Barriers to accessing mental health services for postnatal depression in the UK: a literature review
reportposted on 16.01.2012, 10:34 by Sheila Bonas, Elizabeth Ockleford
Postnatal depression (PND) is believed to affect 10-15% of mothers in the early months after birth (Cooper et al., 1988; O’Hara & Swain, 1996, Leverton & Elliott, 2000). It has a negative effect on the quality of life for these women, is also associated with high levels of depression in fathers (Ballard, 1996) and impacts on the cognitive and social development of children (Cooper & Murray, 1995; Murray & Cooper, 1997; Martins & Gaffan, 2000). Many of those affected by PND may not be receiving appropriate care: the NHS Direct webpage reports: “A study carried out into postnatal depression showed that only 1 in 4 women sought any help” (NHS Direct Online Health Encyclopaedia). This review aims to provide a critical interpretive synthesis (CIS) of the evidence concerning barriers to access to mental health services for PND in the UK. The research data on this topic are varied and include evaluations of interventions, quantitative surveys that tap the views of patients and health professionals, and qualitative interviews accessing the experiences of women with PND and of health professionals. Methods for reviewing and synthesising such diverse forms of evidence have been the topic for much recent debate. CIS has been demonstrated to provide a useful framework that draws upon qualitative methodology to analyse diverse evidence, generate categories and consider the links between them in order to develop new explanatory theory (Dixon-Woods et al. 2006). CIS does not exclude papers on the basis of any hierarchy of evidence or quality checklist. Dixon-Woods et al., (2006) argue that this is not desirable for several reasons: there is no ‘hierarchy of evidence’ for qualitative data and no consensus on how to appraise papers for inclusion in reviews; quality check lists can exclude papers that may make a substantial theoretical contribution on the basis of ‘surface mistakes’ (Dixon-Woods et al., in press; Sandelowski, 1997). Instead, CIS is inclusive in order to ensure that any papers that may make valuable contributions are not excluded and involves criticism, at all stages of analysis and synthesis, throughout the process. This requires a recursive and reflexive approach. This review focuses on UK evidence because it aims to inform policy making and practice within a NHS, UK context. Whilst research in other countries may inform theories concerning what influences women’s access to mental health services for PND, there are likely to be differences arising from the variations in service delivery and cultural and social contexts between countries. It is therefore considered preferable to review each country independently before attempting to achieve a broader synthesis.