Factors Associated with Women's Acceptability of a Screening Procedure for Postpartum Depression

Purpose: Postpartum depression (PPD) is a serious disorder that affects many women globally, with potentially negative personal and familial consequences. Despite these negative consequences and various treatment options many women do not seek treatment. Screening procedures for PPD have been implemented around the world in order to raise women's awareness of their condition and promote treatment use. Nevertheless, not all postpartum women participate in these initiatives or honestly reveal their feelings. This study examined women's acceptability of a screening procedure (administering the Edinburgh Postnatal Depression Scale) for PPD and factors associated with this acceptability.

Methods: Participants (N= 243) included Israeli women giving birth in the past year. As Israel has a mandated national screening procedure, carried out by public health nurses in Mother-and-Child Health Centers where all well-check visits are done for babies and children aged 0-5, all Israeli women were eligible to participate in the study. Women were approached via Facebook and other electronic media platforms and were asked to fill out a self-report survey regarding their acceptability of the screening procedure, their perceived susceptibility to PPD, perceived severity of PPD, perceived benefit from participating in the screening procedure, perceived shame if one had PPD, and perceived quality of relationship with the screener.

Results: The mean rate of acceptability among participants was 18.59 (SD=5.41, range 5-30), a higher score indicating a higher rate of acceptability. A regression analysis showed that higher perceived benefit from participating in the procedure, perceived quality of relationship with the screener and perceived susceptibility to PPD were significantly associated with higher acceptability of the screening procedure  (ᵦ=0.51, p < 0.001; ᵦ=0.37, p < 0.001; ᵦ=0.11, p < 0.05; respectively). Furthermore, acceptability rates were significantly higher among women who met the same nurse (M=19.17, SD=5.43) compared to women who met different nurses at each well-check visit (M=16.48, SD=4.81).

Implications:

Rate of acceptability was a bit above average. Women who perceived the screening procedure as beneficial for them, had a better relationship with the screener and perceived themselves as vulnerable to PPD were more likely to find the screening procedure acceptable. Based on these findings it is recommended that national and local screening initiatives focus on promoting women's acceptability of PPD screening procedures in order to raise the number of participants and their compliance. In addition, screeners should be professionals who meet women regularly, and emphasis should be put on explaining the benefit of the screening and on discussing women's perceived vulnerability to PPD. Finally, national and local campaigns for promoting screening participation should stress the benefit of such procedures.