Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review

Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

doi:10.1093/fampra/cmw101

Cited by 57 publications

(49 citation statements)

References 45 publications

(82 reference statements)

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“…However, only 31% of respondents in a survey reported being asked by a GP about their mental well-being and whether or not they required any additional support (Royal College of Obstetricians and Gynaecologists, 2017). As a consequence, there appears to be substantial underrecognition of postnatal depression and other perinatal disorders in general practice (Gavin et al, 2015;Ford et al, 2016), and it is estimated that 50% of cases of postnatal depression currently go undiagnosed (Hewitt and Gilbody, 2009). This is likely to be due to two factors.…”

Section: Introductionmentioning

confidence: 99%

Understanding barriers to women seeking and receiving help for perinatal mental health problems in UK general practice: development of a questionnaire

Ford

Roomi

Hugh

et al. 2019

Prim Health Care Res Dev

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Aim: To develop a questionnaire to measure quantitatively barriers and facilitators to women’s disclosure of perinatal mental health problems in UK primary care. To pilot and evaluate the questionnaire for content validity and internal consistency. Background: Around 15% of women develop a mental illness in the perinatal period, such as depression, anxiety or post-traumatic stress disorder. In the United Kingdom, 90% of these women will be cared for in primary care, yet currently in as many as 50% of cases, no discussion of this issue takes place. One reason for this is that women experience barriers to disclosing symptoms of perinatal mental illness in primary care. These have previously been explored qualitatively, but no tool currently exists with which to measure these barriers quantitatively. Methods: Questionnaire items, drawn from qualitative literature and accounts of women’s experiences, were identified, refined iteratively and arranged in themes. The questionnaire was piloted using cognitive debriefing interviews to establish content validity. Women completed a refined version online. Responses were analysed using descriptive statistics. Internal consistency of subscales was calculated using Cronbach’s alpha. Findings: Cognitive debriefing interviews with five women showed the majority of questionnaire items were relevant, appropriate and easy to understand. The final questionnaire was completed by 71 women, and the majority of subscales had good internal consistency. The barrier scoring most highly was fear and stigma, followed by willingness to seek help and logistics of attending an appointment. Family/partner support and general practitioners’ (GPs) reaction were the lowest scoring barriers. Factors facilitating disclosure were GPs being empathetic and non-judgemental and listening during discussions. In the future, this questionnaire can be used to examine which barriers are most important for particular groups of women. This may enable the development of strategies to improve acknowledgement and discussion, and prevent under-recognition and under-treatment, of perinatal mental health problems in primary care.

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Section: Introductionmentioning

confidence: 99%

Understanding barriers to women seeking and receiving help for perinatal mental health problems in UK general practice: development of a questionnaire

Ford

Roomi

Hugh

et al. 2019

Prim Health Care Res Dev

Self Cite

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“…Furthermore, the need to synthesise healthcare professionals (HCPs) experiences of providing care to women with PMHPs and to triangulate findings with the synthesis of women’s experiences has been identified [ 14 ]. A systematic review [ 15 ] examined quantitative studies on FPs recognition and management of perinatal depression and anxiety. Similarly, a meta-synthesis explored the diagnosis and management of perinatal depression and anxiety in general practice [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Family physicians perceived role in perinatal mental health: an integrative review

et al. 2018

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BackgroundResponding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Family physicians are ideally placed to provide an effective response as it is recognised that they are responsible for organising care and supports for women and their families. This paper reports an integrative review undertaken to examine family physicians’ perceived role in perinatal mental health care and concludes with recommendations for health policy, research and practice.MethodA systematic search of literature in seven databases from January 2000 to March 2016 identified a total of 1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored family physicians’ experiences of caring for women who experience perinatal mental health problems.ResultsThirteen articles reporting 11 studies met the inclusion criteria for this review and quality of included studies were assessed using published criteria for the critical appraisal of qualitative and quantitative research methods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes: identification of perinatal mental health problems, management of perinatal mental health problems and barriers to care provision. While family physicians recognise their role in relation to perinatal mental health the collective interpretation revealed that; they receive variable levels of preparation for this role, no consistent approach to screening exists, pharmacological management of mood disorders is the main treatment modality and limited access to specialist perinatal mental health services exists which impacts on pharmacology decisions.ConclusionFamily physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines. Research that examines training needs in relation to perinatal mental health could be used to inform family physician training programmes and curriculum development around perinatal mental health.

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“…Our recent systematic review of quantitative literature found large gaps in the literature and no studies on disorders other than depression (11). Qualitative research can provide a more detailed understanding of the complex factors that influence patient-clinician interactions and decisionmaking.…”

Section: Introductionmentioning

confidence: 99%

“…Following a review of quantitative observational studies in the same area (11), the aim of this review was to synthesise qualitative studies on GPs' attitudes, decision making and routine clinical practice for the diagnosis and treatment of perinatal depression and anxiety in primary care.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies

et al. 2017

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management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. British Journal of General Practice, 67(661), e538-e546. doi: 10.3399/bjgp17X691889 This is the accepted version of the paper.This version of the publication may differ from the final published version. Background: Up to 20% of women experience anxiety and depression during the perinatal period. In Permanent

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Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent

Cited by 57 publications

References 45 publications

Understanding barriers to women seeking and receiving help for perinatal mental health problems in UK general practice: development of a questionnaire

Understanding barriers to women seeking and receiving help for perinatal mental health problems in UK general practice: development of a questionnaire

Family physicians perceived role in perinatal mental health: an integrative review

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies

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