150 results found
Amodia-Bidakowska A, Laverty C, Ramchandani PG, 2020, Father-child play: A systematic review of its frequency, characteristics and potential impact on children's development, Developmental Review, Vol: 57, ISSN: 0273-2297
© 2020 Parent-child play interactions in the first years of life are linked to more positive cognitive and socio-emotional outcomes for children. The vast majority of previous research has focussed on mother-infant play interactions, but the potential positive role of fathers’ early involvement in children's lives is being increasingly recognised, with higher levels of caregiving by fathers in many countries. To characterise the nature and potential impact of father-child play we undertook a systematic review of the published literature in psychological and educational databases up until 2018. We focussed on studies addressing the frequency and characteristics of fathers’ play with children (aged 0–3 years), and the potential impact on children's development. We screened 436 articles, yielding 78 papers addressing the questions of interest. There are 3 key findings. First, fathers spend a significant proportion of their time with their children engaging in playful interactions, often in the form of physical play such as rough and tumble. Second, whilst findings are mixed, on balance the evidence suggests that fathers’ play frequency increases from infancy to preschool age with a subsequent decline in play as children reach early- middle childhood. Third, studies investigating links between fathers’ play and child outcomes suggest that fathers’ play in the early years can positively contribute to children's social, emotional and cognitive outcomes. This potential for substantial benefit for children provides a clear imperative for policy makers and practitioners to facilitate and support fathers, as well as mothers, in developing more positive and playful interactions with their infants.
Ramchandani P, 2020, Children and covid-19., New Sci, Vol: 246, ISSN: 0262-4079
Children will face many hidden negative effects from the new coronavirus- it's not too late to avert them, says Paul Ramchandani.
Ramchandani P, 2020, Children and covid-19, NEW SCIENTIST, Vol: 245, Pages: 21-21, ISSN: 0262-4079
Day C, Briskman J, Crawford MJ, et al., 2020, An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT., Health Technology Assessment, Vol: 24, Pages: 1-188, ISSN: 1366-5278
BACKGROUND: The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs. OBJECTIVES: To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial. DESIGN: A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation. SETTING: Two NHS mental health trusts and concomitant children's social care services. PARTICIPANTS: Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18-65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3-11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent. INTERVENTION: The Helping Families Programme-Modified - a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care - standard care au
Day C, Briskman J, Crawford MJ, et al., 2020, Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties, BMJ OPEN, Vol: 10, ISSN: 2044-6055
Ramchandani P, 2020, Paul Ramchandani on play and how it benefits kids, NEW SCIENTIST, Vol: 245, Pages: 56-56, ISSN: 0262-4079
Ramchandani P, 2020, Q & A, New Scientist, Vol: 245, ISSN: 0262-4079
© 2020 Reed Business Information Ltd, England Everyone loves games, but what if they were central to your life's work? Paul Ramchandani describes what it is like to be a professor of play
Sanfilippo KRM, McConnell B, Cornelius V, et al., 2019, A study protocol for testing the feasibility of a randomised stepped wedge cluster design to investigate a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia., Pilot Feasibility Stud, Vol: 5, Pages: 1-8, ISSN: 2055-5784
Background: Perinatal mental health problems affect up to one in five women worldwide. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries. It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression perinatally, for the benefit of both mother and child. Music-centred approaches may be particularly useful in The Gambia since a range of musical practices that specifically engage pregnant women and new mothers already exist. Methods: This protocol is for a study to examine the feasibility of undertaking a stepped wedge trial to test how a Community Health Intervention through Musical Engagement (CHIME) could be beneficial in alleviating perinatal mental distress in The Gambia. In this study, we plan to recruit 120 pregnant women (n = 60 intervention, n = 60 control) at four antenatal clinics over two 6-week stepped sequences. Women in the intervention will participate in weekly group-singing sessions, led by local Kanyeleng singing groups, for 6 weeks. The control group will receive standard care. We will assess symptoms of anxiety and depression using the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20). The feasibility of the design will be assessed through recruitment, retention and attrition rates of participants, clinics' adherence to the schedule and completeness of data by site. Qualitative interviews and video and audio recordings will be used to evaluate the acceptability of the intervention. Discussion: This feasibility trial will allow us to determine whether a larger trial with the same intervention and target group is feasible and acceptable in The Gambia. Trial registration: Retrospectively registered (24/01/2019) with Pan African Clinica
Sanfilippo KRM, Cornelius V, McConnell B, et al., 2019, Testing the Feasibility of a Complex Intervention for Perinatal Mental Health in The Gambia, Publisher: BMC
Mattock H, Ryan R, O'Farrelly C, et al., 2019, Does a video clip enhance recruitment into a parenting trial? Evidence from a study within a trial (SWAT), Publisher: BMC
Yiran Zhao V, Kulkarni K, Gibson J, et al., 2019, Introducing the Play in Education, Development and Learning (PEDAL) Research Centre, International Journal of Play, Vol: 8, Pages: 308-319
© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This paper provides an overview of the work being conducted at the Play in Education, Development and Learning (PEDAL) Research Centre, based in the Faculty of Education, University of Cambridge, UK. PEDAL has three main aims, (1) To conduct world-class research, (2) To build capacity in play research and (3) To influence policy and practice. The present paper provides an overview of the history and rationale for PEDAL, followed by some detailed examples of the foci of its work. Exemplar research is presented on the theme of ‘Measuring Play’; an endeavour that is common to many of the different research projects led by PEDAL investigators and Ph.D. students.
