Abstract / Summary
Abstract Background Perinatal mental health distress affects 10–20% of pregnancy-carrying parents in high-income countries, including Aotearoa New Zealand (NZ), where the perinatal suicide rate is substantially higher than in comparable settings, and wāhine Māori (Māori women) experience disproportionate harm. International guidelines recommend routine screening using validated tools at multiple time points across the perinatal period, yet implementation in NZ is reported to be inconsistent. Few studies have simultaneously examined parent experiences and healthcare professional (HCP) practices or located findings within the perinatal care pathway. Methods A cross-sectional anonymous mixed-methods survey was distributed nationally between December 2023 and October 2024 via community social media and professional bodies. Eligible participants were pregnancy-carrying parents (currently pregnant or having given birth within the last two years), whānau/non-pregnancy-carrying partners, and HCPs working in perinatal care in NZ. Quantitative items asked about experiences and beliefs about screening, frequency, responsibility, and whānau involvement; open-text items invited elaboration on barriers, improvements to screening practices, and the role of whānau in screening. Quantitative data were analysed using descriptive statistics with exploratory Fisher’s exact tests for between-group comparisons; qualitative data were analysed using reflexive thematic analysis. Results Two hundred and thirty-five people engaged with the survey, with the final sample comprising 230 participants who consented and answered at least one substantive item: 205 pregnancy-carrying parents (13.2% Māori), 21 HCPs (47.6% GPs, 19.0% midwives, 19.0% psychologists, 14.3% other) and 4 whānau (excluded from group-level analyses because the number was insufficient). Only 58 of 205 pregnancy-carrying parents (28.3%) recalled being screened during their last pregnancy. Among the 112 (54.6%) reporting a prior psychiatric diagnosis, 30 (26.8%) were screened; among the 49 (23.9%) who had experienced pregnancy loss, only 6 (12.2%) were screened - significantly fewer than parents without a loss history (52/156, 33.3%; risk difference − 21.1% points, 95% CI − 32.9 to − 9.3; Fisher’s exact p = 0.004). All 21 HCPs endorsed screening as important, and 19 of 21 (90.5%) supported antenatal screening regardless of history. Both groups endorsed frequent postnatal screening at similar rates (monthly: parents 104/205, 50.7%; HCPs 11/21, 52.4%; difference − 1.6% points, 95% CI − 24.1 to 20.8; Fisher’s exact p = 1.00), but 12 of 21 HCPs (57.1%) also endorsed additional postnatal screening when distress was evident, whereas 2 (9.5%) endorsed only distress-contingent screening. However, qualitative accounts indicated that contingent screening is what parents actually encounter. Qualitative themes converged with the quantitative findings, identifying covert and “box-ticking” screening practices, structural fragmentation across the perinatal care pathway, and limited culturally safe approaches for whānau Māori (Māori families). Māori participants identified cultural safety, workforce composition and relational continuity as conditions for disclosure. Most parents (189/205, 92.2%) and HCPs (18/21, 85.7%) supported screening partners in at least one circumstance for their own mental health distress, framing this as a standalone clinical need rather than as collateral information about the pregnancy-carrying parent. Conclusions Screening in NZ is not being delivered in a way that is recognised by parents, equitable for whānau Māori, or extended to whānau. This is particularly true at known points of elevated risk including prior mental illness, pregnancy loss, and the postnatal year. Findings support the development of national screening guidelines that specify frequency, responsibility, and pathways to care across the perinatal period; investment in training for all HCPs with perinatal contact; explicit incorporation of kaupapa Māori-informed approaches; and the inclusion of partners and whānau as routine rather than exceptional.