BackgroundThe experience of pregnancy and having a baby is a time of significant change and transition. One in five perinatal women experience problems with their emotional wellbeing and mental health in this period; adjustment, anxiety and depressive illnesses being most common. Whilst investment in specialist perinatal mental health pathways continues, there is limited understanding of healthcare professionals' views and experiences of these pathways and of support available for women with mild or moderate mental health problems. This study explored healthcare professionals' views on the barriers and facilitators to identification and management of perinatal anxiety, and on how to optimise care pathways.MethodsIn-depth semi-structured interviews were conducted with a purposive sample of healthcare professionals in universal perinatal services (including maternity, primary care, and health-visiting) and specialist (including talking therapies, maternal and perinatal) mental health services. Data were analysed using framework analysis.ResultsInterviews were conducted with 62 healthcare professionals from England and Scotland. 40% of the sample stated they had received no training in perinatal mental health, and 45% reported that they did not use standardised or validated questions or scales when enquiring about mental health. Themes related to barriers, facilitators, and service optimisation are presented for each stage of their care pathway: identification; disclosure; referral and assessment; care and treatment. Recommendations for optimising care included improving mental health education and training to strengthen perinatal healthcare and developing a sustainable perinatal mental health pathway, including for women with mild mental health problems.ConclusionsHealthcare professionals considered that the healthcare pathway for women with severe mental health problems was clear and well-developed, but that healthcare for women with mild and moderate anxiety and mental health problems was under-developed. Improvements in perinatal mental health education, in mandatory training for healthcare professionals, should be put in place in order to improve care. Increasing the number of staff and time available to address perinatal mental health is vital but requires additional resources and should be part of long-term strategies for funding.

Suicide is a leading cause of death amongst children and young people (CYP), and numbers of CYP presenting with suicidality continue to rise. CYP seeking help for suicidal thoughts and behaviours are generally referred to Child and Adolescent Mental Health Services (CAMHS) for assessment and treatment. However, CAMHS across the UK are unable to meet the demand for their services. Little is known about what happens to these children after they have been referred to CAMHS. Grounded in critical realism, and informed by a children's rights approach and feminist perspectives, this qualitative study sought to explore how children and young people presenting with suicidality experience the CAMHS referral process and care journey thereafter. In-depth interviews of between 60-90 minutes duration, were conducted with ten CYP aged between 13-17yrs, living in two different health board areas in Scotland, and having been referred to two different CAMHS (sites A and B). Using Charmaz constructing grounded theory approach, analysis revealed three main themes which are presented: Nothing got resolved: the care experience; "If you had more choice…" about how, when and where they worked with you; The person not the profession who helped, each built upon layers of overlapping subthemes. Further interrogation of the data, and synthesis supported the development of a substantive theory, that conceptualises children and young people presenting with suicidality as "Seen but not Heard". It is argued that CAMHS do not meet these CYP needs even when they are seen. This finding has implications for policy makers and service providers as the CYP in this study express that the support they need and find most helpful is not congruent with CAMHS. Further research is urgently required to develop and design a new service model that better meets the needs of children and young people and prioritises their views.

Background Perinatal mental health problems are increasingly recognised, and specialist services are more widely available for support and treatment. However, little is known about how women use these services. This study examined the use of health and support services associated with perinatal anxiety, and possible inequities. Aims To determine the health service use and healthcare experiences of women with perinatal anxiety, and to examine regional differences and inequalities. Method A prospective longitudinal follow-up of women recruited from 17 hospital trusts. Participants ( N = 722) completed anxiety measures 6 weeks postpartum, and health service use and experience measures 6 months postpartum. Results Anxiety 6 weeks postpartum was associated with more GP (incidence risk ratio (IRR) 1.02, 95% CI 1.01–1.03) and health visitor (IRR 1.01, 95% CI 1.01–1.02) visits for the mother but not for the infant. Effects were moderated by ethnicity for GP visits (IRR 1.03, 95% CI 1.00–1.06) and by level of education for health visitor visits (IRR 1.02, 95% CI 1.01–1.03). Anxiety was associated with lower satisfaction with GP care for the baby, health visitor care and poorer overall healthcare experiences. Women with anxiety were more likely to attend specialist mental health (odds ratio 1.09, 95% CI 1.06–1.12) or other support services (odds ratio 1.04, 95% CI 1.01–1.06). However, 29.2% of those referred to mental health services and 30.8% referred to other support services did not attend. Conclusions Perinatal anxiety increases health service use for mothers but not for infants. Anxiety also negatively impacts satisfaction with healthcare. Findings can inform strategies to improve access and experience of care.

