title: Policy and practice in the management of postnatal depression in Scotland.
abstract: To investigate current policy and practice in postnatal depression in Scotland and to consider how effectively guidelines were addressed. A questionnaire survey of all National Health Service Boards in Scotland between September 2003 and February 2004 to determine what written policies for postnatal depression were in place as at September 2003. This was followed by a questionnaire survey of a representative sample of general practices in Scotland to determine the routine procedures in use for managing postnatal depression in general practice primary care teams. NHS Boards and general practices in Scotland, UK. Forty-seven per cent of policies and 68% of General Practices had implemented the majority of the Scottish Intercollegiate Guidelines Network 60 evidence based recommendations. Practices were more likely than NHS Boards to have addressed a higher percentage of the recommendations (p < 0.05). Practices were more likely to implement antenatal screening for a history of puerperal psychosis if they were within NHS Boards that recommend this as routine practice. Practices within NHS Boards that had in-patient facilities for mother and baby admissions were more likely to identify these services as a treatment option than in the areas where the NHS Boards indicated the facilities were unavailable. Board guidance did not relate significantly to the likelihood of practices following the other evidence-based recommendations. Minimum standards represented by the SIGN 60 evidence-based recommendations were mostly followed in both policy and practice. If Board policy followed guidelines, the guidelines were more likely to be implemented at primary care level.
authors.affiliation: School of Nursing, Midwifery and Social Care, Napier University, Edinburgh, EH9 2TB, UK. e.m.alder@napier.ac.uk
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Alder
authors.forename: Margaret
authors.initials: M
authors.lastname: Reid
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Sharp
authors.forename: Roch
authors.initials: R
authors.lastname: Cantwell
authors.forename: Karen
authors.initials: K
authors.lastname: Robertson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kearney
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019052:Depression, Postpartum / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D011369:Professional-Patient Relations; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration