Background
Methods
Inclusion and exclusion criteria
Search strategy for identification of studies
Study selection and critical appraisal
Data extraction and synthesis
Results
Characteristics of studies
Authors | Country (setting) | Study Design / sampling method | method of data collection (setting) | Sample size | Illness Studied | Type of participants | Sex | Mean Age (SD) | Outcomes | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Know-ledge | Atti-tudes | Help-Seeking | |||||||||
Ayres 2019 [26] | Australia | Cross sectional study/convenience sampling | Questionnaire (hospital) | 218 | Perinatal mental health problems | Pregnant women | Female (100%) | N/A | h, k | ||
Azale 2016 [27] | Ethiopia | Cross sectional study / community sampling | Face-to-face interview (participants’ homes) | 385 | Postpartum depression | Postpartum women with potential depressive disorder (PHQ-9 > =5) | Female (100%) | 28.8 (5.2) | c,g | h, i, k | |
Barrera 2015 [28] | Latin America | Cross sectional study/ convenience sampling | Internet survey | 1760 | Perinatal depression | Pregnant women | Female (100%) | 28.3 (5.7) | i, k | ||
Bina 2014 [29] | Israel | Prospective longitudinal study / convenience sampling | Telephone survey | 88 | Postpartum depression | Postpartum women who screened positive for PPD (EPDS> = 9) | Female (100%) | 29.7 (5.86) | i, k | ||
Branquinho 2019 [30] | Portugal | Cross sectional study/ volunteer and snowball sampling | Internet survey | 621 | Postpartum depression | General public (Perinatal women excluded) | Female (88.1%) Male (11.9%) | 32.05 (9.99) | a, b, c, g | l | |
Branquinho 2020m [31] | Portugal | Cross sectional study / volunteer sampling | Internet survey | 621 | Postpartum depression | General public (Perinatal women excluded) | Female (88.1%) Male (11.9%) | 32.05 (9.99) | l | ||
Buist 2005 [32] | Australia | Cross sectional study / convenience sampling | Questionnaire (postnatal check-up) | 420 | Perinatal depression | Postpartum women | Female (100%) | N/A | a, g | i | |
Buist 2007 [20] | Australia | Cross sectional study/ Convenience sampling | Questionnaire (postnatal check-up) | 394 | Perinatal depression | Postpartum women | Female (100%) | N/A | a | ||
DaCosta 2018 [33] | Canada | Cross sectional study / volunteer sampling | Internet survey | 652 | Perinatal mental health problems | Nulliparous Pregnant women | Female (100%) | 32.0 (4.3) | i, k | ||
Dunford 2017 [34] | UK | Cross sectional study/ volunteer sampling | Internet survey | 185 | Postpartum depression | Postpartum women | Female (100%) | 31 (5.16) | l | k | |
Fonseca 2015 [35] | Portugal | Cross sectional study / volunteer sampling | Internet survey | 198 | Perinatal depression | Perinatal women with a positive screen for depression | Female (100%) | 30.59 (4.63) | h, k | ||
Fonseca 2017 [36] | Portugal | Cross sectional study / volunteer sampling | Internet survey | 231 | Perinatal depression, anxiety | Perinatal women in a romantic relationship | Female (100%) | 29.99 (5.07) | h | ||
Fonseca 2018 [37] | Portugal | Cross sectional study / volunteer sampling | Internet survey | 226 | Perinatal depression & anxiety | Perinatal women | Female (100%) | 30.08 (4.12) | l | h, k | |
Ford 2019 [38] | UK | Cross sectional study / volunteer sampling | Internet survey | 71 | Perinatal mental health problems | Postpartum women with symptoms of distress | Female (100%) | 32.85 (5.69) | k | ||
Goodman 2009 [39] | United States | Cross sectional study / convenience sampling | Questionnaire (Obstetric clinics) | 509 | Perinatal depression | Pregnant women in the third trimester | Female (100%) | 31.6 (5.32) | I, j, k | ||