BACKGROUND:Postpartum post-traumatic stress disorder (PTSD) can lead to significant distress, yet little is known about health service use by those affected. This longitudinal cohort study examined health service use among postpartum women experiencing PTSD symptoms. METHODS:Participants were recruited during pregnancy and completed questionnaires assessing mental health and service use at 6-, 12-, and 24-months postpartum. Analysis compared women reporting at least one PTSD symptom (n = 172-182) to a no symptoms group (n = 322-344) 6-12 months and 12-24 months postpartum.. RESULTS:Women with PTSD symptoms reported greater use of general health services for self and infant. At 6-12 months postpartum they more frequently accessed GP (IRR 1.88, 95% CI: 1.46-2.42), health visitor (IRR 1.47, 95% CI: 1.20-1.80) and hospital outpatient services (IRR 3.70, 95% CI: 2.21-6.20) for themselves; and GP (IRR 1.27, 95% CI: 1.04-1.55) and hospital outpatient services (IRR 1.65, 95% CI: 1.09-2.49) for their baby. Some of the differences for themselves remained 12-24 months postpartum (GP: IRR 1.43, 95% CI: 1.15-1.78; health visitor: IRR 1.32, 95% CI: 1.03-1.72). Women with PTSD symptoms were more likely to be referred to mental health and support services (OR 12.13, 95% CI: 5.65-26.10). However, almost half of women who met criteria for probable PTSD at 6 months did not receive a mental health referral. CONCLUSIONS:Women with PTSD symptoms postpartum are high users of health services but may still experience gaps in care. Improved prevention, screening, referral, and support may reduce the burden of postpartum PTSD for women, their children, and services.

Background To ensure quality, safety and regulatory compliance, research carried out within the United Kingdom’s National Health Service (NHS) must undergo ethics and governance review before commencing. The use of Electronic Health Records (EHRs) holds potential for advances in research but comes with additional regulatory and governance challenges. This paper aims to illustrate these challenges through a case study of a research project involving primary care services. Methods A case study of the processes involved in setting up an investigation of health service use for perinatal mental health in England and Scotland. Twenty-six women provided consent for the research team to assess their health service use through examination of their EHRs held by General Practitioners (GPs). Data for the case study were drawn from records of project milestone dates related to ethics and governance processes, communications with governance bodies, and records of participant and GP engagement. Results Significant challenges included inconsistent responses among the eight local Research and Development (R&D) offices involved and additional bureaucratic requests leading to delays. Median time taken for R&D approvals was 43 working days (range 16 to 67), with one region’s approval still pending at study end after 100 days, and two regions not requiring approval. GP practices were difficult to contact and establish research contracts with, resulting in only four participants’ EHRs being obtained within the study timeframe, which was insufficient to fulfil the project’s original aims. Conclusions Although participants consented to use of their medical data for this research, regulatory and bureaucratic barriers prevented effective data access. This case study illustrates the need to revise and streamline governance systems, improve consistency across local sites, and reduce barriers to GPs’ involvement in research to maximise the potential of EHRs for research purposes.

Background:Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom's guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services' involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population. Limitations:For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal study took part in all the anticipated interviews. Future research:There is a need for high-quality research studies into effective interventions for pregnant women who use drugs. Implementation research is required to test and implement the theory of change for optimum services for women who use drugs in the perinatal period. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130619.

