GPs' and health visitors' views on the diagnosis and management of postnatal depression: a qualitative study
GPs' and health visitors' views on the diagnosis and management of postnatal depression: a qualitative study
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DOI：
10.3399/bjgp08x277212
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发表时间：
2008-03-01
影响因子：
5.9
通讯作者：
Sharp, Deborah
中科院分区：
文献类型：
--
作者：
Chew-Graham, Carolyn;Chamberlain, Elizabeth;Sharp, Deborah
背景在英国，8-15% 的女性患有产后抑郁症，对母亲情绪和儿童发育产生长期影响。先前的文献表明，健康访问者在母亲和婴儿的角色冲突中挣扎。目前的政策正在重新调整健康访客工作的重点和组织，但指南指出，健康访客和全科医生应继续在产后抑郁症的检测和管理中发挥主要作用。目的是探讨全科医生和健康访客对产后抑郁症的诊断和管理的看法。研究设计一项嵌套在多中心随机对照试验中的定性研究。在布里斯托尔、曼彻斯特和伦敦设置九个初级保健信托基金。方法对来自初级保健信托基金的全科医生和健康访客进行深入访谈参加抗抑郁药与健康访客提供的非指导性咨询的随机对照试验。采访被录音并完全转录。使用迭代方法进行主题分析，从记录中开发概念类别。结果对 19 名全科医生和 14 名健康访客进行了访谈。全科医生和健康访问者描述了他们在产后抑郁症诊断和协商方面的工作、与妇女长期关系的价值，以及标签如何影响产后抑郁症妇女的管理。受访者描述了他们如何看待其他人在产后抑郁症管理中的角色，以及国家政策和地方组织变革如何对患者护理产生影响，因此没有一名卫生专业人员全面负责护理患有产后抑郁症的妇女。结论初级保健内正在进行的组织变革，例如健康访客实施共同工作，影响了为妇女提供的产后护理，进而影响了产后抑郁症的诊断和管理。
BackgroundIn the UK, 8-15% of women suffer from postnatal depression, with long-term consequences for maternal mood and child development. Previous literature suggests that health visitors struggle with their conflicting roles with respect to mother and infant. Current policy is redirecting the emphasis and organisation of health visitor work, but guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression.AimTo explore the views of GPs and health visitors on the diagnosis and management of postnatal depression.Design of studyA qualitative study nested within a multicentre randomised controlled trial.SettingNine primary care trusts in Bristol, Manchester, and London.MethodIn-depth interviews with GPs and health visitors from primary care trusts participating in a randomised controlled trial of antidepressants versus health visitor-delivered non-directive counselling. Interviews were audiotaped and fully transcribed. Thematic analysis with an iterative approach was used to develop conceptual categories from the transcripts.ResultsNineteen GPs and 14 health visitors were interviewed. GPs and health visitors described their work in making and negotiating the diagnosis of postnatal depression, the value of a long-term relationship with the woman, and how labelling affects management of women with postnatal depression. Responders described how they viewed others' roles in the management of postnatal depression, and how national policy and local organisational changes had an impact on patient care, so that no one health professional was assuming overall responsibility for the care of women with postnatal depression.ConclusionOngoing organisational changes within primary care, such as the implementation of corporate working by health visitors, affect care provided to women after birth, which in turn has an impact on the diagnosis and management of postnatal depression.