Experiences of health professionals in screening for postpartum depressive symptoms: a qualitative systematic review

The objective of this review was to assess and synthesize the available qualitative evidence on health professionals' experiences in screening for postpartum depressive symptoms.

Postpartum depression is a significant public health problem. Clinical screening is essential to develop appropriate interventions to meet the needs of women and their families. The findings of this review have important implications for decision-making and policy development for continuous professional development programs that promote evidence-based screening for postpartum depressive symptoms.

This review considered studies that explored the experiences of health professionals who screen for postpartum depressive symptoms in any geographic location in any health care facility, scenario, or setting. The review focused on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research.

The review followed a 3-step search strategy in line with JBI methodology for systematic reviews of qualitative evidence. The databases searched included PubMed, CINAHL (EBSCOhost), Embase, Scopus, LILACS, ScienceDirect, PsycINFO (Ovid), Index Psi Periódicos, and PePsic (IPUSP). Unpublished studies were searched for in Google Scholar, Cybertesis, Dart-E, EThOS, and Open Access Theses and Dissertations (OATD). Two independent reviewers evaluated the included studies for methodological quality and extracted data using the JBI data extraction and synthesis tools. The review included studies published in English, Portuguese, and Spanish from database inception until October 2023.

Twenty-four qualitative studies from 14 countries across 5 continents involving 392 health professionals were included. A total of 113 findings were extracted and grouped into 5 categories: i) education and training; ii) responsibility for postpartum depressive symptom screening, referral, and follow-up: job description and work overload; iii) screening, referral, and follow-up; iv) disclosure, judgment, culture; v) and health system structure. Two synthesized findings evolved from these categories: i) the need for training and ongoing education, professional role, professional practice, and ways of caring in screening postpartum women for depressive symptoms; ii) external barriers, facilitating factors, and health system issues.

Health professionals' experiences of screening for postpartum depressive symptoms are influenced by their culture, practices, training, and worldview. Regular workshops and practical training sessions that emphasize the development of screening skills, particularly in recognizing subtle signs of depression and conducting culturally sensitive assessments, could be highly effective for health professionals. Policymakers should collaborate with health care professionals to develop and implement policies tailored to different contexts and cultures. Providing educational subsidies and ensuring monitoring and follow-up after screening are fundamental for the sustainability of screening for and management of postpartum depressive symptoms.