Objectives
The objectives were to examine patients’ perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals.
Method
Four 90-min focus groups were conducted with women 3–36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach.
Results
Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals.
Conclusions
Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals’ perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
This preliminary study is the first to identify mothers' perspectives on barriers and facilitators to addressing postpartum depression (PPD) in pediatric settings. We conducted four 90-min focus groups with women (n = 27) who self-identified a history of perinatal depression and/or emotional complications. Barriers reported included stigma and fear among women and lack of provider knowledge/skills regarding depression. Participants recommended non-stigmatizing approaches to depression screening/referral. Future PPD screening efforts should leverage the pediatrician-mother relationship to mitigate mothers' fears and encourage help-seeking.
At Bronx State Hospital, active treatment modalities—psychotherapeutic, social and psychopharmacological—are offered from the time of admission. Families are dealt with energetically from the start, with particular attention to preventing extrusion of the patient from the family unit. For retraining patients whose social and psychological skills have atrophied from prolonged hospitalization, there is an intensive treatment ward. A “hotel ward” without staff has been established for those who are able to live in a minimally structured environment but have no homes to go to. A work‐for‐pay program, specially tailored to the needs of geriatric patients, also has been organized. For regressed patients there are special programs, including reality orientation and sensory training. A major factor in maintaining staff morale in this difficult work is their active involvement at all staff levels in the regular teaching conferences.
After release of the patient, hospital responsibility continues. Supportive services—psychiatric, social, psychological and recreational—are supplied when necessary, but emphasis is placed on the ex‐patients becoming involved with local community organizations such as community houses and Golden Age clubs.
In the future we hope to place more emphasis on prevention by helping to establish or maintain supportive services in the community for the elderly before they become ill, and by starting therapeutic activities in the earliest stages of illness so that disability and hospital admission can be minimized if not averted. Much can be done for geriatric psychiatric patients.
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