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

Research output: Contribution to journalArticle

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.
LanguageEnglish
JournalInternational Journal of Mental Health Promotion
Volume25 Mar
DOIs
Publication statusPublished - 25 Mar 2013

Fingerprint

General Practitioners
Antidepressive Agents
Guidelines
Pregnancy
Depression
Patient Participation
Mental Health Services
Psychiatry
Decision Making
Mothers
Interviews
Perinatal Care
Northern Ireland
National Institutes of Health (U.S.)
Primary Care Physicians
Women's Health
Health Promotion
General Practice
Pregnant Women
Appointments and Schedules

Keywords

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

Cite this

@article{4ce33659205f47a88fbe7699b86b299b,
title = "A qualitative study into how guidelines facilitate general practitioners to empower women to make decisions regarding antidepressant use in pregnancy",
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.",
keywords = "perinatal depression, guidelines, general practitioners, empowerment, qualitative",
author = "Claire-Odile McCauley and Karen Casson",
note = "Reference text: Adams, J.R., & Drake, R.E. (2006). Shared decision making and evidence-based practice. Community Mental Health Journal, 42(1), 87–105. doi:10.1007/s10597-005-9005-8. Anderson, R.M., & Funnell, M.A. (2010). Patient empowerment: Myths and misconceptions. Patient Education and Counseling, 79, 277–282. doi:10.1016/i.pec.2009.07.025. Aujoulat, I., d’Hoore, W., & Deccache, A. (2007). Patient empowerment in theory and practice: Polysemy or cacophony. Patient Education and Counseling, 66, 13–20. doi:10.1016/j.pec.2006.09.008. Avis, M. (2005). Is there an epistemology for qualitative research? In I. Holloway (Ed.), Qualitativeresearch in health care (pp. 3–15). Maidenhead: Open University Press. Bennett, I.M., Marcus, S.C., Palmer, S.C., & Coyne, J.C. (2010). Pregnancy-related discontinuationof antidepressants and depression care visits among Medicaid recipients. Psychiatric Services,61, 386–391. Retrieved from http://ps.psychiatryonline.org/journal.aspx?journalid=18 Bermejo, I., Schneider, F., Kriston, L., Gaebel, W., Hegrel, U., Berger, M., & Harter, M. (2009). Improving outpatient care of depression by implementing practice guidelines: A controlled clinical trial. International Journal for Quality in Health Care, 21(1), 29–36. doi:10.1093/intqhc/mzn050. Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010a). A qualitative study of health professionals involved in the care and treatment of woman with postnatal emotional distress. International Journal of Mental Health Promotion, 12(3), 5–13. Retrieved from http://www.ijmhp.co.uk/ Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010b). Women’s experience of postnatal depression-beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing,27(3), 44–54. Retrieved from http://www.ajan.com.au/ Bilszta, J.L., Tsuchiya, S., Han, K., Buist, A.E., & Einarson, A. (2011). Primary care physician’sattitudes and practices regarding antidepressant use during pregnancy: A survey of two countries. Archive of Women’s Mental Health, 14, 71–75. doi:10.1007/s00737-010-0197-8. Bonari, L., Koren, G., Einarson, T.R., Jasper, J.D., Taddio, A., & Einarson, A. (2005). Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counselling and determinants of decision making. Archives of Women’s Mental Health, 8,214–220. doi:10.1007/s00737-005-0094-8. Buist, A., Bilszta, J., Barnett, B., Milgrom, J., Ericksen, J., Condon, J., . . . , & Brooks, J. (2005). Recognition and management of perinatal depression in general practice. Australian Family Practice, 34(9), 787–790. Retrieved from http://www.racgp.org.au/afpbackissues/2005/200509/200509buist.pdf Buist, A., Bilszta, J., Milgrom, J., Barnett, B., Hayes, B., & Austin, M.P. (2006). Health professional’s knowledge and awareness of perinatal depression: Results of a national survey. Women and Birth, 19, 11–16. doi:10.1016/j.womi.2005.12.001. Clever, S.L., Ford, D.E., Rubenstein, L.V., Rost, K.M., Meredith, L.S., Sherbourne, C.D., . . ., & Cooper, L.A. (2006). Primary care patients’ involvement in decision-making is associated with improvement in depression. Medical Care, 44(5), 398–405. