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Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK
  1. Megan Sambrook Smith1,
  2. Vanessa Lawrence2,
  3. Euan Sadler3,
  4. Abigail Easter3
  1. 1 Global Mental Health, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
  2. 2 Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  3. 3 Centre for Implementation Science, Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
  1. Correspondence to Dr Abigail Easter; abigail.easter{at}kcl.ac.uk

Abstract

Objective Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. This review examines women, their family members’ and healthcare providers’ perspectives of barriers to accessing mental health services for women with perinatal mental illness in the UK.

Design A systematic review and meta-synthesis of qualitative studies.

Data sources Qualitative studies, published between January 2007 and September 2018, were identified in MEDLINE, PsycINFO, EMBASE and CINAHL electronic databases, handsearching of reference lists and citation tracking of included studies. Papers eligible for inclusion were conducted in the UK, used qualitative methods and were focused on women, family or healthcare providers working with/or at risk of perinatal mental health conditions. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies.

Results Of 9882 papers identified, 35 studies met the inclusion criteria. Reporting of emergent themes was informed by an existing multilevel conceptual model. Barriers to accessing mental health services for women with perinatal mental illness were identified at four levels: Individual (eg, stigma, poor awareness), organisational (eg, resource inadequacies, service fragmentation), sociocultural (eg, language/cultural barriers) and structural (eg, unclear policy) levels.

Conclusions Complex, interlinking, multilevel barriers to accessing mental health services for women with perinatal mental illness exist. To improve access to mental healthcare for women with perinatal mental illness multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway.

PROSPERO registration number CRD42017060389.

  • barriers
  • systematic review
  • mental health
  • pregnancy
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors AE was responsible for the original conception and design of the work, with significant contributions from MSS, ES and VL. MSS was primarily responsible for conducting the review and data analysis, with quality appraisal checks on a sample of studies conducted by AE and ES. All authors made significant contributions to interpretation of the study findings. MSS produced the initial manuscript draft and further redrafts were critically revised and approved by all authors.

  • Funding AE and ES are funded through individual King’s Improvement Science Fellowship awards. King’s Improvement Science is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King’s College London. Its work is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This study is a systematic review— all data included within the present study have been previously published and in the public domain.

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