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Cited by 1Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsMaternal and Neonatal Healthcare

Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study

Open access
Krepak, Dana Katz, Kopit, Avital Bilitzky, Biderman, Aya, Yehoshua, Ilan, Adler, Limor·2025·BMC Primary Care
DOI 10.1186/s12875-025-03004-8PMC PMC12532410
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Abstract

BACKGROUND: Postpartum depression has a significant impact on the lives of the mother, her family, and the newborn. Yet, there is a significant delay in the diagnosis and treatment. Although many primary-care physicians believe it is their role to identify and treat postpartum depression, many of them do not perform screening modalities, and do not initiate treatment. The aim of this research is to shed light on the experiences of the mothers and to describe the process of diagnosis and treatment from their perspective. METHODS: In this qualitative study, we conducted in-depth interviews with Israeli women experiencing postpartum depression in the past 3 years. We utilized thematic analysis model to identify themes related to the diagnosis and treatment of postpartum depression. Each researcher independently read the interviews and identified relevant ideas and quotes. Ideas were coded, and then grouped into central themes and sub-themes. RESULTS: Nine women aged 29 to 45 participated in the study. We identified four main themes. The first was barriers in diagnosing postpartum depression. The women mentioned that physicians do not inquire about their mental state, lack of availability and coordination, women’s shame and judgmental attitude by the medical stuff. The second theme relates to the unique elements in postpartum depression including triggers, violence towards the baby, suicidal thoughts and difficulty in mother-baby bonding. The third theme was facilitators and barriers in the treatment. Women highlighted the importance of the family physician, other healthcare professionals, resources outside the healthcare-system, and fear to receive medications. The fourth theme pertains to women’s recommendations for improving the situation, such as getting support from other women, forming a specialized inpatient unit, administering the screening at a later period and discussion about depression before childbirth. CONCLUSION: In this study, women highlighted the difficulties they faced in receiving treatment for postpartum depression within the framework of primary-care. In addition, we emphasized unique aspects that require specific attention from the medical-team. Training healthcare providers to properly address postpartum depression is of significant importance. It is essential to increase the awareness among physicians so that they can correctly diagnose and offer treatment when needed.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study interviewed nine Israeli women who had recovered from postpartum depression (PPD) to explore diagnosis and treatment in primary care. It identified four themes: diagnostic barriers, unique features of PPD, treatment facilitators/barriers, and women’s recommendations for improvement.

Key findings

  • Nine women aged 29–45 years (mean 35.8) participated; 6/9 experienced PPD after their first child, and 7/9 had a university education.
  • The analysis produced 17 sub-themes grouped into four main themes: barriers in diagnosing PPD (physicians not inquiring about mental state, lack of availability/coordination, shame, judgmental staff); unique elements of PPD (triggers such as traumatic childbirth/obstetric violence and breastfeeding difficulties, violence toward the baby, suicidal thoughts, difficulty bonding with the baby); facilitators and barriers in treatment (importance of the family physician, healthcare-system coordination, outside support, fear of medications for the baby or oneself); and women’s recommendations (peer support, a specialized inpatient unit, later EPDS administration, and prenatal discussion of PPD).
  • Women reported that screening was sometimes absent after childbirth or administered at an inappropriate time; some recommended administering the Edinburgh Postnatal Depression Scale later and discussing PPD during pregnancy.
  • Women described both positive experiences—such as supportive family physicians, nurses, psychologists, welfare services, and mothers’ groups—and negative experiences, including feeling that care focused on the baby and that they were bounced between services without timely treatment.

Methods

  • Qualitative study using in-depth, semi-structured interviews (average 60 minutes, in Hebrew via Zoom in 2021) with women over 18 who had PPD in the past 3 years, had recovered, were Hebrew-speaking, and were affiliated with Maccabi Healthcare Services; diagnosis was confirmed by DSM-5 clinical assessment or positive EPDS.
  • Recruitment occurred through Facebook groups focused on maternal health and parenting; women with current PPD symptoms or severe/unstabilized psychiatric disorders were excluded.
  • Thematic analysis followed Kiger and Varpio’s six-step model; at least two researchers read each transcript, codes were consolidated into 17 sub-themes and four main themes, and trustworthiness was supported by investigator triangulation, an audit trail, prolonged engagement, and peer debriefing.

