What are GPs' and Psychiatrists' perceptions of post-traumatic stress disorder in postnatal women? A qualitative study with a case vignette

Problem

Up to a third of women describe their experience of giving birth as psychologically traumatic, and post-traumatic stress disorder (PTSD) following childbirth is common, affecting 3-4% of women who give birth. Evidence-based treatments for PTSD are available, however UK women presenting to NHS services in the postnatal period with mental health problems are often underdiagnosed and report feeling dismissed. Especially little is known about women’s pathway into NHS services when they are experiencing postnatal PTSD. Thus far, no studies have investigated GPs’ and psychiatrists’ perceptions of PTSD in a postnatal population following a traumatic birth, to help us understand women's experiences of seeking a diagnosis and appropriate care for this condition.

Approach

This qualitative study, making use of a vignette case study, aimed to investigate whether GPs and psychiatrists perceive PTSD symptoms after birth to be indicative of a disorder and what diagnosis and management options they would give a postnatal patient with a classic presentation of PTSD symptoms. Semi-structured interviews were conducted with 6 GPs and 7 psychiatrists based around a fictional vignette featuring a diagnostic case of PTSD in a postnatal woman, based on DSM-5 criteria. Interview transcripts were analysed using thematic analysis and a framework approach.

Findings

None of the six GP participants acknowledged that the woman in the vignette was experiencing PTSD, instead GPs sought to normalise traumatic symptoms or made a postnatal depression diagnosis. GPs said they would offer a combination of antidepressants, referral for psychological therapy, debriefing services and referral to specialist perinatal mental health teams to help manage the presentation. GPs distrusted the timeliness of the referral process both to psychological therapy and secondary psychiatry services. The psychiatrists who took part clearly identified the vignette to be a presentation of PTSD however, like the GPs, the majority were keen to refer this patient to the specialist perinatal mental health team.

Consequences

GPs did not recognise the case study as PTSD and diagnosed distress as postnatal depression. Psychiatrists recognized PTSD but felt specialist treatment in perinatal women was beyond their remit. There is a clear demand from clinicians for specialist perinatal mental health services, which may still be unmet in some geographical areas due to high thresholds for accepting referrals. More research is required to understand the challenges facing GPs caring for such patients, including whether targeted professional education and specialist care ultimately improve outcomes.