Domoney J, Fulton E, Stanley N, et al., 2019, For Baby's Sake: Intervention Development and Evaluation Design of a Whole-Family Perinatal Intervention to Break the Cycle of Domestic Abuse, JOURNAL OF FAMILY VIOLENCE, Vol: 34, Pages: 539-551, ISSN: 0885-7482
Murphy SE, Braithwaite EC, Hubbard I, et al., 2019, Salivary cortisol response to infant distress in pregnant women with depressive symptoms (vol 18, pg 247, 2015), ARCHIVES OF WOMENS MENTAL HEALTH, Vol: 22, Pages: 313-313, ISSN: 1434-1816
Gutierrez-Galve L, Stein A, Hanington L, et al., 2019, Association of Maternal and Paternal Depression in the Postnatal Period With Offspring Depression at Age 18 Years, JAMA PSYCHIATRY, Vol: 76, Pages: 290-296, ISSN: 2168-622X
Lambregtse-van den Berg MP, Tiemeier H, Verhulst FC, et al., 2018, Early childhood aggressive behaviour: Negative interactions with paternal antisocial behaviour and maternal postpartum depressive symptoms across two international cohorts, EUROPEAN PSYCHIATRY, Vol: 54, Pages: 77-84, ISSN: 0924-9338
Fernandes M, Srinivasan K, Menezes G, et al., 2018, Prenatal depression, fetal neurobehavior, and infant temperament: Novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort, DEVELOPMENT AND PSYCHOPATHOLOGY, Vol: 30, Pages: 725-742, ISSN: 0954-5794
Asarnow J, Bloch MH, Brandeis D, et al., 2018, Special Editorial: Open science and the Journal of Child Psychology & Psychiatry - next steps?, JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY, Vol: 59, Pages: 826-827, ISSN: 0021-9630
Fear N, Reed R, Rowe S, et al., 2018, Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers, British Journal of Psychiatry, Vol: 212, Pages: 347-355, ISSN: 0007-1250
BackgroundLittle is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.MethodFathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.ResultsIn total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.ConclusionsThis study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.
