Table 1 Summary of appraised studies that investigated barriers and facilitators to engagement with PMHS
From: Engagement with perinatal mental health services: a cross-sectional questionnaire survey
Author, year, country | Study type, sample | Main findings |
|---|---|---|
Bilzta et al. 2010 [10] Australia | Qualitative study by focus groups, n = 40 postpartum women | Findings suggest the lived experience of postnatal depression and associated attitudes and beliefs result in significant barriers to accessing help. Eight theme clusters were identified: expectations of motherhood; not coping and fear of failure; stigma and denial; poor mental health awareness and access; interpersonal support; baby management; help-seeking and treatment experiences and relationship with health professionals. |
Button et al. 2017 [17] United Kingdom | Metasynthesis of 24 studies | Three main themes affecting women’s decision to seek help for perinatal distress: identifying a problem, the influence of healthcare professionals, and stigma. |
Byatt et al. 2012 [18] United States | Qualitative study by face-to-face interview, n = 4 groups of perinatal health care professionals | Participants identified patient-, provider- and system-level barriers and facilitators to addressing perinatal depression. Provider-level barriers included lack of resources, skills and confidence needed to diagnose, refer and treat perinatal depression. Limited access to mental health care and resources were identified as system-level barriers. |
Byatt et al. 2015 [9] United States | Systematic review of 17 studies | Higher rates of mental health care use were associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers compared to screening alone. |
Dennis et al. 2006 [11] Canada | Systematic review of 40 qualitative studies | A common help-seeking barrier was women’s inability to disclose their feelings, which was often reinforced by family members and health professionals’ reluctance to respond to the mothers’ emotional and practical needs. The lack of knowledge about postpartum depression or the acceptance of myths was a significant help-seeking barrier and rendered mothers unable to recognize the symptoms of depression. Significant health service barriers were identified. |
Flynn et al. 2010 [12] United States | Qualitative study by semi-structured interviews, n = 23 | Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma. |
Goodman 2009 [13] United States | Quantitative study by cross sectional survey, n = 509 antenatal women | The greatest perceived potential barriers to treatment were lack of time (65%), stigma (43%), and childcare issues (33%). Most women indicated a preference to receive mental health care at the obstetrics clinic, either from their obstetrics practitioner or from a mental health practitioner located at the clinic. |
Highet et al. 2014 [19] Australia | Qualitative study by interview, n = 28 postpartum women | Particular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience. |
Kim et al. 2010 [8] United States | Mixed methods approach by telephone interview, n = 51 perinatal women | Barriers to successful treatment linkage were identified at the patient, provider, and system levels. Although 59% of at-risk women accepted mental health referrals, only 27% ultimately engaged in treatment. |
Kopelman et al. 2008 [20] United States | Mixed methods approach, n = 1416 antenatal women | Results suggest that addressing financial and logistical barriers through changes in mental health services and policy will improve access to care for antenatal depression. |
McCarthy. 2008 [21] Australia | Qualitative study by interview, n = 15 postpartum women | The majority of women interviewed had reached “crisis point” before they sought and received treatment. The stigma attached to an inability to cope and being a “bad mother” emerged as the main barrier to seeking help earlier. In addition, women were unable to differentiate between “normal” levels of postpartum distress and depressive symptoms that might require intervention. Talking about their distress and experiences, both with health professionals and other mothers, was regarded as of primary importance in the recovery process. |
Myers et al. [22] 2013 United States | Systematic review of 40 studies | Rates of referral and treatment for women with positive screening results were substantially higher in two studies where screening, diagnosis, and treatment were provided in the same setting. |
Myors et al. 2014 [23] Australia | Mixed-methods study, n = 244 perinatal women | Results indicated there was no significant difference in the risk factors for mental illness during the perinatal period in women who engaged and those who did not with PMHS. The time lag between initially assessment and contact by PMHS was a barrier to initial engagement. Stigma was another barrier and clinicians using women led model of service delivery with flexibility was more likely to be successful to promote engagement. |
Reilly et al. 2013 [24] Australia | Case control study, n = 1804 drawn from the Australian Longitudinal Study on Women’s Health | The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment. |