Limitations

  • Stated: the small sample limits generalizability; all participants were Israeli Jewish women aged 29–45 from a single healthcare organization, and selection bias likely favored educated women connected to social networks who may consume more services and be more critical, possibly including those with more severe or difficult experiences.
  • Stated: the study included only women’s perspectives, not those of healthcare providers, policymakers, or family members; interviews conducted during the COVID-19 pandemic and via Zoom may have shaped responses and interview dynamics.
  • Evident from the text: all participants were secular Jewish and Hebrew-speaking and were recruited through Facebook, so findings may not represent women of other ethnic, linguistic, cultural, or religious backgrounds.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12875-025-03004-8

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 53 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    There is a gap between women's preferences and available services for postpartum depression care in Israel.

    “The preferred professionals were psychologists, alternative therapists and family physicians, underscoring a gap between women’s preferences and available services [17].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] 17. Simhi M, Sarid O, Cwikel J. Preferences for mental health treatment for post-partum depression among new mothers. Isr J Health Policy Res. 2019 Dec 5;8(1):84. source

      The Results (page unavailable) identify psychologists, alternative therapists, and family physicians as the preferred professionals. The Study measures section says the questionnaire reflected treatment options available in Israel, but the paper does not compare those preferences with service availability or establish the claimed gap. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Simhi et al. found that Israeli mothers with postpartum depression symptoms preferred psychotherapy and community-based care over pharmacological or digital interventions.

    “Simhi et al. examined treatment preferences among 1,000 Israeli mothers and found that those with PPD symptoms preferred psychotherapy and community-based care over pharmacological or digital interventions.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] 17. Simhi M, Sarid O, Cwikel J. Preferences for mental health treatment for post-partum depression among new mothers. Isr J Health Policy Res. 2019 Dec 5;8(1):84. source
  • Premisecitation

    The preferred professionals for Israeli mothers with postpartum depression symptoms were psychologists, alternative therapists, and family physicians.

    “The preferred professionals were psychologists, alternative therapists and family physicians, underscoring a gap between women’s preferences and available services [17].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] 17. Simhi M, Sarid O, Cwikel J. Preferences for mental health treatment for post-partum depression among new mothers. Isr J Health Policy Res. 2019 Dec 5;8(1):84. source
  • Premisecitation

    Jeannette Milgrom et al. demonstrated that training family physicians to treat PPD significantly improved symptoms.

    “Jeannette Milgrom et al. demonstrated that training family physicians to treat PPD significantly improved symptoms [36].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [36] 36. Milgrom J, Holt CJ, Gemmill AW, Ericksen J, Leigh B, Buist A, et al. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling. BMC Psychiatry. 2011 Dec 27;11(1):95. source

      The Methods say participating GPs received training, and the Discussion reports significant reductions in depressive symptoms in all treatment groups. But the Discussion also says there was no untrained or wait-listed control group, so the trial cannot establish that GP training itself caused the improvement. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    The women described feeling detached from the baby for many months.

    “The women described feeling detached from the baby for many months.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 46
  • May combine two claims. 32
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In several studies and according to WHO definitions, postpartum depression can be diagnosed up to 12 months after childbirth.

    “In several studies and according to WHO definitions, PPD can be diagnosed up to 12 months after childbirth [5, 6].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [5] 5. Kroska EB, Stowe ZN. Postpartum Depression. Obstet Gynecol Clin North Am. 2020 Sep;47(3):409–19. source
    • cites [6] 6. Moraes GP de A, Lorenzo L, Pontes GAR, Montenegro MC, Cantilino A. Screening and diagnosing postpartum depression: when and how? Trends Psychiatry Psychother. 2017 Mar;39(1):54–61. source

      The Abstract reports that some researchers diagnosed postpartum depression 12 months or more after childbirth, and the Conclusions describe depressive episodes diagnosed up to one year after delivery. The paper does not attribute that one-year window to WHO definitions; its Discussion instead describes a four-week postpartum-onset limit in the DSM-5. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postpartum depression poses a risk for health related issues in children.

    “and health related issues in children [9, 10].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [9] 9. Marmorstein NR, Malone SM, Iacono WG. Psychiatric Disorders Among Offspring of Depressed Mothers: Associations With Paternal Psychopathology. American Journal of Psychiatry. 2004 Sep;161(9):1588–94. source
    • cites [10] 10. Adler L, Azuri J. Maternal perinatal depression and health services utilisation in the first 2 years of life: a cohort study. BMJ Open. 2021 Nov 9;11(11):e052873. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of postpartum depression in Israel is estimated around 5-20%, depending on ethnic background.

