Prady Stephanie L, Endacott Charlotte, Dickerson Josie, Bywater Tracey J, Blower Sarah L
Department of Health Sciences, University of York, York, United Kingdom.
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom.
PLoS One. 2021 Mar 15;16(3):e0248631. doi: 10.1371/journal.pone.0248631. eCollection 2021.
Maternal mental health problems in the perinatal period can cause significant distress and loss of functioning, and can have lasting impact on children. People living in disadvantage are at risk of health inequalities, including for perinatal mental health. A review of current guidance found that overall implementation of the UK detection and management strategy was satisfactory, but equity was not considered in the review. Greater understanding of implementation equity is needed. We aimed to reanalyse an existing systematic review on the implementation of current guidance for the identification and management of perinatal mental health problems for equity.
Studies reporting the presence or absence of variation by a social, economic or demographic group were quality appraised and the presence and direction of disparity tabled. We calculated standardised absolute prevalence estimates for overall detection and management, and absolute and relative estimates by determinants grouping. A thematic analysis of the studies that examined potential reasons for disparity was undertaken.
Six studies, with no major quality concerns, provided consistent evidence of reduced identification and management for ethnic minority women, both those who do, and do not, speak English. There was less consistent evidence of inequality for other axes of social disparity and for characteristics such as age, parity and partnership status. Explanations centred on difficulties that translation and interpretation added to communication, and hesitancy related to uncertainty from healthcare providers over cultural understanding of mental health problems.
The identification and management of perinatal mental health problems is likely to be inequitable for ethnic minority women. Further systems-based research should focus on clarifying whether other groups of women are at risk for inequalities, understand how mismatches in perception are generated, and design effective strategies for remediation. Inequalities should be considered when reviewing evidence that underpins service planning and policy decision-making.
围产期孕产妇心理健康问题可导致严重困扰和功能丧失，并可对儿童产生持久影响。生活处于不利地位的人群面临健康不平等风险，包括围产期心理健康方面。对当前指南的一项审查发现，英国检测和管理策略的总体实施情况令人满意，但审查中未考虑公平性。需要更深入地了解实施公平性。我们旨在重新分析一项现有的系统评价，以探讨当前围产期心理健康问题识别和管理指南实施中的公平性。
对报告按社会、经济或人口群体存在或不存在差异的研究进行质量评估，并列出差异的存在情况和方向。我们计算了总体检测和管理的标准化绝对患病率估计值，以及按决定因素分组的绝对和相对估计值。对研究潜在差异原因的研究进行了主题分析。
六项研究（无重大质量问题）提供了一致证据，表明少数族裔妇女（无论是否说英语）的识别和管理率降低。关于社会差异的其他维度以及年龄、胎次和伴侣状况等特征的不平等证据不太一致。解释集中在翻译和口译给沟通带来的困难，以及医疗服务提供者对心理健康问题文化理解的不确定性导致的犹豫。
围产期心理健康问题的识别和管理对少数族裔妇女而言可能存在不公平现象。进一步基于系统的研究应聚焦于明确其他女性群体是否存在不平等风险，理解认知不匹配是如何产生的，并设计有效的补救策略。在审查支撑服务规划和政策决策的证据时，应考虑不平等问题。