Background:Depression is the most common mental ill health condition, and its prevalence is increasing. Despite this, its treatment is variable often due to a lack of capacity within healthcare systems to support this vulnerable population. Community pharmacy staff could offer additional support. This systematic review identifies depression services led by community pharmacy staff, their service components, outcomes, and barriers/facilitators to their implementation. Methods:Four bibliographic databases were searched (Medline, EMBASE, PsycINFO, and CINAHL) from 2000 onwards. Title/abstract and full-text screening was conducted. Data on the service components were mapped to the Template for Intervention Description and Replication (TIDieR). Clinical, humanistic, economic, and service outcomes were charted. Barriers and facilitators were mapped to the Consolidated Framework for Implementation Research (CFIR). Quality assessment was performed using the Quality Assessment with Diverse Studies (QuADS) tool. Results:Fifty studies were included. Seventeen studies identified general attitudes regarding community pharmacy services for depression, which were generally supportive. The majority (n = 33) explored an implemented depression service focusing on depression advice/education (n = 15), screening (n = 12), medication adherence (n = 4), medication review (n = 1), and disease therapy management (DTM) (n = 1). Clinical outcomes were the most commonly reported types of outcomes, with varied results. Key facilitators were linked to the pharmacy 'inner setting', including accessibility of community pharmacies, the use of private consultation rooms, and skills/training of staff. Barriers to service delivery related often to the external 'outer setting', especially societal stigma, low public awareness of pharmacy roles, funding constraints, and limited collaboration with other healthcare professionals. Conclusion:This international review identified a range of different services that community pharmacy staff can deliver to support people with depression, ranging from supporting diagnosis, health literacy, and management plans. The accessibility of community pharmacies for depression service delivery warrants further investigation. However, limited empirical evidence of clinical and economic outcomes and reported implementation barriers may complicate broader implementation.

Background Women who use drugs in the perinatal period can have complex health and social needs requiring additional support during and after pregnancy yet there is wide variation in availability of services and women may avoid engaging due to fears of surveillance and judgement. This study addressed this issue through exploring women’s experiences and care pathways. An aim of the study was to co-produce recommendations for optimal perinatal services for women who use or are in treatment for drug use during and after pregnancy. Methods We used a co-production approach to develop a Theory of Change that sets out key requirements for optimal care services. Working with a multidisciplinary group of experts including peer advisors, we integrated experiential knowledge with primary and secondary research data in a series of co-production workshops. Findings The Theory of Change sets out key recommendations to improve services for women who use drugs during the perinatal period. These include: person-centred and trauma informed policy development and commissioning, shared values throughout services and co-production of guidance involving women with lived experiences; support for staff training and infrastructure; service level interventions such as provision of community hubs, care co-ordination and advocacy, and non-stigmatising, relational based care. Conclusions Using the Theory of Change we found that adding services in one area may not be effective if the whole system of care is not considered. Most of the recommendations are directed at organisational/strategic and service level with fewer recommendations at individual staff level. This is in recognition that staff are only able to provide optimum care when service infrastructure, resources, training, and shared values enable them to do so. Consideration of a whole service approach is necessary to deliver safe, person centred services to women who use or are in treatment for drug use and their infants.

There is little knowledge of how women who use and are in treatment for using drugs in the perinatal period experience multidisciplinary services prenatally. This study used qualitative longitudinal methods to explore women’s experiences of care in four sites in England and Scotland. Thirty-six women who used and were in treatment for drug use (opioid, stimulants, and benzodiazepines) were recruited via maternity services. Framework analysis was used to manage the data and data were coded thematically. The profile of research participants included experiences of a range of cooccurring physical and mental health problems. Most women for whom this was not their first maternity, had had previous children removed from their care. The findings focus on women’s experiences of surveillance and uncertainty surrounding referrals to social services, social work assessments and possible removal of babies. Research participants reported managing the conceptual entanglement of treatment for opioid use with illicit drug use. Participants described being subject to multi-agency monitoring and there were few examples of trauma-informed care at the point of delivery. Findings have implications for how multi agency services engage with women who use drugs and call for approaches that are responsive to their needs and those of their babies.

BACKGROUND:Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment. AIMS:To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment. METHOD:This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point. RESULTS:The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1-24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4-35.1). The most prevalent disorders were obsessive-compulsive disorder (8.2%, 95% CI 5.7-11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7-8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%). CONCLUSIONS:Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

