title: Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study.
abstract: BACKGROUND
  In the UK, 8-15% of women suffer from postnatal depression with long term consequences for maternal mood and child development. Current guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. Previous literature suggests that women are reluctant to disclose symptoms of postnatal depression. This study aimed to explore general practitioners' (GPs), health visitors' and women's views on the disclosure of symptoms which may indicate postnatal depression in primary care.
  
  
  METHODS
  In-depth interviews with GPs, health visitors and women who were participating in a randomised controlled trial of anti-depressants versus health visitor delivered non-directive counselling for the treatment of postnatal depression. Interviews were audio-taped and fully transcribed. Thematic analysis with an iterative approach was used, allowing the views of practitioners and patients to be explored and then compared.
  
  
  RESULTS
  Nineteen GPs, 14 health visitors and 28 women were interviewed. A number of common themes were identified across all three data sets: understanding and negotiating the diagnosis of postnatal depression, hindering and facilitating disclosure, and the system of care. Both women and health professionals described postnatal depression in psychosocial terms: an adjustment reaction to change in life circumstances and the reality of motherhood not meeting personal expectations. Women described making a conscious decision about whether or not to disclose their feelings to their GP or health visitor. Health professionals described strategies used to hinder disclosure and described a reluctance to make a diagnosis of postnatal depression, as they had few personal resources to manage women with postnatal depression themselves, and no services to which to refer women for further treatment.
  
  
  CONCLUSIONS
  To improve disclosure of symptoms in primary care, there should be a move away from questioning why health professionals do not make the diagnosis of depression and in response suggesting that education and training will improve skills and thus improve detection of depression. Improving the detection and management of postnatal depression in primary care requires recognition of the context in which women consult, and system changes that ensure health professionals work in an environment that can facilitate disclosure and that the necessary resources for management are available.
  
  
  BACKGROUND
  ISRCTN 16479417.
authors.affiliation: School of Community-Based Medicine, University of Manchester, and National School for Primary Care Research, National Institute of Health Research, Manchester, UK. cchew@manchester.ac.uk.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
authors.forename: Deborah
authors.initials: D
authors.lastname: Sharp
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chamberlain
authors.forename: Liz
authors.initials: L
authors.lastname: Folkes
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Turner
mesh_terms: D003152:Community Health Nursing; D019052:Depression, Postpartum / Q000175:diagnosis*; D005194:Family Practice; D005260:Female; D006801:Humans; D007407:Interviews as Topic