Healthcare professionals' perspectives on identifying and managing perinatal anxiety: a qualitative study.

Abstract

Perinatal mental health problems are those that 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 during the perinatal phase 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 guidance on perinatal mental health has identified PNA as a research priority. To explore the perspectives and experiences of healthcare professionals (HCPs) in the identification and management of PNA. This was a qualitative study in primary and secondary care set in the West Midlands from February 2017 to December 2017. Semi-structured interviews (n = 23) with a range of HCPs. Iterative approach to data generation and analysis, using principles of constant comparison. Patient and Public Involvement and Engagement (PPIE) group was involved throughout the study. Twenty-three HCPs interviewed: 10 GPs, seven midwives, five health visitors, and one obstetrician. Four themes were uncovered: PNA as an 'unfamiliar concept'; reliance on clinical intuition and not clinical tools; fragmentation of care; and opportunities to improve care. Awareness and understanding of PNA among HCPs is variable, with debate over what is 'normal' anxiety in pregnancy. HCPs suggested that PNA can be challenging to identify, with mixed views on the use and value of case-finding tools. Opportunistic identification was noted to be significant to aid diagnosis. Care for women diagnosed with PNA was reported to be fragmented and interprofessional communication poor. Potential solutions to improve care were identified.