Perinatal Mental Health Care in Switzerland (MADRE)

Perinatal Mental Health Care in Switzerland: Unraveling the Perspectives of Affected Women and Health Professionals

This qualitative study with quantitative elements examines the health care provided to women who suffered from mental disorder during pregnancy and / or in the first year after birth (i.e. during the perinatal phase). Investigators will perform individual interviews with former PMD patients, and health and social care professionals to gain insights into current health care for PMD patients.

Study Overview

• Status: Unknown
• Conditions: Depression; Anxiety Disorders; Post Traumatic Stress Disorder; Psychosis; Substance Abuse; Panic Disorder; Behavior Disorders; Mental Disorder; Health Care Utilization; Adaptation Reaction; Health Care Seeking Behavior; Health Care Acceptability; Perinatal

Detailed Description

Background: Perinatal mental disorders (PMD) are highly prevalent (up to 20%), and patients use mental health care at high rates (Berger et al 2018). It is not known if the health care for PMD patients meets the needs of the patients.

Aim: The Investigators will identify factors that promote or hinder service provision and access to care, for a range of relevant PMD. The investigation will cover the user and provider perspectives.

Methods: The qualitative study consists of two complementary parts to assess user and provider perspectives. In part 1 the Investigators will conduct individual semi-structured interviews with 24 women who have had PMD. The sample will comprise of 4 clusters of relevant ICD-10 F-diagnoses, covering a wide range of mental disorders. The sample will also comprise of participants who received or did not receive mental health care before the last pregnancy. In part 2, the Investigators perform 3 focus groups (with 6-8 participants per group) with health and social care professionals, and a health-insurance delegate, to collect their experiences and perspectives on perinatal health care for PMD patients. The Investigators are guided for data collection and analysis by Levesque's et al (2013) conceptual model on access to health care.

Expected results: The study will identify barriers and facilitators for health care access (user perspective) and provision (provider perspective). The study will generate the evidence base needed to develop integrated, coordinated, patient- and family-centered care for patients with various types of PMD.

• Study Type: Observational
• Enrollment (Anticipated): 24

Contacts and Locations

• Study Contact: Name: Anke Berger, Dr.; Phone Number: +41318483543; Email: anke.berger@bfh.ch
• Study Contact Backup: Name: Eva Cignacco, Prof. Dr.; Phone Number: +41 31 848 45 18; Email: eva.cignacco@bfh.ch

Study Locations

• Switzerland
  • Bern, Switzerland, 3008
    • Recruiting
    • Anke Berger
    • Contact: Anke Berger, Dr.; Phone Number: +41318483543; Email: anke.berger@bfh.ch
    • Contact: Eva Cignacco, Prof. Dr.; Phone Number: +41 31 848 45 18; Email: eva.cignacco@bfh.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Population 1: 24 former PMD patients, by 4 groups of F-diagnoses (ICD-10) and 2 groups (yes or no) of pre-existent mental disorders.

Population 2: 18-24 professional health care and social care providers, who are experienced in service provision for PMD patients and are

• Nurses
• Midwives
• Gynecologists
• Medical primary care providers
• Pediatricians
• Neonatologists
• Psychiatrists
• Psychologists
• Social care providers (community service)
• Expert from a health insurance

Description

Sample 1: patients with former PMD

Inclusion criteria:

1. PMD within the past 24 months before the interview,
2. Recovered from acute PMD and stable for at least 12 months before the interview;
3. Able to share experiences;
4. More than 18 years old
5. Speak and understand German

6. At least 1 diagnosis in the last perinatal phase out of 4 groups of psychiatric disorders (ICD-10 Chapter V, F00-F99):

   1. Mood (affective) disorders (F30-F39); Anxiety disorders (F41); Reaction to severe stress, and adjustment disorders (F43); and Obsessive-compulsive disorder (F42);
   2. Disorders of adult personality and behavior (F60-F69; especially F60.3 Emotionally unstable personality disorder);
   3. Mental and behavioral disorders due to psychoactive substance use (F10-F19; excluding tobacco (F17) if it is the sole F-diagnosis of the patient);
   4. Psychosis (F20-F29 Schizophrenia, schizotypal and delusional disorders).

Exclusion criterion: Current pregnancy

Sample 2: Professional health and social care providers

Inclusion criteria:

1. Professional experience of at least two years,
2. Have cared for at least 2 PMD patients the year before the focus group, a
3. Speak and understand German.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Narratives of barriers to perinatal mental health care use	Narratives of access-inhibiting factors, in semi-structured individual interviews with former PMD patients	perinatal phase, i.e. pregnancy and first year after birth
Narratives of mentions of facilitators of perinatal mental health care use	Narratives of access-promoting factors, in semi-structured individual interviews with former PMD patients	Perinatal phase, i.e. pregnancy and first year after birth
Narratives of mentions of barriers to perinatal mental health care provision	Narratives of provision-inhibiting factors, in focus group interviews with health and social care providers	Perinatal phase, i.e. pregnancy and first year after birth
Narratives of mentions of facilitators of perinatal mental health care provision	Narratives of provision-promoting factors, in focus group interviews with health and social care providers	Perinatal phase, i.e. pregnancy and first year after birth

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sociodemographic data of participating affected PMD patients	Sociodemographic data of participating affected PMD patients	2019-2020
Sociodemographic data of participating health care professionals	Sociodemographic data of participating health care professionals	2019-2020

Collaborators and Investigators

• Sponsor: Bern University of Applied Sciences
• Collaborators: University of Bern

Publications and helpful links

General Publications

• Berger A, Bachmann N, Signorell A, Erdin R, Oelhafen S, Reich O, Cignacco E. Perinatal mental disorders in Switzerland: prevalence estimates and use of mental-health services. Swiss Med Wkly. 2017 Mar 7;147:w14417. doi: 10.4414/smw.2017.14417. eCollection 2017.
• Berger A, Schenk K, Ging A, Walther S, Cignacco E. Perinatal mental health care from the user and provider perspective: protocol for a qualitative study in Switzerland. Reprod Health. 2020 Feb 17;17(1):26. doi: 10.1186/s12978-020-0882-7.

Study record dates

Study Major Dates

• Study Start (ACTUAL): July 10, 2019
• Primary Completion (ANTICIPATED): February 29, 2020
• Study Completion (ANTICIPATED): February 29, 2020

Study Registration Dates

• First Submitted: November 19, 2019
• First Submitted That Met QC Criteria: December 3, 2019
• First Posted (ACTUAL): December 4, 2019

Study Record Updates

• Last Update Posted (ACTUAL): December 4, 2019
• Last Update Submitted That Met QC Criteria: December 3, 2019
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Keywords: Access to care; Barriers; Social stigma; Facilitators
• Additional Relevant MeSH Terms: Chemically-Induced Disorders; Pathologic Processes; Trauma and Stressor Related Disorders; Substance-Related Disorders; Disease; Anxiety Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Mental Disorders; Panic Disorder
• Other Study ID Numbers: 2218-2018

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The Ethics Committee does not allow sharing of patients' data. The Ethics Committee allows and the Investigators are willing to share the data collected from health and social care professionals upon publication of the study.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No