Access and utilisation of maternity care for disabled women who experience domestic abuse:a systematic review

BACKGROUND: Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services. METHODS: Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement. RESULTS: Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse. CONCLUSIONS: Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base

Detecting suicidality among adolescent outpatients: evaluation of trained clinicians' suicidality assessment against a structured diagnostic assessment made by trained raters

<p>Abstract</p> <p>Background</p> <p>Accurate assessment of suicidality is of major importance. We aimed to evaluate trained clinicians' ability to assess suicidality against a structured assessment made by trained raters.</p> <p>Method</p> <p>Treating clinicians classified 218 adolescent psychiatric outpatients suffering from a depressive mood disorder into three classes: 1-no suicidal ideation, 2-suicidal ideation, no suicidal acts, 3-suicidal or self-harming acts. This classification was compared with a classification with identical content derived from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) made by trained raters. The convergence was assessed by kappa- and weighted kappa tests.</p> <p>Results</p> <p>The clinicians' classification to class 1 (no suicidal ideation) was 85%, class 2 (suicidal ideation) 50%, and class 3 (suicidal acts) 10% concurrent with the K-SADS evaluation (γ²= 37.1, df 4, p = 0.000). Weighted kappa for the agreement of the measures was 0.335 (CI = 0.198–0.471, p < 0.0001). The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation.</p> <p>Conclusion</p> <p>There was only a modest agreement between the trained clinicians' suicidality evaluation and the K-SADS evaluation, especially concerning suicidal or self-harming acts. We suggest a wider use of structured scales in clinical and research settings to improve reliable detection of adolescents with suicidality.</p

Proposal for a Short Version of the Beck Hopelessness Scale Based on a National Representative Survey in Hungary.

In our study we assessed the frequency of reported hopelessness and suicide attempts in the national representative survey Hungarostudy 2002. The randomly selected sample consisted of 14,000 individuals over the age of 18. We created a short version of the widely used Beck Hopelessness Scale for screening purposes in suicide prevention. The short version of the BHS consists of four items and has high internal consistency (Cronbach's alpha = 0.85). Moreover, we conducted an investigation into psychological, somatic, sociological and socio-economic as well as cultural variables that show a positive or negative correlation with hopelessness and important predictors of suicide. The following psychological variables showing a positive correlation with hopelessness were identified: dysfunctional attitudes, exhaustion, psychological distress, hostility, lack of life goals and inability to cope emotionally. Sense of coherence, social support, perceived self-efficiency, subjective well-being and problem-solving coping showed a negative correlation with hopelessness. Concerning the relationship between hopelessness and suicide attempts, we found that participants who attempted suicide in the last year scored higher (mean = 4.86) than participants who attempted suicide more than 3 years ago (mean = 3.57). These results indicate that applying the short version of the BHS could be very useful in general practice and in psychiatric care

Maternal interpersonal affiliation is associated with adolescents’ brain structure and reward processing

Considerable animal and human research has been dedicated to the effects of parenting on structural brain development, focusing on hippocampal and prefrontal areas. Conversely, although functional imaging studies suggest that the neural reward circuitry is involved in parental affection, little is known about mothers' interpersonal qualities in relation to their children's brain structure and function. Moreover, gender differences concerning the effect of maternal qualities have rarely been investigated systematically. In 63 adolescents, we assessed structural and functional magnetic resonance imaging as well as interpersonal affiliation in their mothers. This allowed us to associate maternal affiliation with gray matter density and neural responses during different phases of the well-established Monetary Incentive Delay task. Maternal affiliation was positively associated with hippocampal and orbitofrontal gray matter density. Moreover, in the feedback of reward hit as compared with reward miss, an association with caudate activation was found. Although no significant gender effects were observed in these associations, during reward feedback as compared with baseline, maternal affiliation was significantly associated with ventral striatal and caudate activation only in females. Our findings demonstrate that maternal interpersonal affiliation is related to alterations in both the brain structure and reward-related activation in healthy adolescents. Importantly, the pattern is in line with typical findings in depression and post-traumatic stress disorder, suggesting that a lack of maternal affiliation might have a role in the genesis of mental disorders

Families with Distinct Levels of Marital Conflict and Child Adjustment: Which Role for Maternal and Paternal Stress?

This study addresses the links between distinct levels of marital conflict and mothers\u2019 and fathers\u2019 parenting stress and their associations with children\u2019s internalizing and externalizing behaviors. Using a sample of 358 Italian father\u2013mother dyads with school-aged children, the study explores: the relationship between interparental conflict and children\u2019s adjustment; the relationship between interparental conflict and parenting stress; the potential mediating role of maternal and paternal stress in the association between interparental conflict and children\u2019s adjustment. Results show that: high levels of marital conflict negatively affect children\u2019s adjustment; in families with moderate and high levels of marital conflict is correlated to both maternal and paternal stress; and in high conflict families maternal stress mediates the relationship between interparental discord and children\u2019s internalizing behaviors, while paternal stress explains the effect of marital conflict on externalizing behaviors. Future direction of research are discusse