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 best practice model for perinatal depression care. Psychiatric Services, 60, 1429–1431. Retrieved from http://ps.psychiatryonline.org/journal.aspx?journalid = 18], which has been 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 and accessible perinatal mental health service. Australasian Psychiatry, 19, 240–246. doi:10.3109/10398562.2011.562294]. The lack of clarity surrounding safety information has impacted treatment decisions with general practitioners (GPs) reportedly feeling hesitant to prescribe antidepressants [Bilszta, J.L., Tsuchiya, S., Han, K., Buist, A.E., & Einarson, A. (2011). Primary care physicians attitudes 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], yet the usage of perinatal depression 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 the opinions of GPs on how clinical guidelines for perinatal depression facilitated them to empower pregnant women to make an informed decision about the use of antidepressants in pregnancy. Using qualitative methodology, semi-structured interviews were conducted with one GP from eight practices in Derry City, Northern Ireland. The main areas explored in the interview schedule were guidelines on perinatal depression, GP understanding of ‘patient empowerment’, GP practice policy on patient decision making, constraints of treatment decisions and a discussion on which health promotion model was most reflective of their views on the provision of healthcare. Only some of the GPs were aware of the National Institute National Institute for Health and Clinical Excellence Clinical Excellence [NICE (2007). Antenatal and postnatal mental health: Clinical management and service guidance (Clinical Guideline No. CG45). Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf] perinatal depression guidelines but acknowledged that they were generic and lacked utility, instead they relied on their own professional experience and patient knowledge to make decisions. Involving patients in treatment decision making was viewed as central to patient empowerment; however, its application in routine practice was often limited by complex clinical scenarios. Findings from this study suggested an identified need for a local specialist perinatal service to provide evidence-based information and timely support. An empowerment 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

Acknowledgements

The authors would like to thank all the GPs who participated in this study for sharing their opinions and perspectives with us and the practice managers for their assistance in arranging suitable participants and scheduling interviews.