Advocacy for mothers with psychiatric illness: a clinical perspective.

Motherhood is a challenging role and a life-changing experience. For women living with psychiatric illness, the challenge of motherhood is amplified. Psychiatric illness (including schizophrenia, affective and personality disorders) is associated with multiple adversities that can impair the capacity to parent. Social adversity, fluctuating symptoms, and medications and their related side-effects, can create difficulties for the new mother as she adjusts to her role. The risk for relapse among women who are unwell is heightened during the post-partum period. For many other women, the post-partum period is when psychiatric symptoms emerge for the first time. Equally important are the continuing concerns pertaining to infant well-being where maternal psychiatric illness is present. For mothers who exhibit symptoms at this time, a very real threat of protective removal exists. In the mother-infant setting, child protection legislation is biased towards the rights of the child. While there are cases for which this bias is clearly appropriate, there are less clear situations from which the infant is removed with little regard for the mother. Often mothers with psychiatric illness struggle to meet the cognitive, emotional, and financial demands of drawn-out custody proceedings. For these mothers, there is a paucity of appropriate support available, as will be evidenced throughout the present paper. There is an urgent need for professional advocacy to support women who are unwell in their transition to motherhood. The mental health nurse is able to fill a key advocating role in the perinatal psychiatric setting. Nurses in this role hold a unique position whereby social and community supports can be activated, while guidance is imparted from a ground-level standpoint. The nurse in this role has the capacity to liaise with authorities, negotiate service provision, and ensure that key parenting skills are acquired by the mother as she works to secure her role. Through the provision of proactive advocacy during this time, the nurse has the potential to ameliorate the outcomes of mothers who are unable to cope alone and the well-being of their infants.

First-Time Fathers' Study: psychological distress in expectant fathers during pregnancy.

OBJECTIVE: High levels of distress have previously been reported among expectant fathers, with the level of distress for new fathers falling after the birth and during the first year of their infants' lives. The aim of the present study was to report on the associations with the fathers' initial high levels of distress. METHOD: The men completed a series of questionnaires on various aspects of their psychological functioning at a baseline assessment when their partners were in the late first trimester of their pregnancy. The General Health Questionnaire-28 (GHQ-28) was the key measure of psychological distress for the present study. Men scoring >5 on the GHQ were considered to be cases of distress. The cases and non-cases were contrasted on the baseline psychosocial measures. RESULTS: A total of 312 men completed the questionnaires, of whom 18.6% were designated as cases. GHQ caseness was associated with high levels of symptoms on other measures of psychological distress, higher levels of alcohol consumption, poorer quality of their current intimate relationship, poorer social support, a lower quality of life, high levels of neuroticism and the use of immature ego defences. Multiple regression analysis identified the key variables associated with psychological distress to be high levels of neuroticism, dissatisfaction with social support and an excess number of additional life events. CONCLUSIONS: Psychological distress among expectant fathers is associated with a range of psychological variables, particularly poor marital relationship and poor social networks. This is consistent with a general vulnerability model for psychological distress. Fathers who had insufficient information about pregnancy and childbirth were also at risk of being distressed, suggesting that more attention needs to be paid to providing information to men about their partner's pregnancy, childbirth and issues relating to caring for a newborn infant.

Vision and quality of life: the development of a utility measure.

PURPOSE: To identify the content for a vision and quality of life-related utility measure (Vision Quality of Life Index [VisQoL]) for the economic evaluation of eye care and rehabilitation programs. METHODS: Focus groups of the visually impaired elicited key concepts. Based on these and previous research, 33 items were generated. These were administered to visually impaired adults (n = 70) and a representative sample of unimpaired adults (n = 86). The item bank was reduced through examination of item properties, exploratory factor (EFA), item response theory (IRT), and structural equation modeling (SEM) analyses. The resultant model was confirmed through administration to a second sample of participants. RESULTS: Focus group themes included physical well-being, social well-being, independence, self-actualization, emotional well-being, and planning and organization. Poorly performing items were eliminated on basic psychometric properties, including failure to discriminate. Next, EFA loadings were used to select items. Twelve items survived. To minimize redundancy, IRT analysis and SEM reduced the VisQoL item pool to six items (Cronbach alpha = 0.88). To confirm this model, these items were then administered to an additional 218 participants; 35% with a vision impairment. A pooled SEM analysis showed the model to have very good fit properties (root mean square error of approximation [RMSEA] = 0.000). A preliminary test of the model against visual acuity showed a significant monotonic relationship. CONCLUSIONS: The short 6-item VisQoL has excellent psychometric properties as a simple summative instrument. It can be used in its present state as a condition-specific outcome measure for the evaluation of healthcare interventions for the visually impaired. The descriptive model is also suitable for generating utility values for the economic evaluation of vision-related programs and services.