Understanding Perinatal Mental Health: A Systems Science Approach to Identify Common Drivers and Opportunities for Intervention.

PNDA are complex health conditions affecting up to one in five women. The causes of PNDA are not well understood and no proven prevention exists. This study aimed: (1) to understand health professionals' perspectives of the common drivers contributing to PNDA amongst women from regional and rural areas in Australia; (2) to identify clinical practice related to PNDA-associated challenges; (3) to identify and inform areas for intervention. We conducted four online Group Model Building (GMB) workshops with health professionals from the southwest of Victoria, Australia. Informed by local data, participants built a model that progressed from connection circles to causal loop diagrams (CLD) to capture a shared understanding of the key drivers of PNDA rates within the region. The CLD was thematically analysed and common drivers were grouped. The GMB transcripts were thematically analysed inductively identifying emergent themes about PNDA drivers and intervention ideas. The CLD revealed 28 drivers and four key themes that stakeholders perceived to be driving the increasing rates of PNDA. An additional three major themes were identified from the GMB transcripts: (1) Social determinants of women's health; (2) Health system issues; (3) Negative birth experiences. Three key intervention themes were proposed, to improve collaboration between health services and departments, increase training availability, and increase continuity of care. Our findings suggest that dedicated training and pathways for collaboration between large regional and smaller rural services are necessary to address the rising rates of PNDA in the region.