Introduction
The risk of developing postpartum depression (PPD) is relatively high during the first year after giving birth and remains elevated in subsequent years.¹ Unfortunately, three-fifths of women do not seek treatment after receiving positive screens for PPD.² Some barriers to seeking treatment include a lack of time, lack of childcare, transportation issues, stigma, and a lack of emotional support from family and friends.³ Unmanaged PPD has negative consequences for mothers, such as a lower quality of life, diminished social functioning, and poor physical and mental health. In this state, mothers may feel detached from their babies, which increases the risk of negative outcomes for the infants, including challenges with feeding, adverse emotional development, and childhood behavioral problems.⁴ Family members, health care providers (HCPs), and the patients themselves all play a role in successfully addressing these factors and supporting the treatment of PPD.

Personal Barriers
Mothers with PPD may have trouble recognizing its symptoms and can often attribute their feelings to being tired. Furthermore, some mothers report feeling too physically and emotionally exhausted to seek help.⁴ The perception of motherhood and the gender norms associated with it are additional barriers to treatment among women with PPD. It is normalized that the transition to motherhood should come “naturally” to many and is seen as a joyous period in a new mother’s life; however, some new mothers struggle since this may not be what they experience after delivery.⁵ Financial stressors are also significant barriers to care, as most resources are channeled toward infant needs during early infancy.⁶ 

Health Care Barriers
Although most providers consider postpartum depression as a mental health condition, women are less likely to seek help from providers who seem to be dismissive of their feelings, with some fearful of being labeled as “mentally ill.”⁶ The structure of the healthcare system can also create barriers for women trying to receive treatment for PPD. Barriers to healthcare also include access issues, which include cost, a lack of transportation, and language challenges.^6,7 Furthermore, healthcare facilities may restrict appointment scheduling—such as having limited appointment slots for physician referrals—and some facilities may only allow appointments for patients stepping down from inpatient care to outpatient care.⁷

While some providers and patients associate PPD solely with psychiatry, studies show that integrated care between mental health professionals and obstetrics and gynecology (OB/GYN) specialists produced better treatment outcomes than referrals to mental health services.^7,8 One study showed that HCPs have difficulty recognizing cues from mothers seeking help because patients and providers may have different ideas of what help-seeking is. Women with PPD may give cues such as appearing overly tired, but providers may perceive it as a common occurrence for new mothers.⁹

Conclusion
The risk of postpartum depression (PPD) is high after childbirth, yet many women do not seek treatment. Barriers include personal factors like exhaustion, societal expectations, financial constraints, and healthcare system issues like access, stigma, and limited provider training. Integrated care between mental health and OB/GYN specialists has shown promise for better outcomes. Addressing these barriers is crucial for improving PPD treatment and support for new mothers. In this way, the community as a whole can provide a helping hand to address these unmet needs.

References:

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