Postpartum Depression Help-Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review
Abstract
BACKGROUND: Despite the well-documented risk factors and health consequences of postpartum depression, it often remains undetected and untreated. No study has comprehensively examined postpartum depression help-seeking barriers, and very few studies have specifically examined the acceptability of postpartum depression treatment approaches. The objective of this study was to examine systematically the literature to identify postpartum depression help-seeking barriers and maternal treatment preferences. METHODS: Medline, CINAHL, and EMBASE databases were searched using specific key words, and published peer-reviewed articles from 1966 to 2005 were scanned for inclusion criteria. RESULTS: Of the 40 articles included in this qualitative systematic review, most studies focused on women's experiences of postpartum depression where help seeking emerged as a theme. 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. Women preferred to have "talking therapies" with someone who was nonjudgmental rather than receive pharmacological interventions. CONCLUSIONS: These results suggest that women did not proactively seek help, and the barriers involved both maternal and health professional factors. Common themes related to specific treatment preferences emerged from women of diverse cultural backgrounds. The clinical implications outlined in this review will assist health professionals in addressing these barriers and in developing preventive and treatment interventions that are in accord with maternal preferences.
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Perinatal healthcare professional-level barriers to PPD care include lack of time for psychological assessment and communicating diagnostic suspicion during check-ups, and lack of training in mental health.
“At the perinatal healthcare professionals' level, barriers include a lack of time for further psychological assessment and adequately communicating the diagnostic suspicion during check-ups, in addition to a lack of training in mental health.”
From App-based intervention for reducing depressive symptoms in postpartum women: Protocol for a feasibility randomized controlled trial (2023) · cites this paper as Dennis and Chung-Lee, 2006
Patient-level barriers to PPD care include misunderstandings or negative beliefs about PPD and psychological treatments, stigma, fear of being judged as an unfit parent, concerns about antidepressant risk, lack of time or energy, lack of social support, childcare issues, lack of confidence in healthcare professionals, and economic barriers.
“At the patients' level, they include misunderstandings or negative beliefs about PPD and psychological treatments, stigma, and fear of being judged as an unfit parent, concerns about the risk of antidepressant use, lack of time or energy, lack of social support, childcare issues, lack of confidence on healthcare professionals and economic barriers.”
From App-based intervention for reducing depressive symptoms in postpartum women: Protocol for a feasibility randomized controlled trial (2023) · cites this paper as Dennis and Chung-Lee, 2006
The tension between PMADs symptoms and expectations of motherhood can contribute to feelings of guilt, shame, and grief.
“This tension can contribute to feelings of guilt, shame, and grief [11].”
From Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms (2022) · cites this paper as [11]
Mothers already report excessive guilt, so this format was used to prevent these feelings and emphasize provider acceptance of the real-world challenges that new mothers experience.
“Mothers already report excessive guilt [11], so this format was used to prevent these feelings and emphasize provider acceptance of the real-world challenges that new mothers experience.”
From Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms (2022) · cites this paper as [11]
Mothers after childbirth need to recognize the symptoms of PPD and know when to seek advice and assistance.
“Mothers after childbirth need to recognize the symptoms of PPD and know when to seek advice and assistance[33, 34].”
From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [34]
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- Authors
- Dennis, C., & Chung‐Lee, L.
- Affiliations
- Toronto Public Health (CA)
- Corresponding author
- Dennis, Cindy‐Lee
- ORCID
- Dennis, Cindy‐Lee
- Venue
- Birth
- Publisher
- Wiley
- Published
- 2006-11-27
- Volume
- 33
- Issue
- 4
- Pages
- 323-331
- ISSN
- 0730-7659 (ISSN-L)
- 1523-536X
- OpenAlex
- W2011868122
- Cited by
- 881
- References
- 60
- Citations by year
- 2026: 29 · 2025: 46 · 2024: 64 · 2023: 60 · 2022: 57 · 2021: 62 · 2020: 42 · 2019: 66 · 2018: 53 · 2017: 59 · 2016: 55 · 2015: 63 · 2014: 32 · 2013: 35 · 2012: 44
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Birth (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum depression, help-seeking barriers, health service barriers, psychotherapy, pharmacotherapy, women's experiences, cultural diversity
- MeSH terms
- Adult, Female, Humans, Health Knowledge, Attitudes, Practice, Maternal Health Services, Patient Acceptance of Health Care, Pregnancy, Self Disclosure, Severity of Illness Index, Depression, Postpartum
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