RESUMO
We conducted a qualitative study to examine the critical pathways of 23 women survivors of sexual assault who navigated health care-based services in six states in Guatemala. We also captured the components of quality health care that were important to them, including the experience of the waiting room, being able to make active decisions, providing informed consent, and receiving emotional support. Our results from the in-depth, semi-structured interviews indicate the importance of creating and strengthening mechanisms for social support and trauma-informed, competent, and sensitive health services to accompany women as they move toward rebuilding their lives post-sexual violence.
Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde/estatística & dados numéricos , Estupro/psicologia , Sobreviventes/psicologia , Adolescente , Adulto , Feminino , Guatemala , Pesquisas sobre Atenção à Saúde , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Apoio Social , Adulto JovemRESUMO
BACKGROUND: Postpartum depression (PPD) is amenable to detection and treatment, but effectively addressing it is contingent on policies, practices, and health care providers working together to address the issue. The aim of this study is to describe a sample of health care providers' existing practices in public-sector obstetric units in Mexico related to detecting and offering care to women with depressive symptomology. METHODS: Semi-structured interviews with 40 health care providers (16 physicians, 13 nurses, three social workers, and eight psychologists) from one tertiary-level and two secondary-level, public-sector obstetric units, were conducted by members of a trained research team from May to July 2012. Qualitative data were analyzed in Spanish according to Grounded Theory, using Nvivo 10 software. RESULTS: Lack of hospital guidelines, training, and time constraints are reasons given for not detecting PPD symptoms among women. Providers reported that their role is cursory and limited to giving women anticipatory guidance for what to expect emotionally after childbirth or providing a trusting atmosphere for women to express their feelings. Care is fragmented and inadequate, in part because of the lack of protocols that define who makes mental health referrals and where. Providers indicated PPD is important but not prioritized in health care for pregnant and postpartum women. CONCLUSION: Critical needs in obstetric units include formal mental health care detection and care protocols during the perinatal period, strategies to address mental health needs despite short hospital stays, and training for providers on how to implement detection and care protocols and strategies.
Assuntos
Atitude do Pessoal de Saúde , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/terapia , Hospitais Públicos/normas , Cuidado Pós-Natal/métodos , Feminino , Pessoal de Saúde/educação , Humanos , Entrevistas como Assunto , México , Gravidez , Pesquisa QualitativaRESUMO
This article critically examines federal, state and facility-level policies, as well as clinical practice guidelines regarding postnatal depression in Mexico. Thirteen documents including national health plans, national action plans, federal and state laws and regulations, clinical practice guidelines, and public-sector healthcare facility policies were collected and evaluated according to whether they included a statement of intent and/or actions related to the care of women at risk for or experiencing postnatal depression. While postnatal depression is included in several policies in Mexico, it is not addressed in ways that guide actions to manage postnatal depression. Specific direction on postnatal depression in policies would bridge a gap in maternal mental healthcare given that medication, treatment, and timing of interventions is unique in the postpartum context.
Assuntos
Depressão Pós-Parto/terapia , Política de Saúde , Saúde Mental , Saúde da Mulher , Governo Federal , Feminino , Prioridades em Saúde , Promoção da Saúde , Humanos , México , Política Organizacional , Guias de Prática Clínica como Assunto , Governo EstadualRESUMO
This study examined the association between postnatal depressive symptoms and a set of demographic and psychosocial factors among 604 women attending a public hospital for postnatal care in Mexico City. Specific profiles of women that would indicate an increased probability for developing postnatal depression (PND) based on discrete combinations of risk and protective factors were generated. In a logistic model, followed by the estimation of predicted probabilities, we examined the association between depressive symptomatology and psychosocial factors: low social support, unplanned pregnancies, history of depression, and exposure to moderate or severe intimate partner violence (IPV) during pregnancy. Postnatal depressive symptomatology was reported by 10.6 % of the women, as measured by scores at 12 or above on the Edinburgh Postnatal Depression Scale. The cumulative probability of presenting PND in the simultaneous presence of the psychosocial factors was 67.0 %; however, this could be reduced to 5.5 % through preventive measures that work to eliminate low social support, unplanned pregnancy, and exposure to severe IPV during pregnancy. Early identification of psychosocial risk factors, specifically low social support, unplanned pregnancies, history of depression, and exposure to violence during pregnancy, is recommended.
Assuntos
Depressão Pós-Parto/diagnóstico , Hospitais Públicos/estatística & dados numéricos , Mães/psicologia , Parceiros Sexuais/psicologia , Apoio Social , Maus-Tratos Conjugais/psicologia , Adolescente , Adulto , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Relações Interpessoais , México/epidemiologia , Período Pós-Parto , Gravidez , Prevalência , Fatores de Proteção , Setor Público , Estudos Retrospectivos , Risco , Fatores Socioeconômicos , Inquéritos e Questionários , ViolênciaRESUMO
In this article we describe the knowledge frameworks that 61 physicians, nurses, social workers, and psychologists from five public-sector health care facilities in Mexico used to conceptualize postpartum depression. We also demonstrate how providers applied social and behavioral antecedents in their conceptualizations of postpartum depression. Using grounded theory, we identify two frameworks that providers used to conceptualize postpartum depression: biochemical and adjustment. We highlight an emerging model of the function of social and behavioral antecedents within the frameworks, as well as the representation of postpartum depression by symptoms of distress and the perception among providers that these symptoms affected responsibilities associated with motherhood. The results provide a foundation for future study of how providers' conceptualizations of postpartum depression might affect detection and treatment practices and might be useful in the development of training materials to enhance the quality of care for women who experience any form of distress in the postpartum period.