Postnatal women's experiences of management of depressive symptoms: a qualitative study

Abstract

Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally. AimTo provide the first integrated in-depth exploration of postnatal women's experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial. SettingGeneral practice: primary care within the former Trent regional health authority, England. MethodThirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PoNDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles. ResultsWhen accepted, psychological sessions were experienced as positive, effective, and 'ideal care'. Women approved of using the EPDS but did not understand the health visitor's role in supporting women. Seeking help and accepting sessions depended on women's perspectives of their health visitor as an individual. ConclusionWomen's experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women. INTRODUCTIONPostnatal depression is a public health issue affecting 10-13% of women, 1 and influencing the woman herself, her partner, 2 her relationship with her infant, 3 and consequent child development. 4 Support for women is provided mainly within primary care. Health visitors have been encouraged to see identification of postnatal depression and subsequent provision of support as a part of their role. 5 The most commonly used method for identifying symptoms is the Edinburgh Postnatal Depression Scale (EPDS), 6 alongside a health visitor's clinical judgement.Postnatal women with depressive symptoms are reluctant to seek help, partly because of the perceived stigma and wishing to be seen as 'good mothers'.

Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis

“…For interventions to manage PND, women said the relationship with the health visitor as an individual was important in determining whether they would seek help and accept support (Slade et al, 2010).…”

Jumping (or being pushed) from maternity care

“…6 With the emphasis on improving skills of health visitors, there is less direct relevance for GPs, though it is a reminder that this is a condition often encountered in routine general practice, and reminds us of the importance of collaborative team working. The issue is discussed more fully in the accompanying editorial.…”

“…The paper by Slade and colleagues reports the striking, but to a GP unsurprising, finding that the personal relationships between women and their health visitors was a powerful determinant of success in treating postnatal depression. 6 …”

Management of postnatal depression in primary care: a window of opportunity

“…In this issue of the BJGP, Slade and colleagues 10 report on a qualitative study embedded within the PoNDER trial, 11 which investigated the benefits of specific training for health visitors in providing psychological interventions for PND. This study involved 4084 women, making it the largest published intervention trial for PND in a primary care setting.…”

“…Women fear judgment, fear being regarded as unsuitable parents, are unsure about who is the appropriate health professional to seek help from, and are concerned about the level of expertise of healthcare professionals in discussing PND. 7,10,14 …”