Abstract
BackgroundThe international literature clearly indicates that perinatal mental health issues affect many women, and can have profound negative consequences for both the mother, infant and family, and that the causes of perinatal mental health issues are multifaceted and complex. AimThis scoping review explores the existing research on perinatal mental health in Ireland to provide a baseline and to guide further research as well as inform the implementation of the recent policy strategies. DesignScoping Review MethodsWe conducted a structured literature search on Science Direct, Web of Science, PubMed, PsychInfo and Scopus, using key words to search for publications up to December 2018. All publications based on empirical studies on perinatal mental health in Ireland (regardless of research design, sample size, and methods used) were included. Exclusion criteria were: study location not the Republic of Ireland; not relating to the perinatal period (pregnancy up to the first 12 months after birth); not relating to mental health; and not relating to maternal mental health, not relating to human subjects; not an empirical study; international study with generalised results. Data were mapped onto a charting form, allowing us to a) conduct a basic numerical analysis of prevalent research questions and designs, and b) to identify key themes within the data, utilising Braun and Clarke's (2006) thematic analysis. ResultsThe search resulted in 623 unique references. 29 publications were included in this review. Our analysis resulted in three main findings. (1) A significant number of women in Ireland are affected by perinatal mental health problems, but prevalence rates vary significantly between studies. (2) A history of mental health problems and lack of social support were identified as key risk factors. (3) The existing perinatal mental health services in Ireland are generally inadequate. We further noted a focus on quantitative approaches and a medicalisation of perinatal mental health, resulting in an absence of women's voices and their lived experiences, particularly those of women of colour, migrant women and ethnic minorities. Conclusions and implications for practice: We conclude that in order to further the vision of woman-centred maternity care, we need to conduct woman-centred research that puts women's subjective experiences of perinatal mental health and well-being at the centre, including those of marginalised women in an increasingly diverse Irish society.
Highlights
Pregnancy, birth and the first year with a new baby constitute life-changing experiences for many women, encompassing a whole range of emotional and psychological states (Jomeen 2017)
Stage 1: Identifying the research question The broad guiding question that informed the systematic gathering of data was: What do we know about perinatal mental health in Ireland, based on empirical studies? In line with the international literature, we defined perinatal mental health as women’s emotional and psychological well-being during pregnancy, birth and the first twelve months after giving birth (Jomeen 2017)
By posing a broad research question, we ensured that the scoping review would include health services research as well as population research
Summary
Birth and the first year with a new baby constitute life-changing experiences for many women, encompassing a whole range of (positive and negative) emotional and psychological states (Jomeen 2017). Research and policy in this area focus on “measuring and evaluating the effects of negative aspects of well-being” (O’Leary et al 2016: 666), that is, on perinatal mental health problems These include depression, anxiety, obsessive-compulsive disorders, post-traumatic stress disorder and postpartum psychosis (Jomeen 2017: 186). Abortion only became legal after a progressive social movement won a referendum on the issue in 2018 Despite these recent changes, numerous failures in maternity care in the past two decades (Government of Ireland 2006, Arulkumaran 2013, HIQA 2015; Scally 2018) are stark examples of the on-going influence of a hierarchical, paternalistic healthcare system which does not put women’s well-being at the centre. Continuity of carer models are the exception rather than the rule, and are mostly provided by private obstetric consultants (Healy 2017: 11)
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