Delivery of care in perinatal mental health: A systematic review and meta-analysis of psychological interventions for perinatal anxiety and a qualitative exploration of healthcare professionals’ experiences of working with women experiencing perinatal mental health difficulties

Background: Perinatal mental health (PMH) is a significant global public health concern. Up to 20% of women will experience mental health difficulties during the perinatal period (conception to one-year post childbirth; Jones et al., 2014). Perinatal mental health difficulties (PMHDs) can have a significant and detrimental impact on women, their infants and families (Silverwood et al., 2019). Improving service provision and care pathways for PMH is regarded as a public health priority for both the UK and Scottish Governments. This thesis aims to extend the current evidence base by providing a systematic review and meta-analysis of the psychological treatments for perinatal anxiety and by qualitatively exploring the personal experiences of healthcare professionals working with women experiencing PMHDs in non-specialist settings. Method: The review involved conducting a systematic search of relevant online databases to identify appropriate articles which were then selected by utilising pre-set inclusion and exclusion criteria. This process led to the identification of 16 articles, 12 of which were included in the meta-analysis. The methodological quality and risk of bias of each included study were independently evaluated by two reviewers using the revised Cochrane risk-of-bias tool for randomised trials. The qualitative empirical study involved conducting in-depth, semi-structured interviews with 13 community-based healthcare professionals. These interviews were digitally recorded and transcribed verbatim. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: The meta-analysis found that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety, with a medium post treatment effect size. The results also indicated support for the use of group-based and self-guided interventions, and both face to face and online delivery methods. In addition, small but significant effect sizes were found for both Cognitive Behavioural Therapy (CBT) and Mindfulness Based Interventions (MBIs) in the treatment of perinatal anxiety. In the qualitative study, a number of superordinate and subordinate themes emerged from the analysis of the interview transcripts. The five superordinate themes were: navigating a complex system, two lives to care for, “working at the coalface”, “it’s okay to talk about it” and needs led interventions. Conclusions: From the results of the review, it is suggested that psychological interventions should be made more readily available for women experiencing anxiety during pregnancy and in the postnatal period. Both CBT and MBIs demonstrated effectiveness, as did group-based, self-guided, online and face to face interventions, suggesting that therapeutic modality, type of intervention and mode of delivery could be tailored to meet the individual and perinatal-specific needs of each woman. The results of the empirical study suggest that the delivery of care to women experiencing PMHDs is common across a number of professions and services. Whilst this is a common occurrence, participants indicated that the difficulties women experience are often complex and multifaceted, and practitioners often feel that they have not received sufficient training to confidently address concerns and deliver care. In addition, the findings suggested that there were a number of service and organisational barriers that impacted on their ability to deliver an optimal integrated and multi-disciplinary approach