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Review
. 2023 Jul 20;13(7):e066703.
doi: 10.1136/bmjopen-2022-066703.

Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

Rebecca Webb  1 , Nazihah Uddin  2 , Georgina Constantinou  2 , Elizabeth Ford  3 , Abigail Easter  4   5 , Judy Shakespeare  6 , Agnes Hann  7 , Nia Roberts  8 , Fiona Alderdice  9 , Andrea Sinesi  10 , Rose Coates  2 , Sally Hogg  11 , Susan Ayers  2 ; MATRIx Study Team
Collaborators, Affiliations
Review

Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

Rebecca Webb et al. BMJ Open. .

Abstract

Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.

Objectives: To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.

Design: A meta-review of systematic reviews.

Review methods: Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating.

Results: A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators.

Conclusion: The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals.

Prospero registration number: CRD42019142854.

Keywords: anxiety disorders; depression & mood disorders; health policy; psychiatry.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram. From Moher et al. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta Analyses.
Figure 2
Figure 2
The MATRIx multilevel model of barriers and facilitators to women accessing PMH care. PMH, perinatal mental health.
Figure 3
Figure 3
Barriers and facilitators mapped onto the MATRIx care pathway. Note: Some parts of the pathway are redundant in healthcare systems where the woman can contact mental health services directly (eg, France or via Improving Access to Psychological Therapies services in the UK). Further, the process is not always linear women might jump over certain stages.
See this image and copyright information in PMC

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