Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies

Background: Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). Aim: This review aimed to synthesise the available information from qualitative studies on GPs’ attitudes, recognition and management of perinatal anxiety and depression. Design & Setting: Meta-synthesis of the available published qualitative evidence on GPs recognition and management of perinatal anxiety and depression. Method: A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science, and grey literature was searched using Google, Google Scholar and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs’ diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Results: Five themes were established from five eligible papers: Labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and Isolation: The role of other professionals. GPs considered perinatal depression as a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting women back regularly for GP visits. GPs felt isolated when dealing with perinatal mental health issues. Conclusion: GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training needs to focus on these issues and needs to be evaluated to consider if this makes a difference to outcomes for women.