Collaboration with Brighton and Sussex Medical School, City University London, King's College London, Royal College of General Practioners, St George's, University of London and University of York.
Background: Perinatal mental health problems affect up to one in five women, and the cost to the UK is estimated as £8.1 billion for every one-year cohort of births. Perinatal mental illness can have adverse effects on women, their infants and families. It is therefore important to identify and treat perinatal mental health problems quickly, yet it is estimated that half of women do not come to the attention of healthcare services and still fewer receive treatment.
Aim: The aim of this evidence synthesis is to identify the barriers and facilitators to perinatal mental health assessment and treatment at individual, relational (e.g. woman-healthcare professional), organisational and systemic levels; and determine how these can be used to inform and improve perinatal mental healthcare services.
Methods: This evidence synthesis will be conducted in three phases. Phase 1 will determine the barriers and facilitators to implementing perinatal mental health assessment and treatment in different NHS contexts. This will be achieved through a focused systematic review following PRISMA guidelines.
Phase 2 will identify factors that prevent women accessing treatment. This will be done through a meta-review of reviews. It will also enable us to evaluate the quality of the current evidence, map the geographical distribution of the evidence, and make recommendations for NHS practice and research based on these findings.
Phase 3 will map the findings from phases 1 and 2 onto a conceptual framework developed by the research team and Royal College of General Practitioners. Phase 3 will be done in three stages. Firstly, overall concepts and themes from the literature will be identified from Phases 1 and 2. Secondly, reviews will be grouped at different levels (i.e. individual, interpersonal, organisational, social) and a detailed thematic analysis carried out to identify both existing and missed themes. Thirdly, the conceptual framework will be refined based on the themes and an expert stakeholder panel will assess its validity. The framework will then be revised based on their feedback. Recommendations to improve the chances of women being identified and accessing treatment will be formulated by the research team and expert stakeholder panel.
Anticipated impact: This evidence synthesis was developed through our partnerships with women who have experience of perinatal mental illness, health professionals and service managers. They identified this as a priority and will work with us through the project to ensure its relevance to women, their partners and families and the NHS. The anticipated impact is four-fold: (i) the evidence synthesis will provide recommendations to improve identification and access to perinatal mental health care; (ii) improving access should reduce the morbidity and mortality associated with unidentified and untreated, or inappropriately treated, perinatal mental health problems; (iii) implementing recommendations from the evidence synthesis has the potential to improve service users’ experience; and (iv) new knowledge will be generated in terms of a conceptual framework which will identify the multifactorial reasons why women do not access perinatal mental healthcare and/or receive appropriate assessment or treatment