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Cited by 125Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcareMaternal and Perinatal Health Interventions

Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study

Open access
Chew-Graham, Carolyn A, Sharp, Deborah, Chamberlain, Elizabeth, Folkes, Liz, Turner, Katrina M·2009·BMC Family Practice
DOI 10.1186/1471-2296-10-7PMC PMC2637839
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Abstract

BACKGROUND: In the UK, 8-15% of women suffer from postnatal depression with long term consequences for maternal mood and child development. Current guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. Previous literature suggests that women are reluctant to disclose symptoms of postnatal depression. This study aimed to explore general practitioners' (GPs), health visitors' and women's views on the disclosure of symptoms which may indicate postnatal depression in primary care. METHODS: In-depth interviews with GPs, health visitors and women who were participating in a randomised controlled trial of anti-depressants versus health visitor delivered non-directive counselling for the treatment of postnatal depression. Interviews were audio-taped and fully transcribed. Thematic analysis with an iterative approach was used, allowing the views of practitioners and patients to be explored and then compared. RESULTS: Nineteen GPs, 14 health visitors and 28 women were interviewed. A number of common themes were identified across all three data sets: understanding and negotiating the diagnosis of postnatal depression, hindering and facilitating disclosure, and the system of care. Both women and health professionals described postnatal depression in psychosocial terms: an adjustment reaction to change in life circumstances and the reality of motherhood not meeting personal expectations. Women described making a conscious decision about whether or not to disclose their feelings to their GP or health visitor. Health professionals described strategies used to hinder disclosure and described a reluctance to make a diagnosis of postnatal depression, as they had few personal resources to manage women with postnatal depression themselves, and no services to which to refer women for further treatment. CONCLUSION: To improve disclosure of symptoms in primary care, there should be a move away from questioning why health professionals do not make the diagnosis of depression and in response suggesting that education and training will improve skills and thus improve detection of depression. Improving the detection and management of postnatal depression in primary care requires recognition of the context in which women consult, and system changes that ensure health professionals work in an environment that can facilitate disclosure and that the necessary resources for management are available. TRIAL REGISTRATION: ISRCTN 16479417.

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  • Other studies have echoed similar responses among women, including difficulty admitting to challenges, feelings of failure, fear of being judged as bad mothers, concerns about having their children taken away by social services, and fear of judgmental attitudes from the medical staff.

    “Other studies have echoed similar responses among women, including difficulty admitting to challenges, feelings of failure, fear of being judged as bad mothers, concerns about having their children taken away by social services, and fear of judgmental attitudes from the medical staff [15, 23].”

    From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [15]

    The Results (Disclosure and hindering disclosure; page unavailable) report reluctance to disclose difficulties, fear of being seen as a bad mother, and fear that children would be referred to social services. The Discussion (Comparisons with existing literature; page unavailable) also reports fear of being judged unfit to care for a child. The copy does not explicitly report feelings of failure or fear that children would be taken away; referral to social services is a narrower claim. (LLM, conf=0.83)

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  • Physicians characterize the current health system as hindering early detection of postpartum depression.

    “Physicians, on the other hand, characterize the current health system as hindering early detection of PPD [15].”

    From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [15]

  • Patients note the difficulty of disclosing their feelings to the physician and the perception of the physician as someone who is unwilling to listen and lacks time for it.

    “Patients also note the difficulty of disclosing their feelings to the physician and the perception of the physician as someone who is unwilling to listen and lacks time for it.”

    From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [15]

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Research works printed but not linked: 28

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Cited by

Sorted by citations

Authors
Chew-Graham, C. A., Sharp, D., Chamberlain, E., Folkes, L., & Turner, K. M.
Affiliations
  • University of Manchester (GB)
  • University of Bristol (GB)
Corresponding author
Chew-Graham, Carolyn A
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2009-01-21
Volume
10
Issue
1
Pages
7-7
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/1471-2296-10-7
PMC
PMC2637839
OpenAlex
W2073794085
Cited by
125
References
4
Citations by year
2026: 3 · 2025: 11 · 2024: 3 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 4 · 2019: 12 · 2018: 9 · 2017: 7 · 2016: 7 · 2015: 12 · 2014: 11 · 2013: 9 · 2012: 4
FWCI
3.46
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
postpartum depression, symptom disclosure, general practitioners, health visitors, primary care, depression diagnosis, barriers to disclosure, maternal mental health, non-directive counseling, antidepressants, referral services, health professions education
MeSH terms
Community Health Nursing, Family Practice, Female, Humans, Interviews as Topic, Depression, Postpartum

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