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01-12-2018 | Original Article

Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women

Authors: Deborah Da Costa, Phyllis Zelkowitz, Tuong-Vi Nguyen, Jean-Benoit Deville-Stoetzel

Published in: Archives of Women's Mental Health | Issue 6/2018

Abstract

This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30–39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.

Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Rucci P, Cassano GB (2011) From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Compr Psychiatry 52:343–351. https://doi.org/10.1016/j.comppsych.2010.08.003 CrossRefPubMed

Bell L, Feeley N, Hayton B, Zelkowitz P, Tait M, Desindes S (2016) Barriers and facilitators to the use of mental health services by women with elevated symptoms of depression and their partners. Issues Ment Health Nurs 37:651–659. https://doi.org/10.1080/01612840.2016.1180724 [doi]CrossRefPubMed

Bergink V, Kooistra L, Lambregtse-van den Berg MP, Wijnen H, Bunevicius R, van Baar A, Pop V (2011) Validation of the Edinburgh depression scale during pregnancy. J Psychosom Res 70:385–389. https://doi.org/10.1016/j.jpsychores.2010.07.008 CrossRefPubMed

Bhat A, Reed SD, Unutzer J (2017) The obstetrician-gynecologist’s role in detecting, preventing, and treating depression. Obstet Gynecol 129:157–163. https://doi.org/10.1097/AOG.0000000000001809 CrossRefPubMedPubMedCentral

Bowen A, Bowen R, Butt P, Rahman K, Muhajarine N (2012) Patterns of depression and treatment in pregnant and postpartum women. Can J Psychiatr 57:161–167. https://doi.org/10.1177/070674371205700305 CrossRef

Brijnath B, Protheroe J, Mahtani KR, Antoniades J (2016) Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. J Med Internet Res 18:e165. https://doi.org/10.2196/jmir.5463 CrossRefPubMedPubMedCentral

Burns JM, Davenport TA, Durkin LA, Luscombe GM, Hickie IB (2010) The internet as a setting for mental health service utilisation by young people. Med J Aust 192:S22–S26PubMed

Committee on Obstetric Practice (2015) The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol 125:1268–1271. https://doi.org/10.1097/01.AOG.0000465192.34779.dc CrossRef

Dennis CL (2014) Psychosocial interventions for the treatment of perinatal depression. Best Pract Res Clin Obstet Gynaecol 28:97–111. https://doi.org/10.1016/j.bpobgyn.2013.08.008 CrossRefPubMed

Dennis CL, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33:323–331. https://doi.org/10.1111/j.1523-536X.2006.00130.x CrossRefPubMed

Dunkel SC, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25:141–148. https://doi.org/10.1097/YCO.0b013e3283503680 CrossRef

Fonseca A, Canavarro MC (2017) Women’s intentions of informal and formal help-seeking for mental health problems during the perinatal period: the role of perceived encouragement from the partner. Midwifery 50:78–85. https://doi.org/10.1016/j.midw.2017.04.001 CrossRefPubMed

Fonseca A, Gorayeb R, Canavarro MC (2015) Womens help-seeking behaviours for depressive symptoms during the perinatal period: socio-demographic and clinical correlates and perceived barriers to seeking professional help. Midwifery 31:1177–1185. https://doi.org/10.1016/j.midw.2015.09.002 CrossRefPubMed

Fung K, Wong YL (2007) Factors influencing attitudes towards seeking professional help among East and Southeast Asian immigrant and refugee women. Int J Soc Psychiatry 53:216–231. https://doi.org/10.1177/0020764006074541 CrossRefPubMed

Gary FA (2005) Stigma: barrier to mental health care among ethnic minorities. Issues Ment Health Nurs 26:979–999. https://doi.org/10.1080/01612840500280638 CrossRefPubMed

Gaynes BN et al. (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 1–8

Glasheen C, Richardson GA, Fabio A (2010) A systematic review of the effects of postnatal maternal anxiety on children. Arch Womens Ment Health 13:61–74. https://doi.org/10.1007/s00737-009-0109-y CrossRefPubMed

