Top

BMC Primary Care

Published in:

Open Access 01-12-2018 | Research article

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study

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

Published in: BMC Primary Care | Issue 1/2018

Abstract

Background

Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources.

Method

In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework.

Results

Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions.

Conclusions

GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.

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. https://doi.org/10.1093/fampra/cmw101.CrossRefPubMed

Noonan M, Doody O, Jomeen J, Galvin R. Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: an integrative review. Midwifery. 2017;45:56–71. https://doi.org/10.1016/j.midw.2016.12.010.CrossRefPubMed

Howard LM, Ryan EG, Trevillion K, Anderson F, et al. Accuracy of the Whooley questions and the Edinburgh postnatal depression scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry. 2018;212:50–6.CrossRef

Jairaj C, Fitzsimons CM, McAuliffe FM, et al. A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh postnatal depression scale (epds). Archives of Women’s Health. https://doi.org/10.1007/s00737-018-0893-3.

Leahy-Warren P, McCarthy G, Corcoran P. Postnatal depression in first-time mothers: prevalence and relationships between functional and structural social support at 6 and 12 weeks postpartum. Arch Psychiatr Nurs. 2011;25(3):174–84.CrossRef

Falah-Hassani K, Shiri R, Dennis C-L. The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychol Med. 2017;47(12):2041–53.CrossRef

Bauer A, Parsonage M, Knapp M, Lemmi V, Adelaja B. The costs of perinatal mental health problems. London: Personal Social Services Research Unit. Centre for Mental Health and London School of Economics; 2014.

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. https://doi.org/10.1016/S0140-6736(14)61277-0.CrossRefPubMed

Department of Health. Creating a better future together National Maternity Strategy. Dublin, Ireland: Department of Health; 2016.

10.

Noonan M, Jomeen J, Galvin R, Doody O. Survey of midwives’ perinatal mental health knowledge, confidence, attitudes and learning needs. Women and Birth. 2018. https://doi.org/10.1016/j.wombi.2018.02.002.

11.

The National Child Birth Trust. The Hidden Half Bringing postnatal mental illness out of hiding. 2017, The National Childbirth Trust, London. https://www.nct.org.uk/sites/default/files/related_documents/NCT%20The%20Hidden%20Half_0.pdf

12.

Khan L. Falling through the gaps: perinatal mental health and general practice. UK: Centre for Mental Health; 2015.

13.

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. https://doi.org/10.3399/bjgp17X691889.CrossRefPubMedPubMedCentral

14.

Noonan M, Doody O, O’Regan A, Jomeen J, Galvin R. Family physicians perceived role in perinatal mental health: an integrative review. BMC Family Practice. 2018, 19(154), available, https://doi.org/10.1186/s12875-018-0843-1.

15.

Department of Health (Ireland). ‘A Vision for Change’: report of the Expert Group on Mental Health Policy. Dublin: Stationary office, 2006.

16.

Health Service Executive. Specialists Perinatal Mental Health Services Model of Care for Ireland. Dublin: National Mental Health Division, Health Service Executive; 2017. https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/specialist-perinatal-mental-health-services-model-of-care-2017.pdf.

17.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(4):349–57.CrossRef

18.

Green J, Thorogood N. Qualitative methods for Health Research. 3rd ed. London: Sage; 2014.

19.

Braun V, Clarke V. Successful qualitative research a practical guide for beginners. London: Sage; 2013.

20.

Ashford MT, Ayers S, Olander EK. Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK. Health and Social Care in the Community. 2017;25(3):1257–64.CrossRef

21.

Button S, Lee S, Shakespeare J, Ayers S. Seeking help for perinatal psychological distress: a meta-synthesis of women’s experiences. Br J Gen Pract. 2017. https://doi.org/10.3399/bjgp17X692549.

22.

Bambridge GA, Shaw EJ, Ishak M, Clarke SD, Baker C. Perinatal mental health: how to ask and how to help. Obstet Gynaecol. 2017;19:147–53. https://doi.org/10.1111/tog.12376.CrossRef

23.

Prady SL, Pickett KE, Petherick ES, Gilbody S, Croudace T, Mason D, et al. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. Br J Psychiatry. 2016;208(5):453–61. https://doi.org/10.1192/bjp.bp.114.158832.CrossRefPubMedPubMedCentral

24.

Watt K, Abbott P, Reath J. Developing cultural competence in general practitioners: an integrative review of the literature. BMC Fam Pract. 2016;17:158. https://doi.org/10.1186/s12875-016-0560-6.CrossRefPubMedPubMedCentral

25.

National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health: Clinical management and service guidance. NICE clinical guideline. 2014;45 guidandce.nice.org.uk/cg192.

26.

Khalifeh H, Brauer R, Toulmin H, Howard LM. Perinatal mental health: what every neonatologist should know. Early Hum Dev. 2015;91:649–53. https://doi.org/10.1016/j.earlhumdev.2015.08.010.CrossRefPubMed

27.

The Regulation and Quality Improvement Authority. Review of Perinatal Mental Health Services in Northern Ireland. 2017. Available to access at: https://www.rqia.org.uk/RQIA/files/28/28f4ee85-a5e9-4004-b922-525bc41ae56d.pdf.

28.

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.CrossRef

29.

Legere LE, Wallace K, Bowen A, McQueen K, Montgomery P, Evans M. Approaches to health-care provider education and professional development in perinatal depression: a systematic review. BMC Pregnancy and Childbirth. 2017;17:239. https://doi.org/10.1186/s12884-017-1431-4.CrossRefPubMedPubMedCentral

30.

Agyapong VIO, Jabbar F, Conway C. Shared care between specialised psychiatric services and primary care: the experiences and expectations of general practitioners in Ireland. Int J Psychiatry Clin Pract. 2012;16:293–9. https://doi.org/10.3109/13651501.2012.667115.CrossRefPubMed

31.

MIND. Better equipped, better care improving mental health training for GPs and practice nurses. London: MIND; 2016.

32.

Morrell JC, Cubison J, Ricketts T, Williams AS, Hall P. Training Health-Care Professionals for the Assessment and Management of Perinatal depression and Anxiety. In: Milgrom GAW, editor. Identifying Perinatal Depression and Anxiety Evidence-Based Practice in Screening, Psychosocial Assessment, and Management. Oxford: Wiley Blackwell; 2015. p. 210–27.

33.

Murray M, Murray L, Donnelly M. Systematic review of interventions to improve the psychological well-being of general practitioners. BMC Fam Pract. 2016;17:36. https://doi.org/10.1186/s12875-016-0431-1.CrossRefPubMedPubMedCentral

Title: Irish general practitioners' view of perinatal mental health in general practice: a qualitative study
Authors: Maria Noonan
Owen Doody
Andrew O’Regan
Julie Jomeen
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/s12875-018-0884-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study

Abstract

Background

Method

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data

General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study

Factors associated with the use of dietary supplements and over-the-counter medications in Japanese elderly patients

Risk of opioid misuse in chronic non-cancer pain in primary care patients - a cross sectional study

Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study

Primary palliative care team perspectives on coordinating and managing people with advanced cancer in the community: a qualitative study