Ford Elizabeth, Shakespeare Judy, Elias Fatin, Ayers Susan
Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
Royal College of General Practitioners, 30 Euston Square, London NW1 2FB, UK.
Fam Pract. 2017 Feb;34(1):11-19. doi: 10.1093/fampra/cmw101. Epub 2016 Sep 22.
Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period.
A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum.
Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training.
Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices.
围产期焦虑和抑郁十分普遍，孕期及产后有多达20%的女性受其影响。在英国，围产期心理健康管理属于全科医生（GP）的职责范围。我们回顾了关于全科医生对围产期焦虑和抑郁的常规识别、诊断及管理的文献。
对Embase、Medline、PsycInfo、Pubmed、Scopus和Web of Science进行了系统检索。如果研究报告了全科医生或家庭医生对孕期或产后焦虑或抑郁的评估、识别及管理的定量指标，则该研究符合入选标准。
从美国、澳大利亚、英国、荷兰和加拿大共识别出13篇论文，报告了10项研究。所有研究均涉及抑郁症；两项研究包含焦虑症。报告显示，全科医生对围产期抑郁症的知晓率和诊断能力较高。全科医生了解并在英国使用筛查工具，但在美国则较少使用。抗抑郁药是一线治疗药物，各种选择性5-羟色胺再摄取抑制剂（SSRI）被认为是最安全的。产后全科医生进行咨询和转诊至专科医生的情况很常见，孕期则较少。治疗选择取决于资源、态度、知识和培训。
关于全科医生对围产期抑郁症的知晓和管理的数据稀少，且不太可能具有普遍性。提出了未来的研究方向；例如探索文献中基本缺失的焦虑症的管理，以及更多地了解初级保健中信息披露和识别方面的障碍。更标准化的培训有助于改善识别和管理实践。
