Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

Rebecca Webb; Nazihah Uddin; Georgina Constantinou; Elizabeth Ford; Abigail Easter; Judy Shakespeare; Agnes Hann; Nia Roberts; Fiona Alderdice; Andrea Sinesi; Rose Coates; Sally Hogg; Susan Ayers; MATRIx Study Team

doi:10.1136/bmjopen-2022-066703

Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

BMJ Open. 2023 Jul 20;13(7):e066703. doi: 10.1136/bmjopen-2022-066703.

Authors

Collaborators

MATRIx Study Team:
Elaine Clark, Evelyn Frame, Simon Gilbody, Sarah McMullen, Camilla Rosan, Debra Salmon, Clare Thompson, Louise R Williams

Affiliations

¹ Centre for Maternal and Child Health Research, City University, London, UK rebecca.webb.2@city.ac.uk.
² Centre for Maternal and Child Health Research, City University, London, UK.
³ Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
⁴ Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
⁵ Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁶ Retired, Oxford, UK.
⁷ National Childbirth Trust, London, UK.
⁸ Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
⁹ Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK.
¹⁰ Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), University of Stirling, Stirling, UK.
¹¹ Faculty of Education, University of Cambridge, Cambridge, UK.

Abstract

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.

Objectives: 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.

Design: A meta-review of systematic reviews.

Review methods: 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.

Results: 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.

Conclusion: 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.

Prospero registration number: CRD42019142854.

Keywords: anxiety disorders; depression & mood disorders; health policy; psychiatry.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Female
Health Personnel / psychology
Humans
Mental Health
Mental Health Services*
Parturition*
Pregnancy
Systematic Reviews as Topic

Grants and funding

NIHR128068/DH_/Department of Health/United Kingdom