    “The prevalence in Israel is estimated around 5–20%, depending on ethnic background [2, 3].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] 2. Adler L, Tsamir J, Katz R, Koren G, Yehoshua I. Associations of sociodemographic and clinical factors with perinatal depression among Israeli women: a cross-sectional study. BMC Psychiatry. 2019 Dec 1;19(1):331. source

      The Background (page unavailable) reports that Israeli studies found perinatal depression rates of 5.2–43.0%, not an estimated postpartum prevalence of 5–20%. The Discussion (page unavailable) reports differences by population group, with greater risk among Arab women and lower risk among Orthodox Jewish women, but does not establish the claimed range by ethnic background. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [3] 3. Shwartz N, Shoahm-Vardi I, Daoud N. Postpartum depression among Arab and Jewish women in Israel: Ethnic inequalities and risk factors. Midwifery. 2019 Mar;70:54–63. source

  • Classified as probably not a substantial claim.

    Premisecitation

    Physicians characterize the current health system as hindering early detection of postpartum depression.

    “Physicians, on the other hand, characterize the current health system as hindering early detection of PPD [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] 15. Chew-Graham CA, Sharp D, Chamberlain E, Folkes L, Turner KM. Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract. 2009 Dec 21;10(1):7. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Evidence suggests that screening for postpartum depression can reduce depressive symptoms in women with depression and decrease the prevalence of depression in the population, especially when combined with treatment.

    “Evidence suggests that screening for PPD can reduce depressive symptoms in women with depression and decrease the prevalence of depression in the population, especially when combined with treatment [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. O’Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women. JAMA. 2016 Jan 26;315(4):388. source

  • May combine two claims.

    Premisecitation

    Other studies have echoed similar responses among women, including difficulty admitting to challenges, feelings of failure, fear of being judged as bad mothers, concerns about having their children taken away by social services, and fear of judgmental attitudes from the medical staff.

    “Other studies have echoed similar responses among women, including difficulty admitting to challenges, feelings of failure, fear of being judged as bad mothers, concerns about having their children taken away by social services, and fear of judgmental attitudes from the medical staff [15, 23].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [15] 15. Chew-Graham CA, Sharp D, Chamberlain E, Folkes L, Turner KM. Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract. 2009 Dec 21;10(1):7. source

      The Results (Disclosure and hindering disclosure; page unavailable) report reluctance to disclose difficulties, fear of being seen as a bad mother, and fear that children would be referred to social services. The Discussion (Comparisons with existing literature; page unavailable) also reports fear of being judged unfit to care for a child. The copy does not explicitly report feelings of failure or fear that children would be taken away; referral to social services is a narrower claim. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [23] 23. Pinar S, Bedford H, Ersser S, McMillan D. Women’s experiences of perinatal depression: Symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family. Midwifery. 2022 Sep;112:103389. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a qualitative study by Julián Rodríguez-Almagro et al., maternal narratives emerge concerning negative childbirth experiences and their impact on the postpartum period and PPD.

    “Similar to our study, in a qualitative study conducted by Julián Rodríguez-Almagro et al., maternal narratives emerge concerning negative childbirth experiences and their impact on the postpartum period and PPD [27].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] 27. Rodríguez-Almagro J, Hernández-Martínez A, Rodríguez-Almagro D, Quirós-García JM, Martínez-Galiano JM, Gómez-Salgado J. Women’s Perceptions of Living a Traumatic Childbirth Experience and Factors Related to a Birth Experience. Int J Environ Res Public Health. 2019 May 13;16(9):1654. source

  • May combine two claims.

    Premisecitation

    Patients note the difficulty of disclosing their feelings to the physician and the perception of the physician as someone who is unwilling to listen and lacks time for it.

    “Patients also note the difficulty of disclosing their feelings to the physician and the perception of the physician as someone who is unwilling to listen and lacks time for it.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [15] 15. Chew-Graham CA, Sharp D, Chamberlain E, Folkes L, Turner KM. Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract. 2009 Dec 21;10(1):7. source
    • cites [23] 23. Pinar S, Bedford H, Ersser S, McMillan D. Women’s experiences of perinatal depression: Symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family. Midwifery. 2022 Sep;112:103389. source

  • Classified as probably not a substantial claim.