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx Cohen, L.S., Nonacs, R.M., & Bailey, J.W. (2004). Relapse of depression during pregnancy following antidepressant discontinuation: A preliminary prospective study. Archive Women’s Mental Health, 7, 217–221. doi:10.1007/s00737-004-0059-3. Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. Vale and M. King, (eds). Existential phenomenological alternatives for psychology (48–71) New York: Oxford University Press. Department of Health, Social Services and Public Safety (2003). Investing for health: Promoting mental health strategy and action plan 2003–2008, (Report Reference No. 19/02). Retrieved from http://www.dhsspsni.gov.uk/promoting_mental_health.pdf Department of Health, Social Services and Public Safety. (2011). Health survey Northern Ireland: First results from the 2010/2011 survey. Retrieved from http://www.dhsspsni.gov.uk/health_ survey_northern_ireland_-_first_results_from_the_2010–11_survey.pdf Downie, R.S., Tannahill, C., & Tannahill, A. (1996). Health promotion: Models and values. Oxford:Oxford Medical Publications. Fishbein, M. (2008). A reasoned action approach to health promotion. Medical Decision Making, 28(6), 834–844. doi:10.1177/0272989x08326092. Fisher, P., & Owen, J. (2008). Empowering interventions in health and social care: Recognition through ‘ecologies of practice’. Social Science and Medicine, 67, 2063–2071. doi:10.1016/j.socscimed.2008.09.035. Gentile, S., & Galbally, M. (2011). Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: A systematic review. Journal of Affective Disorders, 128(1–2),1–9. doi:10.1016/j.jad.2010.02.125. Goodman, J.H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth, 36(1), 60–69. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1523-536X Holzman, C., Eyster, J., Tiedje, L.B., Roman, L.A., Seagull, E., & Rahbar, M.H. (2006). A life course perspective on depressive symptoms in mid-pregnancy. Maternal and Child Health Journal, 10(2), 127–138. doi:10.1007/s10995-005-0044-0. Judd, F., Stafford, L., Gibson, P., & Ahrens, J. (2011). The early motherhood service: An acceptable and accessible perinatal mental health service. Australasian Psychiatry, 19(3), 240–246. doi:10.3109/10398562.2011.562294. 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. Laverack, G. (2005). Public health: Power, empowerment and professional practice. Hampshire:Palgrave Macmillan. Lee, A.M., Lam, S.K., Sze Mun Lau, S.M., Shin Yin Chong, C., Wai Chui, H., & Yee Tak Fong, D.(2007). Prevalence, course and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5), 1102–1112. doi:10.1097/01.AOG.0000287065.59491.70. Lewis, A.J., Galbally, M., Opie, G., & Buist, A. (2010). Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication. Australian and New Zealand Journal of Psychiatry, 44, 482–487. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1614 Loureiro, M.I., Goes, A.R., Da Camara, G.P., Goncalves-Pereira, M., Maia, T., & Nunes, L.S. (2009). Priorities for mental health promotion during pregnancy and infancy in primary health care. Global Health Promotion, 16(1), 29–38. doi:10.1177/1757975908100748. Marcus, S.M., & Flynn, H.A. (2008). Depression, antidepressant medication, and functioning outcomes among pregnant women. International Journal of Gynecology and Obstetrics, 100(3),248–251. doi:10.1016/ijgo.2007.09.016. McConnell, P., Bebbington, P., McClelland, R., Gillespie, K., & Houghton, S. (2002). Prevalence of psychiatric disorder and the need for psychiatric care in Northern Ireland: Population study in the District of Derry. The British Journal of Psychiatry, 181, 214–219. doi:10.1192/bjp.181.3.214. Mcdaid, S., & Delaney, S. (2011). A social approach to decision-making capacity: Exploratory research with people with experience of mental health treatment. Disability and Society, 26(6),729–742. doi:10.1080/09687599.2011.602864. Murphy, H., & Lloyd, K. (2007). 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year = "2013",
month = "3",
day = "25",
doi = "10.1080/14623730.2013.781872",
language = "English",
volume = "25 Mar",
journal = "International Journal of Mental Health Promotion",
issn = "1462-3730",

