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

Background: Responding to and caring for women who experience mental health problems during the perinatalperiod, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Familyphysicians are ideally placed to provide an effective response as it is recognised that they are responsible fororganising care and supports for women and their families. This paper reports an integrative review undertaken toexamine family physicians’ perceived role in perinatal mental health care and concludes with recommendations forhealth policy, research and practice.Method: A systematic search of literature in seven databases from January 2000 to March 2016 identified a total of1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored familyphysicians’ experiences of caring for women who experience perinatal mental health problems.Results: Thirteen articles reporting 11 studies met the inclusion criteria for this review and quality of includedstudies were assessed using published criteria for the critical appraisal of qualitative and quantitative researchmethods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes:identification of perinatal mental health problems, management of perinatal mental health problems and barriers tocare provision. While family physicians recognise their role in relation to perinatal mental health the collectiveinterpretation revealed that; they receive variable levels of preparation for this role, no consistent approach toscreening exists, pharmacological management of mood disorders is the main treatment modality and limitedaccess to specialist perinatal mental health services exists which impacts on pharmacology decisions.Conclusion: Family physicians require timely access to local integrated care pathways that provide a wide range ofservices that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primarypractice supported by succinct guidelines. Research that examines training needs in relation to perinatal mentalhealth could be used to inform family physician training programmes and curriculum development aroundperinatal mental health.Keywords: Integrative review, Family physician, General practitioner, Perinatal mental health, Postpartumdepression, Screening, Referral pathways, Integrated service