Goodman JH (2009) Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36:60–69. https://doi.org/10.1111/j.1523-536X.2008.00296.x CrossRefPubMed

Goodman JH, Chenausky KL, Freeman MP (2014) Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry 75:e1153–e1184. https://doi.org/10.4088/JCP.14r09035 CrossRefPubMed

Gravel R, Beland Y (2005) The Canadian Community Health Survey: mental health and well-being. Can J Psychiatr 50:573–579. https://doi.org/10.1177/070674370505001002 CrossRef

Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C (2004) Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry 185:342–349. https://doi.org/10.1192/bjp.185.4.342 CrossRefPubMed

Halbreich U (2005) The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions—the need for interdisciplinary integration. Am J Obstet Gynecol 193:1312–1322. https://doi.org/10.1016/j.ajog.2005.02.103 CrossRefPubMed

Huang ZJ, Wong FY, Ronzio CR, Yu SM (2007) Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Matern Child Health J 11:257–267. https://doi.org/10.1007/s10995-006-0168-x CrossRefPubMed

Josefsson A, Sydsjo G (2007) A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years. Arch Womens Ment Health 10:141–145. https://doi.org/10.1007/s00737-007-0185-9 CrossRefPubMed

Kauer SD, Mangan C, Sanci L (2014) Do online mental health services improve help-seeking for young people? A systematic review. J Med Internet Res 16:e66. https://doi.org/10.2196/jmir.3103 CrossRefPubMedPubMedCentral

Kim J, Garman E (2003) Financial stress and absenteeism: an empirically derived model. J Financial Couns Plan 14:31–42

Kim JJ, La Porte LM, Corcoran M, Magasi S, Batza J, Silver RK (2010) Barriers to mental health treatment among obstetric patients at risk for depression. Am J Obstet Gynecol 202:312–315. https://doi.org/10.1016/j.ajog.2010.01.004 CrossRefPubMed

MacKenzie KR (1999) Canada: a kinder, gentler health care system? Psychiatr Serv 50:489–491. https://doi.org/10.1176/ps.50.4.489 CrossRefPubMed

Magaard JL, Seeralan T, Schulz H, Brutt AL (2017) Factors associated with help-seeking behaviour among individuals with major depression: a systematic review. PLoS One 12:e0176730. https://doi.org/10.1371/journal.pone.0176730 CrossRefPubMedPubMedCentral

Marcus SM (2009) Depression during pregnancy: rates, risks and consequences—Motherisk update 2008. Can J Clin Pharmacol 16:e15–e22PubMed

Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU (2010) Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev 86:305–310. https://doi.org/10.1016/j.earlhumdev.2010.04.004 CrossRefPubMed

McGarry J, Kim H, Sheng X, Egger M, Baksh L (2009) Postpartum depression and help-seeking behavior. J Midwifery Womens Health 54:50–56. https://doi.org/10.1016/j.jmwh.2008.07.003 CrossRefPubMed

Mojtabai R, Olfson M (2006) Treatment seeking for depression in Canada and the United States. Psychiatr Serv 57:631–639. https://doi.org/10.1176/ps.2006.57.5.631 CrossRefPubMed

Mounts KO (2009) Screening for maternal depression in the neonatal ICU. Clin Perinatol 36:137–152. https://doi.org/10.1016/j.clp.2008.09.014 CrossRefPubMed

Nelson CH, Park J (2006) The nature and correlates of unmet health care needs in Ontario, Canada. Soc Sci Med 62:2291–2300. https://doi.org/10.1016/j.socscimed.2005.10.014 CrossRefPubMed

O'Hara MW, Wisner KL (2014) Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol 28:3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002 CrossRefPubMed

Oliver MI, Pearson N, Coe N, Gunnell D (2005) Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. Br J Psychiatry 186:297–301. https://doi.org/10.1192/bjp.186.4.297 CrossRefPubMed

