Patient, provider, and system-level barriers and facilitators to addressing perinatal depression

Abstract

Objective: To explore perinatal health care professionals’ perspectives on barriers and facilitators to addressing perinatal depression. Background: Perinatal depression is common and associated with deleterious effects on mother, foetus, child and family. Although the regular contact between mothers and perinatal health care professionals may make the obstetric setting ideal for addressing depression, barriers persist, and depression remains under-diagnosed and under-treated. Methods: Four 90-minute focus groups were conducted with perinatal health care professionals, including obstetric resident and attending physicians, licensed independent practitioners, nurses, patient care assistants, social workers and administrative support staff. Focus groups were transcribed, and resulting data were analysed using a grounded theory approach. Results: Participants identified patient-, provider- and system-level barriers and facilitators to addressing perinatal depression. Provider-level barriers included lack of resources, skills and confidence needed to diagnose, refer and treat perinatal depression. Limited access to mental health care and resources were identified as system-level barriers. Facilitators identified included targeted training for perinatal health care professionals’, structured screening and referral processes, and enhanced support and guidance from mental health providers. Conclusion: A complex set of interactions between women and perinatal health care professionals contributes to perinatal depression being untreated. Service gaps could be closed by addressing identified barriers through integrated obstetric and depression care and enhanced collaborations. Future intervention testing could include targeted training, improved access, and mental health provider support to empower perinatal health care professionals’ to address perinatal depression, and thereby improve delivery of depression treatment in obstetric settings

Patient’s views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals?

“…Our previously published qualitative study with perinatal health care professionals [52] also suggests that complex interactions between patients and perinatal health care professionals contribute to untreated perinatal depression. In our previous study, we conducted four focus groups with perinatal health care professionals ( n =28) including obstetric resident and attending physicians, licensed independent practitioners, nurses, patient care assistants, social workers and administrative support staff.…”

Barriers to Addressing Psychological Problems in Diabetes: Perspectives of Diabetologists on Routine Diabetes Consultations in Denmark

“…A study of barriers to the provision of evidencebased psychosocial care in oncology underlines that there is a lack of referral systems, that clinicians sometimes find psychosocial problems secondary to medical issues and that it can be stressful for clinicians to deal with psychosocial problems [27]. A study of healthcare professionals' perception of barriers and facilitators to addressing perinatal depression identified barriers on patient, provider and system level [28].…”

Prevalence and associated risk factors of depression, anxiety and stress in pregnancy

“…Many obstetricians report that primary training in maternity care has not prepared them to address these important issues of women"s mental health. 6 There is evidence from developing countries that the risk factors of psychiatric disorders in pregnancy are culturally determined. Evidence of stress in pregnancy is shown in certain subgroups of women.…”