%0 Journal Article %J Women Health %D 2013 %T Views and experiences of suicidal ideation during pregnancy and the postpartum: findings from interviews with maternal care clinic patients. %A Tabb, Karen M %A Gavin, Amelia R %A Guo, Yuqing %A Huang, Hsiang %A Debiec, Kate %A Katon, Wayne %K Adult %K Depression %K Depression, Postpartum %K Female %K Follow-Up Studies %K Humans %K Interviews as Topic %K Maternal Health Services %K Mothers %K Postpartum Period %K Pregnancy %K Pregnancy Complications %K Risk Factors %K Stress, Psychological %K Suicidal Ideation %K Surveys and Questionnaires %K Young Adult %X

INTRODUCTION: Perinatal suicidality (i.e., thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child) is a significant public health concern. Few investigations have examined the patients' own views and experiences of maternal suicidal ideation.

METHODS: Between April and October 2010, researchers identified 14 patient participants at a single university-based medical center for a follow-up, semi-structured interview if they screened positive for suicidal ideation on the Patient Health Questionnaire-9 (PHQ-9) short form. In-depth interviews followed a semi-structured interview guide. Researchers transcribed all interviews verbatim and analyzed transcripts using thematic network analysis.

RESULTS: Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and family member attempts), and pregnancy complications. The network of themes included the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use.

IMPLICATIONS: The interview themes suggested that in this small sample, pregnancy represented a critical time period to screen for suicide and to establish treatment for the mothers in the study. These findings may assist health care professionals in the development of interventions designed to identify, assess, and prevent suicidality among perinatal women.

%B Women Health %V 53 %P 519-35 %8 2013 %G eng %N 5 %R 10.1080/03630242.2013.804024 %0 Journal Article %J Gen Hosp Psychiatry %D 2011 %T Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma. %A Zatzick, Douglas %A Rivara, Frederick %A Jurkovich, Gregory %A Russo, Joan %A Trusz, Sarah Geiss %A Wang, Jin %A Wagner, Amy %A Stephens, Kari %A Dunn, Chris %A Uehara, Edwina %A Petrie, Megan %A Engel, Charles %A Davydow, Dimitri %A Katon, Wayne %K Adult %K Aged %K Clinical Protocols %K Cognitive Therapy %K Comorbidity %K Cooperative Behavior %K Female %K Humans %K Male %K Middle Aged %K Models, Theoretical %K Patient Care Team %K Stress Disorders, Post-Traumatic %K Survivors %K Trauma Centers %K Wounds and Injuries %X

OBJECTIVE: The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions.

METHOD: We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures.

RESULTS: Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers.

CONCLUSIONS: Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.

%B Gen Hosp Psychiatry %V 33 %P 123-34 %8 2011 Mar-Apr %G eng %N 2 %R 10.1016/j.genhosppsych.2011.01.001