SummaryThis study explored the barriers and facilitators that women perceive in disclosing their postpartum mood disorders to their healthcare providers.
The 211 study participants were white, middle class, partnered women from urban areas in the southeastern United States. Women were surveyed using a combination of tools in an online survey. The study concludes that while there is universal screening of PPMD, many women do experience clinically-significant levels of PMDD but did not disclose their symptoms to a care provider. Efforts to promote PPMD disclosure and help-seeking should not only focus on universal screening but should also target mothers’ social support networks. Research Questions and Design of the StudyThe research question examined what the perceived barriers and facilitators were to women’s disclosure of postpartum mood disorder symptoms to healthcare professionals. The design was community-based participatory research, examining the effects on woman within three years postpartum. Sample and SettingThe population included English-speaking caucasian women who had delivered a baby after January 1, 2012, who were 18 years and older, middle-income, had partners, and lived in the area of a large city in the southeastern United States. Research MethodsMultiple strategies were used to recruit participants, specifically, recruits were based off of convenience and snowball sampling.
The study thoroughly explained the DASS-21 scale, a 21-item questionnaire that measures the symptoms of severity of depression, anxiety, and tension/stress. The researchers chose this tool because it assesses many psychological symptoms, and women with postpartum depression experience different symptoms. The study also used the Maternal Social Support Scale (MSSS), a 6-item questionnaire that examines friendship, family and partner support, conflict, feelings of control, and perception of being loved. The researchers found that the reliability of this score was sufficient. Lastly, researchers used the Perceived Barriers to Psychological Treatment (PBPT), a 27-item scale that examines how participants rated the level to which their access to mental health treatment was hindered by each item. Study Findings and LimitationsFindingsKey findings from this study included:While over half of women reported experiencing symptoms of PPMD, 21% indicated that they did not disclose their symptoms to healthcare providers46% of the participants indicated that at least one barrier made treatment “impossible” or “extremely difficult, including stigma (19%), time constraints (18%), and lack of motivation (16%). These findings suggest that the women who need treatment the most are also the ones who perceive the most barriers to receiving care.Strong social support was identified as an enabler to seeking care, though over a third indicated they lacked good social support.
LimitationsThe study is limited by its narrow and homogeneous sampling, which included only adult, middle-class white women with partners. The findings could be more representative and generalizable if the study had assessed a broader range of mothers, such as adolescent, single mothers, and those of other races and incomes. Women who chose to participate in the study may also be more cognizant of their symptoms than women who chose not to participate. Therefore, the results may not be representative of the overall postpartum population. The study included women that were up to three years postpartum. Consequently, recall bias may be a limitation because the longer the duration of time since a woman’s pregnancy and delivery, the more likely it is that she may forget what her experiences were with PPMD, especially if her experience was earlier on in her postpartum period, or if it resolved relatively quickly. The opposite may also be true for women who are closer to their delivery date — her memories may be more keen. The DASS-21 survey tool has some indications of being less useful with Asian populations; however, as the sample did not include any Asian women, this limitation may not have affected the quality of the results.
The study did not address the participant’s perception of the provider attitudes and how this may have affected the participants’ decisions to seek treatment.Research RelevanceThe goal of this study was to determine the factors that affect whether or not treatment is obtained for PPD. The findings from this study demonstrate the importance of public awareness of the range of emotions that woman experience following childbirth, and the range of barriers that women face in seeking treatment. It is important to bring awareness to families and society to start recognizing symptoms and support woman with PPD, and to gear interventions and outreach towards surmounting barriers and promoting enablers to women’s seeking of treatment. Greater community awareness and reduction of stigma may help to decrease the barriers that women identified (stigma, time constraints, and lack of motivation) increase their disclosure of symptoms and seeking of treatment, and reduce the negative impact of PPMD on the lives of women and their families.
There are many implications for clinical practice from the results of this study. The three main barriers (stigma, time constraints, and lack of motivation) can all be addressed by both healthcare providers as well as public awareness outreach campaigns. Additionally, changes to maternity leave policy, including paid leave, would promote women’s ability to care for both their newborns and themselves and potentially reduce PMDD incidence as well as barriers to seeking care for it.Women can also try making a post-birth plan (as opposed to just a birth plan) in which they identify social support network, resources, and plans for self care.
They can use this as an opportunity to fortify their social network while pregnant so that they feel more comfortable relying on it in the postpartum period.