Electronic supplementary material
Search methods and inclusion/exclusion criteria
Quality appraisal and data extraction
Summary of study characteristics
Educational Intervention or Knowledge Assessment
Identifying perinatal mental health continuing education needs
Jones, Creedy, and Gamble 
Descriptive – cross-sectional
Practicing, student and non-practicing midwives (n = 815).
A survey was distributed to midwives and collected demographic information and previous educational preparation for the screening and care of women with antenatal and/or postpartum depression, as well as how adequate they perceived this training. 20 multiple choice questions also assessed knowledge of antenatal/postpartum depression.
The sample received an average score of 62.9% on antenatal depression and 70.7% on postpartum depression. A minimum score of 75% deemed a topic to be known. Many midwives felt their educational preparation was not adequate.
Buist et al. 
Descriptive – cross-sectional
General practitioners (GP), maternal child health nurses (MCHN) and midwives (n = 1153).
Participants answered questions in a hypothetical vignette and a knowledge questionnaire about perinatal women. The hypothetical vignette required providers to consider what a women’s perinatal concern was and what would be the best course of action to take.
MCHN had higher levels of awareness of perinatal depression. GP and MCHN were more likely than midwives to recognize the need for providing help to women in emotional distress.
McCauley, Elsom, Muir-Cochrane, and Lyneham 
Exploratory descriptive study
Midwives from 20 hospitals (n = 161).
A questionnaire was modified from two existing instruments that were used to survey mental health workers’ skills and knowledge. The questionnaire was distributed to midwives to explore their attitudes, skills, knowledge and experiences of working with perinatal women who have a mental illness.
Few participants in this study reported receiving any training in mental health and in many cases, mental health skills and knowledge were not seen by midwives as important in their work.
Nurses (n = 390), GPs (n = 14), and clinical commission group (CCG) leads (n = 14).
Questionnaires were distributed to nurses, GPs and CGCs leads. The questionnaires for nurses had questions related to demographic information and perceived responsibilities and training needs regarding mental health and wellbeing. GPs and CGCs were asked fewer questions.
Nearly half of the nurses (42%) reported having had no training in mental health and wellbeing. 60.1% of nurses, 78.6% of CCGs and 53.8% of GPs felt that nurse also require training in managing mild to moderate depression and anxiety.
McConachie and Whitford 
Qualitative, exploratory study
Mental health nurses (n = 19).
Focus groups were conducted with mental health nurses to understand insights and attitudes towards the care of women with a severe mental illness during the perinatal period. Their experience working with perinatal women was explored through analyzing transcribed focus group interviews.
Four themes were identified: 1) normalization, 2) fear and anxiety, 3) frustration, and 4) confidence. Generally, mental health nurses had little experience and felt uneasy working with perinatal women.
Educational and professional development strategies to advance knowledge and skills in perinatal mental health
Jardri et al. 
Midwives (n = 21).
A three-hour perinatal depression assessment training course for midwives was offered. The course had five sections: 1) general data about perinatal depression, 2) risk markers for perinatal depression, 3) examination of previous screening, 4) recommendations from the department, and 5) how to use the EPDS appropriately. A summary of recommendations were sent to each midwife following the course.
Correlation between midwife assessments and diagnosis of perinatal depression improved following training (significantly). The training course led to a 37.7% improvement in diagnosis of major depressive episodes.
Morrell et al. 
Cluster randomized trial
Health visitors in 101 general practices.
A psychologically-informed approach was used to train health visitors on identifying perinatal depressive symptoms using the EPDS and assess mood and suicidal thought. The participants were trained to deliver psychologically-informed sessions based on either cognitive behavioural principles or person-centred principles.
At six months, 34% of women in the intervention group (had providers who received training) and 46% of women in the control group had a score ≥ 12, indicating a reduction in symptoms in the intervention group.
Ingadottir and Thome 
Controlled quasi-experimental intervention study
Nurses in 6 community health centres.
A web-based course focusing on evidence-based interventions for postpartum emotional distress was offered to nurses. There were seven self-study units which focused on postpartum emotional distress and nursing interventions, interventions for stress and fatigue, irritable infants, and a case study on a postpartum emotional distress and the effect on the spouse.
At 15 and 24 weeks there was a significant difference between mothers’ EPDS scores at the experimental and control centres in favour of the intervention group of nurses who received the web-based course.
Hegarty et al. 
Quasi-experimental, pre-post test
Staff on a maternity unit (n = 27) (21 midwives, 5 doctors, 1 multi-cultural worker).
Staff were trained using a new (ANEW) program based on a previous postnatal program, conducted over 26 weeks with a commitment of 1–2 h per week. The goal of ANEW was to enhance the knowledge and skills of providers to identify and support women experiencing psychosocial issues during pregnancy. Evidence-based resources were provided and there were four interactive workshops using role play and feedback with simulated patients.
There was a significant increase in the proportion of women who reported that midwives helped them to talk about emotional and social issues in the post-intervention group (ANEW).
King, Pestell, Farrar, North, and Brunt 
Quasi-experimental, pre-post test
Hospital maternity staff (n = 126), community maternity staff (n = 23).
Community hospital maternity staff took part in attending psychological assessment training. The course took place over three, 2-h sessions. The training was conducted by a clinical psychologist or a counsellor. Staff were asked to rate their levels of confidence before and after the training.
T-tests showed that staff confidence in all areas was significantly increased by attending the training program.
Quasi-experimental, post-test only
Midwives and their mentors (n = 30).
The Perinatal Mental Health Curricular Framework was developed to address the educational needs of providers. A multi-disciplinary approach guided the educational material, and it was applied using both e-learning and face-to-face learning. Two, day-long workshops were held and modules were introduced online. Assessment was performed using a modified online examination. The professional role of the module facilitator was not specified.
All students successfully passed the exam. Collectively, the feedback was mainly positive. The multidisciplinary aspect was highly favoured by all students and they welcomed gaining insight into other professional approaches to perinatal mental health.
McLachlan, Forster, Collins, Gunn, and Hegarty 
Before-and-after survey design
Midwives at two hospitals (n = 25).
An advanced communication skills education package was delivered. Midwives attended seven sessions over a six-month period for a four week course, with three two-hour workshops facilitated by a psychologist. Workshop topics explored the aspects of providing woman-centred care for perinatal women. The program used evidence-based resources as well as role play and feedback with simulated patients.
Midwives felt more confident in their knowledge of psychosocial issues and in supporting women experiencing these issues in the early postnatal period following the educational program.