Centre for Maternal and Child Health Research, City University, London, UK
Centre for Maternal and Child Health Research, City University, London, UK.
BMJ Open. 2023 Jul 20;13(7):e066703. doi: 10.1136/bmjopen-2022-066703.
Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.
To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.
A meta-review of systematic reviews.
Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating.
A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators.
The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals.
CRD42019142854.
围产期心理健康（PMH）问题很常见，会对女性及其家庭产生不利影响。然而，研究表明，相当一部分有 PMH 问题的女性并未寻求治疗。
综合之前关于女性寻求帮助、获得帮助和参与 PMH 护理的障碍和促进因素的系统评价结果，并为临床实践和政策提出建议。
元评价系统综述。
搜索并使用系统评价和荟萃分析的首选报告项目检索策略对 7 个数据库进行了回顾。纳入了关注寻求帮助和获得 PMH 护理的女性观点的研究。使用主题综合分析法对数据进行分析。采用系统评价方法学质量评估-2 评估了综述方法。为了提高结果的有效性，进行了定性敏感性分析，以评估无论其质量评分如何，主题是否在所有综述中保持一致。
共纳入 32 项综述。确定了影响女性获得 PMH 护理的广泛障碍和促进因素。这些因素映射到影响因素的多层次模型（个体、医疗保健专业人员、人际间、组织、政治和社会）和护理路径（从咨询决定到接受护理）。根据确定的障碍和促进因素，提出了支持 PMH 护理设计和实施的循证建议。
确定的障碍和促进因素表明许多因素之间存在复杂的相互作用，突出了需要国际努力提高对 PMH 问题的认识，减少心理健康污名化，并提供以女性为中心、灵活的护理，由训练有素且具有文化敏感性的初级保健、产妇和精神健康专业人员提供。
PROSPERO 注册号：CRD42019142854。
