Barriers and facilitators of mental health screening in pregnancy

Dawn Kingston; Marie-Paule Austin; Maureen Heaman; Sheila McDonald; Gerri Lasiuk; Wendy Sword; Rebecca Giallo; Kathy Hegadoren; Lydia Vermeyden; Sander Veldhuyzen van Zanten; Joshua Kingston; Karly Jarema; Anne Biringer

doi:10.1016/j.jad.2015.06.029

Barriers and facilitators of mental health screening in pregnancy

J Affect Disord. 2015 Nov 1:186:350-7. doi: 10.1016/j.jad.2015.06.029. Epub 2015 Jul 29.

Authors

Affiliations

¹ University of Alberta, Edmonton, Alberta, Canada. Electronic address: dawn.kingston@ualberta.ca.
² FRANZCP, University of New South Wales, New South Wales, Australia.
³ University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ University of Calgary, Calgary, Alberta, Canada.
⁵ University of Alberta, Edmonton, Alberta, Canada.
⁶ University of Ottawa, Ottawa, Ontario, Canada.
⁷ Murdoch Children's Research Institute, Parkville, Australia.
⁸ MacEwan University, Edmonton, Alberta, Canada.
⁹ University of Toronto, Toronto, Ontario, Canada.

PMID: 26281038
DOI: 10.1016/j.jad.2015.06.029

Abstract

Background: Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening. However, few studies to date have identified barriers and facilitators that affect pregnant women's responses to mental health screening. The objective was to identify barriers and facilitators that influence pregnant women's responses to the screening process and factors associated with their identification.

Methods: This multi-site, cross-sectional survey recruited pregnant women >16 years of age who spoke/read English in Alberta, Canada. Main outcomes were barriers and facilitators of mental health screening. Descriptive statistics were generated to identify the most common barriers and facilitators and multivariable logistic regression models were conducted to determine factors associated with barriers and facilitators.

Results: Study participation rate was 92% (460/500). Women's most common barriers were: significant others normalizing their emotional difficulties; desiring to handle mental health problems on their own; preferring to discuss feelings with significant others; and not knowing what emotions were 'normal'. Women who identified these barriers were more likely not to have been treated previously for mental illness, were primiparous, and could not be completely honest with their provider. Main facilitators were provider characteristics (sensitive, interested), reassurance that mental healthcare is a part of routine prenatal care, hearing that other women have emotional problems during pregnancy and knowing that help was available.

Limitations: The sample comprised largely Caucasian, well-educated, and partnered women, which limits generalizability of the findings.

Conclusions: Personal and stigma-related barriers influence pregnant women's responses to mental health screening. Efforts to minimize barriers and enhance facilitators should be explored as potential strategies for optimizing prenatal mental health screening.

Keywords: Antenatal anxiety; Antenatal depression; Mental health; Pregnancy; Screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alberta
Cross-Sectional Studies
Female
Health Knowledge, Attitudes, Practice*
Humans
Mass Screening / psychology*
Mental Disorders / diagnosis*
Mental Disorders / psychology
Mental Health Services
Pregnancy
Pregnancy Complications / diagnosis
Pregnancy Complications / psychology*
Prenatal Care / methods
Prenatal Care / psychology*
Young Adult