Mothers' Perspectives on Follow-up for Postpartum Depression Screening in Primary Care

ABSTRACT: Objective: To qualitatively assess mothers' perspectives on barriers to and facilitators of follow-up of at-risk postpartum depression (PPD) screening test results. Methods: We conducted semistructured qualitative telephone interviews with 17 women who scored in the moderate or high-risk range on the Edinburgh Postnatal Depression Scale. Interviews explored personal experience with depressive symptoms, barriers and facilitators to receiving mental health care postpartum, and suggestions for primary care follow-up of at-risk screens. The team created a coding structure that was updated during review of transcripts. Findings were triangulated and external validity assessed via discussions with a mother who experienced PPD, a perinatal social worker, and a perinatal psychologist. Results: Personal health/attitude, family/friends, community, and health care system factors influenced mothers' follow-up of at-risk PPD screening test results. Health and personal attitude factors included anxiety, physical and emotional exhaustion, self-care and recognition of symptoms, and living up to personal and family expectations. Family/friend factors included material and emotional support and competing priorities. Community factors included child care affordability and availability, access to transportation, geographic access to resources, social networks, and community mental health stigma. Health care factors included pediatrician taking the mother's symptoms seriously, adequate time with the pediatrician, mother and pediatrician focus on the child's health, and access to mental health referrals. Conclusion: Addressing barriers to follow-up after PPD screening may enable better service access for at-risk families. Address for reprints: Hannah R. Canty, MD, 3181 SW Sam Jackson Park Road, Mail Code: CDRCP Portland, OR 972393; e-mail: hcanty88@gmail.com. Disclosure: The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org). Received May 22, 2018 Accepted September 05, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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