Clinical trial NCT04185896: Perinatal Mental Health Care in Switzerland
Official title: Perinatal Mental Health Care in Switzerland: Unraveling the Perspectives of Affected Women and Health Professionals
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Mental Disorder
Perinatal
Depression
Anxiety Disorders
Panic Disorder
Post Traumatic Stress Disorder
Adaptation Reaction
Behavior Disorders
Substance Abuse
Psychosis
Health Care Seeking Behavior
Health Care Utilization
Health Care Acceptability
Keywords: Social stigma
Access to care
Facilitators
Barriers
Lead sponsor: Bern University of Applied Sciences
Sponsor class: OTHER
Collaborators: name: University of Bern
First posted: 2019-12-04
Enrollment: 24
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: OTHER
Time perspective: OTHER
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Population 1: 24 former PMD patients, by 4 groups of F-diagnoses (ICD-10) and 2 groups (yes or no) of pre-existent mental disorders.

Population 2: 18-24 professional health care and social care providers, who are experienced in service provision for PMD patients and are

* Nurses
* Midwives
* Gynecologists
* Medical primary care providers
* Pediatricians
* Neonatologists
* Psychiatrists
* Psychologists
* Social care providers (community service)
* Expert from a health insurance

Brief summary: This qualitative study with quantitative elements examines the health care provided to women who suffered from mental disorder during pregnancy and / or in the first year after birth (i.e. during the perinatal phase). Investigators will perform individual interviews with former PMD patients, and health and social care professionals to gain insights into current health care for PMD patients.

Detailed description: Background: Perinatal mental disorders (PMD) are highly prevalent (up to 20%), and patients use mental health care at high rates (Berger et al 2018). It is not known if the health care for PMD patients meets the needs of the patients.

Aim: The Investigators will identify factors that promote or hinder service provision and access to care, for a range of relevant PMD. The investigation will cover the user and provider perspectives.

Methods: The qualitative study consists of two complementary parts to assess user and provider perspectives. In part 1 the Investigators will conduct individual semi-structured interviews with 24 women who have had PMD. The sample will comprise of 4 clusters of relevant ICD-10 F-diagnoses, covering a wide range of mental disorders. The sample will also comprise of participants who received or did not receive mental health care before the last pregnancy. In part 2, the Investigators perform 3 focus groups (with 6-8 participants per group) with health and social care professionals, and a health-insurance delegate, to collect their experiences and perspectives on perinatal health care for PMD patients. The Investigators are guided for data collection and analysis by Levesque's et al (2013) conceptual model on access to health care.

Expected results: The study will identify barriers and facilitators for health care access (user perspective) and provision (provider perspective). The study will generate the evidence base needed to develop integrated, coordinated, patient- and family-centered care for patients with various types of PMD.

Eligibility criteria: Sample 1: patients with former PMD

Inclusion criteria:

1. PMD within the past 24 months before the interview,
2. Recovered from acute PMD and stable for at least 12 months before the interview;
3. Able to share experiences;
4. More than 18 years old
5. Speak and understand German
6. At least 1 diagnosis in the last perinatal phase out of 4 groups of psychiatric disorders (ICD-10 Chapter V, F00-F99):

   1. Mood (affective) disorders (F30-F39); Anxiety disorders (F41); Reaction to severe stress, and adjustment disorders (F43); and Obsessive-compulsive disorder (F42);
   2. Disorders of adult personality and behavior (F60-F69; especially F60.3 Emotionally unstable personality disorder);
   3. Mental and behavioral disorders due to psychoactive substance use (F10-F19; excluding tobacco (F17) if it is the sole F-diagnosis of the patient);
   4. Psychosis (F20-F29 Schizophrenia, schizotypal and delusional disorders).

Exclusion criterion: Current pregnancy

Sample 2: Professional health and social care providers

Inclusion criteria:

1. Professional experience of at least two years,
2. Have cared for at least 2 PMD patients the year before the focus group, a
3. Speak and understand German.

Primary outcomes:
measure: Narratives of barriers to perinatal mental health care use
timeFrame: perinatal phase, i.e. pregnancy and first year after birth
measure: Narratives of mentions of facilitators of perinatal mental health care use
timeFrame: Perinatal phase, i.e. pregnancy and first year after birth
measure: Narratives of mentions of barriers to perinatal mental health care provision
timeFrame: Perinatal phase, i.e. pregnancy and first year after birth
measure: Narratives of mentions of facilitators of perinatal mental health care provision
timeFrame: Perinatal phase, i.e. pregnancy and first year after birth
Secondary outcomes:
measure: Sociodemographic data of participating affected PMD patients
timeFrame: 2019-2020
measure: Sociodemographic data of participating health care professionals
timeFrame: 2019-2020
Other outcomes:
Locations:
city: Bern
country: Switzerland
facility: Anke Berger
Study officials:
References:
citation: Berger A, Bachmann N, Signorell A, Erdin R, Oelhafen S, Reich O, Cignacco E. Perinatal mental disorders in Switzerland: prevalence estimates and use of mental-health services. Swiss Med Wkly. 2017 Mar 7;147:w14417. doi: 10.4414/smw.2017.14417. eCollection 2017.
citation: Berger A, Schenk K, Ging A, Walther S, Cignacco E. Perinatal mental health care from the user and provider perspective: protocol for a qualitative study in Switzerland. Reprod Health. 2020 Feb 17;17(1):26. doi: 10.1186/s12978-020-0882-7.