Postpartum depression: the (in) experience of Brazilian primary healthcare professionals

Abstract

This article reports experiences of Brazilian physicians and nurses caring for women with postpartum depression in primary healthcare settings. Prevalence of postpartum depression in Brazil ranges from 12-37%, which fits with international claims about differences in the magnitude of the problem and consistency of screening. Qualitative descriptive. This study was situated in health units of the Family Health Strategy in Campina Grande, Brazil. Data were collected from September 2010-January 2011 through open-ended interviews with ten nurses and seven physicians, observations, and field diary records. Inductive content analysis was used to develop categories. Three categories: (1) Limited professional exposure to postpartum depression; (2) Postpartum depression as the domain of psychiatry; and (3) Challenges dealing with postpartum depression demonstrated that few professionals felt postpartum depression merited their attention. Women, with signs of postpartum depression, were usually identified by family members who noticed behaviours that seemed abnormal. Care providers indicated they had inadequate time and access to screening techniques to identify women with depression attending unit-based pregnancy and postpartum groups. When identified, women were referred directly to psychiatric care. Without consistent screening and diagnostic techniques, Brazilian health professionals are insecure about identifying and treating cases of postpartum depression. Referring women to psychiatric units entail more time for women to be diagnosed and treated and increased costs for health services. Primary healthcare professionals require training to screen, identify, and treat postpartum depression in primary healthcare settings.