Perinatal care professional perspectives of screening for perinatal mood and anxiety disorders: a qualitative analysis

Aims: The goal of this study was to understand perinatal care professionals’ perceptions of perinatal mental health screening and determinants of equitable screening implementation. Methods: Study participants were perinatal care professionals (n = 24), including obstetricians/gynaecologists, midwives, doulas, and other healthcare providers. Eligibility criteria required participants to either provide care to patients in the United States insured through Medicaid or other public insurance programs or work in practices serving individuals facing socioeconomic challenges. We conducted semi-structured interviews to explore participants’ experiences with screening for perinatal mental health. Thematic analysis was employed to identify emergent themes related to the determinants of screening implementation, with the Health Equity Implementation Framework (HEIF) serving as the organising structure. Results: Perinatal care professionals perceived screening results to facilitate discussion, awareness of mental health, and clinical decision-making. They identified several determinants influencing equitable implementation through impacting perceived screening validity, completion, patient experience, follow-up, and clinical workflows. Determinants aligned with the HEIF and included characteristics of the (1) screening (e.g. modality, frequency, type of tool), (2) perinatal individual, (3) perinatal care professionals, (4) clinical encounter, (5) other individuals involved before or after screening, and (6) context. Conclusion: Perinatal care professionals view screening as an important element of clinical decision-making. Reducing inequities in detecting perinatal mood and anxiety disorders requires offering screenings in patients’ preferred languages, improving patient-provider relationships, and training to implement best practices. Future research should examine variations in screening implementation to ensure equitable detection of perinatal mood and anxiety disorders.