BACKGROUND:The digital transition in the workplace has increased trends such as permanent connectivity, an increased sedentary lifestyle, and reduced social interaction, leading to additional psychosocial and ergonomic risks for workers. Musculoskeletal disorders (MSDs) and mental health problems are particularly prevalent, posing a significant burden. To address these challenges, organisations can implement digital or blended interventions targeting MSDs and mental health problems. However, there is still limited evidence on combined workplace interventions targeting both MSDs and mental health problems and respective facilitators and barriers for their successful implementation and sustainability. The objective of this scoping review is to identify barriers and facilitators to the implementation of blended and digital interventions targeted at combined mental health and MSDs in the workplace. METHODS:Bibliographic databases will be searched for studies published since 2014 and reported on the implementation of interventions with a digital component targeted at mental health and MSDs in the workplace. Studies will be included if the intervention was delivered within, or access provided through, the workplace. The title and abstract screen and the full-text screening will be completed independently by two reviewers, with a third reviewer resolving any arising conflicts in the process. RESULTS:Descriptive characteristics of the study design, workplace sector, mode of working, intervention details, mode of intervention delivery, outcomes, and barriers and facilitators will be extracted. Results will be reported in accordance with the PRISMA for Scoping Reviews checklist and a narrative synthesis used to summarise characteristics of included studies, as well as barriers and facilitators to the implementation of interventions. DISCUSSION:The findings from this review will provide practical recommendations relevant to researchers and practitioners developing or implementing digital interventions in the workplace targeting mental health conditions and MSDs. SYSTEMATIC REVIEW REGISTRATION:Research Registry, reviewregistry1847, https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/66671b683a0f410028a230bd/ .

Background:Anxiety is a common mental illness that can occur during and after pregnancy, which is associated with an increased risk of adverse outcomes for women and their infants. Despite this, there is no consensus on the best method of assessing anxiety. Objectives:The methods of assessing perinatal anxiety (MAP) study aimed to identify the most acceptable, effective and feasible method for assessing anxiety in pregnancy and after birth. Design and methods:The MAP study had four work packages: a qualitative and cognitive interview study (work package 1); a prospective longitudinal cohort study of women during pregnancy (early, mid- and late pregnancy) and post partum, with nested diagnostic interviews (work package 2) and implementation case studies (work package 3). Secondary analysis of cohort data was commissioned as an add-on project to examine the impact of socioeconomic deprivation on perinatal anxiety (work package 4). The MAP study evaluated four assessment measures based on clinical criteria and research evidence: the General Anxiety Disorder Questionnaire, 2-item, or 7-item version scale, Whooley questions, Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version scale. Setting and participants:Qualitative and cognitive interviews (work package 1) were conducted with 41 pregnant and postpartum women, recruited through patient and public involvement representative organisations and social media. The MAP cohort (work package 2) included 2243 women recruited through 12 National Health Service Trusts in England and 5 National Health Service Boards in Scotland. Diagnostic interviews were conducted with a consecutive subsample of 403 participants. Implementation case studies (work package 3) were conducted with two National Health Service sites in England and one in Scotland. Results:Routine assessment of perinatal anxiety was acceptable to women and was viewed positively, although this was qualified by the extent to which the process was informed and personalised. Results from cognitive interviews found that all measures were acceptable and easy to use. Diagnostic accuracy was greatest for the Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version. Increased anxiety on all measures was associated with greater difficulties with daily living, poorer quality of life and participants wanting treatment. Early pregnancy (i.e. the first trimester) was the optimal time for identifying participants with anxiety disorders who wanted treatment. Two measures met criteria for implementation: the Stirling Antenatal Anxiety Scale and the Clinical Outcomes in Routine Evaluation - 10 item version. The Stirling Antenatal Anxiety Scale was preferred by stakeholders (41 women and 55 health professionals), so it was implemented. Acceptability to health professionals (N = 27) of routine assessment using the Stirling Antenatal Anxiety Scale was good. Potential barriers to conducting assessments informed the development of a guide to implementation. The prevalence of anxiety disorders was 19.9% (confidence interval 16.1 to 24.1), with highest prevalence in early pregnancy (25.5%, confidence interval 17.4 to 35.1). A complex relationship was found between regional deprivation and perinatal anxiety, with regional differences in prevalence being explained by sociodemographic composition. Limitations:The MAP cohort had a greater ethnic diversity than the general population, but participants were highly educated. The study evaluated four measures, so it could not determine whether other measures are more effective. The qualitative and observational research design means causality could not be inferred. Conclusions:The MAP study found that routine assessment of perinatal anxiety is acceptable to women and is feasible to implement in National Health Service services. The Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version were most effective at identifying women with perinatal anxiety disorders who wanted treatment. Future work:Further research is needed to determine whether implementing routine assessment of perinatal anxiety results in improved outcomes for women and children. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/16.

