A systematic review of systematic reviews to improve maternal mental health and well-being

Objective: to identify non-invasive interventions in the perinatal period that could enable midwives to offer effective support to women within the area of maternal mental health and well-being.

Methods: a total of 9 databases were searched: MEDLINE, PubMed, EBSCO (CINAHL/British Nursing Index), MIDIRS Online Database, Web of Science, The Cochrane library, CRD (NHS EED/DARE/HTA), Joanne Briggs Institute and EconLit. A systematic search strategy was formulated using key MeSH terms and related text words for midwifery, study aim, study design and mental health. Inclusion criteria were articles published from 1999 onwards, English language publications and articles originating from economically developed countries, indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Data were independently extracted using a data collection form, which recorded data on the number of papers reviewed, time frame of the review, objectives, key findings and recommendations. Summary data tables were set up outlining key data for each study and findings were organised into related groups. The methodological quality of the reviews was assessed based on predefined quality assessment criteria for reviews.

Findings: 32 reviews were identified as examining interventions that could be used or co-ordinated by midwives in relation to some aspect of maternal mental health and well-being from the antenatal to the postnatal period and met the inclusion criteria. The review highlighted that based on current systematic review evidence it would be premature to consider introducing any of the identified interventions into midwifery training or practice. However there were a number of examples of possible interventions worthy of further research including midwifery led models of care in the prevention of postpartum depression, psychological and psychosocial interventions for treating postpartum depression and facilitation/co-ordination of parent-training programmes. No reviews were identified that supported a specific midwifery role in maternal mental health and well-being in pregnancy, and yet, this is the point of most intensive contact.

Key conclusions and implications for practice: This systematic review of systematic reviews provides a valuable overview of the current strengths and gaps in relation to maternal mental health interventions in the perinatal period. While there was little evidence identified to inform the current role of midwives in maternal mental health, the review provides the opportunity to reflect on what is achievable by midwives now and in the future and the need for high quality randomised controlled trials to inform a strategic approach to promoting maternal mental health in midwifery.

“It’s like a problem that doesn’t exist”: The emotional well-being of mothers caring for a child with brain injury.

Background: Although research has shown that significant burden and adverse psychological impact are associated with caring for a child with brain injury, limited knowledge exists concerning the qualitative experience and impact of this burden.
Objective: To provide an account of the experiences of mothers who care for a childhood survivor of brain injury.
Research design: Postal survey.
Methods and procedures: A self-report questionnaire was sent to a consecutive sample of mothers (n=86) of children (aged 8-28) with acquired brain injury, registered with a UK children’s brain injury charity. Five essay style questions enabled mothers to reflect on and describe at length their caring experiences, with particular emphasis placed on the perceived impact on emotional well-being.
Main outcomes and results: Thematic analysis identified five key themes: Perpetually Anxious, The Guilty Carer, The Labour of Caring, A Self-Conscious Apologist and Perpetually Grieving. Collectively, these themes highlight two core processes shaping mothers’ caring experiences and concomitant mental well-being. Firstly, the collective and enduring nature of caregiver burden over time. Second, the crucial role played by socio-cultural values in perpetuating caregiver burden.
Conclusions: Societal norms, particularly those relating to the nature and outcome of brain injury and motherhood, serve to marginalise mothers and increase feelings of isolation. Findings suggest the value of peer support programs as an effective means of providing appropriate social support.

Being observant and observed: embodied citizenship training in the Home Guard and the Boy Scout Movement, 1907-1945

Building upon recent studies by geographers and social scientists on the everyday practices of (scientific) observation, this paper focuses on the role of two distinct, yet similar organisations that held observation as an essential and 'automatic' embodied skill. Utilising the examples of Home Guard camouflage and the Boy Scout Movement, the paper critically examines how these organisations sought to articulate the individual as both observer and observed, thereby exposing a much more complex entanglement of different visual positions and practices hitherto neglected in studies of observation. Moreover, the paper emphasises the importance of the act of 'not-being-seen' as a complementary and fundamental aspect of (non-)observational practice, accentuated and promoted by civic institutions in terms of duty and responsibility. Finally, the paper considers the evolutionary aspects of observation through the lifecourse, revealing a complex, relational geography of expertise, experience and skill that crossed age-distinctions. © 2012 Elsevier Ltd.

