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

Ford, Elizabeth; Lee, Suzanne Elizabeth; Shakespeare, Judy; Ayers, Susan

doi:10.3399/bjgp17x691889

Cited by 42 publications

(50 citation statements)

References 41 publications

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“…GPs were reluctant to ‘medicalize’ patients’ concerns, differentiating between ‘real depression’ and normal sadness caused by an understandable response to difficult life circumstances ( 14 , 18 –20 , 22 –27 ). GPs also resisted the categorization imposed by guidelines ( 17 ), and more experienced GPs preferred to use clinical intuition over intrusive screening questions ( 11 , 17 –19 , 22 ).…”

Section: Resultsmentioning

confidence: 99%

“…GPs described feeling that they needed to balance timekeeping with giving patients effective support ( 17 , 26 ). Lack of time was described as a barrier to identification, disclosure and listening to patients ( 14 , 15 , 17 , 19 , 24 , 32 ). Having more time to listen to patients would reduce the need for GPs to prescribe antidepressants ( 32 ).…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

et al. 2020

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Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

et al. 2020

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“…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 ]. This current review synthesises the findings from qualitative and quantitative studies to provide a comprehensive review of the global evidence exploring FPs role in PMH.…”

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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“…• collaborate with public health to develop the data, skills, and research based around primary care to describe and manage the spectrum of distress to mental illness, including crisis and complex presentations (these challenges are described with reference to perinatal disorders by Ford et al in this issue of the BJGP); and 13 • address the gaps between physical health and mental health (life expectancy, long-term conditions, and medically unexplained symptoms). 14,15 Examples of good practice abound.…”

Section: Reimagining Mental Health In Primary Carementioning

confidence: 99%

Reimagining mental health in primary care: a blueprint for STPs

Turner¹,

Newbigging

2017

Br J Gen Pract

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

Cited by 42 publications

References 41 publications

Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

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

Reimagining mental health in primary care: a blueprint for STPs

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