Strategies for Improving Perinatal Mental Health Care: A Systematic Review and Meta-synthesis
TL;DR
These findings, based on stakeholder experiences and perceptions of acceptability and feasibility, suggest that policymakers and service planners should consider mandating integrated care pathways and funding diversified, patient-centered modalities to ensure equitable, accessible, and high-quality PMH care.
Abstract
Context: Perinatal mental health (PMH) disorders are among the most common complications of pregnancy and childbirth; however, a substantial treatment gap persists because of systemic, structural, and interpersonal barriers. This systematic review and meta-synthesis aimed to synthesize global qualitative evidence on strategies to improve PMH care, thereby informing policy, service design, and clinical practice. Evidence Acquisition: Guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research Type (SPIDER) framework, we conducted a systematic search of seven electronic databases (MEDLINE via PubMed, CINAHL, Scopus, Scientific Information Database (SID), PsycINFO, Embase, and Web of Science) to identify qualitative and mixed-methods studies examining PMH care strategies, barriers, and facilitators. No date restrictions were applied. Methodological quality was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist, and confidence in the evidence was assessed using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research). Data were analyzed using thematic meta-synthesis following the framework of Thomas and Harden (1). The review protocol was registered with PROSPERO (registration No. CRD420261501502). Results: A total of 41 studies were included. The studies spanned high-, middle-, and low-income countries across 6 continents and involved diverse participants, including perinatal women, partners, midwives, nurses, psychologists, community health workers, and policymakers. Five overarching analytical themes were generated. First, compassionate, person-centered communication was identified as a fundamental therapeutic strategy to facilitate disclosure and mitigate women’s fears of judgment. Second, integrated and coordinated service delivery, particularly the co-location of mental health professionals within obstetric settings, emerged as a structural imperative to reduce referral attrition and care fragmentation. Third, community-based and peer-supported care was highlighted as a vital strategy to reduce stigma, validate women’s experiences, and extend the reach of formal services. Fourth, workforce development and task-sharing were recognized as essential for sustainable care, requiring practical training and embedded specialist supervision to develop the skills of nonspecialist providers. Finally, flexible, tailored, and technology-assisted delivery models were endorsed as equity-oriented strategies to overcome logistical barriers, although human connection remained irreplaceable. Conclusions: Closing the PMH treatment gap requires a paradigm shift from reactive, siloed care to proactive, integrated, and highly relational support systems. Sustainable improvement depends on a coordinated approach that includes structural integration, workforce expansion, community partnerships, and flexible service delivery, all underpinned by trauma-informed communication. These findings, based on stakeholder experiences and perceptions of acceptability and feasibility, suggest that policymakers and service planners should consider mandating integrated care pathways and funding diversified, patient-centered modalities to ensure equitable, accessible, and high-quality PMH care.