Is intimate partner violence more common in pregnant women with severe mental illness? A retrospective study

Objective: To examine the risk of past and current experiences of intimate partner violence (IPV) in women with severe mental illness (SMI) in pregnancy. Methods: We examined past and current experiences of IPV in women with SMI in pregnancy. The data of 304 women with SMI including schizophrenia and related psychotic disorders and Bipolar Disorder meeting International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) criteria were extracted from hospital records at King Edward Memorial Hospital, Western Australia. Comparisons were made between our study data and the Australian population data reported by the Australian Bureau of Statistics, which included data on pregnant women in Western Australia. Additional measures included reported demographics, substance use and pregnancy variables. Results: Around 48% of pregnant women with SMI had experienced IPV and were three times the risk when compared with the general pregnant population in Australia. There was no difference in rates of IPV in those women with psychotic disorders when compared with bipolar disorder. Furthermore, the rates of smoking and illicit substance use were significantly higher in pregnant women with SMI who experienced IPV compared with those who have not experienced IPV. Conclusion: These findings suggest women with SMI in pregnancy are at significantly higher risk of having experienced or experiencing IPV. In addition, IPV in pregnant women with SMI may increase the risk of smoking and illicit substance use. Together this suggests that maternity and mental health services should ensure there are both screening and support pathways for IPV that are developed and evaluated specifically for pregnant women with SMI

Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness

Objective Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. Design Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection Setting A multidisciplinary antenatal clinic in Australia Method Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder Main outcome measures Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions Results Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin Discussion Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Peer reviewe

Obstetric outcomes for women with severe mental illness : 10 years of experience in a tertiary multidisciplinary antenatal clinic

Purpose This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI). Methods A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007-2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, chi(2)(,) ANOVA and odds ratio (OR). Results Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p <0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64-14.65), gestational diabetes OR 3.59 (95% CI 2.18-5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29-0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement. Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003). Conclusion Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes. Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.Peer reviewe

Teaching and assessment of clinical diagnostic reasoning in medical students

Background: Teaching diagnostic reasoning and giving feedback has an important role in medical education. Clinicians who teach may recognise errors, but be unfamiliar with the terminology used to describe them, leading to a lack of consistent and useful student feedback. Objective: This prospective project evaluation study aimed to develop an examiner training package regarding errors in diagnostic reasoning, utilising consistent language and feedback tool, and report on diagnostic reasoning errors in second year medical students over the transition from preclinical to early clinical training at objective structured clinical exams (OSCEs). Results: Likert questionnaire regarding examining, assessment and feedback pre- and post-training showed improvement in all measures, including examiner feedback confidence post training (p \u3c .001). Students (n = 235) within the cohort were examined at the first preclinical OSCE 12 weeks into the teaching year and 236 students at the end of year OSCE. A range of 0–6 diagnostic reasoning errors were reported for individual students. When comparing mean history station scores at the preclinical OSCE for students who were observed to have diagnostic reasoning errors, students with ‘poor pattern recognition’ had a 4.2% lower score than those without this error type (p = .04, 95% CI of difference .14, 8.32), while those with ‘unfocused data collection’ error had a station score 7.7% lower than those without this error (p \u3c .001, 95% CI of difference 3.50, 11.99). At the end of teaching year clinical OSCE, all common error types were associated with poorer performance. Error pattern shifted through the two longitudinal assessments, resulting in ‘poor pattern recognition’ having reduced and ‘too narrow’ and ‘premature closure’ increased rates. Conclusions: Incorporating the identification and feedback of common diagnostic reasoning errors into existing clinical assessments was feasible and easy to implement. Understanding, identifying and providing consistent feedback on common errors assists educators and could guide curriculum design

A Scoping review and environmental scan of health literacy and resources related to menstrual health for Aboriginal women in Australia

