"It's Harder to Chase Pain Than It Is to Prevent It": Perinatal Individual and Care Professional Attitudes Towards Preventing Perinatal Mood and Anxiety Disorders in Obstetric Settings.

Abstract

Purpose: Depression and anxiety disorders are prevalent in the perinatal period and disproportionately impact individuals who experience economic marginalization. <15% of at-risk individuals are referred for recommended preventative counseling interventions. Little is known about the attitudes of care professionals and perinatal individuals towards prevention. This study's objective was to elicit attitudes of perinatal care professionals and individuals with lived experience of perinatal depression and anxiety who have been marginalized due to their economic status towards prevention interventions for perinatal mood and anxiety disorders in routine perinatal care settings.

Methods: We conducted semi-structured qualitative interviews with economically marginalized individuals with lived experience of perinatal anxiety or depression (n = 12) and perinatal care professionals (n = 12). We used a thematic analysis approach for data analysis.

Results: Participants endorsed generally positive attitudes towards prevention. Both individuals and professionals identified gaps in current practices and expressed interest in prevention because they felt that it could improve outcomes. Both groups described skepticism that prevention is possible. Perinatal individuals also described concerns about professional capacity, stigma, and medical mistrust while professionals had concerns about potential for harm and resource limitations. Participants emphasized the importance of professional-patient relationships and multidisciplinary teams in effective delivery of prevention care.

Conclusions: Current approaches to prevention of mood and anxiety disorders in the perinatal period are lacking. Integration of prevention into routine obstetric care is of interest to perinatal individuals and professionals as a strategy to improve outcomes and reduce care inequities. Improving education and awareness of prevention interventions may reduce skepticism towards these interventions. Steps to build communication and trust between patients and professionals are needed to improve comfort and engagement with prevention interventions.