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Recovery

Recovery is often a complex, ongoing process for individuals with mental illness,1 and recovery from postpartum depression (PPD) is no exception.2 Unfortunately, significantly fewer women with postpartum-onset depression receive treatment than women with non-postpartum-onset depression.3 Many studies indicate that fewer than 30% of women with PPD receive treatment.4-6

Treatment Barriers and Potential Solutions

Lack of Awareness of PPD: Education and training. Stigma: Advocacy and raising awareness of postpartum depression. Choice Restricted Services: Service planning as a collaborative process driven by client; Example: Treatment Decision Making Worksheet. Culturally Insensitive Services: Practices informed by the beliefs, values, and traditional treatment practices of each client’s culture. Poorly Coordinated Services: Interdisciplinary collaboration to coordinate client services. Inconvenient Treatment Services: Flexible, in vivo approaches; Example: ACT teams.

Lack of Awareness of PPD

  • Both treatment providers’ and women’s lack of awareness and knowledge of postpartum depression impeded the receipt of treatment for PPD.7, 8 
  • Learn about PPD and educate clients about PPD symptoms and treatment services.8-10

Stigma

  • Women with PPD frequently identified stigma against mothers with mental illness and the fear of being perceived as an unfit mother as a barrier to seeking help.7, 9, 11
  • Acknowledge the mother’s fears of diagnostic labeling and loss of child custody and refer the mother to services that support maternal role functioning.8
  • Advocacy efforts such as raising public awareness of PPD may help reduce public stigma.7, 11

Choice Restricted Services

  • Lack of choice in treatment services is also a treatment barrier, as women reported that treatment professionals who only offered interventions that were perceived as unacceptable blocked their future care-seeking.8
  • Treatment decision making process should be driven by the preferences and needs of client,12, 13 with the treatment provider offering information about treatment options and support.7, 8
  • See Treatment Decision Making for more information.

Culturally Insensitive Services

  • For women with ethic or cultural minority backgrounds, a lack of sensitivity to traditional cultural practices impeded treatment use.7
  • Recognize the client’s conception of mental illness and the maternal role to provide culturally relevant services.7

Poorly Coordinated Services

  • Poorly coordinated services and disparate service providers complicate the process of obtaining treatment for women with PPD.7, 8, 11
  • Collaborate with service providers from other disciplines to coordinate client service provision.8 

Inconvenient Treatment Services

  • Includes difficulties obtaining transportation to and from treatment services and childcare during appointments.7, 14
  • Utilize flexible, in vivo approaches to provide services that are accessible to the client.7
    • Approaches may include telephone-based or home-based services7, 9 such as Assertive Community Treatment (ACT) teams.
    •  

References

  1. Pachoud, B., Plagnol, A., & Leplege, A. (2010). Outcome, recovery and return to work in severe mental illnesses. Disability & Rehabilitation, 32(12), 1043-1050. doi: 10.3109/09638281003775618
  2. Beck, C. T., & Driscoll, J. W. (2006). In Driscoll J. (Ed.), Postpartum mood and anxiety disorders: A clinician’s guide. Sudbury, MA: Jones and Bartlett Publishers.
  3. Vesga-Lopez, O., Blanco, C., Keyes, K., Olfson, M., Grant, B. F., & Hasin, D. S. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry, 65(7), 805-815. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=fyh&AN=MFS-33136732&site=ehost-live&scope=site
  4. Coates, A. O., Schaefer, C. A., & Alexander, J. L. (2004). Detection of postpartum depression and anxiety in a large health plan. Journal of Behavioral Health Services & Research, 31(2), 117-133. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=12910992&site=ehost-live&scope=site
  5. Herrick, H. (2002). Postpartum depression: Who gets help? Results from the Colorado, New York, and North Carolina PRAMS surveys 1997-1999. Retrieved from http://www.schs.state.nc.us/SCHS/pdf/SB24-1.pdf
  6. Horowitz, J. A., & Cousins, A. (2006). Postpartum depression treatment rates for at-risk women. Nursing Research, 55(2), 23-27. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009165809&site=ehost-live&scope=site
  7. Dennis, C., & Chung-Lee, L. (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. BIRTH, 33(4), 323-331. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009547198&site=ehost-live&scope=site
  8. Sword, W., Busser, D., Ganann, R., McMillan, T., & Swinton, M. (2008). Women’s care-seeking experiences after referral for postpartum depression. Qualitative Health Research, 18(9), 1161-1173. doi: 10.1177/1049732308321736
  9. Letourneau, N., Duffett-Leger, L., Stewart, M., Hegadoren, K., Dennis, C., Rinaldi, C. M., & Stoppard, J. (2007). Canadian mothers’ perceived support needs during postpartum depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36(5), 441-449. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=psyh&AN=2007-14061-005&site=ehost-live&scope=site
  10. Liberto, T. L. (2008). Factors that influence help seeking behaviors in postpartum women with depressive symptoms. Southern Online Journal of Nursing Research, 8(2), 2p. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010064211&site=ehost-live&scope=site
  11. Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010). Women’s experience of postnatal depression: Beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing, 27(3), 44-54. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010637442&site=ehost-live&scope=site
  12. National Institute for Health and Clinical Excellence. (2007). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf
  13. Pearlstein, T. (2008). Perinatal depression: Treatment options and dilemmas. Journal of Psychiatry & Neuroscience, 33(4), 302-318. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009979613&site=ehost-live&scope=site
  14. Nylen, K. J., Segre, L. S., & O’Hara, M. W. (2005). Public health implications of postpartum depression. Psychiatric Annals, 35(7), 599-609. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=hch&AN=28025804&site=ehost-live&scope=site

Last Updated July 18, 2011