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Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Maria Noonan, Owen Doody, Julie Jomeen, Andrew O’Regan, Rose Galvin

Published in: BMC Primary Care | Issue 1/2018

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Abstract

Background

Responding 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.

Method

A 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.

Results

Thirteen 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.

Conclusion

Family 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.
Literature
2.
go back to reference Noonan M, Galvin R, Doody O, Jomeen J. A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems. J Adv Nurs. 2017;73(3):545–57.CrossRefPubMed Noonan M, Galvin R, Doody O, Jomeen J. A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems. J Adv Nurs. 2017;73(3):545–57.CrossRefPubMed
3.
go back to reference Austin MP. Perinatal mental health: opportunities and challenges for psychiatry. Australasian Psychiatry. 2003;11:399–403.CrossRef Austin MP. Perinatal mental health: opportunities and challenges for psychiatry. Australasian Psychiatry. 2003;11:399–403.CrossRef
4.
go back to reference Howard LM, Moyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Perinatal mental health 1 non-psychotic mental disorders in the perinatal period. Lancet. 2014;384:1775–87.CrossRefPubMed Howard LM, Moyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Perinatal mental health 1 non-psychotic mental disorders in the perinatal period. Lancet. 2014;384:1775–87.CrossRefPubMed
5.
go back to reference Jones I, Chandra PS, Dazzan P, Howard LM. Perinatal mental health 2 bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014;384:1789–99.CrossRefPubMed Jones I, Chandra PS, Dazzan P, Howard LM. Perinatal mental health 2 bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014;384:1789–99.CrossRefPubMed
6.
go back to reference Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard L, Pariante CM. Perinatal mental health 3 effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384:1800–19.CrossRefPubMed Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard L, Pariante CM. Perinatal mental health 3 effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384:1800–19.CrossRefPubMed
7.
go back to reference Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67:1012–24.CrossRefPubMedPubMedCentral Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67:1012–24.CrossRefPubMedPubMedCentral
8.
go back to reference Goodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: a systematic review and meta-analysis. J Affect Disord. 2016;203:292–331.CrossRefPubMed Goodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: a systematic review and meta-analysis. J Affect Disord. 2016;203:292–331.CrossRefPubMed
9.
go back to reference Wee KY, Skouteris H, Pier C, Richardson B, Milgrom J. Correlates of ante-and postnatal depression in fathers: a systematic review. J Affect Disord. 2011;130:358–77.CrossRefPubMed Wee KY, Skouteris H, Pier C, Richardson B, Milgrom J. Correlates of ante-and postnatal depression in fathers: a systematic review. J Affect Disord. 2011;130:358–77.CrossRefPubMed
10.
go back to reference Davalos DB, Yadon CA, Tregallas HC. Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Womens Ment Health. 2012;15:1–14.CrossRefPubMed Davalos DB, Yadon CA, Tregallas HC. Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Womens Ment Health. 2012;15:1–14.CrossRefPubMed
13.
go back to reference Khan L. Falling through the gaps: perinatal mental health and general practice. London: Centre for Mental Health; 2015. Khan L. Falling through the gaps: perinatal mental health and general practice. London: Centre for Mental Health; 2015.
14.
go back to reference Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health. 2015;18:745–59.CrossRefPubMed Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health. 2015;18:745–59.CrossRefPubMed
15.
go back to reference Ford E, Shakespeare J, Elias F, Ayers S. Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Fam Pract. 2017;34(1):11–9.CrossRefPubMed Ford E, Shakespeare J, Elias F, Ayers S. Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Fam Pract. 2017;34(1):11–9.CrossRefPubMed
16.
go back to reference Ford E, Lee S, Shakespeare J, Ayers S. Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. Br J Gen Pract. 2017;67(661):e538–46.CrossRefPubMedPubMedCentral Ford E, Lee S, Shakespeare J, Ayers S. Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. Br J Gen Pract. 2017;67(661):e538–46.CrossRefPubMedPubMedCentral
17.
18.
