Department of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 01655.
Gen Hosp Psychiatry. 2013 Nov-Dec;35(6):598-604. doi: 10.1016/j.genhosppsych.2013.07.011. Epub 2013 Aug 19.
The objectives were to examine patients' perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals.
Four 90-min focus groups were conducted with women 3-36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach.
Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals.
Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals' perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
本研究旨在探讨患者对解决门诊产科环境下围产期抑郁的患者、提供者和系统层面障碍和促进因素的看法。我们还比较了患者和围产期保健专业人员的观点。
对分娩后 3-36 个月出现围产期抑郁、焦虑或情绪困扰症状的女性（n=27）进行了 4 次 90 分钟的焦点小组讨论。对焦点小组的讨论内容进行了转录，并使用扎根理论方法对所得数据进行了分析。
解决围产期抑郁的障碍包括对污名和失去父母权利的恐惧、对围产期保健提供者的负面体验以及专业人员缺乏抑郁管理知识/技能。促进因素包括心理教育、同伴支持和专业人员培训。
患者认为存在许多多层次的治疗障碍，这些障碍与我们之前对围产期保健专业人员观点的类似研究中发现的障碍相似。然而，患者和专业人员在彼此的看法上确实存在差异。干预措施需要弥合这些差距，并包括一个共情的筛查和转介过程，以促进对心理健康问题的讨论。干预措施应利用患者和专业人员都确定的策略，包括通过教育、资源和获得各种心理健康护理选择来增强双方的能力。