Background:During pregnancy and the first postnatal year, a substantial proportion of women experience perinatal anxiety, which is associated with increased risk of adverse birth, maternal and child development outcomes. Identification of perinatal anxiety is recommended in various countries, but there is a lack of consensus on the most effective, acceptable and feasible measure to use. The Methods of Assessing Perinatal Anxiety study previously found the Stirling Antenatal Anxiety Scale to be diagnostically accurate and acceptable to women. Objectives:This study aimed to determine the acceptability and feasibility of implementing new assessment of perinatal anxiety in healthcare services. Design and methods:Implementation case studies of perinatal anxiety assessment using the Stirling Antenatal Anxiety Scale in three National Health Service sites in the United Kingdom. Semistructured interviews and focus groups were conducted before and after implementation with healthcare professionals working in maternity, primary care and psychological services that had contact with perinatal women. Preimplementation data collection was used to develop an implementation and training strategy for each site. Interviews and focus groups were conducted with the same participants post implementation. Data were analysed using framework analysis and a combined inductive-deductive approach. Setting and participants:Two National Health Service trusts in England and one National Health Service health board in Scotland. Participants were healthcare professionals, including midwives, health visitors, clinical psychologists and mental health nurses, who used the scale during the implementation period. Other stakeholders such as service managers and team leads were also interviewed. Sites were selected to represent different types of service and pathways of care. The sample comprised 37 participants at preimplementation and 27 at the postimplementation stage. Intervention:Implementation of new assessment of perinatal anxiety in National Health Service services. Results:At the English sites, one focus group and two interviews were conducted at site E1, and five interviews at site E2. At the Scottish site, two focus groups and six interviews were conducted. Evaluation findings were categorised into 5 themes (experience of change in practice, barriers/facilitators to implementation, acceptability, feasibility, improvements to implementation strategy) with 16 subthemes. The experience of introducing a new assessment tool in clinical practice was generally seen as positive, with the scale enabling more focused conversations with women about their symptoms and different types of anxiety. Potential barriers to conducting assessments included women not having English as first language and stigma towards anxiety in some cultures. The scale overall was acceptable to healthcare professionals. Recommendations to improve the implementation strategy included adding the tool to patients' electronic notes and getting wider buy-in from senior management. Limitations:Healthcare practitioners mainly used paper versions of the scale, while most National Health Service services are moving towards patients' electronic notes. Only 73% of participants were interviewed at the postimplementation stage. Variation in clinical pathways and services means results may not be generalisable to other settings. Conclusions:Implementation of a new measure of perinatal anxiety was perceived positively overall. Future work:Further research should explore the use of a digital version of the tool and translated versions. Replication in National Health Service services with different care pathways is also recommended. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/16.

Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress. The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388). We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by ‘frontline’ statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74

