Seeking Help for Postpartum Depression: Predicting Treatment Utilization and Longitudinal Depressive Symptoms

Purpose: Postpartum depression (PPD) is a serious disorder that affects many women globally, with prevalence estimated between 10%-20%, and with potentially devastating personal and familial consequences. Despite the availability of treatments and multiple contacts with healthcare providers during the postpartum period, very few women utilize help for their depression. The ultra-orthodox Jewish (UOJ) community, which this study focused on, is known for having a high birth rate and for its congregants' reluctance to use mental health services. These factors put the UOJ women with PPD at a higher risk of recurrence and of going untreated. Few studies examined barriers or factors that promote treatment for PPD, and therefore it is not clear what steps should be taken in order to ensure that more women receive treatment. The purpose of this study was, therefore, to examine factors that may enhance the likelihood that women with PPD will seek and utilize help. Methods: Using a prospective longitudinal design participants were surveyed at three measurement points. One to two days postpartum 1059 women were recruited from the maternity department at a large hospital in Jerusalem, Israel, and were assessed for factors that may predict seeking help for their depression. Participants were then followed up and screened for PPD at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Women who screened positive (EPDS>=9) were referred for treatment and were followed up at 6 months postpartum in order to find out whether they utilized mental health care, what type of care they utilized, and whether they still had PPD. Results: 805 of the 1059 (76%) women participated at the 6-week follow up, and 94 of them (11.7%) screened positive for PPD; 88 of these 94 (93.6%) women participated at the 6-month follow up; 61 of these 88 (69.3%) women sought help (professional or non-professional) for their depressive symptoms, and 27 of them (30.6%) continued to screen positive for PPD at the 6 month follow up. The logistic regression analyses showed that higher EPDS scores and confidence in mental health practitioners significantly predicted utilization of professional help (OR 1.356 [95% confidence interval (CI) 1.052-1.747] and OR 1.333 [95% CI 1.002-1.773] respectively). Furthermore, utilization of non-professional help and lower EPDS scores on the 6-week postpartum screening significantly predicted absence of depressive symptoms at the 6-month screening (OR 1.289 [95% CI 1.052-1.578] and OR .326 [95% CI .119-.896] respectively). Implications: High follow up rates and seeking help rates emphasize the importance of screening women for PPD. The screening procedure is highly appreciated by postpartum women, raises their awareness to their situation, and is time and cost-efficient. Furthermore, as expected in the UOJ community, women with PPD symptoms preferred to turn to non-professional help, which in turn predicted absence of later on PPD symptoms. If this type of help assists in reducing PPD symptoms and is culturally adequate for the UOJ community it should be further investigated and developed in order to ensure that women receive the help that suits them and ultimately recover from their depression.