to administer and feasible for routine use. Improving detection and subsequently the treatment gap for perinatal depression require not just training of frontline healthcare workers but the introduction of additional measures such as universal screening along with supportive supervision. The main study from which the data for this report was extracted was retrospectively registered 03 December 2019. Registration number: ISRCTN 94,230,307.
Male infertility presents a public health concern. As most men wish to become fathers, it is important to increase men’s awareness of infertility risk factors. We developed a mobile health application (mHealth app), Infotility XY, to promote men’s reproductive health. This study evaluates whether use of the app led to increased knowledge of infertility risk factors, and whether knowledge change was associated with participants’ sociodemographic characteristics and/or app usage. Participants were recruited between August and October 2020. Eligibility criteria included: identified as male; 18–45 years old; childless; no infertility history; able to read and write in English/French; had internet access. We assessed participants’ fertility knowledge before and after app use. App usage data were captured during the 2-week intervention period. Our sample included 49 men aged 18–45. Seventy-eight percent of participants had not previously sought fertility information. Participants viewed on average 75% of the app’s articles, and 96% of participants said the app increased their fertility knowledge. Before app use, 55% of men said they were aware of infertility risk factors, compared to 96% after app use. Men correctly identified more risk factors after app use compared to before, t(48) = 8.28, p < .001. Participants’ sociodemographic characteristics and amount of app usage were not associated with knowledge change. This study provides evidence of the feasibility of an mHealth app to improve men’s awareness of infertility risk factors. Given the positive relationship between male reproductive health and overall health, increased awareness of infertility risk factors may lead to men’s improved overall health.
This pilot study explored the relationship between parental therapeutic alliance, maternal attachment style and child and family functioning in a sample of families with a child aged five to twelve years receiving child psychiatry day hospital treatment for complex co-morbid disorders.Self-report measures of therapeutic alliance, maternal attachment style, child behaviour and family functioning were administered to parents at the end of the assessment period (T1) and at discharge (T2). The original study cohort included 90 families, and 44 families completed all the study measures at T2. Correlational analysis was conducted on these 44 families measuring parental alliance, maternal attachment style with child and family functioning scores. Comparisons were made between participants that completed T1 and T2 of the study with participants that only completed T1.For the 44 families who completed both T1 and T2 measures, the combination of secure maternal attachment style and positive therapeutic alliance at T1 was associated with positive child outcomes, that is, improved scores on both the internalizing and externalizing dimensions as measured by the CBCL between T1 and T2. Significant changes were identified in family functioning with improvement on cohesion and expressiveness, enhanced intellectual-cultural orientation and improved family organization as measured by the FES.Capacity for secure attachment and positive alliance are associated with improved child and family systems outcomes in a high risk cohort of children with co-morbid disorders from a day and evening multimodal family treatment program.
Background Infertility is a distressing chronic condition affecting one in six couples; many of them seek to achieve a pregnancy via assisted reproductive technologies. Online resources for information and support are a mainstay of the self-help strategies of fertility patients. Patients seek explanations online about their diagnoses and treatment options, and hope to connect with others who have lived through a diagnosis of infertility. However, medical information found online is often inaccurate or hard to understand. Importantly, online forums that might provide social support are seldom monitored, allowing for the dissemination of potentially misleading information. In this study we describe the development of an mHealth app, Infotility, designed to provide evidence-based reproductive health information and a monitored message board to provide social support to users. Objective The objective was to describe the steps involved in the production of an mHealth app created specifically for fertility patients. Methods Our team followed guidelines established for the development of complex health interventions. To evaluate the existing online information sources, we assessed web-based information on infertility using standardized tools for readability, suitability and quality. To determine our stakeholders’ perspectives on what content to include in the app, a needs assessment survey was conducted in a sample of 289 male and 370 female fertility patients and 127 health care providers at clinics in Montreal and Toronto. A comprehensive review of the literature on the medical and psychosocial aspects of infertility was undertaken; summaries were then reviewed for accuracy and pertinence by patients, clinicians, researchers and professionals in the field of fertility. A technology partner was hired to create a user-friendly mobile app that contained the informational summaries, with separate portals for men and women, leading to content specifically curated for the user’s interests. There was also a closed discussion platform, “Connect”, monitored by 18 previous or current fertility patients. Peer monitors underwent one-on-one training and received an instructional manual created to assist with responding to forum messages from participants. Between November 2018 and April 2019, the app was pilot tested in a sample of 72 male and 187 female fertility patients to assess feasibility of recruitment, acceptability, and user satisfaction. Results Initial results show that men and women appreciated Infotility. The most popular sections included information on modifiable lifestyle risks (eg, diet, exercise, environment), and medical and psychosocial information. Men preferentially visited pages about lifestyle factors whereas the most common pages visited by women related to medical information. Importantly, the “Connect” social network logged 39 open forum conversations with 258 total posts, as well as 14 private messages. Both men and women lurked and posted on the board; women posted more often than men. Conclusions The design of a mobile health app for fertility patients should consider user experience and design along with the quality and accessibility of information. A fertility mHealth app should provide access to monitored social support through the interface and consider how to effectively tailor information to men and women.
Objective This study undertook to estimate the prevalence of post-partum depression in the community by means of telephone screening. Demographic correlates of post-partum depression were also investigated. Method The sample was identified through two community health centres. Over a period of 17 months, 1559 childbearing women were screened at six weeks post-partum, using the ten-item Edinburgh Postnatal Depression Scale (EPDS). Results The prevalence of post-partum depression was estimated to be 6.2%, using a outpoint of 10 on the EPDS, and 3.4% using the more stringent cut point of 12. Women who were not working, or those with lower occupational status, were at greater risk for depression. Recent immigrants, particularly those who were not working or who had given birth to a second child, were also at higher risk. Conclusion Telephone screening for post-partum depression is feasible, and can aid in the identification of women at risk.
Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression.In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16-36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal.There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD-1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD-3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to -0∙62; p = 0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p = 0∙001).This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes.An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings.ISRCTN16775958. Registered on 30 April 2019.