    Findingown data

    These women expressed a desire to receive early explanations during pregnancy about the symptoms of depression, similar to the explanations they received about breastfeeding and the delivery process.

    “These women expressed a desire to receive early explanations during pregnancy about the symptoms of depression, similar to the explanations they received about breastfeeding and the delivery process.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average age of participants was 35.8 years (range 29 to 45 years).

    “The average age was 35.8 years (range 29 to 45 years).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Nine women participated in the study and underwent in-depth interviews.

    “Nine women participated in the study and underwent in-depth interviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of the interviewees experienced postpartum depression after the birth of their first child (6 out of 9).

    “The majority of the interviewees experienced PPD after the birth of their first child (6 out of 9).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Concerns arise about the mother's ability to care for and attend to the baby, as well as violence towards the infant.

    “Additionally, concerns arise about the mother’s ability to care for and attend to the baby, as well as violence towards the infant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The majority of women expressed frustration with the lack of availability of appointments for mental health treatment, including psychiatrists or psychologists, leading to delays in receiving diagnosis and treatment.

    “The majority of women expressed frustration with the lack of availability of appointments for mental health treatment, including psychiatrists or psychologists, leading to delays in receiving diagnosis and treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women describe that pediatricians, gynecologists, and family physicians seldom inquire about their emotional state, leading many women not to disclose their feelings.

    “They describe that pediatricians, gynecologists, and family physicians seldom inquire about their emotional state, leading many women not to disclose their feelings.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Most of the women reside in the central region of Israel.

    “Most of the women reside in the central region of Israel.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All women in the study were secular Jewish.

    “All women in the study were secular Jewish.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A number of women referred to shame as one of the major factors that delayed diagnosis, feeling shame both in front of their physician and their community.

    “A number of women referred to shame as one of the major factors that delayed diagnosis. These women mentioned feeling shame both in front of their physician and their community.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Many women reported concerns about the side effects of medications and also expressed apprehension about the stigma associated with mental illness once they start treatment.

    “Many women reported concerns about the side effects of medications and also expressed apprehension about the stigma associated with mental illness once they start treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Other women mentioned that they did not want to be hospitalized in regular psychiatric wards.

    “Other women mentioned that they did not want to be hospitalized in regular psychiatric wards.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In one of the interviews, there was a suggestion to open a dedicated inpatient unit for women with PPD.

    “In one of the interviews, there was a suggestion to open a dedicated inpatient units for women with PPD.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Many women have talked about the importance that women who have experienced PPD would support each other.

    “Many women have talked about the importance that women who have experienced PPD would support each other.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    The study identified four main themes: barriers in diagnosing postpartum depression, unique elements in postpartum depression, facilitators and barriers in the treatment of postpartum depression, and women's recommendations for improving the diagnosis and treatment of postpartum depression.

    “In our study, we identified four main themes: barriers in diagnosing postpartum depression, unique elements in postpartum depression, facilitators and barriers in the treatment of postpartum depression, and women’s recommendations for improving the diagnosis and treatment of postpartum depression.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Some of the women mentioned that a discussion during pregnancy about PPD could have helped them to cope later on with the feelings of depression, leading to earlier diagnosis.

    “Some of the women mentioned that a discussion during pregnancy about PPD could have helped them to cope later on with the feelings of depression, leading to earlier diagnosis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most of the women were educated, with 7 out of 9 having a university education.

    “Most of the women were educated, with 7 out of 9 having a university education.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The sample size was reached when saturation of themes was achieved.

    “The sample size was reached when saturation of themes was achieved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postpartum depression is linked to the emotional, cognitive, and behavioral development of the child.

    “It is linked to the emotional, cognitive, and behavioral development of the child [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 7. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D. Maternal Depression and Child Psychopathology: A Meta-Analytic Review. Clin Child Fam Psychol Rev. 2011 Mar 4;14(1):1–27. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    These elements highlight unique aspects that medical teams need to recognize and be aware of.

    “These elements highlight unique aspects that medical teams need to recognize and be aware of.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The research, alongside previous studies, emphasizes the importance of PCPs directly asking women about their mental state during pregnancy and after childbirth beyond the EPDS surveys.

    “Our research, alongside previous studies, emphasizes the importance of PCPs directly asking women about their mental state during pregnancy and after childbirth beyond the EPDS surveys.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • May combine two claims.