O'Mahen HA, Flynn HA (2008) Preferences and perceived barriers to treatment for depression during the perinatal period. J Women’s Health (Larchmt) 17:1301–1309. https://doi.org/10.1089/jwh.2007.0631 [doi]CrossRefPubMed

Redshaw M, Henderson J (2013) From antenatal to postnatal depression: associated factors and mitigating influences. J Women’s Health (Larchmt) 22:518–525. https://doi.org/10.1089/jwh.2012.4152 CrossRef

Rickwood DJ, Deane FP, Wilson CJ (2007) When and how do young people seek professional help for mental health problems? Med J Aust 187:S35–S39PubMed

Roth D, Crane-Ross D (2002) Impact of services, met needs, and service empowerment on consumer outcomes. Ment Health Serv Res 4:43–56CrossRefPubMed

Sareen J et al (2007) Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychiatr Serv 58:357–364. https://doi.org/10.1176/ps.2007.58.3.357 CrossRefPubMed

Schueller S, Munoz R, Mohr DC (2013) Realizing the potential of behavioral intervention technologies. Curr Dir Psychol Sci 22:478–483. https://doi.org/10.1177/0963721413495872 CrossRef

Spanier GB (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 38:15–28CrossRef

Statistics Canada (2016) Health Fact Sheets. Trends in Canadian births, 1993 to 2013. https://www.statcan.gc.ca/pub/82-625-x/2016001/article/14673-eng.htm. Accessed April 17, 2018

Steele L, Dewa C, Lee K (2007) Socioeconomic status and self-reported barriers to mental health service use. Can J Psychiatr 52:201–206. https://doi.org/10.1177/070674370705200312 CrossRef

Sunderland A, Findlay LC (2013) Perceived need for mental health care in Canada: results from the 2012 Canadian community health survey-mental health. Health Rep 24:3–9PubMed

Thio IM, Oakley Browne MA, Coverdale JH, Argyle N (2006) Postnatal depressive symptoms go largely untreated: a probability study in urban New Zealand. Soc Psychiatry Psychiatr Epidemiol 41:814–818. https://doi.org/10.1007/s00127-006-0095-6 [doi]CrossRefPubMed

Vigod S, Sultana A, Fung K, Hussain-Shamsy N, Dennis CL (2016) A population-based study of postpartum mental health service use by immigrant women in Ontario, Canada. Can J Psychiatr 61:705–713. https://doi.org/10.1177/0706743716645285 CrossRef

Vliegen N, Casalin S, Luyten P (2014) The course of postpartum depression: a review of longitudinal studies. Harv Rev Psychiatry 22:1–22. https://doi.org/10.1097/HRP.0000000000000013 CrossRefPubMed

Wang J (2006) Perceived barriers to mental health service use among individuals with mental disorders in the Canadian general population. Med Care 44:192–195CrossRefPubMed

Weinfield N, Ingerski L, Moreau S (2009) Maternal and paternal depressive symptoms as predictors of toddler adjustment. J Child Fam Stud 18:39–47CrossRef

Weissman MM, Wickramaratne P, Nomura Y, Warner V, Pilowsky D, Verdeli H (2006) Offspring of depressed parents: 20 years later. Am J Psychiatry 163:1001–1008. https://doi.org/10.1176/ajp.2006.163.6.1001 CrossRefPubMed

Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J (2009) Seeking help for anxiety and depression after childbirth: results of the maternal health study. Arch Womens Ment Health 12:75–83. https://doi.org/10.1007/s00737-009-0049-6 CrossRefPubMed

Yelland J, Sutherland G, Brown SJ (2010) Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 10:771. https://doi.org/10.1186/1471-2458-10-771 CrossRefPubMedPubMedCentral

Title: Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women
Authors: Deborah Da Costa
Phyllis Zelkowitz
Tuong-Vi Nguyen
Jean-Benoit Deville-Stoetzel
Publication date: 01-12-2018
Publisher: Springer Vienna
Published in: Archives of Women's Mental Health / Issue 6/2018
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-018-0864-8

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