The Complexities of Managing Gestational Diabetes in Women of Culturally and Linguistically Diverse Backgrounds: A Qualitative Study of Women’s Experiences

Aim: This study aimed to explore women’s perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds. Methods: Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis. Results: Three themes were generated: “cultural beliefs and obligations impact lifestyle management of gestational diabetes”, which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; “the relationship between cultural foods and gestational diabetes management”, which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; “gestational diabetes education lacks cultural awareness and sensitivity”, which illustrates how current education fails to address differences in cultural beliefs, language and eating practices. Conclusion: Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group.Melissa Oxlad, Sharni Whitburn, and Jessica A. Griege

Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model

BACKGROUND: Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s grief following pregnancy loss and neonatal loss. METHODS: A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men’s experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men’s grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men’s grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth. RESULTS: A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men’s grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience. CONCLUSION: There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men’s grief.Kate Louise Obst, Clemence Due, Melissa Oxlad and Philippa Middleto

Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample

Published online: 07 January 2021Background: Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. Methods: Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style. Results: Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. Conclusions: Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.Kate Louise Obst, Melissa Oxlad, Clemence Due and Philippa Middleto

General and specific avoidance: the development and concurrent validation of a new measure of avoidance coping

Research on coping has been hampered by psychometric shortcomings in coping scales, which have typically relied on items based on face-value, extracted too many factors or lacked the evidence for the obtained structure from confirmatory factor analysis. The present paper describes the development and concurrent validation of a new three-factor avoidance coping scale, the General and Specific Avoidance Questionnaire (GSAQ), which comprises General Avoidance, Emotional Avoidance and Conflict Avoidance. In contrast to earlier scales the items were derived from a scenario technique which elicits items from participants’ experience, and the three factor structure was endorsed by two confirmatory factor analyses on independent samples and a further exploratory factor analysis based on the total pooled sample of participants from all three analyses. Factor correlations indicate that the scales measure discrete facets of the avoidance coping domain, and while concurrent validation showed that General and Conflict Avoidance were related in predictable ways to criterion measures, the pattern for Emotional Avoidance was unexpected

Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery

We aimed to explore the combined contribution of pre-surgical depression and anxiety symptoms for recovery following coronary artery bypass graft (CABG) using data from 251 participants. Participants were assessed prior to surgery for depression and anxiety symptoms and followed up at 12 months to assess pain and physical symptoms, while hospital emergency admissions and death/major adverse cardiac events (MACE) were monitored on average 2.68 years after CABG. After controlling for covariates, baseline anxiety symptoms, but not depression, were associated with greater pain (β = 0.231, p = 0.014) and greater physical symptoms (β = 0.194, p = 0.034) 12 months after surgery. On the other hand, after controlling for covariates, baseline depression symptoms, but not anxiety, were associated with greater odds of having an emergency admission (OR 1.088, CI 1.010–1.171, p = 0.027) and greater hazard of death/MACE (HR 1.137, CI 1.042–1.240, p = 0.004). These findings point to different pathways linking mood symptoms with recovery after CABG surgery

Psychological approaches to assisting individuals diagnosed with cancer

Lisa Beatty and Melissa Oxla

Managing accountability for domestic violence: Identities, membership categories and morality in perpetrators’ talk

Psychological research and popular discussion around domestic violence/intimate partner abuse have focussed on broad features of descriptive accounts such as victim precipitation, excusing of aggressors, and minimizing or denying the violence. Few studies have examined the finer detail of how such matters are routinely invoked in talk, and how they are regularly built in ways that make their authors appear credible and warranted. This study uses a discursive psychological approach to examine the talk of men recruited from domestic violence counselling groups who participated in one-on-one interviews about their violent/abusive behaviour. The analytic focus is on instances of situated identity categorization in these men’s accounts that involved the consequential moral assessment of self and partner in ways that justify or warrant violence/abuse. Routinely, in these men’s talk about their abused partner, subtle and particular categorizations associated with being a woman were worked up sequentially to depict her as having breached the normative moral order. These warranting practices were evident in the talk of both men who denied, and who overtly acknowledged, the wrongness of their violent/abusive actions. The findings raise important issues for understanding how commonsense reasoning around the causes of domestic violence and its justifiability is sustained, as well as having practical implications for theory, prevention and treatment.Amanda Le Couteur and Melissa Oxla