Perinatal mental health training and supervision for primary care and community-based staff: a systematic review.

BACKGROUND

Perinatal mental health problems are common yet often under-detected and under-treated in primary care and community services. International guidelines call for integration of mental health into perinatal care, but clarity is lacking on how best to equip non-specialist providers. Training and supervision programmes exist but vary widely in content and delivery, and their effectiveness and feasibility across settings are not comprehensively synthesised.

AIM: To evaluate the effectiveness of perinatal mental health training for primary care and community-based providers on provider competence, maternal outcomes, and implementation in routine care.

METHOD: Seven databases and grey literature were systematically searched to September 2025. Eligible studies evaluated training delivered to health or community providers involved in perinatal care. Due to heterogeneity, findings were narratively synthesised. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence appraised using GRADE.

RESULTS

Of 707 citations screened, 39 studies were included, spanning high- and low-income countries and involving over 10,000 providers. Interventions varied in intensity and modality, including novel approaches such as extended reality simulation and cascade 'train-the-trainer' models. Training consistently improved provider knowledge, skills, attitudes, and confidence, and was associated with increased screening and referral, particularly when supported by supervision or system-level integration. Patient outcomes were less frequently assessed; where reported, some studies showed reductions in depressive symptoms and improvements in broader maternal outcomes, though findings were mixed.

CONCLUSION

Training enhances provider capacity in perinatal mental health, but evidence on patient impact, sustainability, cost-effectiveness, and equity remains limited, highlighting priorities for future research and policy.