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

Abstract

BackgroundUp to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs.AimThis review aimed at synthesising the available information from qualitative studies on GPs’ attitudes, recognition, and management of perinatal anxiety and depression.Design and settingMeta-synthesis of the available published qualitative evidence on GPs’ recognition and management of perinatal anxiety and depression.MethodA systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs’ diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography.ResultsFive themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues.ConclusionGPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients.