Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies

Br J Gen Pract. 2017 Aug;67(661):e538-e546. doi: 10.3399/bjgp17X691889. Epub 2017 Jul 17.


Background: Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs.

Aim: This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression.

Design and setting: Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression.

Method: A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography.

Results: Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues.

Conclusion: GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients.

Keywords: anxiety; depression; diagnosis; disease management; perinatal.

Publication types

  • Review

MeSH terms

  • Antidepressive Agents
  • Anxiety / diagnosis*
  • Anxiety / etiology
  • Anxiety / therapy*
  • Depression / diagnosis*
  • Depression / etiology
  • Depression / therapy*
  • Female
  • General Practice*
  • Health Services Accessibility
  • Humans
  • Infant, Newborn
  • Perinatal Care*
  • Physician-Patient Relations
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / psychology
  • Pregnancy Complications / therapy*
  • Qualitative Research
  • United Kingdom


  • Antidepressive Agents