Research That Matters (January 17 - 20, 2008)

This study seeks to understand factors influencing help-seeking among low-income women with postpartum depression (PPD). PPD is a mental health disorder that affects at least 13% of new mothers and is more prevalent among women with financial hardships. Untreated PPD is implicated in cognitive and developmental risks for children and enduring psychological risks for new mothers (Murray, Fiore-Cowley, Hooper, & Cooper, 1996). Studies show that PPD is a largely treatable disorder (Blesdoe & Grotte, 2006), but it is under-diagnosed and under-treated, particularly among low-income women (Horowitz & Cousins, 2006). Despite this fact, research to date has not closely examined low-income women's help-seeking for PPD.

Existing research examining help-seeking for PPD focuses primarily on middle-class women (Beck, 2002). Sensitizing concepts concerning help-seeking among low-income women that are raised in the literature on general women's depression include logistical barriers, fear of professionals, beliefs about depression, and stigma. This study is the first to explore specific factors related to help-seeking for PPD among low-income mothers and thus fills a significant research gap.

Methods:

Guided by grounded theory methodology, the researchers collected data from two subject groups: new mothers and service providers. In-depth semi-structured interviews were conducted with 20 ethnically diverse (African-American, Latin American, and West Indian), low-income mothers with children under age one. These participants were recruited by convenience from Women Infant and Children (WIC) program clinics and were screened for PPD. In addition, four focus groups with a total of 24 participants were conducted with a purposive sample of helping professionals who work with low-income new mothers. Aided by qualitative software, data were analyzed using the constant comparative method (Strauss & Corbin, 1998), which included stages of code development, memoing, and theoretical abstraction.

Results:

None of the participants had sought professional help, despite self-recognition of depression. Barriers to service use that mothers reported were clustered around an array of cultural beliefs about depression and about mental health service providers. Women felt that seeking services meant that they were “bad” and incompetent mothers. Mothers also described a lack of knowledge about accessing mental health assistance and expressed a strong fear of medication. These themes were less pronounced among service providers, who focused more on logistical barriers such as insurance status, transportation, language fluency, and childcare. Both service providers and mothers recommended outreach in community locations that low-income mothers frequent and are comfortable (e.g., WIC clinics, pediatrician, churches).

Conclusion and Implications:

This study provides implications for outreach and treatment efforts for low-income women with PPD. While media attention around this issue has increased, these messages have largely been targeted to a middle-class population. Findings from this study suggest that low-income women may benefit from public health messages that offer not only educational information about PPD, but also culturally-sensitive, stigma-challenging messages that provide encourage women to seek help in the postpartum period. Findings also suggest that a traditional outpatient mental health treatment model may not be appropriate for this population of overwhelmed new mothers and a home-based treatment model may produce greater adherence.