Pediatricians' and health visitors' views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study.

Eirini Agapidaki,Kyriakos Souliotis,Christina Dimitrakaki,Suzanne F Jackson,Yannis Tountas,Vassiliki Benetou,Stylianos Christogiorgos

doi:10.1186/1471-244x-14-108

Abstract

BackgroundThe present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system.MethodsTwenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation.ResultsFear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health.ConclusionsEven though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.

Highlights

The present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system
It had been assumed that health visitors would hold different views and opinions compared to pediatricians
The analysis revealed that pediatricians and health visitors shared common views and practices and faced common barriers

Summary

Introduction

The present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Maternal depression affects child’s physical, Pediatric primary health care professionals (e.g. pediatricians and health visitors) usually have the most frequent contact with women of childbearing age and they are in an advantaged position to detect maternal depression during the well-child visits [13,14,15]. Even though most pediatric primary health care professionals acknowledge the importance of prevention of maternal depression, they fail to contribute effectively to prevent it [16]. In many cases severe depression is detected in the context of primary health care but mild or moderate depression is seldom identified [17]. The early detection and management of maternal depression is recommended by the European Union policy framework which mentions for parenting and the early years of life’ as a major action area [18]

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Discussion

Conclusion