Healthcare professionals’ perspectives on identifying and managing perinatal anxiety: a qualitative study

Abstract

BackgroundPerinatal mental health problems are those that occur during pregnancy or up to 12 months postpartum, and affect up to 20% of women. Perinatal anxiety (PNA) is at least as common as depression during the perinatal phase and can adversely impact on both mother and child. Despite this, research into anxiety has received less attention than depression. The National Institute for Health and Care Excellence guidance on perinatal mental health has identified PNA as a research priority.AimTo explore the perspectives and experiences of healthcare professionals (HCPs) in the identification and management of PNA.Design and settingThis was a qualitative study in primary and secondary care set in the West Midlands from February 2017 to December 2017.MethodSemi-structured interviews (n = 23) with a range of HCPs. Iterative approach to data generation and analysis, using principles of constant comparison. Patient and Public Involvement and Engagement (PPIE) group was involved throughout the study.ResultsTwenty-three HCPs interviewed: 10 GPs, seven midwives, five health visitors, and one obstetrician. Four themes were uncovered: PNA as an ‘unfamiliar concept’; reliance on clinical intuition and not clinical tools; fragmentation of care; and opportunities to improve care.ConclusionAwareness and understanding of PNA among HCPs is variable, with debate over what is ‘normal’ anxiety in pregnancy. HCPs suggested that PNA can be challenging to identify, with mixed views on the use and value of case-finding tools. Opportunistic identification was noted to be significant to aid diagnosis. Care for women diagnosed with PNA was reported to be fragmented and interprofessional communication poor. Potential solutions to improve care were identified.

Exploring women’s experiences of identifying, negotiating and managing perinatal anxiety: a qualitative study

“…Missed opportunities are likely to be common in the context of the fragmentation of perinatal care reported by HCPs. 13 An apparent clinical preoccupation with depression also invalidated women's experiences and concerns about PNA. 23 Our research provides new insights into experiences of managing PNA.…”

“…TK has a background in social science, and VS is an academic General Practitioner (GP); both conducted data collection on a recent PNA study involving Healthcare Professionals (HCPs). 13 Interviews were conducted face to face or by telephone and took place at the participant’s home, Keele University or Midlands Partnership NHS Foundation Trust. Interview formats and locations were selected based on participant preferences.…”

“…12 A lack of awareness among healthcare professionals, difficulties distinguishing between ‘normal’ and clinical levels of anxiety and service fragmentation are also reported as barriers to the identification and management of PNA. 13 The National Health Service (NHS) Mental Health Taskforce 14 15 recognise PMH services as a key priority and recommend an integrated physical–mental healthcare approach to support appropriate referrals, follow-up and management of women in community settings. 16…”

Validation of the Numerical Anxiety Rating Scale in postpartum females: a prospective observational study

“…However, in order to discuss maternal anxiety in the postpartum period on the basis of scientific evidence, maternity staff should have a simple and relevant tool to measure it. A study by the Silverwood team (2019) [16] shows that there is insufficient understanding of what perinatal anxiety is among healthcare professionals. Employees declare that they lack knowledge concerning "normal perinatal anxiety", as well as simple tools for its screening.…”

Maternal six week postnatal check should assess for postnatal anxiety

“…3 Our work indicates that awareness and understanding of perinatal anxiety among healthcare professionals is limited, with care being fragmented and interprofessional communication poor. 4 An article discussing what to cover in the maternal six week health check should have emphasised the important role of the GP in identifying postnatal mental health problems and the particular need to identify and manage postnatal anxiety.…”