    Premisecitation

    Many women do not receive treatment for postpartum depression for various reasons, including a lack of trust in the mental health system, fear and stigma associated with taking medications, guilt, and concerns about the effects of medications on breastfeeding.

    “Yet, many women do not receive treatment for various reasons, including a lack of trust in the mental health system, fear and stigma associated with taking medications, guilt, and concerns about the effects of medications on breastfeeding [13, 14].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] 13. Hadfield H, Wittkowski A. Women’s Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Womens Health. 2017 Nov 6;62(6):723–36. source
    • cites [14] 14. Turner KM, Sharp D, Folkes L, Chew-Graham C. Women’s views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Fam Pract. 2008 Dec 1;25(6):450–5. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    An audit trail was maintained, documenting coding decisions, theme development, and selected participant quotes in a shared file accessible to the entire research team.

    “An audit trail was maintained, documenting coding decisions, theme development, and selected participant quotes in a shared file accessible to the entire research team.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In these encounters, nurses have the ability to rescue mothers by offering quick diagnosis and assistance, and they can miss the diagnosis if they do not allocate time for assessing the woman's mental health.

    “In these encounters, nurses have the ability, on one hand, to “rescue” the mothers by offering quick diagnosis and assistance, and on the other hand, they can miss the diagnosis if they do not allocate time for assessing the woman’s mental health.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    We emphasized unique aspects that require specific attention from the medical-team.

    “In addition, we emphasized unique aspects that require specific attention from the medical-team.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Investigator triangulation was implemented, with at least two researchers independently analyzing each transcript and contributing to the coding framework.

    “Investigator triangulation was implemented, with at least two researchers independently analyzing each transcript and contributing to the coding framework.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Factors that can assist in the early diagnosis of PPD by community nurses include home visits, explicitly stating that the purpose of the visit is to treat both the mother and the baby, longer meetings without time constraints, and continuity of care.

    “Among these factors are home visits, explicitly stating that the purpose of the visit is to treat both the mother and the baby, longer meetings without time constraints, and continuity of care.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] 23. Pinar S, Bedford H, Ersser S, McMillan D. Women’s experiences of perinatal depression: Symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family. Midwifery. 2022 Sep;112:103389. source
    • cites [24] 24. Vik K, Aass IM, Willumsen AB, Hafting M. Experiences with the routine use of the Edinburgh Postnatal Depression Scale from health visitors’ and midwives’ perspectives – An exploratory qualitative study. Midwifery. 2021 Sep;100:103017. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Regular team discussions allowed for reflection and consensus building.

    “Regular team discussions allowed for reflection and consensus building.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Postpartum depression negatively impacts women's quality of life and the ability to care for and establish a proper connection with the infant.

    “PPD negatively impacts women’s quality of life and the ability to care for and establish a proper connection with the infant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 7. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D. Maternal Depression and Child Psychopathology: A Meta-Analytic Review. Clin Child Fam Psychol Rev. 2011 Mar 4;14(1):1–27. source

  • Classified as probably not a substantial claim.

    Premisecitation

    Family physicians reported that they do not perform formal screenings or actively seek signs of PPD but rely on intuition, hoping that if there are signs of depression, they will notice them.

    “Family physicians reported that they do not perform formal screenings or actively seek signs of PPD but rely on intuition, hoping that if there are signs of depression, they will notice them [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] 21. Chew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GPs’ and health visitors’ views on the diagnosis and management of postnatal depression: a qualitative study. British Journal of General Practice. 2008 Mar 1;58(548):169–76. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postpartum depression poses a risk for maternal mortality.

    “PPD poses a risk for maternal mortality [8]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] 8. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005 Jun 11;8(2):77–87. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Quotes were translated from Hebrew to English and then reviewed and refined by a professional translator to preserve the original intent, tone, and contextual meaning of participants' narratives.

    “Quotes were translated from Hebrew to English by AB. The translations were then reviewed and refined by a professional translator. This two-step process was undertaken to preserve the original intent, tone, and contextual meaning of participants’ narratives.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Prolonged engagement with the data and peer debriefing further enhanced the credibility and dependability of the analysis.

    “Prolonged engagement with the data and peer debriefing further enhanced the credibility and dependability of the analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to the DSM-5, postpartum depression is characterized as major depression that initiates either during pregnancy or within four weeks of delivery.

