Diskusi

Peningkatan tekanan
Temuan utama dari studi ini adalah bahwa peningkatan pasangan 'saling terkait mengenai gejala depresi, kecemasan negara, dan
penyesuaian diad. Selanjutnya, pasangan meningkat secara signifikan setelah intervensi pada semua skala. These results are supported
by findings from other studies in that couples' distress correlates with regard to depressive symptoms, anxiety, and dyadic adjustment
(Cox et al. 1999, Perren et al. 2005, Figueiredo et al. 2008). There is also support for the conclusion of couples' improved antenatal
distress from a study on the effectiveness of massage therapy which shows similar results to ours about the alleviation of antenatal
depression and anxiety and improvement of the couple relationship (Field et al. 2008).
Table 2 Prospective couple's (n = 39) change after the family nursing intervention.
.

M. Thome and SB Arnardottir

What is already known about this topic
ple's distressing symptoms found in other studies offers another explanation of their improvement (Matthey et al.
Women's emotional distress during pregnancy is
2000, Condon et al. 2004, Perren et al. 2005). It is also
common and is frequently expressed by symptoms of
possible that men improved due to the focus in
conversations depression and anxiety.
on the cognitive, affective, and behavioural domains of
Men living with distressed partners are more likely to
family functioning implied in the CFIM. This could have
also suffer from a higher degree of depressive symptoms
helped them to 'think family' and thereby affect family and
anxiety than those living with non-distressed ones.
functioning, even though they were not all the time physically
Psychosocial interventions benefit distressed women
present. Furthermore, an intervention effect on men's cogni-
during child-bearing.
tive domain of family functioning could have carried over to the affective and/or behavioural domain and affected them as
What this paper adds
well (Wright & Leahey 2005). The high drop-out rate of men in the beginning and during the course of the study could
After a brief intervention for expecting couples based on
have rendered data with insufficient power for detecting a
the Calgary Family Nursing Model, they experience
real difference after the intervention. Nevertheless, the
reduced symptoms of depression and anxiety and
significant improvement found on all scales favours the
enhanced self-esteem and dyadic adjustment.
conclusion of a real change having occurred.
Distressed prospective fathers are likely to improve after the family nursing intervention.
Midwives' clinical judgement on antenatal emotional
Implications for nursing and midwifery
distress is valid and concurrent with self-report
It is unknown how midwives in Iceland identify distressed
assessments.
women although it was found in one study that they may do so (Furber et al. 2009). Whether clinical guidelines for
Implications for practice and/or policy
antenatal health care affect midwives assessment of women's mental health is also unknown (NICE 2007, Land-
The Calgary Family Nursing model for families in
lknisembtti 2008). The results of this study show
transition to parenthood is appropriate for the care of
nevertheless that all distressed women that were referred by
distressed prospective couples in a primary care setting.
midwives to the primary antenatal mental health service
Partners of distressed pregnant women may be attended
suffered from a mental health problem that was confirmed
by to by healthcare professionals to promote their mental
self-report scales of frequent depressive symptoms, anxiety,
health.
problematic dyadic adjustment, low self-esteem, or a combi-
Prospective parents who do not improve after the brief
nation of these. The proportion of mothers scoring 12 on
family nursing intervention should be referred to
the EDS found in this study is high (573%) compared
with specialist services and be followed up.
the population mean of 14% in Iceland and to the prevalence rates of depression of 1015% reported from other countries (Thome
2000, Evans et al. 2001, Bennett et al. 2004, Rubertsson et al. 2005). With a view to these prevalence The significant improvement in
the men challenges the
 rates, it is assumed that the small clinical sample
identified by conclusion from another study that distress in expecting
midwives could represent the tip of an iceberg. Men's
report fathers persists over the perinatal period (Condon et al. 2004,
of lower rates of distress than that of women is
consistent Matthey 2004). Benefits of psychotherapy have been reported
with findings from other studies (Ballard et al. 1994,
Matthey for depressed pregnant women (Spinelli & Endicott 2003).
et al. 2001, Condon et al. 2004). However, couple's
interre- The findings from our study add to these as they show that a
lated distress and its improvement after the
intervention brief and a conceptually different intervention based on the
suggest that healthcare professionals should attend to
the Calgary Family Nursing Model may benefit prospecting
mental health of partners of distressed pregnant women
as parents. Men's participation in the conversations during
well. It is suggested from the findings that midwives'
and home visits is considered modest, as only about one-third
nurses' clinical assessment of mental health of
prospecting followed the recommendation of attending at least two
parents should be studied further. Prenatal assessment
should conversations. Their participation may therefore not suffi-
be comprehensive enough to identify the majority of
clients ciently explain improvement. Concordance between a cou-
who are in need of mental health care during pregnancy
8 2012 Blackwell Publishing Ltd

JAN: ORIGINAL RESEARCH Family nursing, pregnancy, and distress

(Austin et al. 2008). Assessment should, furthermore, form a
and Margaret M. Hansen, Associate Professor, and
Fulbright base from which to decide whether midwives and nurses
Scholar for reading and commenting on the final draft.
ought to manage mild to moderate distress or refer clients to specialist care (NICE 2007, Furber et al. 2009).
Funding
Limitations of the study
The study was supported by grants from the University of Iceland Research Fund and the Science Fund of the Icelandic The design of
this clinical quasi-experimental study with only
Nurses' Association. one group and testing before and
after limits the conclusion that can be drawn as to the effects of the intervention. As there was no group for comparison and because
couples did
Conflict of interest
not have a psychiatric diagnosis, there remains some uncer-
No conflict of interest has been declared by the
authors. tainty as to the specific effect of the intervention and probable confounding factors. The small sample size and the high drop-
out rate of men limit the conclusion that can be drawn
Author contributions
regarding change over time.
All authors meet at least one of the following criteria (recommended by the ICMJE: http://www.icmje.org/ethi-
Conclusion
cal_1author.html) and have agreed on the final version:
substantial contributions to conception and design,
acqui- The findings of this study support the appropriateness of the
sition of data, or analysis and interpretation of data;
Calgary Family Nursing model for the care of distressed
drafting the article or revising it critically for
important prospective couples. It was tested for the first time in a
intellectual content. primary care setting in Iceland
and requires further testing and development as a theoretical framework for family nursing care during life transitions in various
cultures and