Abstract
Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n = 211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient’s perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking “extremely difficult” or “impossible.” Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers’ social support networks.
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References
American College of Obstetricians and Gynecologists. (2015). Screening for perinatal depression: Committee Opinion No. 630. Obstetrics and Gynecology, 125, 1268–1271. doi:10.1097/01.AOG.0000465192.34779.dc.
Beck, C. T. (2002a). Postpartum depression: A metasynthesis. Qualitative Health Research, 12(4), 453–472. doi:10.1177/104973202129120016.
Beck, C. T. (2002b). Theoretical perspectives of postpartum depression and their treatment implications. The American Journal of Maternal Child Nursing, 27(5), 282–287.
Bener, A., Gerber, L. M., & Sheikh, J. (2012). Prevalence of psychiatric disorders and associated risk factors in women during their postpartum period: A major public health problem and global comparison. International Journal of Women’s Health, 4(1), 191–200. doi:10.2147/IJWH.S29380.
Boyd, R. C., Le, H. N., & Somberg, R. (2005). Review of screening instruments for postpartum depression. Archives of Women’s Mental Health, 8(3), 141–153. doi:10.1007/s00737-005-0096-6
Byatt, N., Biebel, K., Friedman, L., Debordes-Jackson, G., & Ziedonis, D. (2013). Women’s perspectives on postpartum depression screening in pediatric settings: A preliminary study. Archives of Women’s Mental Health, 16(5), 429–432. doi:10.1007/s00737-013-0369-4.
Centers for Disease Control. (2008). Prevalence of self-reported postpartum depressive symptoms–17 states, 2004–2005. Morbidity and Mortality Weekly Report, 57(14), 361–366.
Cohen, S. (2004). Social relationships and health. The American Psychologist, 59(November), 676–684. doi:10.1037/0003-066X.59.8.676.
DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207–218. doi:10.1037/0278-6133.23.2.207.
Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. Journal of the American Board of Family Medicine, 20(3), 280–288. doi:10.3122/jabfm.2007.03.060171.
Glazier, R., Elgar, F., Goel, V., & Holzapfel, S. (2004). Stress, social support, and emotional distress in a community sample of pregnant women. Journal of Psychosomatic Obstetrics & Gynecology, 25(3–4), 247–255. doi:10.1080/01674820400024406.
Goodman, J. H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth (Berkeley, CA), 36(1), 60–69. doi:10.1111/j.1523-536X.2008.00296.x.
Goodman, J. H., & Tyer-Viola, L. (2010). Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. Journal of Women’s Health, 19(3), 477–490. doi:10.1089/jwh.2008.1352.
Hansotte, E., Payne, S. I., & Babich, S. M. (2017). Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: A systematic literature review. Public Health Reviews, 38(1), 3. doi:10.1186/s40985-017-0050-y.
Hutto, H. F., Kim-Godwin, Y., Pollard, D., & Kemppainen, J. (2011). Postpartum depression among White, African American, and Hispanic low-income mothers in rural Southeastern North Carolina. Journal of Community Health Nursing, 28(1), 41–53. doi:10.1080/07370016.2011.539088.
Hyde, J. S., Klein, M. H., & Essex, M. (1995). Maternity leave and women’s mental health. Psychology of Women Quarterly, 19, 257–285.
Ko, J. Y., Farr, S. L., Dietz, P. M., & Robbins, C. L. (2012). Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005–2009. Journal of Women’s Health, 21(8), 830–836. doi:10.1089/jwh.2011.3466.
Liberto, T. L. (2012). Screening for depression and help-seeking in postpartum women during well-baby pediatric visits: An integrated review. Journal of Pediatric Health Care, 26(2), 109–117. doi:10.1016/j.pedhc.2010.06.012.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd edn.). Sydney: Psychology Foundation of Australia.
Minkler, M., & Wallerstein, N. (Eds.). (2008). Community-based participatory research for health: From process to outcomes (2nd edn.). San Francisco: Jossey-Bass.
Mohr, D. C., Hart, S. L., Howard, I., Julian, L., Vella, L., Catledge, C., & Feldman, M. D. (2006). Barriers to psychotherapy among depressed and nondepressed primary care patients. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 32, 254–258. doi:10.1207/s15324796abm3203_12.
Mohr, D. C., Ho, J., Duffecy, J., Baron, K. G., Lehman, K. A., Jin, L., & Reifler, D. (2010). Perceived barriers to psychological treatments and their relationship to depression. Journal of Clinical Psychology, 66(4), 394–409. doi:10.1002/jclp.20659.
Myers, E. R., Aubuchon-Endsley, N., Bastian, L. A., Gierisch, J. M., Kemper, A. R., Swamy, G. K., … Sanders, G. D. (2013). Efficacy and safety of screening for postpartum depression. Comparative effectiveness review 106. Rockville, MD: Agency for Healthcare Research and Quality.
O’Mahen, H. A., & Flynn, H. A. (2008). Preferences and perceived barriers to treatment for depression during the perinatal period. Journal of Women’s Health, 17(8), 1301–1309. doi:10.1089/jwh.2007.0631.
Olson, A. L., Kemper, K. J., Kelleher, K. J., Hammond, C. S., Zuckerman, B. S., & Dietrich, A. J. (2002). Primary care pediatricians’ roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics, 110(6), 1169–1176.
Santora, K., & Peabody, H. (2010). Identifying and treating maternal depression: Strategies and considerations for health plans. Washington, DC: National Institute for Health Care Management Issue Brief.
Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., … Pignone, M. P. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 315(4), 380. doi:10.1001/jama.2015.18392.
Staehelin, K., Bertea, P. C., & Stutz, E. Z. (2007). Length of maternity leave and health of mother and child—A review. International Journal of Public Health, 52(4), 202–209. doi:10.1007/s00038-007-5122-1
Teaford, D., Goyal, D., & McNeish, S. G. (2015). Identification of postpartum depression in an online community. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44(5), 578–586. doi:10.1111/1552-6909.12740.
Umberson, D., Crosnoe, R., & Reczek, C. (2011). Social relationships and health behavior across life course. Annual Review of Sociology, doi:10.1146/annurev-soc-070308-120011.Social.
US Census Bureau. (2016). QuickFacts: Wake County North Carolina. Retrieved May 16, 2016 from http://www.census.gov/quickfacts/table/RHI105210/37183.
Webster, J., Linnane, J. W. J. J., Dibley, L. M., Hinson, J. K., Starrenburg, S. E., & Roberts, J. A. (2000). Measuring social support in pregnancy: Can it be simple and meaningful? Birth (Berkeley, CA), 27(2), 97–101. doi:10.1046/j.1523-536x.2000.00097.x.
Wiley, C. C., Burke, G. S., Gill, P. A., & Law, N. E. (2004). Pediatricians’ views of postpartum depression: A self-administered survey. Archives of Women’s Mental Health, 7(4), 231–236. doi:10.1007/s00737-004-0058-4.
Wright, A., Jorm, A. F., Harris, M. G., & McGorry, P. D. (2007). What’s in a name? Is accurate recognition and labelling of mental disorders by young people associated with better help-seeking and treatment preferences?. Social Psychiatry and Psychiatric Epidemiology, 42(3), 244–250. doi:10.1007/s00127-006-0156-x.
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Prevatt, BS., Desmarais, S.L. Facilitators and Barriers to Disclosure of Postpartum Mood Disorder Symptoms to a Healthcare Provider. Matern Child Health J 22, 120–129 (2018). https://doi.org/10.1007/s10995-017-2361-5
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DOI: https://doi.org/10.1007/s10995-017-2361-5