Health services research into postnatal depression : results from a preliminary cross-cultural study

Background: Little is known about the availability and uptake of health and welfare services by women with postnatal depression in different countries. Aims: Within the context of a cross- cultural research study, to develop and test methods for undertaking quantitative health services research in postnatal depression. Method: Interviews with service planners and the collation of key health indicators were used to obtain a profile of service availability and provision. A service use questionnaire was developed and administered to a pilot sample in a number of European study centres. Results: Marked differences in service access and use were observed between the centres, including postnatal nursing care and contacts with primary care services.Rates of use of specialist services were generally low.Common barriers to access to care included perceived service quality and responsiveness. On the basis of the pilot work, a postnatal depression version of the Service Receipt Inventory was revised and finalised. Conclusions: This preliminary study demonstrated the methodological feasibility of describing and quantifying service use, highlighted the varied and often limited use of care in this population, and indicated the need for an improved understanding of the resource needs and implications of postnatal depression

Postnatal depression across countries and cultures : a qualitative study

Background: Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. Aims: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people’s perceptions of remedies and services for morbid states of unhappiness within the context of local services. Method: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and grandmothers, and interviews with health professionals.Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. Results: All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness remediable by health interventions. Conclusions: Although the findings of this study support the universality of a morbid state of unhappiness following childbirth, they also support concerns about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals; this has implications for future research

Perceptions of postnatal depression across countries and cultures: from a TransCultural Study of PostNatal Depression (TCS-PND)

Objectives The qualitative study was conducted within the international “Transcultural study of postnatal depression (PND)” in 17 centres located in 13 different countries. The aim was to explore perceptions of PND by lay and professional key informants, specifically regarding description of symptoms, awareness of this pathology and of possible care. Methods Broad areas of inquiry and open-ended probes were developed by the TCS-PND research group during international workshops to obtain data comparable between countries on perceptions of PND. A non-random convenience sampling method was used to recruit postpartum mothers for focus groups, and fathers and grandmothers for interviews. Influential healthcare planners and clinicians were interviewed as professional key informants in each centre. Within sites, transcripts of focus groups and interviews underwent a process of text analysis in the original language until exhaustive theme extraction was achieved. Themes (in English) from all the centres were combined into broader categories and after consensus discussions these categories were revalidated. Results and discussion Qualitative data were supplemented in each centre with sociodemographic data to address the issues of: (i) whether perceptions of PND are related to some specific cultural perception of mental heath and/or of status of parenthood and (ii) how high or low levels of general care and specificity of health policy relate to differences in perception of needs for care. Data collected using the same probes and methodology in different countries and cultures has enabled a comparative analysis of perceptions of PND. In addition it has shown that, although not described with the same words, PND is a well-recognised condition by recent mothers in all countries in this study. Data on focus groups and interviews from selected countries are given in the following abstracts to illustrate some similarities and differences in perceptions between countries

Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study

International audienceObjectiveThe aim of this study was to evaluate the effect of hydroxychloroquine (HCQ) on fetal preterm delivery and intrauterine growth restriction (IUGR) in a cohort of pregnant women with systemic lupus erythematosus (SLE).MethodsOver an 11-year period (January 1, 2001 to December 31, 2011), all women with SLE and admitted to deliver after 22 weeks of gestation to Bordeaux University Hospital (France), were retrospectively enrolled in the present study. The population was then split into two groups based on the treatment they received: HCQ exposed (HCQ+) versus HCQ non-exposed (HCQ?) group.Results118 pregnancies were included, 41 in the HCQ+ group and 77 in the HCQ? group. The rate of adverse fetal outcome was significantly lower in the HCQ+ group (p?=?0.001), particularly in terms of preterm delivery, 15.8 % versus 44.2 % (p?=?0.006), and IUGR, 10.5 % versus 28.6 % (p?=?0.03). No adverse outcomes were reported in the HCQ+ group.ConclusionHCQ reduces neonatal morbidity in women with SLE by significantly decreasing the rate of prematurity and intrauterine growth restriction

Contextual assessment of the maternity experience (CAME): development of an instrument for cross-cultural research

Background: There is evidence that stressors may trigger the onset of a depressive episode in vulnerable women. A new UK interview measure, the Contextual Assessment of the Maternity Experience (CAME), was designed to assess major risk factors for emotional disturbances, especially depression, during pregnancy and post-partum. Aims: Within the context of a cross- cultural study, to establish the usefulness of the CAME, and to test expected associations of the measure with characteristics of the social context and with major or minor depression. Method: The CAME was administered antenatally and postnatally in ten study sites, respectively to 296 and 249 women. Affective disorder throughout pregnancy and up to 6 months postnatally was assessed by means of the Structured Clinical Interview for DSM IV Axis I Disorders. Results: Adversity, poor relationship with either a partner or a confidant, and negative feelings about the pregnancy all predicted onset of depression during the perinatal period. Conclusions: The CAME was able to assess major domains relevant to the psychosocial context of the maternity experience in different cultures.Overall, the instrument showed acceptable psychometric properties in its first use in different cultural settings.Fernand Seguin Research Centre (Montreal, Canada)

Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery

<p>BACKGROUND: Gynaecological laparoscopic surgery outcomes can be compromised by the formation of de novo adhesions. This randomized, double-blind study was designed to assess the efficacy and safety of 4% icodextrin solution (Adept®) in the reduction of de novo adhesion incidence compared to lactated Ringer's solution (LRS).</p> <p>METHODS: Patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts were treated with randomized solution as an intra-operative irrigant and 1l post-operative instillate. De novo adhesion incidence (number of sites with adhesions), severity and extent were independently scored at a second-look procedure and the efficacy of the two solutions compared. The effect of surgical covariates on adhesion formation was also investigated. Initial exploratory analysis of individual anatomical sites of clinical importance was progressed.</p> <p>RESULTS: Of 498 patients randomized, 330 were evaluable (160 LRS – 75% myomectomy/25% endometriotic cysts; 170 Adept – 79% myomectomy/21% endometriotic cysts). At study completion, 76.2% LRS and 77.6% Adept had ≥1 de novo adhesion. The mean (SD) number of de novo adhesions was 2.58 (2.11) for Adept and 2.58 (2.38) for LRS. The treatment effect difference was not significant (P = 0.909). Assessment of surgical covariates identified significant influences on the mean number of de novo adhesions regardless of treatment, including surgery duration (P = 0.048), blood loss in myomectomy patients (P = 0.019), length of uterine incision in myomectomy patients (P < 0.001) and number of suture knots (P < 0.001). There were 15 adverse events considered treatment-related in the LRS patients (7.2%) and 18 in the Adept group (8.3%). Of 17 reported serious adverse events (9 LRS; 8 Adept) none were considered treatment-related.</p> <p>CONCLUSIONS: The study confirmed the safety of Adept in laparoscopic surgery. The proportion of patients with de novo adhesion formation was considerably higher than previous literature suggested. Overall there was no evidence of a clinical effect but various surgical covariates including surgery duration, blood loss, number and size of incisions, suturing and number of knots were found to influence de novo adhesion formation. The study provides direction for future research into adhesion reduction strategies in site specific surgery.</p&gt