Insan Nafisa, Weke Anthony, Rankin Judith, Forrest Simon
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
Department of Sociology, Durham University, Durham, UK.
BMC Pregnancy Childbirth. 2022 Apr 6;22(1):293. doi: 10.1186/s12884-022-04642-x.
Perinatal mental health (PMH) is a worldwide public health issue crossing cultural boundaries. However, the prevalence of PMH conditions vary considerably. These disparities stem in part from poor understanding and stigma surrounding PMH which hinder pregnant women from seeking mental health care and may exacerbate their conditions. Bangladesh, India and Pakistan are South Asian countries with a higher burden of PMH conditions than in the Global North-West and very different social and cultural norms around gender and mental health. The aim of this systematic review (PROSPERO Ref: CRD42020167903) was to identify, synthesise and appraise the available literature on perceptions and attitudes of perinatal (pregnant and postpartum) women, their families and healthcare providers surrounding PMH in Bangladesh, India and Pakistan.
Five electronic databases, MEDLINE, Embase, PsycINFO, Scopus and Web of science, and grey literature were searched using predefined search terms. Qualitative or quantitative articles with a qualitative component reporting perceptions and attitudes surrounding PMH in Bangladesh, India and Pakistan were eligible for inclusion, if published in English between January 2000 and January 2021. The Critical Appraisal Skills Programme Qualitative Research Checklist and Newcastle-Ottawa Scale for cross-sectional studies were used to assess study quality. Findings were synthesised using thematic synthesis, as described by Thomas and Harden 2008.
Eight studies were included. Five overarching themes comprising 17 sub-categories were identified. These descriptive themes were: perceived causes of PMH, perceived symptoms of PMH, perceptions of motherhood, accessing PMH care and emotional sharing and coping strategies. Sociocultural expectations underpin many of the themes identified in this review including the importance of familial and societal causes of PMH, emphasis on physical symptoms, sacredness of motherhood, lack of awareness, stigma, shame, limited resources allocated for mental health and lack of emotional sharing.
There is a complex range of perceptions and attitudes around PMH which influence women's experiences and access to PMH care. These findings will inform policy and practice through targeted interventions to tackle stigmatising attitudes and increasing education and training for healthcare providers.
围产期心理健康（PMH）是一个跨越文化界限的全球性公共卫生问题。然而，PMH状况的患病率差异很大。这些差异部分源于对PMH的理解不足和污名化，这阻碍了孕妇寻求心理健康护理，并可能加剧她们的病情。孟加拉国、印度和巴基斯坦是南亚国家，与全球西北部相比，PMH状况的负担更重，并且在性别和心理健康方面有着截然不同的社会和文化规范。本系统评价（PROSPERO编号：CRD42020167903）的目的是识别、综合和评估关于孟加拉国、印度和巴基斯坦围产期（怀孕和产后）妇女、其家人及医疗保健提供者对PMH的看法和态度的现有文献。
使用预定义的检索词在五个电子数据库（MEDLINE、Embase、PsycINFO、Scopus和Web of science）以及灰色文献中进行检索。如果在2000年1月至2021年1月期间以英文发表，报告孟加拉国、印度和巴基斯坦围产期妇女、其家人及医疗保健提供者对PMH的看法和态度的定性或定量文章（包含定性部分）符合纳入标准。使用批判性评估技能计划定性研究清单和横断面研究的纽卡斯尔-渥太华量表来评估研究质量。按照Thomas和Harden 2008年所述，采用主题综合法对研究结果进行综合分析。
纳入了八项研究。确定了五个总体主题，包含17个子类别。这些描述性主题为：PMH的感知原因、PMH的感知症状、对母亲身份的看法、获得PMH护理以及情感分享和应对策略。社会文化期望是本评价中确定的许多主题的基础，包括PMH的家庭和社会原因的重要性、对身体症状的强调、母亲身份的神圣性、意识缺乏、污名化、羞耻感、分配给心理健康的资源有限以及情感分享的缺乏。
围绕PMH存在一系列复杂的看法和态度，这些影响着妇女的经历以及获得PMH护理的机会。这些研究结果将通过针对性干预措施来消除污名化态度，并增加对医疗保健提供者的教育和培训，从而为政策和实践提供参考。
