支持围产期心理健康有困难的妇女的服务机构与她们的家庭合作的经验：英格兰的一项定性研究。
Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England.
机构信息
Division of Psychiatry, University College London, London, UK.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, UK.
出版信息
BMJ Open. 2019 Jul 24;9(7):e030208. doi: 10.1136/bmjopen-2019-030208.
OBJECTIVES
Partners and wider family members play a vital role in relation to women's perinatal mental health. Clinical guidelines in the UK and internationally recommend that services supporting women with perinatal mental health difficulties involve and support their families too. However, little is known about family members' needs and experiences, or whether they feel included by mental health services. This study set out to explore this.
METHODS
This research formed part of a wider study exploring experiences of perinatal mental health care in England. The broader study included semi-structured interviews with 52 women across England who received treatment for a perinatal mental health difficulty, and 32 family members identified by the women as offering them some support. Data from these 84 interviews relating to how services work with partners and families were extracted and analysed thematically.
RESULTS
Analysis identified three overarching themes: (1) the centrality of women's families to their perinatal mental health/access to support, (2) experiences of partners and families being excluded by services and (3) ambivalence among women and their families about increasing family involvement/support. We found that partners and families appear to have an important influence on women's perinatal mental health, access to care and interactions with services, but that services tend to focus on individual women (and babies) with little regard for their wider family context. The complexity of involving and supporting partners and families, coupled with anxiety about this among women and their families, reinforces the tendency to marginalise them.
CONCLUSION
Involving women's families and providing the support they need is challenging, but important. Experiences of women and their families of services treating perinatal mental health difficulties suggests greater focus is needed on overcoming barriers to family inclusion and on challenging underlying gender roles and expectations, rather than allowing these to shape and guide practice.
目的
伴侣和更广泛的家庭成员在女性围产期心理健康中起着至关重要的作用。英国和国际上的临床指南建议，支持围产期心理健康困难的女性的服务也应涉及并支持她们的家庭。然而，对于家庭成员的需求和体验，或者他们是否感到被心理健康服务所包容，我们知之甚少。本研究旨在探讨这一点。
方法
本研究是一项更广泛研究的一部分，该研究探讨了英格兰围产期心理健康护理的经验。该更广泛的研究包括对英格兰 52 名接受围产期心理健康治疗的女性以及女性确定的 32 名提供支持的家庭成员进行半结构化访谈。从这些 84 次访谈中提取了与服务如何与伴侣和家庭合作相关的数据，并进行了主题分析。
结果
分析确定了三个总体主题：（1）女性家庭对其围产期心理健康/获得支持的核心地位，（2）服务排斥伴侣和家庭的经历，以及（3）女性及其家庭对增加家庭参与/支持的矛盾态度。我们发现，伴侣和家庭似乎对女性的围产期心理健康、获得护理和与服务的互动有重要影响，但服务往往侧重于个体女性（和婴儿），而很少考虑到她们更广泛的家庭背景。涉及和支持伴侣和家庭的复杂性，以及女性及其家庭对此的焦虑，强化了将他们边缘化的趋势。
结论
让女性的家人参与并为他们提供所需的支持具有挑战性，但很重要。女性及其家庭对服务治疗围产期心理健康困难的经验表明，需要更加关注克服家庭包容的障碍，并挑战潜在的性别角色和期望，而不是让这些障碍来塑造和指导实践。
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