Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK.
BMC Med. 2023 Oct 2;21(1):370. doi: 10.1186/s12916-023-02978-5.
Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities-Black and South Asian women in particular-are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals' views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women.
Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis.
Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients' relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services.
Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.
围产期精神疾病影响了三分之一的新产妇和孕妇。少数民族群体的个体经历更高的心理健康问题和更高的自杀率。尽管如此，少数民族妇女——尤其是黑人妇女和南亚裔妇女——在围产期获得心理健康服务支持的可能性较小。在这段时间与女性接触的医疗保健专业人员（HCP）具有独特的视角，他们的观点可能有助于了解和纠正这种健康不平等。本研究旨在确定医疗保健专业人员对当前围产期心理健康服务的可及性和可接受性的看法，并通过解决这些女性的障碍来改善服务。
对 24 名在围产期与患者合作的医疗保健专业人员进行了半结构化访谈。采用目的抽样法从一系列不同的专业（包括心理健康工作人员、助产士、初级保健、社会关怀）中选择 HCP。使用框架分析对数据进行分析。
从数据中确定了三个主要主题：（1）医疗保健专业人员和患者对围产期精神疾病和服务结构缺乏认识和理解；（2）患者与家人、朋友和医疗保健专业人员的关系既可以阻碍也可以促进获得服务；（3）医疗保健专业人员鼓励提高认识、灵活性、发展共同理解和质疑假设，以提高服务的可及性和可接受性。
医疗保健专业人员提出了解释和纠正观察到的种族群体之间健康不平等的关键见解。建议包括分享信息；采取措施确保每位女性在与自己的文化、族裔和育儿实践的关系中都被视为个体；医疗保健专业人员通过参与个人反思实践来解决他们可能存在的无意识偏见。目前尚未实施这些建议的原因值得进一步研究，同伴支持工作者等新角色在弥合理想与实践之间的差距方面的潜力需要进一步调查。