Sethna V, Murray L, Edmondson O, et al., 2018, Depression and playfulness in fathers and young infants: A matched design comparison study, JOURNAL OF AFFECTIVE DISORDERS, Vol: 229, Pages: 364-370, ISSN: 0165-0327
Holmes EA, Ghaderi A, Harmer CJ, et al., 2018, The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science, LANCET PSYCHIATRY, Vol: 5, Pages: 237-286, ISSN: 2215-0374
Ramchandani P, 2017, ECAP Editorial, European Child and Adolescent Psychiatry, Vol: 26, Pages: 1407-1408, ISSN: 1018-8827
Ramchandani P, O'Farrelly C, Babelis D, et al., 2017, Preventing enduring behavioural problems in young children through early psychological intervention (Healthy Start, Happy Start): study protocol for a randomized controlled trial, Trials, Vol: 18, ISSN: 1745-6215
Background: Behavioural problems are common in early childhood, and can result in enduring costs to the individualand society, including an increased risk of mental and physical illness, criminality, educational failure and drug andalcohol misuse. Most previous research has examined the impact of interventions targeting older children whendifficulties are more established and harder to change, and have rarely included fathers. We are conducting a trial of apsychological intervention delivered to families with very young children, engaging both parents where possible.Methods: This study is a two-arm, parallel group, researcher-blind, randomized controlled trial, to test the clinicaleffectiveness and cost-effectiveness of a parenting intervention, Video Feedback Intervention to Promote PositiveParenting and Sensitive Discipline (VIPP-SD) for parents of young children (12–36 months) at risk of behaviouraldifficulties. VIPP-SD is an evidence-based parenting intervention developed at Leiden University in the Netherlandswhich uses a video-feedback approach to support parents, particularly by enhancing parental sensitivity and sensitivediscipline in caring for children.The trial will involve 300 families, who will be randomly allocated into either an intervention group, who will receivethe video-feedback intervention (n = 150), or a control group, who will receive treatment as usual (n = 150). The trialwill evaluate whether VIPP-SD, compared to treatment as usual, leads to lower levels of behavioural problems in youngchildren who are at high risk of developing these difficulties. Assessments will be conducted at baseline, and 5 and24 months post-randomization. The primary outcome measure is a modified version of the Preschool Parental Accountof Child Symptoms (Pre-PACS), a structured clinical interview of behavioural symptoms. Secondary outcomes includecaregiver-reported behavioural difficulties, parenting behaviours, parental sensitivity, parental mood and anxiety a
Capron L, Ramchandani P, Glover V, 2017, Maternal prenatal stress and placental gene expression of NR3C1 and HSD11B2; the effects of maternal ethnicity, Psychoneuroendocrinology, Vol: 87, Pages: 166-172, ISSN: 0306-4530
BackgroundPrenatal stress is associated with altered fetal and infant development. Previous studies have suggested that these effects may be mediated in part via altered functioning of placental enzymes and receptors involved in the HPA-axis, including the glucocorticoid receptor (NR3C1) and HSD11B2, the enzyme which metabolises cortisol. However, previous studies have not examined the potential ethnicity effects on these associations. This study aimed to characterise the association between maternal prenatal stress and placental genes expression and subsequently, any potential effect of maternal ethnicity.MethodPregnant women(n = 83) were recruited prior to elective caesarean section and assessed for trait anxiety, depression and life events. Placentas were collected and placental gene expression of NR3C1 and HSD11B2 were analysed. We examined associations between maternal prenatal stress and placental gene expression, and the tested for a possible moderating effect of maternal ethnicity(59.0% Caucasian;41.0% non-Caucasian:12.0% South Asian;6.0% African/African-American;14.4% Other;8.4% Mixed).ResultsAnalyses demonstrated a trend in the association between both maternal trait anxiety and depression symptoms with placental gene expression of NR3C1(adj.β = .220,p = .067;adj.β = .212,p = .064 respectively). We found a significant interaction with maternal ethnicity(β = .249;p = .033). In Caucasian women only prenatal trait anxiety and depressive symptoms were associated with an increase in placental NR3C1 expression(adj.β = .389,p = .010;adj.β = .294;p = .047 respectively). Prenatal life events were associated with a down regulation of HSD11B2(adj.β = .381;p = .008), but only in Caucasians.ConclusionThese results support previous findings of an association between maternal prenatal stress and the expression of placental genes associated with the HPA-axis, but only in Caucasians. These ethnic specific findings are novel and require replica
Crawford MJ, Gold C, Odell-Miller H, et al., 2017, International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278
