1 in 5 Women With Postpartum Mood Disorders Keep Quiet

A recent study from North Carolina State University finds that 21 percent of recent mothers experiencing postpartum mood disorders (PPMDs), such as anxiety and depression, do not disclose their symptoms to healthcare providers.

“Our study finds that many women who would benefit from treatment are not receiving it, because they don’t tell anyone that they’re dealing with any challenges,” says Betty-Shannon Prevatt, a practicing clinical psychologist and Ph.D. student at NC State who was lead author of a paper on the work.

“We know that 10-20 percent of women experience significant mood disorders after childbirth, and those disorders can adversely affect the physical and emotional well-being of both mothers and children,” Prevatt says. “Our goal with this study was to see how many women are not disclosing these problems, since that’s a threshold issue for helping women access treatment.”

To address this question, researchers conducted an anonymous survey of 211 women who had given birth within the previous three years. The survey asked women whether they’d experienced PPMD symptoms; whether they had disclosed PPMD symptoms to healthcare providers – from doulas and lactation consultants to nurses and doctors; and a range of questions related to their mental health and obstacles to seeking care.

Survey responses showed that 51 percent of study participants met the criteria for a PPMD. However, just more than one in five of those who experienced PPMDs did not disclose their problems to healthcare providers.

“To place this in context, there are national guidelines in place telling healthcare providers to ask women about PPMD symptoms after childbirth,” says Sarah Desmarais, an associate professor of psychology at NC State and co-author of the paper. “With so many women in our study not disclosing PPMDs to their providers, it strongly suggests that a significant percentage of these women did not disclose their symptoms even when asked.”

The study found that women experiencing the highest levels of stress, and women with the strongest social support networks, were most likely to report their PPMD symptoms to healthcare providers.

The study did not identify any specific barriers to disclosing PPMD symptoms. However, the study did find that women who were unemployed, had a history of mental health problems or were experiencing severe symptoms were more likely to report barriers to treatment – though the specific barriers to treatment varied significantly.

“This work highlights the importance of support networks and the need to normalize the wide variety of reactions women have after childbirth,” Prevatt says. “We need to make it OK for women to talk about their mental health, so that they can have better access to care. Working with the people around new mothers may be key.”

“We don’t just need to teach women how to develop a birth plan, we need to teach them how to develop a social support plan,” Desmarais says.

The paper, “Facilitators and Barriers to Disclosure of Postpartum Mood Disorder Symptoms to a Healthcare Provider,” is published in the Maternal and Child Health Journal.

The researchers are currently recruiting participants for a follow-up study aimed at addressing similar questions in Spanish-language communities.

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Note to Editors: The study abstract follows.

“Facilitators and Barriers to Disclosure of Postpartum Mood Disorder Symptoms to a Healthcare Provider”

Authors: Betty-Shannon Prevatt and Sarah L. Desmarais, North Carolina State University

Published: Aug. 1, Maternal and Child Health Journal

DOI: 10.1007/s10995-017-2361-5

Abstract: Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n=211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient’s perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking “extremely difficult” or “impossible.” Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers’ social support networks.