Jovanović Nikolina, Lep Žan, Janković Jelena, Dirik Aysegul, Rees Anna, Conneely Maev
Centre for Psychiatry and Mental Health, Wolfson Institute of Population Sciences, Queen Mary, University of London, London, UK.
East London NHS Foundation Trust, London, UK.
Health Soc Care Deliv Res. 2024 Oct 30:1-17. doi: 10.3310/YTRK6337.
During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women.
To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups.
This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses.
The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey.
The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period.
The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors.
The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.
在孕期和产后期间，女性的心理健康可能会迅速恶化。及时且便捷地获得服务至关重要；然而，对于女性获取服务的途径却知之甚少。先前的研究表明，与英国白人女性相比，英国少数族裔女性在获取服务方面面临更多问题。
描述获取专科社区围产期心理健康服务的途径，并探讨这些途径在不同服务机构和种族群体之间的差异。
这是一项在伯明翰和伦敦进行的为期6个月（2019年7月1日至12月31日）的双地点纵向回顾性服务评估。获取了228名女性的电子记录，并提取了关于求助行为、转诊过程和途径类型（即简单或复杂）的数据。使用改编后的世界卫生组织接诊表格收集数据，并采用单变量和多变量分析进行分析。
从围产期精神疾病开始到接触围产期心理健康服务的中位时间为20周。大多数患者通过初级保健机构获取围产期心理健康服务（69%），且其途径较为简单，即在接触围产期心理健康服务之前仅看过一个服务机构（63%）。简单途径被用作可及服务的替代指标。在伯明翰，与伦敦相比，更多的转诊来自二级保健机构，更多女性的心理健康状况正在恶化，且更多女性遵循复杂途径。尽管不同种族群体在途径类型和患者就医时长方面存在差异，但在对临床表现、一般特征和地点等混杂因素进行模型控制后，没有证据表明存在差异。服务机构的地点是途径类型和患者就医时长的最强预测因素。
分类种族群体之间存在异质性；数据从现有电子记录中提取，未与患者自身对就医途径的描述进行验证；未分析被拒绝的转诊；该研究在新冠疫情之前进行，疫情后途径可能有所不同。
该研究为患者如何找到社区围产期心理健康服务提供了重要见解。研究表明，进入这些服务机构所需的时间以及所采用的途径存在很大差异。这种差异并非源于患者的不同需求或不同的临床表现，而是源于服务层面的因素。
英国所研究的社区围产期心理健康服务在患者途径的类型和特征方面存在很大差异。未来的研究应在国家和国际层面探讨这些问题。此外，未来的研究应探索采用不同途径的原因以及与之相关的结果和风险。
本文展示了由英国国家卫生与保健研究所（NIHR）卫生与社会保健服务研究项目资助的独立研究，资助编号为17/105/14。