This scoping review aims to document a comprehensive overview of the available knowledge surrounding menstrual health literacy resources for Aboriginal women in Australia. The review will 1) identify and explore current and past information regarding menstrual health literacy resources for Aboriginal women in Australia, and 2) compile and evaluate existing patient resources from the grey literature. Introduction Improving menstrual health and hygiene has been recognised as a global priority in addressing health inequities and barriers to social participation for women worldwide(1). Menstrual health has been defined as not only the absence of infirmity related to menstruation but also a state of complete physical, mental and social wellbeing (2).The ways in which Aboriginal women understand and manage their menstrual health is thought to be influenced significantly by sociocultural factors and understandings of health and wellbeing (1). However, available resources and guidelines generally provide guidance for management of pathology which may not be aligned with Aboriginal concepts of health and wellbeing. More generally studies of menstrual experiences in high income countries have shown that menstrual health is associated with strict behavioural expectations to conceal menstruation, resource limitations related to materials and appropriate environments to manage menstruation and difficulties with hygiene and physical factors related to menstruation (2). Further, there is a stark paucity of research surrounding the menstrual experiences of disadvantaged or marginalised groups which has had subsequent impacts on policy formation and implementation (2, 3). Ciccia et al(3) , in a recent scoping review of the menstrual experiences of Indigenous people in Australia, Canada and New Zealand, note that in different cultural groups menstrual health literacy can be affected by multiple historical, cultural and social factors. In addition, they discuss that menstrual health literacy is generally poor across different population groups and can lead to delays in diagnosis and care for menstrual health conditions (3). Thus, the aim of this scoping review is to explore the availability of health literacy and health education resources regarding menstrual health for Aboriginal women in Australia. In Australia, Aboriginal people face many barriers in accessing culturally safe health care, with Aboriginal women facing additional challenges in menstrual health care compounding health inequity(1, 4, 5). In their 2019 article, Krusz et al (1) discuss the challenges in menstrual health and hygiene that are pervasive for Aboriginal women in Australia, including resource limitations, such as access to hygiene products, and cultural norms that may discourage discussion of menstruation. In particular, they outline the need for culturally appropriate menstrual health literacy resources and that lack of access to this education has a major impact on women and girls (1). These barriers were further highlighted in a qualitative study conducted by Hall et al (6) which reviewed water sanitation in several remote Aboriginal communities which revealed the gender inequity that occurs with reduced access to menstrual products, a lack of school and primary health care based education surrounding menstrual health, housing infrastructure barriers and the high cost of menstrual products (6). In older women, Jones et al(7) reported that cultural understandings of menopause are varied across Indigenous women globally, including for Aboriginal women, and that deeper understandings of cultural perspectives can help health professionals to provide optimal care. Lansbury and King (8) explored this in their interviews with Aboriginal women in a remote community setting and they outline the stigma associated with menstrual health and care needs along with multiple barriers including structural factors such as living conditions and management of hygiene product use. Aboriginal women’s cultural perspectives of menstrual health have not been incorporated into Australian health care policy or practice. It is essential to acknowledge and understand the interplay between cultural considerations of menstruation and areas for improvement in care delivery, as addressing menstrual health disparities can improve societal participation and quality of life (1). In addition, to improve cultural safety of care delivery guidelines and resources for patients and health care providers, incorporating menstrual cultural perspectives and practices are required to enhance care provision for Aboriginal women (3, 9). Thus, there is a gap in understanding regarding what menstrual health and wellbeing means for Aboriginal women. Research and policy priorities, developed from yarning circles with 12 Aboriginal and Torres Strait Islander women in collaboration with a group of non-Aboriginal researchers and practitioners, on Aboriginal women’s menstrual health have been previously described by Krusz et al (1) and include; 1) establish community-controlled research and evaluation; 2) ensure ongoing product distribution (while affordability and access are being improved); 3) build awareness and provide community-designed education regarding puberty and women’s reproductive health; 4) lobby for menstrual equity through government and community; and 5) engage with Aboriginal women in leading roles to share messages around menstrual health. For these priorities, and the other issues outlined above, to be addressed there needs to be a greater knowledge base drawn from Aboriginal women’s voices regarding menstrual health needs and care preferences. Thus, a scoping review will allow the gathering of evidence to corroborate findings regarding the menstrual health and hygiene preferences of Aboriginal women with a focus on menstrual health literacy and health education resources. As scoping reviews in general aim to descriptively map a body of evidence and describe broader concepts it is an appropriate tool for this question to gain an overarching understanding that is able to incorporate a broad range of evidence types which will be beneficial given the paucity of published evidence. The summation of the available evidence will be of value in determining knowledge gaps and for informing the development of culturally appropriate health education and literacy resources. There are no other registered or previous scoping reviews pertaining to this topic and question. This scoping review protocol has been registered

Psychiatric admission during pregnancy in women with schizophrenia who attended a specialist antenatal clinic

Objectives: The mental health and wellbeing of pregnant women with schizophrenia is an area of research interest. We aim to explore this relationship particularly in regards to psychiatric admission rates, timing and their associated contributing factors. Methods: A total of 98 pregnancies to women with schizophrenia, who attended a specialist antenatal clinic and delivered from July 2007 to February 2016, were retrospectively examined. The cohort was divided into two groups based on psychiatric admission. Descriptive data were analyzed using SPSS software. Results: Overall, 40.8% required psychiatric admission during pregnancy. A higher proportion of subjects had their initial psychiatric admission in the first trimester compared to the third trimester (p = .002). Of note, 10.2% were admitted within one month either side of conception. Women with admission also presented later for their first antenatal appointment (p = .04, 95% CI −2.1 to −1.9). Psychiatric admission was associated with substance (p = .014) and alcohol use (p = .001), child protective services involvement (p = .022) and infant being placed in out-of-home care (p = .01), but not with poorer obstetric or neonatal outcomes. Conclusion: High rates of psychiatric admission are evident throughout pregnancy for women with schizophrenia, with a high proportion of first presentations for admission occurring in the first trimester. Psychiatric admission is associated with poorer antenatal care attendance and adverse psychosocial outcomes, highlighting the need for enhanced multidisciplinary pregnancy care for this at risk group. Inpatient psychiatric services should consider pregnancy testing and contraception review for all women of childbearing age, admitted with schizophrenia

General practitioner perceptions and experiences of managing perinatal mental health: a scoping review

Abstract Background General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. Method A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. Results After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. Conclusion Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care

Identification of the transcription factor MAZ as a regulator of erythropoiesis

Erythropoiesis requires a combination of ubiquitous and tissue-specific transcription factors (TFs). Here, through DNA affinity purification followed by mass spectrometry, we have identified the widely expressed protein MAZ (Myc-associated zinc finger) as a TF that binds to the promoter of the erythroid-specific human alpha-globin gene. Genome-wide mapping in primary human erythroid cells revealed that MAZ also occupies active promoters as well as GATA1-bound enhancer elements of key erythroid genes. Consistent with an important role during erythropoiesis, knockdown of MAZ reduces alpha-globin expression in KS62 cells and impairs differentiation in primary human erythroid cells. Genetic variants in the MAZ locus are associated with changes in clinically important human erythroid traits. Taken together, these findings reveal the zinc-finger TF MAZ to be a previously unrecognized regulator of the erythroid differentiation program