title: Pediatricians' and health visitors' views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study.
abstract: BACKGROUND
  The present study's aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system.
  
  
  METHODS
  Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation.
  
  
  RESULTS
  Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health.
  
  
  CONCLUSIONS
  Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.
authors.affiliation: Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece. eagapidaki@gmail.com.
authors.forename: Eirini
authors.initials: E
authors.lastname: Agapidaki
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Souliotis
authors.forename: Suzanne F
authors.initials: SF
authors.lastname: Jackson
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Benetou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Christogiorgos
authors.forename: Christina
authors.initials: C
authors.lastname: Dimitrakaki
authors.forename: Yannis
authors.initials: Y
authors.lastname: Tountas
mesh_terms: D000328:Adult; D002648:Child; D003695:Delivery of Health Care; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology*; D064691:Nurses, Community Health; D010372:Pediatrics; D011320:Primary Health Care / Q000379:methods; D036301:Qualitative Research; D012017:Referral and Consultation; D057545:Social Stigma
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