Certified Midwives and Nurse-Midwifes' Knowledge and Attitudes about Peripartum Depression Management - The Effectiveness of a Peripartum Depression Management Training

Background: In many countries, midwives and nurses play a vital role in supporting effective perinatal mental health (PMH) care, including peripartum depression (PPD) management. In our study, we aimed to evaluate the effectiveness of PMH training in increasing certified midwives (CMs) and certified nurse-midwives (CNMs)' knowledge about PPD management in primary care settings. The training was a part of postpartum depression (PPD) prevention programme implemented by Polish Ministry of Health. Additionally, we investigated the link between the CMs and CNMs perception of systemic difficulties, attitudes toward work with patients with mental health problems, and the adherence to PPD screening procedures. Method: A total of 379 CMs and CNMs from primary health centres and hospitals who participated in a PPD management training completed the Test of Antenatal and Postpartum Depression Knowledge before and after PMH training and the REASON scale after the training. Results: Before the training, only 17% (n = 66) of CMs and CNMs considered themselves to be educated for PPD management. The participants' knowledge about PPD significantly increased after the training, by three points on average. The effect size was very strong, d = 0.84. However, the prevalence of perinatal mental disorders and the suicide rate among persons with PPD remained misestimated. We also found that age had a substantial influence in controlling the relationship between perceived educational preparation for PPD management, job tenure, and actual knowledge about PPD management. Self-reported higher levels of perceived systemic problems in the workplace and having more negative attitudes toward working with persons experiencing emotional difficulties were associated with declared lower frequency of measuring the severity of PPD, using screening tools, counselling, and making referrals to specialists. Discussion: Even though the training turned out to be effective, a tendency to underestimate the negative consequences of PPD was observed. The participants' perception of systemic problems and personal attitudes were associated with an adherence to PPD screening procedures. The implementation of an obligatory PPD screening may not be enough to change the everyday practice of CMs and CNMs. Further training, taking into account personal attitudes of health care professionals, and systemic changes are required to ensure an optimal management for persons with PPD.