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Table 7 Summary of synthesis

From: Family physicians perceived role in perinatal mental health: an integrative review

Theme Findings Limitations of current evidence Recommendations
 1. Identification of PMHPsa A lack of consistent approach to screening for perinatal depression and anxiety evident.
Limited use of validated screening tools to aid identification of women experiencing psychological distress.
None of the included studies specifically explored FPsb approach to identifying perinatal psychological distress in primary practice.
Studies predominantly examined and explored identification of PPDc.
Universal screening for perinatal depression and anxiety using short validated screening tools to be considered for primary care.
Explore perinatal mental wellbeing at all antenatal and postnatal interactions with women and their partners.
Training opportunities are required to prepare FPsb to incorporate validated screening tools into primary practice.
Further research to explore current screening practices including the specific cues and observations that alert FPsb to the possibility of PMHPsa.
 2. Management of PMHPsa in Primary care Pharmacological management of PMHPsa was identified as the main treatment modality offered to women in primary care. The review identified studies which predominantly focused on pharmacological management and made limited reference to non-pharmacological management of PMHPsa. FPsb require support with perinatal pharmacological treatment decisions for women experiencing PMHPsa.
FPsb require access to a variety of PMHd specific treatment interventions including both pharmacological and non-pharmacological options.
Further research is required to identify the non-pharmacological options available to and required by FPsb.
Barriers to service provision
 3a. Service user A reluctance of women particularly from minority ethnic and diverse cultural backgrounds to ask for help because of the perceived stigma associated with PMHPsa. Only one study explored FPsb encounters with Black and minority ethnic women experiencing PMHd care. National campaigns are required to increase awareness of the spectrum of PMHPsa and encourage women and their families to seek support.
Stigma at an individual, public and service level needs to be addressed through awareness and availability of resources and supports.
Further research to explore FPsa encounters with women from diverse ethnic and minority groups to identify support mechanisms required by FPsb.
 3b. Physician level A lack of knowledge and skills were reported as barriers to screening and treatment of PMHPs by FPsa. Only one study evaluated the training and education needs of FPsa in relation to PMHd. An exploration of FPsb training and education needs in relation to PMHd would ensure that education strategies and professional development opportunities are appropriately contextualised to the needs of FPsb.
 3c. System level A lack of available and timely access to resources, clearly defined care pathways and specialist PMHd services. Included studies did not examine the PMHd referral support needs of FPsb. FPsb require timely access to a range of culturally sensitive and PMHd specific services.
A family approach to PMHd care has to be considered to support the woman and family as a whole.
  1. a PMHPs perinatal mental health problems
  2. b FP Family Physician
  3. c PPD Postpartum Depression
  4. d PMH perinatal mental health