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Identifying and managing perinatal anxiety: perspectives of healthcare practitioners. A qualitative study


Identifying and managing perinatal anxiety: perspectives of healthcare practitioners. A qualitative study Thumbnail



Perinatal mental health (PMH) problems are those which occur during pregnancy or up to 12 months postpartum, and affect up to 20% of women. Perinatal anxiety (PNA) is at least as common as depression and can adversely impact on both mother and child. Despite this, research into anxiety has received less attention than depression. The National Institute for Health and Care Excellence (NICE) guidance on PMH (CG192) has identified PNA as a research priority. This study aimed to explore the perspectives and experiences of a variety of healthcare professionals (HCPs) in the identification and management of PNA.
This qualitative study took place across both primary and secondary care. Semistructured interviews (n=23) utilising a topic guide with a range of HCPs were performed. Data was generated and analysed via an iterative approach using principles of constant comparison. A PMH patient and public involvement and engagement (PPIE) group were involved throughout the study.
Twenty-three HCPs were interviewed: ten general practitioners, seven midwives, five health visitors and one obstetrician. Findings are presented within two chapters. The first findings chapter discusses ‘The concept of PNA’ with sub-themes of: PNA as an unfamiliar concept; PNA as a hidden problem; The identification of PNA and The use of case-finding tools vs. clinical intuition. The second findings chapter describes ‘Organisation of care’ with the following sub-themes: Supporting women with PNA; Fragmented care; Education, training and resources and Opportunities to improve care.
Awareness and understanding of PNA amongst HCPs is variable, with debate over what is ‘normal’ anxiety in pregnancy. Apparent reluctance of women to present means that PNA appears to be a ‘hidden problem’. HCPs suggested that PNA can be challenging to identify with mixed views on the use and value of case-finding tools. A variety of ways in which to support women with PNA were discussed. Care for women diagnosed with PNA was reported to be fragmented and inter-professional communication was described as poor. There was some confusion around responsibilities and role boundaries. HCPs expressed concerns about a lack of formal education and training around PNA and PMH in general. Opportunities to provide good care for women with PNA were discussed and HCPs suggested that an integrated approach to PNA care would be beneficial. Implications for clinical practice and policy were identified including raising the profile of PNA amongst clinicians, improving HCP education and training and developing more integrated care pathways. Recommendations for further research include understanding women’s’ perspectives about PNA.

Publication Date Oct 1, 2019


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