Barriers and facilitators of mental health screening in pregnancy.
BACKGROUND
Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening. However, few studies to date have identified barriers and facilitators that affect pregnant women's responses to mental health screening. The objective was to identify barriers and facilitators that influence pregnant women's responses to the screening process and factors associated with their identification.


METHODS
This multi-site, cross-sectional survey recruited pregnant women >16 years of age who spoke/read English in Alberta, Canada. Main outcomes were barriers and facilitators of mental health screening. Descriptive statistics were generated to identify the most common barriers and facilitators and multivariable logistic regression models were conducted to determine factors associated with barriers and facilitators.


RESULTS
Study participation rate was 92% (460/500). Women's most common barriers were: significant others normalizing their emotional difficulties; desiring to handle mental health problems on their own; preferring to discuss feelings with significant others; and not knowing what emotions were 'normal'. Women who identified these barriers were more likely not to have been treated previously for mental illness, were primiparous, and could not be completely honest with their provider. Main facilitators were provider characteristics (sensitive, interested), reassurance that mental healthcare is a part of routine prenatal care, hearing that other women have emotional problems during pregnancy and knowing that help was available.


CONCLUSIONS
The sample comprised largely Caucasian, well-educated, and partnered women, which limits generalizability of the findings.


CONCLUSIONS
Personal and stigma-related barriers influence pregnant women's responses to mental health screening. Efforts to minimize barriers and enhance facilitators should be explored as potential strategies for optimizing prenatal mental health screening.
University of Alberta, Edmonton, Alberta, Canada. Electronic address: dawn.kingston@ualberta.ca.
Dawn
D
Kingston
FRANZCP, University of New South Wales, New South Wales, Australia.
Marie-Paule
MP
Austin
University of Manitoba, Winnipeg, Manitoba, Canada.
Maureen
M
Heaman
University of Calgary, Calgary, Alberta, Canada.
Sheila
S
McDonald
University of Alberta, Edmonton, Alberta, Canada.
Gerri
G
Lasiuk
University of Ottawa, Ottawa, Ontario, Canada.
Wendy
W
Sword
Murdoch Children's Research Institute, Parkville, Australia.
Rebecca
R
Giallo
University of Alberta, Edmonton, Alberta, Canada.
Kathy
K
Hegadoren
University of Alberta, Edmonton, Alberta, Canada.
Lydia
L
Vermeyden
University of Alberta, Edmonton, Alberta, Canada.
Sander Veldhuyzen
SV
van Zanten
MacEwan University, Edmonton, Alberta, Canada.
Joshua
J
Kingston
University of Alberta, Edmonton, Alberta, Canada.
Karly
K
Jarema
University of Toronto, Toronto, Ontario, Canada.
Anne
A
Biringer
D000328:Adult; D000416:Alberta; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008605:Mental Health Services; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods / Q000523:psychology*; D055815:Young Adult
Antenatal anxiety; Antenatal depression; Mental health; Pregnancy; Screening