<p> <b>Background:</b> In low- and lower-middle-income countries (LLMICs), 16% of pregnant and 20% of postpartum women experience common maternal mental health disorders, far surpassing global rates of 10% and 13%, respectively. Maternal depression is associated with poor perinatal outcomes, including maternal, newborn, and early childhood outcomes. The Edinburgh Postnatal Depression Scale (EPDS) was recently validated in Rwanda, yet maternal depression prevalence and associated factors are unknown.</p><p> <b>Objectives:</b> The primary objectives of the study are to describe antenatal depression prevalence and its associated factors.</p><p> <b>Methods:</b> This is a secondary analysis of the Preterm Birth Initiative-Rwanda randomized controlled trial of group antenatal care (ANC) data obtained between June 2017 &ndash; June 2018. Thirty-four health centers in five districts were selected. At each health center, convenience sampling was used to ascertain EPDS scores from the first five women to present for initial ANC each calendar month. A cut-off EPDS score of &ge;13 was used to define maternal depression. Multi-level simple and multiple logistic regressions were used to explore associated factors of antenatal depression. The study obtained informed consent and was approved by the Rwanda National Ethics Committee and the University of California, San Francisco institutional review board. </p><p> <b>Results:</b> Twenty-percent of women in the antenatal period screened positive for depression. In the adjusted multi-level multiple logistic regression model, family social support, age, ability to communicate with partner, and perceived stress were significantly associated with antenatal depression.</p><p> <b>Conclusions:</b> Antenatal and postpartum depression prevalence in Rwanda exceeds LLMIC averages. The authors recommend universal depression screening and treatment for pregnant and postpartum women.</p><p>

<p> <b>Background:</b> Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. </p><p> <b>Purpose:</b> The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. </p><p> <b>Methods:</b> In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. </p><p> <b>Results:</b> The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.</p>

Thesis--St. John's University, N.Y. / Vita. Includes bibliographical references.

Thesis--St. John's University, N.Y. / Vita. Includes bibliography.