This study aims to investigate decisional conflict and elucidate challenges in decision-making among perinatal women using or considering using antidepressant (AD) during pregnancy. A sequential, mixed-methods study was employed among pregnant and postnatal women in Norway who had been offered ADs in the last 5 years. Quantitative data were obtained through an electronic questionnaire. Decisional conflict in pregnancy was assessed using the Decisional Conflict Scale (DCS) defined as either low (< 25) or moderate-high ( ≥ 25) (evaluated retrospectively for postnatal women). Logistic regression was used to identify factors associated with moderate–high decisional conflict. Qualitative data were collected through focus groups with pregnant and postnatal women, and an inductive approach was used for data analysis. Among 174 pregnant and 102 postnatal women, 67.8% and 69.6%, respectively, reported moderate–high decisional conflict during pregnancy. Unsatisfactory doctor-patient relationship was associated with greater likelihood of having moderate–high decisional conflict in pregnancy, both in pregnant (aOR = 1.20, 95% CI: 1.00–1.44) and postnatal women (aOR = 1.40, 95% CI: 1.08–1.82). Reported barriers to decision-making regarding AD use in pregnancy encompassed five DCS subscales: uninformed knowledge following contradictory research and unfamiliarity with authorised resources, unclear values due to emotional blunting and fear associated with AD use, inadequate support, uncertainty in decisions and ineffective decisions due to difficulty in finding personalised treatment, and diverging recommendations by the healthcare providers (HCPs). The quality of the interaction with the HCP plays a crucial role in managing decisional conflict and supporting informed decisions in the management of perinatal mental illness. This study highlights the need for increased provision of clear, evidence-based information by HCPs to facilitate shared decision-making and create personalised treatments for perinatal women considering AD use during pregnancy.

本研究旨在调查妊娠期间使用或考虑使用抗抑郁药 (AD) 的围产期妇女的决策冲突并阐明决策中的挑战。对过去 5 年接受过 AD 治疗的挪威孕妇和产后妇女进行了一项序贯混合方法研究。通过电子问卷获得定量数据。使用决策冲突量表（DCS）评估怀孕期间的决策冲突，定义为低（< 25）或中高（≥ 25）（对产后妇女进行回顾性评估）。使用逻辑回归来识别与中度至高度决策冲突相关的因素。通过孕妇和产后妇女焦点小组收集定性数据，并采用归纳法进行数据分析。在 174 名孕妇和 102 名产后妇女中，分别有 67.8% 和 69.6% 的人报告在怀孕期间存在中度至高度决策冲突。不满意的医患关系与怀孕期间出现中度至高度决策冲突的可能性更大相关，无论是孕妇（aOR = 1.20，95% CI：1.00–1.44）还是产后妇女（aOR = 1.40，95% CI：1.08– 1.82）。报告的关于妊娠期使用 AD 的决策障碍包括五个 DCS 分量表：相互矛盾的研究和不熟悉授权资源后的不知情知识、由于情绪迟钝和与 AD 使用相关的恐惧而导致的价值观不明确、支持不足、决策不确定和由于决策无效而导致的决策障碍。难以找到个性化治疗，以及医疗保健提供者 (HCP) 的建议存在分歧。与 HCP 互动的质量在围产期精神疾病管理中管理决策冲突和支持知情决策方面发挥着至关重要的作用。这项研究强调，HCP 需要更多地提供清晰、基于证据的信息，以促进共同决策，并为考虑在怀孕期间使用 AD 的围产期妇女制定个性化治疗方案。