Introduction
Postpartum depression (PPD) is the most common psychological condition following childbirth, with a prevalence of over 17% of women globally.1 However, PPD remains a grossly underdiagnosed condition.2 The stigma surrounding mental health, particularly in the postpartum period, can substantially hinder a woman's willingness to seek help and receive appropriate care.3 Meanwhile, women may experience desperation, sadness, changes in sleep and eating habits, anxiety, feelings of isolation, or thoughts of harming themselves or their infants.4 As a result of perceived stigma, women fear being judged as “bad mothers,” causing reluctance to communicate their true feelings.5 Furthermore, PPD can negatively impact the infant, the woman’s partner, and the entire family.6
Efforts to reduce stigma and promote social support for struggling mothers and families can help to reduce the prevalence of PPD. The role of health care professionals (HCPs) in these efforts cannot be overstated. Numerous studies highlight the importance of education, awareness, and training to aid health care practices in eliminating stigma and providing patient support.2,7–9
What Should Training Include?
Training efforts should emphasize communication techniques to normalize PPD and remove perceptions of judgment.8,10 It is essential for patients to feel and understand that they are not alone. Studies show that HCPs who normalize discussions about mental health and use patient-centered, compassionate communication strategies can help reduce stigma.2,10
In particular, anti-stigma training can positively impact HCPs’ knowledge, attitudes, skills, and patient-perceived empathy.11 Training should emphasize supportive language and phrases to initiate judgment-free conversations. Providers should practice active listening to seek a deeper understanding of the patient’s perspective by asking follow-up questions and rephrasing or repeating what has been said.12 HCPs can also offer professional self-disclosure, in which they share their own experiences with patients.10 Finally, providers should provide patient resources and treatment options for PPD, including counseling, patient education, medication, and support groups.
What Format Should Training Take?
Training for the entire care team, including doctors, nurses, psychologists, social workers, and others, can take many forms. Effective programs include workshops, seminars, and role-playing exercises. With the rapidly evolving science, ongoing education and professional development on topics in mental health of child-bearing women should be considered.13 Lastly, successful training programs should be evaluated for effectiveness, allowing for adjustments when necessary.
Conclusion
PPD continues to affect millions of women across the globe. Persistent negative stigma can cause struggling mothers to avoid seeking the help and support they need. Providers, as the frontline in patient care, can proactively initiate conversations with new mothers and evaluate for signs or symptoms of PPD. Equipped with the skills outlined above, HCPs can play a pivotal role in supporting their patients through existing stigma and working toward recovery.
References:
1. Wang Z, Liu J, Shuai H, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1):543. doi:10.1038/s41398-021-01663-6
2. Manso-Córdoba S, Pickering S, Ortega MA, Asúnsolo Á, Romero D. Factors related to seeking help for postpartum depression: a secondary analysis of New York City PRAMS data. Int J Environ Res Public Health. 2020;17(24):9328. doi:10.3390/ijerph17249328
3. Place JMS, Renbarger K, Van De Griend K, Guinn M, Wheatley C, Holmes O. Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Front Glob Womens Health. 2024;5. doi:10.3389/fgwh.2024.1335437
4. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-295. doi:10.1016/j.genhosppsych.2004.02.006
5. Edhborg M, Friberg M, Lundh W, Widström AM. “Struggling with life”: narratives from women with signs of postpartum depression. Scand J Public Health. 2005;33(4):261-267. doi:10.1080/14034940510005725
6. Carlson K, Mughal S, Azhar Y, Siddiqui W. Postpartum depression. In: StatPearls. StatPearls Publishing; 2024. Accessed September 10, 2024. http://www.ncbi.nlm.nih.gov/books/NBK519070/
7. Jannati N, Farokhzadian J, Ahmadian L. The experience of healthcare professionals providing mental health services to mothers with postpartum depression. Sultan Qaboos Univ Med J. 2021;21(4):554-562. doi:10.18295/squmj.4.2021.031
8. Wang T, Pavelko R. Increasing social support for women via humanizing postpartum depression. Health Commun. 2024:1-11. doi:10.1080/10410236.2024.2361582
9. Almutairi HA, Alyousef SM, Alhamidi SA, Almoammar DN. Exploring the healthcare services’ contribution to reducing postpartum depression. SAGE Open Nurs. 2023;9:23779608231171780. doi:10.1177/23779608231171780
10. Phelan SM, Salinas M, Pankey T, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations. Ann Fam Med. 2023;21(Suppl 2):S56-S60. doi:10.1370/afm.2924
11. Potts LC, Bakolis I, Deb T, et al. Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction. Soc Psychiatry Psychiatr Epidemiol. 2022;57(9):1861-1873. doi:10.1007/s00127-022-02284-0
12. Building empathy: the power of active listening in reducing Stigma - stigma free mental health society. April 10, 2024. Accessed September 13, 2024. https://stigmafreementalhealth.com/blog/building-empathy-the-power-of-active-listening-in-reducing-stigma/
13. Norms C on the S of CBHS, Board on Behavioral C, Education D of B and SS and, National Academies of Sciences E. Approaches to reducing stigma. In: Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. National Academies Press (US); 2016. Accessed September 15, 2024. https://www.ncbi.nlm.nih.gov/books/NBK384914/