Seeking Help for Perinatal Depression and Anxiety: A Systematic Review of Systematic Reviews from an Interdependent Perspective

Background and purpose: Perinatal mental health is globally recognized as a major social and public health challenge, since pregnant women and new mothers are at a high risk of experiencing mental health problems, such as perinatal mood and anxiety disorders (PMAD), leading to wide-spread long-lasting negative consequences. Hence, seeking help for PMAD is crucial for women’s mental health and babies’ development, yet many women do not seek help for their condition and remain undiagnosed and untreated. The mental health help-seeking process has often been viewed as an individual’s process. However, help-seeking is not a one-sided process, but, rather, is a collaborative process, dependent on what is offered to the help seekers and how it is made accessible to them. This study included a systematic review of systematic reviews aimed at summarizing and synthesizing findings from all systematic reviews on seeking help for PMAD in the context of Interdependence theory, highlighting the interdependent relationship between women and healthcare providers and how it may impact women’s help-seeking process.

Methods: A collaborative research approach was employed, bringing together researchers from social work, public health and psychology disciplines in order to provide a new perspective for understanding this complex challenge of seeking help for PMAD. A literature search was performed in four electronic databases, and 18 studies published up to 2023 met inclusion criteria for review.

Results: The Capability, Opportunity and Motivation model of Behavior was used as a framework for organizing and presenting the results. Results demonstrate that seeking help for PMAD is a function of the interdependent relationship between perinatal women’s and healthcare providers’ psychological capabilities (e.g., women’s lack of awareness to their need for help and providers’ lack of knowledge about depression) and physical capabilities (e.g., providers’ lack of practical skills for detecting depression), social opportunities (e.g., women’s lack of trust in healthcare providers) and physical opportunities (e.g., women’s financial constraints and broken referral systems between health and mental health providers), and their reflective and automatic motivation (e.g., women’s negative attitudes toward mental health treatment and providers’ perception that discussing mental health issues is not their role).

Conclusions and implications: Unmet needs in perinatal mental healthcare is an important social and public health problem, and as such, an interdisciplinary and collaborative approach to understanding this problem is crucial. Social workers should play a key role in bringing these disciplines together while collaborating with women with lived experience in order to provide a broad understanding of the problem and offer innovative pathways to care. This systematic review of systematic reviews highlighted the importance of this collaborative approach by stressing the interdependent process women and providers engage in which impacts women’s help-seeking. Hopefully this perspective may offer new insights for understanding the perinatal mental health help-seeking challenge and for shaping healthcare systems, designing interventions and implementing national guidelines and policies for providing adequate perinatal mental health care and pathways to care in a way that will enhance rates of mental health treatment use.