Factors affecting implementation of perinatal mental health screening in women of refugee background

Abstract

BackgroundFor women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background.MethodsSemi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral.ResultsAlmost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation.ConclusionsThis research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

“…Six studies evaluated the impact of pre-and post-qualification training (Elliott, Ross-Davie, Sarkar, & Green, 2007; Higgins, Carroll, & Sharek, 2012;Higgins, Carroll, & Sharek, 2016;Jardri et al, 2010;Lau, McCauley, Moss, Miles, & Cross, 2015;McLachlan, Forster, Collins, Gunn, & Hegarty, 2011). Two looked at specific groups of women: black and ethnic minority women (Edge, 2010) and those with a refugee background (Nithianandan et al, 2016). Midwives' involvement in, and views of, PMH screening and assessment were examined in five studies (Rollans, Schmied, Kemp, & Meade, 2013a;Rompala, Cirino, Rosenberg, Fu, & Lambert, 2016;Williams, Turner, Burns, Evans, & Bennert, 2016;Yamashita et al, 2007;Yelland, McLachlan, Forster, Rayner, & Lumley, 2007).…”

“…Sub-themes in this domain were time pressures, referral pathways and further services, the organization of maternity care, training and support for midwives. Many midwives said that time pressures made assessment and care more challenging and could be a barrier to effective assessment (Edge, 2010;Lees et al, 2009;Nithianandan et al, 2016;Phillips, 2015;Rompala et al, 2016). Some felt that caring for women with PMH problems required additional time (McCauley et al, 2011;Mivšek et al, 2008).…”

Prenatal depression screening among a diverse healthy start population.

“…It has also been found that prenatal depression among refugee women has been poorly documented, even though they have unique life stressors that make them more vulnerable to prenatal depression (24,25). Des Moines, Iowa is a city in the United States that has resettled refugees for over 40 years (26).…”

“…An Australian study looked at the factors that affect the implementation of prenatal depression screening for women of refugee backgrounds, as the prevalence of prenatal depression among this population is poorly documented (25). The study found that participants recognized a need for mental health screening, although this may have been due to selection bias meaning those who participated were more likely to understand the need for screening (25). Des Moines, Iowa has been an official refugee resettlement city since 1975, resettling people from Southeast Asia, Eastern…”

“…(24,25). An Australian study looked at the factors that affect the implementation of prenatal depression screening for women of refugee backgrounds, as the prevalence of prenatal depression among this population is poorly documented (25).…”