go back to reference Strobe Modified from Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12. Copyrighted © 2000, American Medical Association. All rights reservedCrossRef Strobe Modified from Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12. Copyrighted © 2000, American Medical Association. All rights reservedCrossRef
19.
go back to reference Leiferman JA, Dauber SE, Heisler K, Paulson JF. Primary care physicians’ beliefs and practices toward maternal depression. J Women’s Health. 2008;17:1143–50.CrossRef Leiferman JA, Dauber SE, Heisler K, Paulson JF. Primary care physicians’ beliefs and practices toward maternal depression. J Women’s Health. 2008;17:1143–50.CrossRef
21.
go back to reference Rees A, Beecroft C, Booth A. Critical appraisal of the evidence. In: Gerrish K, Lathleen J, editors. The research process in nursing. 7th ed. West Sussex: Wiley Blackwell; 2015. p. 110–1. Rees A, Beecroft C, Booth A. Critical appraisal of the evidence. In: Gerrish K, Lathleen J, editors. The research process in nursing. 7th ed. West Sussex: Wiley Blackwell; 2015. p. 110–1.
23.
go back to reference Bilszta JL, Tsuchiya S, Han K, Buist AE, Einarson A. Primary care physician’s attitudes and practices regarding antidepressant use during pregnancy: a survey of two countries. Arch Womens Ment Health. 2011;14:71–5.CrossRefPubMed Bilszta JL, Tsuchiya S, Han K, Buist AE, Einarson A. Primary care physician’s attitudes and practices regarding antidepressant use during pregnancy: a survey of two countries. Arch Womens Ment Health. 2011;14:71–5.CrossRefPubMed
24.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
26.
go back to reference Smith V, Begley CM, Clarke M, Devane D. Professionals’ views of fetal monitoring during labour: a systematic review and thematic analysis. BMC Pregnancy Childbirth. 2012;12:166.CrossRefPubMedPubMedCentral Smith V, Begley CM, Clarke M, Devane D. Professionals’ views of fetal monitoring during labour: a systematic review and thematic analysis. BMC Pregnancy Childbirth. 2012;12:166.CrossRefPubMedPubMedCentral
27.
go back to reference Seehusen DA, Baldwin LM, Runkle GP, Clark G. Are family physicians appropriately screening for postpartum depression? J Am Board Fam Pract. 2005;18:104–12.CrossRefPubMed Seehusen DA, Baldwin LM, Runkle GP, Clark G. Are family physicians appropriately screening for postpartum depression? J Am Board Fam Pract. 2005;18:104–12.CrossRefPubMed
28.
go back to reference Buist A, Bilszta J, Barnett B, Milgrom J, Ericksen J, Condon J, Hayes B, Brooks J. Recognition and management of perinatal depression in general practice a survey of GPs and postnatal women. Aust Fam Physician. 2005;34:787–90.PubMed Buist A, Bilszta J, Barnett B, Milgrom J, Ericksen J, Condon J, Hayes B, Brooks J. Recognition and management of perinatal depression in general practice a survey of GPs and postnatal women. Aust Fam Physician. 2005;34:787–90.PubMed
29.
go back to reference Buist A, Bilszta J, Milgrom J, Barnett B, Hayes B, Austin M-P. Health professional’s knowledge and awareness of perinatal depression: results of a national survey. Women Birth. 2006;19:11–6.CrossRefPubMed Buist A, Bilszta J, Milgrom J, Barnett B, Hayes B, Austin M-P. Health professional’s knowledge and awareness of perinatal depression: results of a national survey. Women Birth. 2006;19:11–6.CrossRefPubMed
30.
go back to reference Chew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GP’s and health visitors’ views on the diagnosis and management of postnatal depression: a qualitative study. Br J Gen Pract. 2008;58:169–76.CrossRefPubMedPubMedCentral Chew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GP’s and health visitors’ views on the diagnosis and management of postnatal depression: a qualitative study. Br J Gen Pract. 2008;58:169–76.CrossRefPubMedPubMedCentral
32.
go back to reference Edge D. Falling through the net- black and minority ethnic women and perinatal mental healthcare: health professionals’ views. Gen Hosp Psychiatry. 2010;32:17–25.CrossRefPubMed Edge D. Falling through the net- black and minority ethnic women and perinatal mental healthcare: health professionals’ views. Gen Hosp Psychiatry. 2010;32:17–25.CrossRefPubMed
33.
go back to reference McCauley C-O, Casson K. A qualitative study into how guidelines facilitate general practitioners to empower women to make decisions regarding antidepressant use in pregnancy. Int J Ment Health Promot. 2013;15:3–28.CrossRef McCauley C-O, Casson K. A qualitative study into how guidelines facilitate general practitioners to empower women to make decisions regarding antidepressant use in pregnancy. Int J Ment Health Promot. 2013;15:3–28.CrossRef
34.