    “According to the DSM-5, PPD is characterized as major depression that initiates either during pregnancy or within four weeks of delivery [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013. Chapter: Depressive Disorders; pages 186-188.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    There is a significant gap between the consensus that it is PCPs' role to diagnose PPD and the fact that most physicians do not actually diagnose PPD.

    “yet there is a significant gap between this data and the fact that most physicians do not actually diagnose PPD.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] 16. Glasser S, Levinson D, Bina R, Munitz H, Horev Z, Kaplan G. Primary Care Physicians’ Attitudes Toward Postpartum Depression. J Prim Care Community Health. 2016 Jan 16;7(1):24–9. source
    • cites [21] 21. Chew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GPs’ and health visitors’ views on the diagnosis and management of postnatal depression: a qualitative study. British Journal of General Practice. 2008 Mar 1;58(548):169–76. source
    • cites [22] 22. Leiferman JA, Dauber SE, Heisler K, Paulson JF. Primary Care Physicians’ Beliefs and Practices toward Maternal Depression. J Womens Health. 2008 Sep;17(7):1143–50. source

  • May combine two claims.

    Premisecitation

    Bina et al. reported that only 24% of Orthodox Jewish women diagnosed with postpartum depression sought professional help, often due to cultural stigma and lack of trust in mental health services.

    “Bina et al. studied help-seeking behavior among Orthodox Jewish women and reported that only 24% of those diagnosed with PPD sought professional help often due to cultural stigma and lack of trust in mental health services [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Bina R. Seeking Help for Postpartum Depression in the Israeli Jewish Orthodox Community: Factors Associated with Use of Professional and Informal Help. Women Health. 2014 Jul 4;54(5):455–73. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postpartum depression affects 12-15% of women after childbirth.

    “Postpartum depression (PPD) affects 12–15% of women after childbirth [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Liu X, Wang S, Wang G. Prevalence and Risk Factors of Postpartum Depression in Women: A Systematic Review and Meta-analysis. J Clin Nurs. 2022Oct 8;31(19–20):2665–77. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Treatment guidelines for postpartum depression involve a combination of psychotherapy and antidepressant medications.

    “Treatment guidelines for PPD involve a combination of psychotherapy and antidepressant medications [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Kroska EB, Stowe ZN. Postpartum Depression. Obstet Gynecol Clin North Am. 2020 Sep;47(3):409–19. source

  • May combine two claims.

    Premisecitation

    Glasser et al. found that while nearly all primary care physicians recognized the importance of identifying postpartum depression, few were confident initiating treatment, with most preferring to refer patients to other professionals.

    “Glasser et al. surveyed primary care physicians and found that while nearly all recognized the importance of identifying PPD, few were confident initiating treatment, with most preferring to refer patients to other professionals [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] 16. Glasser S, Levinson D, Bina R, Munitz H, Horev Z, Kaplan G. Primary Care Physicians’ Attitudes Toward Postpartum Depression. J Prim Care Community Health. 2016 Jan 16;7(1):24–9. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    87% of pediatricians agreed that assessing the woman's mental state is crucial to evaluating child care.

    “This data is in line with the 87% of pediatricians who agreed that assessing the woman’s mental state is crucial to evaluating child care [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] 32. Heneghan AM, Morton S, DeLeone NL. Paediatricians’ attitudes about discussing maternal depression during a paediatric primary care visit. Child Care Health Dev. 2007 May 16;33(3):333–9. source

  • May combine two claims.

    Study design and conductnone given

    All participants were Israeli, Jewish women aged 29 to 45 years, affiliated with a single healthcare organization in Israel.

    “All participants were Israeli, Jewish women aged 29 to 45 years, affiliated with a single healthcare organization in Israel.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationnone given

    PPD presents unique characteristics compared to depression at other stages of life, necessitating comprehensive attention from healthcare professionals, including nurses, family physicians, pediatricians, and gynecologists.

    “PPD presents unique characteristics compared to depression at other stages of life, necessitating comprehensive attention from healthcare professionals, including nurses, family physicians, pediatricians, and gynecologists.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    There is significant importance in collaboration among nurses, family physicians, and psychiatrists to provide adequate treatment for PPD.