Background:Preliminary studies have indicated that music therapy may benefit children with autismspectrum disorders (ASD).Objectives:To examine the effects of improvisational music therapy (IMT) on social affect andresponsiveness of children with ASD.Design:International, multicentre, three-arm, single-masked randomised controlled trial, including aNational Institute for Health Research (NIHR)-funded centre that recruited in London and the east ofEngland. Randomisation was via a remote service using permuted blocks, stratified by study site.Setting:Schools and private, voluntary and state-funded health-care services.Participants:Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent orguardian who provided written informed consent. We excluded children with serious sensory disorder andthose who had received music therapy within the past 12 months.Interventions:All parents and children received enhanced standard care (ESC), which involved three60-minute sessions of advice and support in addition to treatment as usual. In addition, they wererandomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESCalone, over 5 months in a ratio of 1 : 1 : 2.Main outcome measures:The primary outcome was measured using the social affect score derived fromthe Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment.Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and12 months (higher scores indicated greater impairment).Results:A total of 364 participants were randomised between 2011 and 2015. A total of 182 children wereallocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocatedto ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) inthe intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171(94.0
Braithwaite EC, Murphy SE, Ramchandani PG, et al., 2017, Associations between biological markers of prenatal stress and infant negative emotionality are specific to sex., Psychoneuroendocrinology, Vol: 86, Pages: 1-7, ISSN: 0306-4530
PURPOSE: Fetal programming is the idea that environmental stimuli can alter the development of the fetus, which may have a long-term effect on the child. We have recently reported that maternal prenatal cortisol predicts infant negative emotionality in a sex-dependent manner: high prenatal cortisol was associated with increased negative emotionality in females, and decreased negative emotionality in males. This study aims to test for this sex-specific effect in a different cohort, and investigate whether sex differences in fetal programming may be specific to glucocorticoid mechanisms by also examining a maternal salivary alpha-amylase (sAA) by sex interaction. METHODS: 88 pregnant women (mean gestational age=27.4 weeks, SD=7.4) collected saliva samples at home over two working days to be assayed for the hormone cortisol (range=0.13-88.22nmol/l) and the enzyme alpha-amylase (range=4.57-554.8units/ml). Samples were collected at waking, 30-min post-waking and 12h post-waking. Two months after birth participants reported infant negative emotionality using the distress to limits subscale of the Infant Behavior Questionnaire. RESULTS: The interaction between maternal prenatal cortisol and infant sex to predict distress to limits approached significance (p=0.067). In line with our previous finding there was a positive association between prenatal cortisol and negative emotionality in females, and a negative association in males. The interaction between sAA and sex to predict distress was significant (p=0.025), and the direction of effect was the same as for the cortisol data; high sAA associated with increased negative emotionality in females and reduced negative emotionality in males. CONCLUSIONS: In line with our previous findings, this research adds to an emerging body of literature, which suggests that fetal programming mechanisms may be sex-dependent. This is the first study to demonstrate that maternal prenatal sAA may be an important biomarker for infant behavior
Domoney J, Iles J, Ramchandani P, 2017, Fathers in the perinatal period: Taking their mental health into account, Transforming Infant Wellbeing: Research, Policy and Practice for the First 1001 Critical Days, Pages: 205-214, ISBN: 9781138689534
Day C, Briskman J, Crawford MJ, et al., 2017, Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme, Contemporary Clinical Trials Communications, Vol: 8, Pages: 67-74, ISSN: 2451-8654
The Helping Families Programme is a psychoeducational parenting intervention that aims to improve outcomes and engagement for parents affected by clinically significant personality difficulties. This is achieved by working collaboratively with parents to explore ways in which their emotional and relational difficulties impact on parenting and child functioning, and to identify meaningful and realistic goals for change. The intervention is delivered via one-to-one sessions at weekly intervals over a period of 16 weeks. This protocol describes a two-arm parallel RCT in which consenting parents are randomly allocated in a 1:1 ratio to either the Helping Families Programme plus the usual services that the parent may be receiving from their mental health and/or social care providers, or to standard care (usual services plus a brief parenting advice session). The primary clinical outcome will be child behaviour. Secondary clinical outcomes will be child and parental mental health, parenting satisfaction, parenting behaviour and therapeutic alliance. Health economic measures will be collected on quality of life and service use. Outcome measures will be collected at the initial assessment stage, after the intervention is completed and at 6-month follow-up by research staff blind to group allocation. Trial feasibility will be assessed using rates of trial participation at the three time points and intervention uptake, attendance and retention. A parallel process evaluation will use qualitative interviews to ascertain key-workers’ and parent participants' experiences of intervention delivery and trial participation. The results of this feasibility study will determine the appropriateness of proceeding to a full-scale trial.
