Maternal mental health in Australia and New Zealand: A review of longitudinal studies

AimThe aim of this paper is to describe the factors that impact on the mental health of Australian and New Zealand (NZ) women in the perinatal period (pregnancy and the year following birth), and to determine the impact of perinatal mental health on women's subsequent health by summarising findings from prospective longitudinal studies conducted in Australia and NZ.MethodsA systematic search was conducted using the databases, Scopus, Medline, PsychInfo and Health Source to identify prospective longitudinal studies focused on women's social and emotional health in the perinatal period. Forty-eight papers from eight longitudinal studies were included.ResultsThe proportion of women reporting depressive symptoms in the first year after birth was between 10 and 20% and this has remained stable over 25 years. The two strongest predictors for depression and anxiety were previous history of depression and poor partner relationship. Importantly, women's mood appears to be better in the first year after birth, when compared to pregnancy and five years later. Becoming a mother at a young age is by itself not a risk factor unless coupled with social disadvantage. Women report a high number of stressors in pregnancy and following birth and the rate of intimate partner violence reported is worryingly high.ConclusionMidwives have an important role in the identification, support and referral of women experiencing mental health problems. As many women do not seek help from mental health services, the potential for a known midwife to impact on women's mental health warrants further examination.     

Research ethics and clinical trials: Fostering collaboration with research participants

Accountability in research is a concept that applies to researchers and study participants alike. Human subjects play an active part in the success or failure of a clinical trial by virtue of their understanding of a study's goals expectations of personal gain, and adherence to study design. Trials must be designed to address patient concerns, offer an improved consent process, and move beyond our narrow conception of “patient rights.”; Problems with protocol adherence may be reduced by conceptualizing clinical research as an endeavor with mutual accountability within a relational ethic.     

Helping partnerships that facilitate recovery from severe mental illness

The intent of this study was to learn how consumers experience helping partnerships that assist them in recovery to inform families, professionals, and peers about meaningful actions and strategies that promote the healing process. In-depth interviews were conducted with a purposeful sample of 10 individuals who had a self-reported diagnosis of severe mental illness. Using the phenomenological research process, helping partnerships and how they develop were described. Six key themes emerged from the data and included Networks of Helping Partnerships, Teaching-Learning, Spirituality, Creative Drive, Time, and Medication Adherence. Characteristics and behaviors of helping partners were identified, as well as structures that promoted their development. Educating the public, consumers, and mental health professionals about how to promote recovery, the role of spirituality and creativity, the benefits of medication and therapy, and the impact of learning on progressing through recovery can go a long way toward eliminating the mystery and fear associated with mental illness.     

Hidden Consumer Loans: An Analysis of Implicit Interest Rates on Bounced Checks

Payday lending attracts attention for its high interest rates, but bounce protection loans are much more expensive. Bounce protection is a program where consumers overdraft—write checks in excess of the checking account balance—and the bank pays the check allowing the account balance to be negative. For this service/loan, banks charge the standard non-sufficient funds (NSF) fee. When the amount borrowed is low and the time outstanding is short, the effective interest rate paid on this loan can be quite high. Using a unique data set we were able to quantify how high the interest rate is. We found that the median implicit interest paid by consumers is over 4,000%.

Clarifying Types of Uncertainty: When Are Models Accurate,and Uncertainties Small?

Professor Aven has recently noted the importance of clarifying the meaning of terms such as "scientific uncertainty" for use in risk management and policy decisions, such as when to trigger application of the precautionary principle. This comment examines some fundamental conceptual challenges for efforts to define "accurate" models and "small" input uncertainties by showing that increasing uncertainty in model inputs may reduce uncertainty in model outputs; that even correct models with "small" input uncertainties need not yield accurate or useful predictions for quantities of interest in risk management (such as the duration of an epidemic); and that accurate predictive models need not be accurate causal models.     

Reducing child poverty by promoting child well-being: Identifying best practices in a time of great need

Child poverty in the United States persists despite a range of social services designed to reduce poverty rates and improve the economic self-sufficiency of families. The economic downturns resulting in job losses and the housing crisis have converged to create a new group of families who were managing to remain out of poverty prior to the recession but are now slipping into poverty, putting additional strain on services. In light of these pressing issues, this article synthesizes the literature examining child poverty to take a long-range view of the relationship between economic strain, system involvement, and impacts on children and the systems attempting to serve these children. The effectiveness of various policy and program efforts aimed at reducing child poverty rates and/or ameliorating the negative effects of living in poverty is reviewed. The article concludes by suggesting a major shift in focus from reducing child poverty as a singular goal to a comprehensive approach to promoting child and family well-being.