Identification of Perinatal Anxiety in Primary Care: implications for interdisciplinary working and education: a qualitative study.
Problem
Perinatal Anxiety (PNA) is anxiety that occurs during pregnancy or up to 12 months post-partum. PNA is as common as perinatal depression (PND) and can adversely impact on both mother and child, with potential implications for long-term health. Despite this, research into PNA has received significantly less attention than PND. The National Institute for Health and Care Excellence (NICE) guidance on perinatal mental health (CG192) has identified PNA as a research priority. We aimed to explore the views of General Practitioners (GPs) about drivers and challenges to the identification and management of PNA.
Approach
This is a qualitative study that utilised semi-structured interviews to collect data. Ethics approval was obtained from University Ethical Review Panel and from the Health Research Authority (HRA).GPs working in the NHS in the West Midlands were identified via the Clinical Research Network and invited to participate in an interview. The topic guide was developed following a review of the literature and provided structure to the interviews, and modified in the light of emerging themes during data generation and analysis. We explored GPs’ understanding of PNA as diagnosis, the identification and management of PNA, and working with other healthcare professionals (HCPs). Data collection was continued until data saturation was achieved.Interviews were digitally recorded with consent, transcribed and anonymised prior to analysis. Thematic analysis using principles of constant comparison was undertaken and themes agreed through discussion within the research team. A ‘Patient and Public Involvement and Engagement’ (PPIE) group has been involved during development of the research idea, study protocol and ethical applications and will meet again to discuss findings.
Findings
10 GPs were interviewed across a range of practice settings. Initial analysis reveals several themes: awareness, barriers to identification, use of diagnostic tools, communication with women, interaction with other HCPs, understanding own role and training needs.
Consequences
GPs reported limited experience of managing women with PNA, resulting in reduced confidence in their skills to appropriately identify and manage the condition. They expressed doubt that they have a role in the diagnosis and management of PNA, suggesting that specialist services would be more suited to this. They admit to rarely using diagnostic tools however feel that an appropriately designed assessment framework would be helpful. GPs described barriers to communication with other HCPs; attributing this to re-location of MWs and HVs from practice premises . Prioritising perinatal mental health in both under- and post-graduate education, and multi-disciplinary learning was suggested as potentially facilitating care for women with PNA.