Women’s experiences of perinatal mental health: a qualitative exploration of women’s experiences of mental health during pregnancy and a review of women’s views of peer support interventions and their effectiveness

Background and Aims: Mental health difficulties during the perinatal period (pregnancy to 1 year postnatal) are commonplace and are associated with significant impacts for mothers and infants. There is an acknowledgement that more needs to be understood about perinatal mental health, particularly during pregnancy, and that service and treatment options need to be improved. Women’s lived experience of difficulties during pregnancy, particularly when experiencing moderate to severe mental health difficulties, is a little researched area. A need for wider treatment options than medication alone has been highlighted and Peer Support Interventions (PSIs) are often considered within this area. Despite this, there is yet to be a review of their effectiveness to date that also considers women’s views of such interventions. Therefore, this thesis aimed to systematically review literature focused on women’s views of PSIs and their effectiveness. In addition, it also aimed to explore the lived experience of women with moderate to severe difficulties with their mental health during pregnancy, with a focus on trying to establish any psychological needs/needs they may have. Methods: A mixed methods systematic review was conducted to meet the aims on PSI interventions. This involved searching electronic databases, quality assessment of included papers and summarising results, including a meta-synthesis for qualitative findings. The empirical project, on women’s lived experiences, utilised an Interpretative Phenomenological Analysis approach to explore the lived experience of women experiencing moderate to severe mental health difficulties during pregnancy. Semi-structured interviews were conducted with 11 women recruited via a specialist perinatal mental health service. Results Thirteen studies were included in the review. Results highlighted the heterogeneity of types of PSIs and methodologies employed to evaluate these. Most studies focused on PSIs for the postnatal period and were often aimed at depression. There was a lack of research on PSIs targeted antenatally, or for other types of mental health difficulties. There was tentative evidence for the use of telephone based PSIs in reducing depressive symptomatology postnatally, but less evidence for the use of other types of PSI, or for interventions during pregnancy. The qualitative evidence highlighted the acceptability of PSIs to women and a meta-synthesis of qualitative research identified a number of themes representing women’s views of PSIs. From the empirical project, several Superordinate themes were identified: Need for acceptance, Need for awareness, Search for explanations, What helped, Emotional intensity, Societal influences and Service provision. Within these a range of emergent themes were also found. These themes highlighted possible psychological needs and other needs during this time, as well as providing a greater understanding of women’s lived experience. Conclusions: There is a need for more research to establish effectiveness of PSIs during pregnancy and of other modes of delivery and to build on existing findings on the effectiveness of telephone based PSIs. Women viewing PSIs as highly acceptable for perinatal mental health difficulties, should cause services to consider their use, or other opportunities for sharing of peer advice/information. Themes identified from the empirical project highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy, as well as the impact of societal influences on women during this time, and the role clinicians and services could play in achieving greater awareness. Small changes within services could help raise awareness levels and help women feel less isolated

“It is not all glowing and kale smoothies”:An exploration of mental health difficulties during pregnancy through women's voices

Objectives: This study aimed to explore the experiences of women with moderate-to-severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. Design: In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. Methods: Semi-structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. Results: Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the ‘wrong’ feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. Conclusions: These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs-matched care. © 2024 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society

Interagency adult support and protection practice of police and health and social care professionals: a realistic evaluation approach.

The purpose of this project was to investigate the interagency Adult Support and Protection practices of police, health and social care professionals in Scotland by means of a Realistic Evaluation Approach. The study comprised of two specific phases. The first phase sought to establish the 'state of play' for cross boundary working by: identifying the gaps in interagency practice; evaluating the education and training needs of professionals working in the area of adult support and protection, and identifying information sharing practices. Focus groups with members of the police and health and social care professionals were conducted in each of the three Police Scotland Command areas. Thirteen focus groups were conducted, with 101 professionals participating. Nine key themes were identified: Information sharing; relationships; people and processes; lessons from child protection; environment; implementation of the act; regional variations and training; rights of the service users. The second phase will inform the development and evaluation of future interprofessional training resources and identify key performance indicators (KPIs). These KPIs will enable subsequent evaluation and monitoring of practice for all professionals involved in adult support and protection

Immunogenicity of Synthetic Peptides related to the core Peptide sequence encoded by the human MUC1 Mucine gene: Effect of Immunization on the growth of Murine Mammary Adenocarcinoma cells transfected with the human MUC1 gene. J. Cancer Immunol

The immune response of CAF1 mice to various synthetic peptides (SP) related to the amino acid sequence (PDTRPAPGSTAPPAHGVTSA) of the tandem repeat of the MUC1 human breast mucin core peptide was evaluated. The most immunogenic preparations of the synthetic peptides were those conjugated to keyhole limpet hemocyanin (KLH) or clustered in a dendritic multiple antigenic peptide (MAP-4) configuration. The mice were immunized subcutaneously with synthetic peptides emulsified in RIBI adjuvant, employing various immunization protocols. Equivalently high IgG responses were induced using SP-KLH conjugates (GVTSAPDTRPAPGSTA-KLH) or an SP--MAP-4 chimeric configuration (SP1-6), which also included a universal malarial CST-3 T-helper epitope (SP1-6 = SAPDTRPAEKKIAKMEKASSVFNVVNS--MAP-4). These IgG antibodies bound both the appropriate MUC1 synthetic peptides and the cell surface expressed MUC1 mucin on murine mammary cells that had been transfected with the human MUC1 gene and a human breast cancer cell line that expresses cell-surface MUC1. A MAP-4 molecule, which included the entire 20-amino-acid sequence of the MUC1 tandem repeat (SP1-5 = PDTRPAPGSTAPPAHGVTSA-MAP-4) induced a poor IgG response. In contrast, all three types of molecule: SP-KLH, SP1-6 and SP1-5, were found to be good immunogens for the induction of specific delayed-type hypersensitivity (DTH) reactions measured using either synthetic peptides or MUC1-transfected cells. In addition, immunization with irradiated MUC1-transfected cells induced strong DTH reactions measured using synthetic peptides that expressed the PDTRP sequence, which has been shown to be, or to overlap, a T cell epitope in humans and a B cell epitope in mice. Finally, it was demonstrated that synthetic MUC1 peptide vaccines could be used both prophylactically and therapeutically to inhibit the growth of MUC1-transfected tumor cells and prolong the survival of tumor-bearing mice

Contextual Factors Influence Professional Development Attendance Among Child Care Providers in Nebraska

Objective: To examine contextual factors that may influence child care providers’ motivators for attending nutrition-related training and their preferences and barriers to attending professional development training. Design: Cross-sectional survey completed between January and April 2017. Setting: Licensed child care programs (n = 1,490) across urban and rural Nebraska. Participants: Child care center directors (n = 336) and family child care home providers (n = 1,154). Main Outcome Measure(s): Motivators, preferences, and barriers of child care providers for attending professional development. Analysis: Descriptive statistics and multiple logistic regression analyses were conducted. Results: Top motivators for attending nutrition-related training included meeting licensure requirements and improving job performance. Child care providers most commonly selected preferences for receiving training included in-person and online delivery. Top barriers to obtaining training were schedule conflicts, accessibility, and cost. Child care centers and participants in the Child and Adult Care Food Program (CACFP) and Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) were more likely to be motivated by licensure requirements. Rural providers were also more likely to report barriers such as inability to travel and limited access to training. Results revealed that child care type, geographic location, CACFP and Go NAP SACC participation can influence child care providers’ motivators, preferences, and barriers to attending training. Conclusions And Implications: Results highlight the importance of offering professional development training that best fits child care providers’ needs and preferences