}

TY - JOUR

T1 - A qualitative study into how guidelines facilitate general practitioners to empower women to make decisions regarding antidepressant use in pregnancy

AU - McCauley, Claire-Odile

AU - Casson, Karen

N1 - Reference text: Adams, J.R., & Drake, R.E. (2006). Shared decision making and evidence-based practice. Community Mental Health Journal, 42(1), 87–105. doi:10.1007/s10597-005-9005-8. Anderson, R.M., & Funnell, M.A. (2010). Patient empowerment: Myths and misconceptions. Patient Education and Counseling, 79, 277–282. doi:10.1016/i.pec.2009.07.025. Aujoulat, I., d’Hoore, W., & Deccache, A. (2007). Patient empowerment in theory and practice: Polysemy or cacophony. Patient Education and Counseling, 66, 13–20. doi:10.1016/j.pec.2006.09.008. Avis, M. (2005). Is there an epistemology for qualitative research? In I. Holloway (Ed.), Qualitativeresearch in health care (pp. 3–15). Maidenhead: Open University Press. Bennett, I.M., Marcus, S.C., Palmer, S.C., & Coyne, J.C. (2010). Pregnancy-related discontinuationof antidepressants and depression care visits among Medicaid recipients. Psychiatric Services,61, 386–391. Retrieved from http://ps.psychiatryonline.org/journal.aspx?journalid=18 Bermejo, I., Schneider, F., Kriston, L., Gaebel, W., Hegrel, U., Berger, M., & Harter, M. (2009). Improving outpatient care of depression by implementing practice guidelines: A controlled clinical trial. International Journal for Quality in Health Care, 21(1), 29–36. doi:10.1093/intqhc/mzn050. Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010a). A qualitative study of health professionals involved in the care and treatment of woman with postnatal emotional distress. International Journal of Mental Health Promotion, 12(3), 5–13. Retrieved from http://www.ijmhp.co.uk/ Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010b). Women’s experience of postnatal depression-beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing,27(3), 44–54. Retrieved from http://www.ajan.com.au/ Bilszta, J.L., Tsuchiya, S., Han, K., Buist, A.E., & Einarson, A. (2011). Primary care physician’sattitudes and practices regarding antidepressant use during pregnancy: A survey of two countries. Archive of Women’s Mental Health, 14, 71–75. doi:10.1007/s00737-010-0197-8. Bonari, L., Koren, G., Einarson, T.R., Jasper, J.D., Taddio, A., & Einarson, A. (2005). Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counselling and determinants of decision making. Archives of Women’s Mental Health, 8,214–220. doi:10.1007/s00737-005-0094-8. Buist, A., Bilszta, J., Barnett, B., Milgrom, J., Ericksen, J., Condon, J., . . . , & Brooks, J. (2005). Recognition and management of perinatal depression in general practice. Australian Family Practice, 34(9), 787–790. Retrieved from http://www.racgp.org.au/afpbackissues/2005/200509/200509buist.pdf Buist, A., Bilszta, J., Milgrom, J., Barnett, B., Hayes, B., & Austin, M.P. (2006). Health professional’s knowledge and awareness of perinatal depression: Results of a national survey. Women and Birth, 19, 11–16. doi:10.1016/j.womi.2005.12.001. Clever, S.L., Ford, D.E., Rubenstein, L.V., Rost, K.M., Meredith, L.S., Sherbourne, C.D., . . ., & Cooper, L.A. (2006). Primary care patients’ involvement in decision-making is associated with improvement in depression. Medical Care, 44(5), 398–405. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx Cohen, L.S., Nonacs, R.M., & Bailey, J.W. (2004). Relapse of depression during pregnancy following antidepressant discontinuation: A preliminary prospective study. Archive Women’s Mental Health, 7, 217–221. doi:10.1007/s00737-004-0059-3. Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. Vale and M. King, (eds). Existential phenomenological alternatives for psychology (48–71) New York: Oxford University Press. Department of Health, Social Services and Public Safety (2003). Investing for health: Promoting mental health strategy and action plan 2003–2008, (Report Reference No. 19/02). Retrieved from http://www.dhsspsni.gov.uk/promoting_mental_health.pdf Department of Health, Social Services and Public Safety. (2011). Health survey Northern Ireland: First results from the 2010/2011 survey. Retrieved from http://www.dhsspsni.gov.uk/health_ survey_northern_ireland_-_first_results_from_the_2010–11_survey.pdf Downie, R.S., Tannahill, C., & Tannahill, A. (1996). Health promotion: Models and values. Oxford:Oxford Medical Publications. Fishbein, M. (2008). A reasoned action approach to health promotion. Medical Decision Making, 28(6), 834–844. doi:10.1177/0272989x08326092. Fisher, P., & Owen, J. (2008). Empowering interventions in health and social care: Recognition through ‘ecologies of practice’. Social Science and Medicine, 67, 2063–2071. doi:10.1016/j.socscimed.2008.09.035. Gentile, S., & Galbally, M. (2011). Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: A systematic review. Journal of Affective Disorders, 128(1–2),1–9. doi:10.1016/j.jad.2010.02.125. Goodman, J.H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth, 36(1), 60–69. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1523-536X Holzman, C., Eyster, J., Tiedje, L.B., Roman, L.A., Seagull, E., & Rahbar, M.H. (2006). A life course perspective on depressive symptoms in mid-pregnancy. Maternal and Child Health Journal, 10(2), 127–138. doi:10.1007/s10995-005-0044-0. Judd, F., Stafford, L., Gibson, P., & Ahrens, J. (2011). The early motherhood service: An acceptable and accessible perinatal mental health service. Australasian Psychiatry, 19(3), 240–246. doi:10.3109/10398562.2011.562294. 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. Laverack, G. (2005). Public health: Power, empowerment and professional practice. Hampshire:Palgrave Macmillan. Lee, A.M., Lam, S.K., Sze Mun Lau, S.M., Shin Yin Chong, C., Wai Chui, H., & Yee Tak Fong, D.(2007). Prevalence, course and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5), 1102–1112. doi:10.1097/01.AOG.0000287065.59491.70. Lewis, A.J., Galbally, M., Opie, G., & Buist, A. (2010). Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication. Australian and New Zealand Journal of Psychiatry, 44, 482–487. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1614 Loureiro, M.I., Goes, A.R., Da Camara, G.P., Goncalves-Pereira, M., Maia, T., & Nunes, L.S. (2009). Priorities for mental health promotion during pregnancy and infancy in primary health care. Global Health Promotion, 16(1), 29–38. doi:10.1177/1757975908100748. Marcus, S.M., & Flynn, H.A. (2008). Depression, antidepressant medication, and functioning outcomes among pregnant women. International Journal of Gynecology and Obstetrics, 100(3),248–251. doi:10.1016/ijgo.2007.09.016. McConnell, P., Bebbington, P., McClelland, R., Gillespie, K., & Houghton, S. (2002). Prevalence of psychiatric disorder and the need for psychiatric care in Northern Ireland: Population study in the District of Derry. The British Journal of Psychiatry, 181, 214–219. doi:10.1192/bjp.181.3.214. Mcdaid, S., & Delaney, S. (2011). A social approach to decision-making capacity: Exploratory research with people with experience of mental health treatment. Disability and Society, 26(6),729–742. doi:10.1080/09687599.2011.602864. Murphy, H., & Lloyd, K. (2007). 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PY - 2013/3/25

Y1 - 2013/3/25

N2 - 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.

AB - 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.

KW - perinatal depression

KW - guidelines

KW - general practitioners

KW - empowerment

KW - qualitative

U2 - 10.1080/14623730.2013.781872

DO - 10.1080/14623730.2013.781872

M3 - Article

VL - 25 Mar

JO - International Journal of Mental Health Promotion

T2 - International Journal of Mental Health Promotion

JF - International Journal of Mental Health Promotion

SN - 1462-3730

ER -