    “Furthermore, there is significant importance in collaboration among nurses, family physicians, and psychiatrists to provide adequate treatment for PPD [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] 24. Vik K, Aass IM, Willumsen AB, Hafting M. Experiences with the routine use of the Edinburgh Postnatal Depression Scale from health visitors’ and midwives’ perspectives – An exploratory qualitative study. Midwifery. 2021 Sep;100:103017. source

  • May combine two claims.

    Study design and conductnone given

    In this study, thematic saturation was reached, supporting the adequacy of the sample size for qualitative analysis.

    “In this study, thematic saturation was reached, supporting the adequacy of the sample size for qualitative analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    It is possible that women who wanted to be interviewed were those experiencing more significant symptoms of depression and those who had more difficult experiences, making it important for them to share.

    “Additionally, it is possible that women who wanted to be interviewed were those experiencing more significant symptoms of depression and those who had more difficult experiences, making it important for them to share.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    These women sometimes consume more medical services and are more critical of the services they receive.

    “These women sometimes consume more medical services and are more critical of the services they receive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Semra Pinar et al. mention two factors that could help women disclose their feelings to their family physician: a non-judgmental approach and the perception that the family physician has knowledge about the symptoms, treatment and referral options, and the ability to clearly explain them to the woman.

    “Semra Pinar et al. mention two factors that could help women disclose their feelings to their family physician: a non-judgmental approach and the perception that the family physician has knowledge about the symptoms, treatment and referral options, and the ability to clearly explain them to the woman [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] 23. Pinar S, Bedford H, Ersser S, McMillan D. Women’s experiences of perinatal depression: Symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family. Midwifery. 2022 Sep;112:103389. source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Establishing a personal connection with the medical staff who administers the questionnaire is crucial to identifying depression.

    “Establishing a personal connection with the medical staff who administers the questionnaire is crucial to identifying depression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Numerous studies emphasize the importance of early diagnosis and treatment of PPD.

    “This notion is supported by numerous studies emphasizing the importance of early diagnosis and treatment of PPD [30, 31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] 30. Badr LK, Ayvazian N, Lameh S, Charafeddine L. Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal? Infant Behav Dev. 2018 May;51:15–23. source
    • cites [31] 31. Faisal-Cury A, Bertazzi Levy R, Kontos A, Tabb K, Matijasevich A. Postpartum bonding at the beginning of the second year of child’s life: the role of postpartum depression and early bonding impairment. Journal of Psychosomatic Obstetrics & Gynecology. 2020 Jul 2;41(3):224–30. source

  • May combine two claims.

    Premisecitation

    In a study conducted among pediatricians, the majority of physicians stated that they did not receive adequate training to diagnose maternal mental health conditions, and they also expressed a lack of knowledge about the resources available for treating PPD.

    “In a study conducted among pediatricians, the majority of physicians stated that they did not receive adequate training to diagnose maternal mental health conditions, and they also expressed a lack of knowledge about the resources available for treating PPD [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] 32. Heneghan AM, Morton S, DeLeone NL. Paediatricians’ attitudes about discussing maternal depression during a paediatric primary care visit. Child Care Health Dev. 2007 May 16;33(3):333–9. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Study design and conductnone given

    All interviews were conducted in 2021, during a time when Israel was still experiencing pandemic-related disruptions.

    “All interviews were conducted in 2021, during a time when Israel was still experiencing pandemic-related disruptions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Mothers after childbirth need to be taught how to take care of themselves, similar to the guidance provided for breastfeeding, diapering, bathing, and routine infant care.

    “Similar to the guidance provided for breastfeeding, diapering, bathing, and routine infant care, mothers need to be taught how to take care of themselves.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • May combine two claims.

    Premisecitation

    Su-Chin Serene Olin et al. examined 18 programs for PPD treatment in primary care settings and found that diagnosis and treatment can be provided by nurses, family physicians, and pediatricians in primary care settings.

    “Su-Chin Serene Olin et al. examined 18 programs for PPD treatment in primary care settings and found that diagnosis and treatment can be provided by nurses, family physicians, and pediatricians in primary care settings, underscoring the importance of training medical teams [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] 37. Olin SCS, Kerker B, Stein REK, Weiss D, Whitmyre ED, Hoagwood K, et al. Can Postpartum Depression Be Managed in Pediatric Primary Care? J Womens Health. 2016 Apr;25(4):381–90. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Although participants were not experiencing active depressive symptoms at the time of the interviews, the broader atmosphere of uncertainty, social isolation, and changes in healthcare access may have shaped how participants interpreted and described their past experiences with PPD.

