Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study.
Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study.
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DOI：
10.1016/j.genhosppsych.2009.07.005
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发表时间：
2010-01
影响因子：
7
通讯作者：
Forman J
中科院分区：
文献类型：
--
作者：
Flynn HA;Henshaw E;O'Mahen H;Forman J
虽然在产科设置抑郁症筛查已被推荐，很少有研究存在指导策略的筛查，随访和抑郁症转诊。本定性研究的目的是根据一组关键女性样本对抑郁症治疗使用和参与的影响的反馈，为产科的抑郁症筛查、随访和转诊提供建议。基于怀孕、社会经济地位和抑郁严重程度的分层有目的抽样被用来确定23名妇女，她们完成了半结构化的访谈，主要是关于在产科护理的背景下，什么可以预防或促进进入抑郁症治疗。我们通过专家文本审查、创建和改进代码以及确定主题的迭代过程进行了主题分析。影响抑郁症治疗使用的两大主题包括实际和心理因素。在实际因素中，妇女报告强烈倾向于在产科诊所或在家中提供治疗，希望有一个积极的转诊过程和接受治疗的灵活选择。心理因素包括对抑郁症的不同概念，对严重程度和治疗的了解，以及耻辱感问题。这项研究表明，目前标准的抑郁症筛查和转诊到专业治疗的做法不符合我们的围产期妇女样本中对治疗使用的感知影响。从结果得出的建议，以改善随访筛查和抑郁症转诊在产科设置提供了一个平台，为进一步的研究。
Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement. A stratified purposeful sampling based on pregnancy, socioeconomic status, and depression severity was used to identify 23 women who completed semi-structured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes, and identifying themes. Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment, and issues of stigma. This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.
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