Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA.
Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.
BMC Public Health. 2021 Oct 21;21(1):1905. doi: 10.1186/s12889-021-11954-8.
Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers' perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa.
Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019-June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems' framework to organise the findings, depicted in a conceptual map.
Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors.
Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.
围产期精神障碍是导致妊娠和产后发病率和死亡率的主要原因，如果及早发现，这些障碍是可以治疗的。然而，许多妇女，特别是在中低收入国家，无法在公共卫生环境中获得常规的精神疾病识别和治疗。与高收入国家的妇女相比，南非妇女患围产期抑郁和焦虑障碍等常见精神障碍的比例高出三倍。公共卫生系统已开始将精神卫生纳入产妇保健，使南非成为围产期精神保健的一个相关案例研究。然而，相关研究却很少。我们试图调查卫生保健提供者对南非公共卫生机构早期识别和筛查常见围产期精神障碍的障碍的看法。
我们采用定性方法，通过目的性抽样确定研究参与者，并通过滚雪球抽样进行补充。2019 年 9 月至 2020 年 6 月，我们在南非对 24 名关键知情者进行了深入访谈。所有访谈均进行了录音并逐字记录。我们采用主题方法生成初始分析主题，然后进行迭代编码以完善这些主题。我们采用了一个交付系统框架来组织研究结果，以概念图的形式呈现。
报告的围产期精神疾病早期识别和治疗障碍涉及四个层面：（1）与政策、系统和资源相关的结构性因素；（2）社会文化因素，包括语言和文化障碍；（3）组织因素，如提供者准备和培训不足以及诊所负担过重；（4）个体患者和医疗保健提供者因素。
障碍在多个层面上发挥作用，降低了精神卫生促进和护理的质量，从而使识别精神障碍和获得优质精神卫生服务的不平等机会嵌入到系统和日常实践中。需要在多个层面上采取综合干预措施，以改善南非围产期妇女的早期精神疾病识别和治疗。我们提供了从我们的研究结果中得出的建议，以克服在四个确定层面上的障碍。