    “Although participants were not experiencing active depressive symptoms at the time of the interviews, the broader atmosphere of uncertainty, social isolation, and changes in healthcare access may have shaped how participants interpreted and described their past experiences with PPD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Physicians do not always know where to refer patients, and women feel they are bounced from one medical entity to another without receiving proper treatment.

    “Physicians do not always know where to refer patients, and women feel they are bounced from one medical entity to another without receiving proper treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] 33. Falana SD, Carrington JM. Postpartum Depression. Nursing Clinics of North America. 2019 Dec;54(4):561–7. source
    • cites [34] 34. Dennis C, Chung-Lee L. Postpartum Depression Help‐Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review. Birth. 2006 Dec 27;33(4):323–31. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The use of Zoom for conducting interviews may have influenced the interview dynamic, particularly in terms of non-verbal communication and interpersonal connection typically afforded in face-to-face settings.

    “Furthermore, the use of Zoom for conducting interviews—while essential for ensuring safety and accessibility—may have influenced the interview dynamic, particularly in terms of non-verbal communication and interpersonal connection typically afforded in face-to-face settings.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Many women feel the questionnaire is insufficient and sometimes not conducted at the appropriate time.

    “Rose Coates et al. reported that many women feel the questionnaire is insufficient and sometimes not conducted at the appropriate time [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] 26. Coates R, de Visser R, Ayers S. Not identifying with postnatal depression: a qualitative study of women’s postnatal symptoms of distress and need for support. Journal of Psychosomatic Obstetrics & Gynecology. 2015 Jul 3;36(3):114–21. source
66 of 66

  • The paper relies on this without support.

    There is often a delay in diagnosis and treatment of postpartum depression.

    “Despite its high prevalence, there is often a delay in diagnosis and treatment of PPD.”

  • The paper relies on this without support.

    Some women conceal their feelings to family physicians due to emotional barriers and their belief that only pharmacological treatment will be offered.

    “Some women also describe concealing their feelings to family physicians due to emotional barriers and their belief that only pharmacological treatment will be offered.”

  • The paper relies on this without support.

    Postpartum depression is often associated with stigma, feelings of shame, and emotional vulnerability.

    “PPD is often associated with stigma, feelings of shame, and emotional vulnerability; thus, one-on-one interviews were most appropriate for encouraging open and honest communication.”

  • The paper relies on this without support.

    Women's accounts of their experiences with PPD and healthcare are accurate and reliable.

    “Our interviews reveal that meeting with the nurses in the ‘mother and child’ clinics plays a critical role in interacting with mothers after childbirth.”

  • The paper relies on this without support.

    PCPs often feel hesitant to initiate medication treatment for PPD and prefer referring women to psychiatrists for further assessment and care.

    “PCPs often feel hesitant to initiate medication treatment for PPD and prefer referring women to psychiatrists for further assessment and care.”

  • The paper relies on this without support.

    The availability of appointments with psychiatrists is limited, leaving many women without treatment.

    “However, the availability of appointments with psychiatrists is limited, leaving many women without treatment.”
6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013. Chapter: Depressive Disorders; pages 186-188.

Cited by

Sorted by citations

Related

Authors
Krepak, D. K., Kopit, A. B., Biderman, A., Yehoshua, I., & Adler, L.
Affiliations
  • Ben-Gurion University of the Negev (IL)
  • Tel Aviv University (IL)
ORCID
Venue
BMC Primary Care
Publisher
Springer Science and Business Media LLC
Published
2025-10-17
Volume
26
Issue
1
Pages
321-321
ISSN
  • 1471-2296 (ISSN-L)
  • 2731-4553
DOI
10.1186/s12875-025-03004-8
PMC
PMC12532410
OpenAlex
W4415278705
Semantic Scholar
5710abfdaeb76322bf06f54df2fcb3a7d142f7a7
Cited by
1
References
36
Citations by year
2026: 1
FWCI
0.90
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Marom, a research program for Maccabi Healthcare Services physicians and residents
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, primary care, barriers to treatment, screening, maternal experience, physician-patient communication, stigma and shame, mother-infant bonding, suicidal ideation, health professions education, postpartum mental health
MeSH terms
Adult, Female, Humans, Interviews as Topic, Israel, Middle Aged, Primary Health Care, Depression, Postpartum, Qualitative Research

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-04.

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