A qualitative study into how guidelines facilitate general practitioners to empower women to make decisions regarding antidepressant use in pregnancy

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Abstract

It is estimated that 14.5%of women suffer depression in pregnancy [Sit,D.K.Y., Flint, C.,Svidergol, D., White, J., Wimer, M., Bish, B., & Wisner, K.L. (2009). An emerging bestpractice model for perinatal depression care. Psychiatric Services, 60, 1429–1431.Retrieved from http://ps.psychiatryonline.org/journal.aspx?journalid¼18], which hasbeen linked to a number of negative outcomes such as higher levels of preterm delivery,reduced cognitive development and poor mother–baby connection [Judd, F., Stafford, L.,Gibson, P., & Ahrens, J. (2011). The early motherhood service: An acceptable andaccessible perinatal mental health service. Australasian Psychiatry, 19, 240–246.doi:10.3109/10398562.2011.562294]. The lack of clarity surrounding safety informationhas impacted treatment decisions with general practitioners (GPs) reportedly feelinghesitant to prescribe antidepressants [Bilszta, J.L., Tsuchiya, S., Han, K., Buist, A.E., &Einarson, A. (2011). Primary care physicians attitudes and practices regardingantidepressant use during pregnancy: A survey of two countries. Archive of Women’sMental Health, 14, 71–75. doi:10.1007/s00737-010-0197-8], yet the usage of perinataldepression guidelines among GPs is reportedly low [Kean, L.J., Hamilton, J., & Shah, P.(2011). Antidepressants for mothers:What are we prescribing? Scottish Medical Journal,56, 94–97. doi:10.1258/smj.2011.011034]. Therefore, this study aimed to explore theopinions of GPs on how clinical guidelines for perinatal depression facilitated them toempower pregnant women to make an informed decision about the use of antidepressantsin pregnancy. Using qualitative methodology, semi-structured interviews were conductedwith one GP from eight practices in Derry City, Northern Ireland. The main areasexplored in the interview schedule were guidelines on perinatal depression, GPunderstanding of ‘patient empowerment’, GP practice policy on patient decision making,constraints of treatment decisions and a discussion on which health promotion model wasmost reflective of their views on the provision of healthcare. Only some of the GPs wereaware of the National Institute National Institute for Health and Clinical ExcellenceClinical Excellence [NICE (2007). Antenatal and postnatal mental health: Clinicalmanagement and service guidance (Clinical Guideline No. CG45). Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf] perinatal depression guidelinesbut acknowledged that they were generic and lacked utility, instead they relied ontheir own professional experience and patient knowledge to make decisions. Involvingpatients in treatment decision making was viewed as central to patient empowerment;however, its application in routine practice was often limited by complex clinicalscenarios. Findings from this study suggested an identified need for a local specialistperinatal service to provide evidence-based information and timely support. Anempowerment model for the improvement of perinatal depression has been developed from the study findings as a framework for women, their community and their GPs.
Original languageEnglish
JournalInternational Journal of Mental Health Promotion
Volume25 Mar
DOIs
Publication statusPublished - 25 Mar 2013

Bibliographical note

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Keywords

  • perinatal depression
  • guidelines
  • general practitioners
  • empowerment
  • qualitative

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