title: Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study.
abstract: Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed-methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non-engagement are 'time to rethink' and 'stigma'. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: 'back to basics' and 'building trust', therapeutic engagement: 'making myself useful', engagement at discharge: 'woman or clinician led', and models that facilitate engagement.
authors.affiliation: School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Myors
authors.affiliation: School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.|Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Johnson
authors.affiliation: School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Cleary
authors.affiliation: School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007406:Interview, Psychological; D001523:Mental Disorders / Q000175:diagnosis* / Q000451:nursing*; D008605:Mental Health Services; D009034:Mother-Child Relations; D017283:Neonatal Nursing / Q000379:methods*; D010348:Patient Care Team; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000451:nursing*; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D035502:Trust
keywords: engagement; mental health service; mixed methods; perinatal and infant mental health; risk factor