title: Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study.
abstract: OBJECTIVE
  Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement.
  
  
  METHODS
  A stratified purposeful sampling based on pregnancy, socioeconomic status and depression severity was used to identify 23 women who completed semistructured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes and identifying themes.
  
  
  RESULTS
  Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma.
  
  
  CONCLUSIONS
  This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA. hflynn@umich.edu
authors.forename: Heather A
authors.initials: HA
authors.lastname: Flynn
authors.forename: Erin
authors.initials: E
authors.lastname: Henshaw
authors.forename: Heather
authors.initials: H
authors.lastname: O'Mahen
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000175:diagnosis / Q000628:therapy; D019052:Depression, Postpartum; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D009774:Obstetrics; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D011247:Pregnancy; D012017:Referral and Consultation; D055815:Young Adult