The qualitative approach employed in this study provided well-grounded, rich descriptions of processes in local contexts from the perspective of the informants. Our material provided unique insights into the Chinese health care system and how professionals in the perinatal health care field perceive mental health services in Shanghai. In accordance with the trustworthiness of our content analysis was ensured by using interviews to collect the data required to answer our research questions. We ensured transferability by carefully selecting our interview participants according to pre-determined selection criteria. This enhances the possibility of applying the results to other contexts. To ensure the trustworthiness and credibility of the results, it was important to evaluate how well categories covered the data and identify similarities and differences between categories.
The experts described how perinatal mental health care is influenced by tradition. Lack of knowledge of severe mental health disorders and discrimination against patients with such those problems prevent people from seeking treatment even for CMD, such as depression and anxiety. The traditions in conceptualizing mental health were especially pervasive in the generation shift. The influence of the parents-in-law on postpartum depression has recently begun receiving attention in China and is considered a causal factor in perinatal MHP. However, despite its high prevalence, the proper identification and treatment of postpartum depression in China are lacking. The impact of the one-child policy is another significant factor yet to be studied in more detail, but early studies have shown a considerable increase of postpartum depression in women belonging to this generation. The family was mentioned as a primary source of support as well as a main cause of MHP, especially during the perinatal period. Educating family members so that they better understand their role in the prevention of MHP among postpartum women, as well as how they can provide support and be a part of the care system, was considered crucial.
The participants noted a need to address the structural problems in the health care system and raise awareness of CMD, hitherto relatively neglected in China. The participants agreed that the healthcare system is guilty of prioritizing quantity over quality; patient volumes are considered much more important than high-quality patient care owing to skewed incentives, financial or otherwise. A general lack of knowledge and understanding of CMD by both health professionals and the public leads to inadequate treatment, misunderstanding of core issues, and denial of their significance. While the high burden of disease is a challenge, it is also an opportunity for policymakers and healthcare professionals to identify factors that affect mental health in China.
Our study provides novel in-depth knowledge about healthcare professionals’ perceptions of MHP such as depression and anxiety in Shanghai. The interviewees stated that the understanding of mental health disorders (severe or more moderate MHP) is generally poor, leading to underestimation of patients’ needs and the services required. The interviewees suggested the need for more health care professionals in treating women with common MHP, and highlighted the lack of professional training and resources available to provide adequate care for patients with MHP.
There are several limitations to our study, including the selection of solely English-speaking interviewees, which potentially skews the results. The interviewees were all senior cadres, who were proficient in spoken English. This entails a certain bias, in that the participants’ views may not be representative of all stakeholders in the Chinese healthcare system. The impact of this bias requires further study. The limited number of interviews impact the generalizability of the results to a certain degree, although the interviewees selected were deemed to adequately represent a relevant cross-section of perinatal mental healthcare decision makers. Despite a small sample size and language bias, our results provide valuable insight into key informants’ perceptions of and attitudes toward perinatal mental health. This knowledge holds potential in aiding further developments in training, education, and resource allocation pertaining to the provision of mental health services in the perinatal period.
