What prevents women with postnatal depression from seeking help?

A Singapore study has recently described the personal motivations of women who are at risk of postnatal depression for seeking treatment. 

Facilitators for and barriers to help-seeking have also been explored. Specifically, stigma and lack of knowledge are some of the reasons why women do not seek professional help.

“The barriers and facilitators reported by study participants were consistent with those in existing literature, though participants’ personal motivations for seeking treatment have not been widely reported,” the researchers said.

A total of 214 women who returned to a public maternity hospital for their postnatal obstetric check-ups underwent screening and were found to be at risk of postnatal depression, with scores of 13 and above on the Edinburgh Postnatal Depression Scale (EPDS) between April 2008 and January 2010.

Forty-eight women consented to an open-ended phone interview, which examined the facilitators and barriers to help-seeking. The researchers recorded, transcribed, and analysed these interviews to identify recurrent themes.

Of the participants, 19 (39.6 percent) were 26–30 years of age, 32 (66.7 percent) were of Chinese ethnicity, 44 (91.7 percent) were married, 26 (54.2 percent) had a full-time job, and 15 (31.3 percent) had a history of depressive episodes prior to their pregnancy.

The analysis of the interviews yielded three overarching themes and corresponding subthemes. These themes included personal motivations, external facilitators, and barriers to seeking treatment. [Proc Singap Healthc 2024;doi:10.1177/20101058241298391]

“Participants’ reported personal motivations for seeking treatment provided an interesting perspective that has not been commonly reported in existing literature,” the researchers said. “Many participants sought help as they feared that their depressive symptoms, left untreated, would affect their ability to care for their children.” 

Under personal motivations, the subthemes were “wish to be a better mother,” “desire for emotional support,” and “wish for diagnosis.” Facilitators for seeking treatment included “family support,” “referral by obstetrician,” and “postnatal emotional health screening.” Finally, the barriers to help-seeking were “practical concerns,” “stigma,” and “lack of knowledge about postnatal depression.”

Confinement

“The barriers to seeking treatment cited by study participants were consistent with barriers described in existing literature,” the researchers said. “Practical concerns such as ‘childcare issues’ and ‘lack of time’ have commonly been cited as reasons for not accessing treatment.” [Birthkit 2009;36:60-69]

In Singapore, women were traditionally in “confinement” or staying at home for postnatal recuperation for 30–40 days. This may make it challenging for postnatal women to seek psychiatric treatment in the first month after delivery, according to the researchers.

When it came to stigma, women reported fears of being labelled “mentally ill,” being judged as a “bad mother,” or being alienated. [J Adv Nurs 1993;18:178–184; Aust J Adv Nurs 2010;27:44-54; Arch Women Ment Health 2007;10:93-101]

“Potential interventions to encourage help-seeking in women at risk of postnatal depression should address barriers and facilitators of help-seeking, and women’s personal motivations for seeking treatment should be explored in greater detail,” the researchers said.

Postnatal depression affects between 10 percent and 25 percent of women worldwide and is considered a major public health problem. [Lancet Psychiatr 2016;3:973-982]