title: Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.
abstract: Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period.
  
  
  
  A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum.
  
  
  
  Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training.
  
  
  
  Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK e.m.ford@bsms.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ford
authors.affiliation: Royal College of General Practitioners, 30 Euston Square, London NW1 2FB, UK.
authors.forename: Judy
authors.initials: J
authors.lastname: Shakespeare
authors.affiliation: Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK.
authors.forename: Fatin
authors.initials: F
authors.lastname: Elias
authors.affiliation: Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Ayers
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy*; D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D058006:General Practice / Q000193:education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy*; D012017:Referral and Consultation
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: General practice; mental health; post-natal depression; pregnancy; systematic review.