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Background Preterm birth (PTB) places a considerable emotional, psychological, and financial burden on parents, families, health care resources, and society as a whole. Efforts to estimate these costs have typically considered the direct medical costs of the initial hospital and outpatient follow-up care but have not considered non-financial costs associated with PTB such as adverse psychosocial and emotional effects, family disruption, strain on relationships, alterations in self-esteem, and deterioration in physical and mental health. The aim of this inquiry is to understand parents’ experience of PTB to inform the design of subsequent studies of the direct and indirect cost of PTB. The study highlights the traumatic nature of having a child born preterm and discusses implications for clinical care and further research. Method Through interviews and focus groups, this interpretive descriptive study explored parents’ experiences of PTB. The interviews were audiotaped, transcribed, and analyzed for themes. Analysis was ongoing throughout the study and in subsequent interviews, parents were asked to reflect and elaborate on the emerging themes as they were identified. Results PTB is a traumatic event that shattered parents’ taken-for-granted expectations of parenthood. For parents in our study, the trauma they experienced was not related to infant characteristics (e.g., gestational age, birth weight, Apgar scores, or length of stay in the NICU), but rather to prolonged uncertainty, lack of agency, disruptions in meaning systems, and alterations in parental role expectations. Our findings help to explain why things like breast feeding, kangaroo care, and family centered practices are so meaningful to parents in the NICU. As well as helping to (re)construct their role as parents, these activities afford parents a sense of agency, thereby moderating their own helplessness. Conclusion These findings underscore the traumatic nature and resultant psychological distress related to PTB. Obstetrical and neonatal healthcare providers need to be educated about the symptoms of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) to better understand and support parents’ efforts to adapt and to make appropriate referrals if problems develop. Longitudinal economic studies must consider the psychosocial implications of PTB to in order to determine the total related costs.

A widely held concern of screening is that its psychological harms may outweigh the benefits of early detection and treatment. This study describes pregnant women's perceptions of possible harms and benefits of mental health screening and factors associated with identifying screening as harmful or beneficial. This study analyzed a subgroup of women who had undergone formal or informal mental health screening from our larger multi-site, cross-sectional study. Pregnant women >16 years of age who spoke/read English were recruited (May-December 2013) from prenatal classes and maternity clinics in Alberta, Canada. Descriptive statistics were generated to summarize harms and benefits of screening and multivariable logistic regression identified factors associated with reporting at least one harm or affirming screening as a positive experience (January-December 2014). Overall study participation rate was 92% (N = 460/500). Among women screened for mental health concerns (n = 238), 63% viewed screening as positive, 69% were glad to be asked, and 87% took it as evidence their provider cared about them. Only one woman identified screening as a negative experience. Of the 6 harms, none was endorsed by >7% of women, with embarrassment being most cited. Women who were very comfortable (vs somewhat/not comfortable) with screening were more likely to report it as a positive experience. Women were largely Caucasian, well-educated, partnered women; thus, findings may not be generalizable to women with socioeconomic risk. Most women perceived prenatal mental health screening as having high benefit and low harm. These findings dispel popular concerns that mental health screening is psychologically harmful.