“I miss being spoon-fed”. A comparison of transition from school to university education from the perspective of undergraduate pharmacy students

Background: The transition from school to university can be challenging and there is increasing concern among academics that students are inadequately prepared for entry to university courses.Aims: To investigate students’ views on transition from school to university education.Method: A focus group was conducted with first-year students and analysed using thematic analysis. Students were invited to participate in an electronic questionnaire; responses were analysed via SPSS for Windows. The Mann– Whitney U test was utilised with p<0.05 set as significant.Results: A response rate of 60% (88/147) was obtained for the questionnaire. Differences included staff-student interactions, learning methods, examination preparation and feedback provision. Many (85%) agreed that the main emphasis in school was on examination preparation; 29.6% considered this to be the case at university (z=-8.315; p<0.05). Most students (95.4%) considered the feedback they received at school helped improve performance; this decreased to 50% when asked about feedback at university (z=-8.326; p<0.05).Conclusion: Students appear to be insufficiently prepared for the demands of higher education. They desire various aspects of their university educational experience to be more akin to that of school, including: a greater level of individual attention, increased access to teaching staff, and further clarification and transparency about the standard required to pass exams. Further work can now be done by academic staff to aid the transition and improve the learning experience.

Dyslexia in higher education: Implications for maths anxiety, statistics anxiety and psychological well-being

This study examined levels of mathematics and statistics anxiety, as well as general mental health amongst undergraduate students with dyslexia (n = 28) and those without dyslexia (n = 71). Students with dyslexia had higher levels of mathematics anxiety relative to those without dyslexia, while statistics anxiety and general mental health were comparable for both reading ability groups. In terms of coping strategies, undergraduates with dyslexia tended to use planning-based strategies and seek instrumental support more frequently than those without dyslexia. Higher mathematics anxiety was associated with having a dyslexia diagnosis, as well as greater levels of worrying, denial, seeking instrumental support and less use of the positive reinterpretation coping strategy. By contrast, statistics anxiety was not predicted by dyslexia diagnosis, but was instead predicted by overall worrying and the use of denial and emotion focused coping strategies. The results suggest that disability practitioners should be aware that university students with dyslexia are at risk of high mathematics anxiety. Additionally, effective anxiety reduction strategies such as positive reframing and thought challenging would form a useful addition to the support package delivered to many students with dyslexia.

Working with fathers to improve children's well-being: Results of a survey exploring service provision and intervention approach in the UK

Interventions for fathers are a recent growth area in family services. Although some specific approaches are beginning to be evaluated, there is little known about what kinds of interventions are more generally being used in practice. A web-based survey of practitioners was conducted in the UK, with contact being made via local authority service managers. Two hundred and twenty-one responses were received from 53% of local authorities. Both interventions specifically for fathers and services for both parents were targeted in the survey. Results are reported on organisational location; targeting of services; type of intervention; numbers and percentages of men attending services, recruitment of fathers; evaluation strategies; and ideological and theoretical approaches. Numbers of fathers engaged are relatively low - e.g. the median annual number of fathers attending structured parenting courses was eight and in courses for both parents, 21% of those attending were men. Responses on ideological and theoretical approaches suggest that overt gender politics play only a small part, but that the dominant views of practitioners are in line with mainstream approaches to parenting support. Cognitive and behavioral approaches were the most popular.

Genuine savings and future well-being in Germany, 1850-2000

Genuine Savings (GS), also known as ‘net adjusted savings’, is a composite indicator of the sustainability of economic development. Genuine Savings reflects year-on-year changes in the total wealth or capital of a country, including net investment in produced capita, investment in human capital, depletion of natural resources, and damage caused by pollution. A negative Genuine Savings rate suggests that the stock of national wealth is declining and that future utility must be less than current utility, indicating that economic development is non-sustainable (Hamilton and Clemens, 1999). We make use of data over a 150 year period to examine the relationship between Genuine Savings and a number of indicators of well-being over time, and compare the relative changes in human, produced, and components of natural capital over the period. Overall, we find that the magnitude of genuine savings is positively related to changes in future consumption, with some evidence of a cointegrating relationship. However, the relationships between genuine savings and infant mortality or average heights are less clear.