The case for mental health support at a primary care level

Management of depression during the perinatal period: state of the evidence

BACKGROUND

Perinatal depression (PND) is a prevalent ailment that affects both the woman and her family. Addressing PND in primary health care, such as pediatrics and obstetric care settings, has been proposed as an effective way to identify and treat women.

OBJECTIVE

The purpose of this study is to examine best practices for management of PND in obstetric and pediatric settings, as well as investigate the evidence that supports the guidelines.

METHODS

Guidelines were identified through a literature search and discussion with experts in the field of perinatal depression, while evidence was examined through a literature search of reviews and thereafter experimental studies.

RESULTS

Twenty-five guidelines, across 17 organizations were retained for analysis. Findings suggest that there is little or varied guidance on the management of PND, as well as a lack of specificity. Treatment was the topic most frequently reported, followed by screening. However best practices vary greatly and often contradict one another. Across all areas, there is inadequate or contrasting evidence to support these guidelines.

CONCLUSIONS

Although there was consensus on the key steps in the pathway to care, the review revealed lack of consensus across guidelines on specific issues relating to identification and management of depression during the perinatal period. Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.

Perceptions about mental illness among general practitioners

Background

General practitioners (GPs) play an important role in the physical care of patients with severe mental illness, so our aim was to analyse the relationships between GPs' sociodemographic status and worked-related variables and their perceptions about mental illness.

Methods

A descriptive, cross-sectional study was conducted in the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population comprised all GPs working in the 13 primary care centres (PCCs) in the hospital's catchment area during the study period. GPs were interviewed to collect data on their attitudes to and knowledge of mental illness, psychiatry and the local mental health team, as well as their sociodemographic status, professional qualifications and experience. Bivariate analysis was carried out.

Results

145 GPs answered the questionnaire (77%). ANOVA revealed that most of the PCCs with the best relationship with their mental health team and best attitude to mental illness were in the Central Community Mental Health Unit, which operated a collaborative model of care.

Conclusions

These results indicated that GPs who worked more closely with their specialist mental health team had a better perception of their relationship with the mental health centre and less stigmatisation in regard to mental illness.