Inequalities in the identification and management of common mental disorders in the perinatal period: An equity focused re-analysis of a systematic review.
Inequalities in the identification and management of common mental disorders in the perinatal period: An equity focused re-analysis of a systematic review.
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DOI：
10.1371/journal.pone.0248631
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Blower SL
中科院分区：
文献类型：
--
作者：
Prady SL;Endacott C;Dickerson J;Bywater TJ;Blower SL
产妇在围产期的心理健康问题可能会导致严重的痛苦和功能丧失，并可能对儿童产生持久的影响。生活在不利地位的人面临着健康不平等的风险，包括围产期心理健康方面的不平等。对现行指南的审查发现，联合王国检测和管理战略的总体实施情况令人满意，但审查中没有考虑公平性。需要更好地理解执行的公平性。我们的目的是重新分析现有的系统性审查的实施目前的指导，以确定和管理围产期心理健康问题的公平性。研究报告的存在或不存在的变化，由社会，经济或人口群体进行质量评估和差异的存在和方向提出。我们计算了标准化的绝对患病率估计的总体检测和管理，绝对和相对估计的决定因素分组。对研究造成差异的潜在原因的研究进行了专题分析。六项研究，没有重大的质量问题，提供了一致的证据，减少识别和管理的少数民族妇女，无论是谁做的，不讲英语。在社会差距的其他方面以及在年龄、均等和伙伴关系状况等特征方面，不平等的证据不那么一致。解释集中在翻译和口译增加沟通的困难，以及与医疗保健提供者对精神健康问题的文化理解的不确定性有关的犹豫。对少数民族妇女来说，确定和处理围产期心理健康问题可能是不公平的。进一步的系统研究应侧重于澄清其他妇女群体是否有遭受不平等待遇的风险，了解观念上的不匹配是如何产生的，并设计有效的补救战略。在审查支持服务规划和政策决策的证据时，应考虑到不平等问题。
Maternal mental health problems in the perinatal period can cause significant distress and loss of functioning, and can have lasting impact on children. People living in disadvantage are at risk of health inequalities, including for perinatal mental health. A review of current guidance found that overall implementation of the UK detection and management strategy was satisfactory, but equity was not considered in the review. Greater understanding of implementation equity is needed. We aimed to reanalyse an existing systematic review on the implementation of current guidance for the identification and management of perinatal mental health problems for equity. Studies reporting the presence or absence of variation by a social, economic or demographic group were quality appraised and the presence and direction of disparity tabled. We calculated standardised absolute prevalence estimates for overall detection and management, and absolute and relative estimates by determinants grouping. A thematic analysis of the studies that examined potential reasons for disparity was undertaken. Six studies, with no major quality concerns, provided consistent evidence of reduced identification and management for ethnic minority women, both those who do, and do not, speak English. There was less consistent evidence of inequality for other axes of social disparity and for characteristics such as age, parity and partnership status. Explanations centred on difficulties that translation and interpretation added to communication, and hesitancy related to uncertainty from healthcare providers over cultural understanding of mental health problems. The identification and management of perinatal mental health problems is likely to be inequitable for ethnic minority women. Further systems-based research should focus on clarifying whether other groups of women are at risk for inequalities, understand how mismatches in perception are generated, and design effective strategies for remediation. Inequalities should be considered when reviewing evidence that underpins service planning and policy decision-making.
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影响因子：
6.6
作者：
Cooper, Claudia;Bebbington, Paul;Livingston, Gill
通讯作者：
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影响因子：
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DOI：
10.1017/s1742058x11000130
发表时间：
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期刊：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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