Ryan R, O'Farrelly C, Ramchandani P, 2017, Parenting and child mental health., London Journal of Primary Care, Vol: 9, Pages: 86-94, ISSN: 1757-1472
This paper reviews parenting programmes and their effectiveness with families of young children and highlights additional resources for primary care practitioners. Typically, 30% of GP consultations concern child behaviour problems and established behaviour problems can have lasting effects on children's life chances. These problems can be identified in infancy and toddlerhood.Parenting is a key risk factor in their development and maintenance, yet is also amenable to change. In this paper we consider six parenting programmes that are widely evaluated and/or available in the U.K. and their evidence base . These include two NICE recommended parenting programmes (Incredible Years and Triple P), which offer tiered and flexible parenting programmes; predominantly for parents of school-age children. We also review Parent-Infant Psychotherapy, which is typically for parents of younger children. Fourth is Family Nurse Partnership, an intensive programme to support young, first-time mothers. Finally we consider, video feedback programmes which use video to focus in detail on parents' interactions with their children, including Video Feedback to Promote Positive Parenting and Video Interactive Guidance. These interventions demonstrate the range of approaches which are being used to intervene early in children's lives to try to prevent the development of enduring behavioural problems. Why this matters to me: It is becoming increasingly clear that the origins of many mental health problems lie in childhood. Family factors, including the quality of care that parents provide for their children, can make a huge difference to children's early life pathways, for better or for worse. Understanding how best to intervene to support parents is a key challenge. In this article, we critically review the most widely used parenting programmes for parents of young children. It is imperative that we judge these early interventions to high standards so
Marcano Belisario JS, Doherty K, O'Donoghue J, et al., 2017, A bespoke mobile application for the longitudinal assessment of depression and mood during pregnancy: protocol of a feasibility study, BMJ Open, Vol: 7, ISSN: 2044-6055
Introduciton: Depression is a common mental health disorders during pregnancy, with important consequences for mothers and their children. Despite this, it goes undiagnosed and untreated in many women attending antenatal care. Smartphones could help support the prompt dentification of antenatal depression in this setting. In addition, these devices enable the implementation of ecological momentary assessment techniques, which could be used to assess how mood is experienced during pregnancy. With this study, we will assess the feasibility of using a bespoke mobile application running on participants’ own handsets for the longitudinal (6 months) monitoring of antenatal mood and screening of depression. Methods and analysis:We will use a randomised controlled study design to compare two types of assessment strategies: retrospective + momentary (consisting of the Edinburgh Postnatal Depression Scale plus 5 momentary and 2 contextual questions), and retrospective (consisting of the Edinburgh Postnatal Depression Scale only). We will assess the impact that these strategies have on participant adherence to a pre-specified sampling protocol, drop-out rates and timeliness of data completion. We will evaluate differences in acceptance of the technology through a short quantitative survey and open ended questions. We will also assess the potential effect that momentary assessments could have on retrospective data. We will attempt to identify any patterns in app usage through the analysis of log data. Ethics and dissemination: This study has been approved by the South East Coast – Surrey Research Ethics Committee. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers. Registration details: This study has been registered in ClinicalTrials.gov under the identifier NCT02516982. STRENGTHS OF
Marcano Belisario JS, Gupta AK, O'Donoghue JM, et al., 2017, Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study, BMC Medical Informatics and Decision Making, Vol: 17, ISSN: 1472-6947
BackgroundMobile devices may facilitate depression screening in the waiting area of antenatal clinics. This can present implementation challenges, of which we focused on survey layout and technology deployment.MethodsWe assessed the feasibility of using tablet computers to administer a socio-demographic survey, the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to 530 pregnant women attending National Health Service (NHS) antenatal clinics across England. We randomised participants to one of two layout versions of these surveys: (i) a scrolling layout where each survey was presented on a single screen; or (ii) a paging layout where only one question appeared on the screen at any given time.ResultsOverall, 85.10% of eligible pregnant women agreed to take part. Of these, 90.95% completed the study procedures. Approximately 23% of participants answered Yes to at least one Whooley question, and approximately 13% of them scored 10 points of more on the EPDS. We observed no association between survey layout and the responses given to the Whooley questions, the median EPDS scores, the number of participants at increased risk of self-harm, and the number of participants asking for technical assistance. However, we observed a difference in the number of participants at each EPDS scoring interval (p = 0.008), which provide an indication of a woman’s risk of depression. A scrolling layout resulted in faster completion times (median = 4 min 46 s) than a paging layout (median = 5 min 33 s) (p = 0.024). However, the clinical significance of this difference (47.5 s) is yet to be determined.ConclusionsTablet computers can be used for depression screening in the waiting area of antenatal clinics. This requires the careful consideration of clinical workflows, and technology-related issues such as connectivity and security. An association between survey layout and EPDS scoring intervals needs to be ex
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