ABSTRACT Objective: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. Method: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. Results: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. Conclusion: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime. RESUMEN Objetivo: revisar y sintetizar la investigación cualitativa referida a la relación entre el estrés durante la infancia y las conductas adictivas en la adultez. Método: metasíntesis que examina los resultados de investigaciones cualitativas basadas en procedimientos orientados a identificar temas o constructos en diferentes estudios en un área específica. Se realizaron búsquedas exhaustivas en múltiples bases de datos electrónicas. La búsqueda inicial arrojó 1.050 artículos. Sus títulos y resúmenes fueron analizados para determinar si debían incluirse en este estudio en base a criterios predeterminados. Se obtuvieron treinta y ocho artículos completos revisados por expertos que fueron evaluados por tres revisores independientes. Entre ellos, doce fueron seleccionados para una revisión detallada y evaluados mediante las herramientas del Programa de Habilidades de Evaluación Crítica (CASP por sus siglas en inglés). Resultados: los resultados revelaron que existe una asociación clara entre el estrés de la infancia y las conductas adictivas en la edad adulta, al igual que entre los traumas infantiles, la violencia y las conductas adictivas. Un aspecto común encontrado en los resultados es que los participantes recurren a las sustancias adictivas como una estrategia para lidiar con experiencias estresantes de su niñez, independientemente de sus efectos secundarios dañinos o de sus resultados sociales perjudiciales. Conclusión: se concluye que la adicción puede ser vista como una forma de lidiar con la adversidad en la niñez y que existe una interrelación entre la adicción, la violencia doméstica y la delincuencia. RESUMO Objetivo: revisar e sintetizar pesquisas qualitativas sobre os vínculos entre o estresse no início da vida e os comportamentos de dependência na idade adulta. Método: metassíntese para revisar resultados de pesquisa qualitativa com base em procedimentos que descrevem como identificar temas ou construtos através de estudos em uma área específica. Foram realizadas pesquisas abrangentes em múltiplas bases de dados eletrônicas. A pesquisa inicial produziu 1.050 artigos, cujos títulos e resumos foram selecionados para inclusão com base em critérios predeterminados. Trinta e oito textos completos de artigos revisados por pares foram recuperados e avaliados por três revisores independentes. Doze artigos foram elegíveis para revisão completa e avaliados usando as ferramentas do Programa de Competências de Avaliação Crítica (Critical Appraisal Skills Programme, CASP). Resultados: os achados revelaram que existem associações claras entre o estresse no início da vida e comportamentos aditivos na idade adulta, como entre trauma na infância, violência e comportamentos aditivos. Um tema comum nas descobertas indica que os participantes se voltam para substâncias aditivas como uma maneira de lidar estrategicamente com experiências estressantes da infância, independentemente dos efeitos colaterais deletérios ou resultados sociais prejudiciais. Conclusão: pode-se inferir que o vício pode ser visto como uma forma de lidar com a adversidade na infância e que existe uma inter-relação entre vício, violência doméstica e crime.

We carried out an investigation of adults' with an acute, traumatic injury to determine how they gauged their experience to provide a pain score on the Numerical Rating Scale (NRS). Methods: Using a rigorous interpretive description (ID) approach, we interviewed 13 participants and then transcribed and analyzed the data collected as per standard ID protocols. Results: We identified three experiential referents used to determine their pain score: receiving the injury, sensing the imminent loss of consciousness, and grasping the immediate context. Participants identified these referents in a systematic way, extending our clinical confidence and knowledge in the NRS's utility. Participants did not consistently use the anchors provided by the health care provider. Participants operationalized the scale in alternate ways including using the imminent loss of consciousness as their guide to obtain their score. Discussion: The concrete phrase imminent loss of consciousness provides a tangible descriptor for the person in pain, rather than vague and abstract terms currently used with the NRS. This phrase provides the clinician with a solid and reliable platform from which to make treatment decisions. Importantly, acute pain is gauged in the pre-reflective present and in the specific situation in which it is being measured, and not against historical or imaginary experiences. Clinicians should consider revisiting pain scale anchors using the imminent loss of consciousness as a potential anchor.

This review of risk assessment and prediction literature briefly describes the historical and philosophical influences on the construct of dangerousness; chronicles the advances in research associated with the reconceptualization of dangerousness as risk; and describes current practice and research related to risk assessment, with particular attention to commonly used risk assessment tools and to existing issues and controversies. This cannot be considered a systematic review of the literature but a reflection of some of the key issues found in the literature.

Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women's preferences for e-screening and disclosure of mental health concerns. Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin's tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs. Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women's disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure. The findings suggest that mental health e-screening is feasible and acceptable to pregnant women. Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).