Background:Women who use and/or are in treatment for using drugs during the perinatal period have complex health and social care needs. Substance use in the perinatal period is multifaceted, with many confounding factors that may impact the long-term health and well-being of both mothers and children. Evidence is needed to identify which psychosocial interventions are effective for women who use and/or are in treatment for drug use during the perinatal period. Objective(s):(1) Describe the range of psychosocial interventions available for women who use and/or are in treatment for drugs in the perinatal period; (2) to document evidence on the effectiveness of interventions and (3) identify interventions that women feel most meet their needs. Design:A mixed-methods systematic review was conducted following a predetermined protocol and the Joanna Briggs Institute guidance for mixed-methods systematic reviews, adopting a segregated approach. Review methods:Eight databases were searched for articles meeting the inclusion criteria on 7 April 2022, and updated searches were run on 5 February 2024. The search was limited to include peer-reviewed articles published after 1990 and available in English. In total, 15,655 articles were identified. Following screening by four reviewers by title and abstract and then full text, 197 articles were included in the review. A data extraction template was used to extract study characteristics and results. Quality was assessed using the mixed-methods Quality Appraisal Tool. Cohen's d was used to measure the effect size for quantitative data to understand if an intervention had a small (> 0.2), medium (> 0.5) or large effect (> 0.8). Effectiveness was measured through three outcomes: (1) improvements and engagement with and retention in substance use treatment services for women in the prenatal and postnatal period; (2) reductions in substance use by women in the perinatal period and (3) improvements in engagement with and retention in prenatal care. For qualitative data, articles were grouped by the intervention type and the authors' analytical themes and conclusions were thematically synthesised. Results:The 197 included studies described 217 separate interventions. Most interventions (85.3%) were community-based, delivered in more than one way (49.3%), and delivered in single settings (50.6%), although some were colocated alongside other services (22.1%). No conclusive evidence for effectiveness was established for any type of intervention, although most interventions that improved retention in substance use services included practical support. The qualitative synthesis supported these findings and additionally suggested that women appreciated being able to access multiple services in one place: non-judgemental, trauma-informed services and peer-support models. Limitations:There were wide discrepancies in the types of information reported related to the age of some studies, limiting our ability to evaluate the effectiveness through quantitative analysis. The qualitative analysis was similarly limited as not all the identified qualitative papers included the views of women about treatment received. Conclusions:Interventions that included practical support were found to be more effective in both the quantitative and qualitative findings. There is also some evidence for the effectiveness and feasibility of integrated, multidisciplinary interventions in both the quantitative and qualitative data. Future work:There is a need for up-to-date, high-quality research studies into interventions for pregnant women who use and/or are in treatment for drug use. It is additionally important that the voices of women are considered in future research. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130619.

Background Anxiety is estimated to affect between 15 and 20 per cent of women during pregnancy and postpartum. The COVID-19 pandemic resulted in wide-ranging changes to how people lived, worked and socialised around the world. COVID and pandemic-related restrictions to maternity services may have exacerbated anxiety during pregnancy and the postnatal period. This study aimed to determine: (1) levels of COVID exposure and perceived risk; (2) adherence to Government guidelines and restrictions; and (3) the impact of COVID and COVID-related restrictions on perinatal anxiety and mental health in the UK. Methods A longitudinal survey ( n = 2122) of COVID and anxiety in women during early pregnancy, mid-pregnancy, late pregnancy and postpartum. Results 38.41% of participants had COVID before or during the study. Perinatal anxiety was predicted by participants having poor general health, being of Asian or mixed ethnicity, having previous mental health problems, believing that COVID would make them severely ill, and reporting that COVID had impacted on their mental health. Over time, more women were infected with COVID, and the perceived severity of COVID decreased. Experiencing mild COVID was associated with decreased anxiety at the subsequent time point (mean difference -0.72, 95% CI -1.38 to -0.07, p = 0.030). Very few participants in this sample had severe COVID (2.9%) or reported it having a severe impact on their mental health (5.66%). Most participants (75.3%) said the pandemic had ‘no’ or a ‘slight’ impact on their mental health. Pandemic-related restrictions to maternity care affected more women, with around 40% reporting anxiety about being separated from baby, their partner not being with them in labor, or having to leave shortly after the birth. Level of adherence to guidelines was variable, depending on the restriction. Conclusions Findings suggest pandemic-related restrictions caused anxiety for more women than COVID per se. Adherence to guidelines was variable yet the prevalence of COVID infections was low compared to the general population. Findings can be used to inform policy and practice for future pandemics and health-related crises.

The purpose of this study was to assess feasibility and acceptability of a stroke-specific mindfulness-based intervention called Helping Ease Anxiety and Depression after Stroke (HEADS: UP). This study was a mixed-methods pilot randomized controlled trial comparing HEADS: UP to treatment as usual (TAU). HEADS: UP is a 9-week mindfulness intervention for stroke survivors. UK (United Kingdon)-based stroke survivors were recruited and attended HEADS: UP Online. Psychological functioning outcomes measures and other data were collected online at pre-intervention (Week 0), post-intervention (Week 9), and follow-up (months 3 and 6). Participants were randomized 1:1 to either HEADS: UP or TAU. Sixty-two participants completed baseline questionnaires and were randomized to HEADS: UP (n = 30) or TAU (n = 32). Retention rates were as follows: HEADS: UP (n = 25, 83.30

Aims and method There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping. Results A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients. Clinical implications The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.