RESUMO
OBJECTIVE: detecting and treating depression early on in pregnancy can improve health outcomes for women and their children. UK guidelines recommend that Midwives screen for antenatal depression (AND) at the woman's first Midwife appointment using recommended depression case finding questions. This is the first qualitative study to explore Midwives' and women's views of using these questions in the context of antenatal care. DESIGN: Semi-structured interviews with Midwives and pregnant women exploring their views and experiences of screening for AND, conducted alongside a validation study of the depression case finding questions. SETTING: the initial appointment with the Midwife when the woman is 10-12 weeks pregnant. Interviewees were working or living in Bristol, England. PARTICIPANTS: maximum variation samples of 15 Midwives and 20 pregnant women. MEASUREMENTS AND FINDINGS: Midwives and pregnant women viewed the depression case finding questions as a useful way of introducing mental health issues. Midwives often adapted the questions rather than using the phrasing specified in the UK guideline. Sometimes Midwives chose not to use the questions, for example if a partner was present. Both Midwives and women struggled to differentiate symptoms of early pregnancy from antenatal depression; yet thought that detecting depression early on in pregnancy was important. Women were unsure about the kind of help that was available; some women reported this as a reason for withholding their true feelings. There was a general lack of awareness among Midwives about the range of non-drug treatments potentially available to women and referral pathways to access them. KEY CONCLUSION: both Midwives and women regard screening for AND as acceptable and important but reported shortcomings with the recommended depression case finding questions. IMPLICATIONS FOR PRACTICE: providing training for Midwives on how to frame the questions and increase their knowledge and application of the referral pathways suggested by UK guidelines will help address some of the issues raised by Midwives and women in our study.