This review of risk assessment and prediction literature briefly describes the historical and philosophical influences on the construct of dangerousness; chronicles the advances in research associated with the reconceptualization of dangerousness as risk; and describes current practice and research related to risk assessment, with particular attention to commonly used risk assessment tools and to existing issues and controversies. This cannot be considered a systematic review of the literature but a reflection of some of the key issues found in the literature. [PUBLICATION ABSTRACT]

Objectives This study tested the efficacy of a 6-week social support intervention for enhancing resilience and quality of life among women living in low socioeconomic areas of Karachi, Pakistan. Methods One hundred and twenty women were randomly allocated to the intervention ( n  = 60) or control group ( n  = 60). Women in the intervention group attended a 6-week social support program, while those in the control group attended a single mental health awareness session. Outcome variables were measured via the resilience scale-14 item (RS-14), the resilience scale for adults (RSA), and World Health Organization quality of life brief scale (WHOQOL-BREF). Results Compared to participants in the control group, women in the intervention group reported improvements in resilience measured by RS-14 ( p  = 0.022) and the structured style subscale of the RSA ( p  = 0.043). A medium effect size was also measured on the structured style subscale ( d  = 0.6, 95% CI = 0.62874, 2.57126). No significant findings were noted on QOL scores. Conclusions Community-based social support interventions are a gender-sensitive-, culturally appropriate-, and resource-sparing approach to promote women’s resilience and improve their mental health.

Background At a prevalence rate of 13-25%, mental health problems are among the most common morbidities of the prenatal and postnatal periods. They have been associated with increased risk of preterm birth and low birthweight, child developmental delay, and poor child mental health. However, very few pregnant and postpartum women proactively seek help or engage in treatment and less than 15% receive needed mental healthcare. While system-related barriers limit accessibility and availability of mental health services, personal barriers, such as views of mental health and its treatment, are also cited as significant deterrents of obtaining mental healthcare. The purposes of this population-based study were to identify the public’s views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views. Methods A computer-assisted telephone survey was conducted by the Population Research Laboratory with a random sample of adults in Alberta, Canada. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Interviews were conducted in English and were less than 30 minutes in duration. Descriptive and multivariable regression analyses were conducted. Results Among the 1207 respondents, 74.8% had post-secondary education, 16.3% were 18-34 years old, and two-thirds (66.1%) did not have children <18 years living at home. The majority of respondents strongly agreed/agreed that all women should be screened in the prenatal (63.0%) and postpartum periods (72.7%). Respondents reported that when seeking help and support their first choice would be a family doctor. Preferred treatments were talking to a doctor or midwife and counseling. Knowledge of perinatal mental health was the main factor associated with different treatment preferences. Conclusions The high acceptability of universal perinatal mental health screening among the public provides a strong message regarding the public value for routine screening during pregnancy and postpartum periods. Perinatal mental health literacy is the most prominent determinant of screening and treatment acceptability and preference. Efforts to enhance population literacy as part of a multifaceted perinatal mental health strategy may optimize pregnant and postpartum women’s mental health.

OBJECTIVES: Depression is a global concern and it is well known that certain segments of the population are at greater risk. Sexual minorities are recognized as being more likely to suffer from depression due to social stigma and prejudice. The aim of this study was to describe the relationship between sexual orientation and depression in the Canadian population. METHODS: The study used the 2012 Canadian Community Health Survey — Mental Health data. The sample comprised 24,788 Canadians living in the ten provinces. Logistic regression analyses were used to examine the relationship of depression and sexual orientation. RESULTS: After adjusting for known risk factors for depression, there was no difference in prevalence of past 12-month or lifetime major depressive episode between sexual minorities and heterosexuals. Bisexuals did have a near significant trend towards higher prevalence of both past 12-month and lifetime depression as a combined group, but there were not clear differences when stratified by sex. CONCLUSION: This study supports important emerging trends in the relationship between sexual orientation and depression. Research on the mental health of sexual minority people must take into account differences between sexual minority groups and avoid aggregating mental health disorders into broad categories. These findings have implications for public health planning and clinical recommendations.