With a prevalence of 15 to 25% [1, 2], depression, stress and anxiety are the most common complications experienced by pregnant and postpartum women. Without treatment, up to 48% of women with prenatal anxiety and 70% of those with prenatal depression  continue to experience symptoms through the postpartum period [4, 5] and into their children’s early years of life [6, 7]. Based on two decades of well-conducted longitudinal studies, the evidence is clear that even mild to moderate perinatal distress can have serious adverse effects on mothers and children, including increased risk of preterm birth and low birthweight , child developmental delay [9–11], impaired mother-child bonding , and poor child mental health [13, 14].
However, very few pregnant and postpartum women proactively seek help or engage in treatment [15, 16] and less than 15% of pregnant and postpartum women receive needed mental healthcare . While system-related barriers limit accessibility and availability of mental health services, personal barriers such as views of mental health and its treatment are also cited as significant deterrents of obtaining mental healthcare .
The Theory of Planned Behavior is a salient framework for understanding the role that views play in explaining the disparity observed in rates of pregnant and postpartum women who require and seek mental healthcare. Empirical testing of the Theory of Planned Behavior (TPB) suggests that both personal (e.g., normative) and societal beliefs play an important role in behavior . Based on this theory, behavior is driven by an individual’s personal beliefs (formed from his/her attitude toward a behavior and desired consequences), the subjective norm (e.g., societal beliefs) related to performing the behavior, and perceived behavioral control (i.e., the perceived ease with which the behavior can be accomplished) . Important referents in an individual’s life (e.g., spouse, friend, family) may play a key role in the formation of his/her normative beliefs. Collectively, normative beliefs form the subjective norm – the perceived obligation that an individual feels about engaging in a particular behavior . Within this framework, a pregnant or postpartum woman’s views and intentions regarding mental healthcare are shaped by her perception of significant others’ views as well as prevailing societal views, and these in turn influence her actions regarding screening and treatment.
Studies have demonstrated that the decision-making processes among childbearing families are heavily informed by the experiences and opinions of friends and family members [16, 19]. Treatment preferences and decisions are also highly influenced by societal beliefs about the causes of poor mental health and the stigma related to treatment, which impacts help-seeking behaviors, outcomes and adherence to treatment [20–22]. Indeed, the stigma associated with having a perinatal mental health problem and receiving treatment is identified as a major deterrent to women’s help-seeking and treatment . While the inverse association between stigma (e.g., negative stereotyping) and help-seeking is well-established in the general population , it may be more pronounced during the perinatal period as women experience shame and guilt for not feeling happy and content during pregnancy or after delivery. The stigma of being an incompetent mother or a danger to their children adds to their substantial burden of concern [24–26].
Given the impact of societal beliefs about mental health on acceptability, preferences, and uptake of treatment [20, 23, 27], identifying the public’s normative views regarding perinatal mental health screening and treatment is instrumental in understanding childbearing women’s views and behaviors, and how to normalize help-seeking behavior for women and families. It is also the basis on which to design effective messages that counter myths and misperceptions, enhance public understanding, and attain public support for needed policy and practice changes.
Few studies have explored the public’s views of perinatal mental health , and none have done so in Canada. The purposes of this study were to identify the public’s views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views.