go back to reference Kean LJ, Hamilton J, Shah P. Antidepressants for mothers: what are we prescribing? Scott Med J. 2011;56:94–7.CrossRefPubMed Kean LJ, Hamilton J, Shah P. Antidepressants for mothers: what are we prescribing? Scott Med J. 2011;56:94–7.CrossRefPubMed
36.
go back to reference Santos HPO, Gualda DMR, Silveria MDA, Hall WA. Postpartum depression: the (in) experience of Brazilian primary healthcare professionals. J Adv Nurs. 2013;69:1248–58.CrossRef Santos HPO, Gualda DMR, Silveria MDA, Hall WA. Postpartum depression: the (in) experience of Brazilian primary healthcare professionals. J Adv Nurs. 2013;69:1248–58.CrossRef
37.
go back to reference Owora AH, Carabin H, Reese J, Garwe T. Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: a systematic review. J Affect Disord. 2016a;201:185–93.CrossRefPubMedPubMedCentral Owora AH, Carabin H, Reese J, Garwe T. Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: a systematic review. J Affect Disord. 2016a;201:185–93.CrossRefPubMedPubMedCentral
38.
go back to reference Owora AH, Carabin H, Reese J, Garwe T. Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: a meta-analysis. J Affect Disord. 2016b;205:335–43.CrossRefPubMedPubMedCentral Owora AH, Carabin H, Reese J, Garwe T. Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: a meta-analysis. J Affect Disord. 2016b;205:335–43.CrossRefPubMedPubMedCentral
40.
go back to reference Milgrom J, Holt CJ, Gemmill AW, Ericksen J, Leigh B, Buist A, Schembri C. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling. BMC Psychiatry. 2011;11:95.CrossRefPubMedPubMedCentral Milgrom J, Holt CJ, Gemmill AW, Ericksen J, Leigh B, Buist A, Schembri C. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling. BMC Psychiatry. 2011;11:95.CrossRefPubMedPubMedCentral
42.
go back to reference Johnson M, Schmeid V, Lupton SJ, Austin M-P, Matthey SM, Kemp L, Meade T, Yeo AE. Measuring perinatal mental health risk. Arch Womens Ment Health. 2012;15:375–86.CrossRefPubMedPubMedCentral Johnson M, Schmeid V, Lupton SJ, Austin M-P, Matthey SM, Kemp L, Meade T, Yeo AE. Measuring perinatal mental health risk. Arch Womens Ment Health. 2012;15:375–86.CrossRefPubMedPubMedCentral
44.
go back to reference Watt K, Abbott P, Reath J. Developing cultural competence in general practitioners: an integrative review of the literature. BMC Fam Pract. 2016;17:158.CrossRefPubMedPubMedCentral Watt K, Abbott P, Reath J. Developing cultural competence in general practitioners: an integrative review of the literature. BMC Fam Pract. 2016;17:158.CrossRefPubMedPubMedCentral
46.
go back to reference Newman D, O’Reilly P, Lee SH, Kennedy C. Mental health service users’ experiences of mental health care: an integrative review. J Psychiatr Ment Health Nurs. 2015;22:171–82.CrossRefPubMed Newman D, O’Reilly P, Lee SH, Kennedy C. Mental health service users’ experiences of mental health care: an integrative review. J Psychiatr Ment Health Nurs. 2015;22:171–82.CrossRefPubMed
47.
go back to reference Evans MG, Phillippi S, Gee RE. Examining the screening practices of physicians for postpartum depression: implications for improving health outcomes. Womens Health Issues. 2015;25-26:703–10.CrossRef Evans MG, Phillippi S, Gee RE. Examining the screening practices of physicians for postpartum depression: implications for improving health outcomes. Womens Health Issues. 2015;25-26:703–10.CrossRef
48.
go back to reference Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy TM, Saxena S, Waheed, W. Interventions for common perinatal mental disorders in women in low- and middle- income coutries: a systematic review and meta-analysis. Bull World Health Organ. 2013: 593-601I. https://doi.org/10.2471/BLT.12.109819. Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy TM, Saxena S, Waheed, W. Interventions for common perinatal mental disorders in women in low- and middle- income coutries: a systematic review and meta-analysis. Bull World Health Organ. 2013: 593-601I. https://​doi.​org/​10.​2471/​BLT.​12.​109819.
49.
go back to reference Slade P, Morrell CJ, Rugby A, Ricci K, Spittlehouse J, Brugha TS. Postnatal women’s experiences of management of depressive symptoms: a qualitative study. Br J Gen Pract. 2010;60:e440–8.CrossRefPubMedPubMedCentral Slade P, Morrell CJ, Rugby A, Ricci K, Spittlehouse J, Brugha TS. Postnatal women’s experiences of management of depressive symptoms: a qualitative study. Br J Gen Pract. 2010;60:e440–8.CrossRefPubMedPubMedCentral
Metadata
Title
Family physicians perceived role in perinatal mental health: an integrative review
Authors
Maria Noonan
Owen Doody
Julie Jomeen
Andrew O’Regan
Rose Galvin
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0843-1

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