Goodman 2013 [40] | United States | Cross sectional study / Convenience sampling | Questionnaire (Hospital) | 60 | Perinatal depression | Pregnant women | Female (100%) | 25.49 (5.19) | h, j, k | ||
Henshaw 2013 [41] | United States | Cross sectional study / Convenience sampling | Telephone survey | Baseline: 36; 6 week follow-up: 28 | Perinatal depression & anxiety | Perinatal women | Female (100%) | 28.4 (4.69) | c | h | |
Highet 2011 [18] | Australia | Cross sectional study/ random sampling | Telephone survey | 1201 | Perinatal depression | General public | Female (73.8%) Male (26.2%) | N/A | a, b, c | l | I |
Holt 2017 [42] | Australia | Cluster randomised controlled trial / cluster sampling | Telephone survey | 541 | Postnatal depression & anxiety | Postpartum women | Female (100%) | Intervention group (IG): 31.5 (4.7); routine care (CG): 32.1 (4.6) | i, k | ||
Kim 2010 [43] | United States | Cross sectional study / Convenience sampling | Telephone survey | 51 | perinatal depression | Perinatal women at risk for depression | Female (100%) | N/A | k | ||
Kingston 2014a [44] | Canada | Cross sectional study / convenience sampling | Telephone survey | 1207 | Perinatal depression & anxiety | General public | Female (50%) Male (50%) | N/A | i, j | ||
Kingston 2014b [17] | Canada | Cross sectional study / random sampling | Telephone survey | 1207 | Perinatal depression & anxiety | General public | Female (50%) Male (50%) | N/A | b, c | ||
Logsdon 2018a [45] | United States | Cross sectional study / Convenience sampling | Interview (Academic health sciences center) | 50 | Postpartum depression | Postpartum Latina immigrant mothers | Female (100%) | 27.9 (6.2) | f | h. j, k | |
Logsdon 2018b [46] | United States | Pretest-posttest design /convenience sampling | Questionnaire (Community organizations; home visits) | Control group: 138; intervention group: 154 | Postpartum Depression | Adolescent postpartum women | Female (100%) | Control group (CG): 18.2 Intervention group (IG): 17.9 | h | ||
Mirsalimi 2020m [47] | Iran | Cross sectional study Convenience sampling | Questionnaire (hospital) | 692 | Postpartum Depression | Perinatal women | Female (100%) | 27.63 (5.46) | i | ||
O’Mahen 2008 [48] | United States | Cross sectional study / Convenience sampling | Telephone survey | 108 | Perinatal depression | Pregnant women | Female (100%) | N/A | i, j, k | ||
O’Mahen 2009 [49] | United States | Longitudinal study/ convenience sampling | Telephone survey | 82 | Perinatal depression | Pregnant women (> = 10 EPDS) | Female (100%) | 30.02 (4.9) | c | k | |
Patel 2011 [50] | United States | Cross sectional study/ volunteer sampling | Internet survey | 100 | Perinatal depression | Perinatal women | Female (100%) | 31 (5.0) | j | ||
Prevatt [51] | United States | Cross sectional study/ convenience and snowball sampling | Internet survey | 211 | Postpartum mood disorder symptoms | Postpartum women | Female (100%) | 32.99 (4.10) | i, k | ||
Ride 2016 [52] | Australia | cross-sectional discrete choice experiment/ convenience sampling | Internet survey | 217 | Perinatal depression & anxiety | Perinatal women | Female (100%) | 32.0 | h, j, k | ||
Sealy 2009 [19] | Canada | Cross sectional study/ Community sampling | Telephone interview | 8750 | Postpartum depression and baby blues | General public | Female (55.8%) Male (44.2%) | N/A | b, g | i | |
Sleath 2005 [53] | United States | Cross sectional study / convenience sampling | (County health department) | 73 | Prenatal depression | Pregnant women 12–32 weeks prenatal | Female (100%) | 23.6 (4.9) | j | ||
Small 1994 [54] | Australia | Case control study | At home | Case group: 45; control group: 45 | Postpartum depression | Postpartum women | Female (100%) | N/A | c | i | |
Smith 2019 [55] | Australia | Cross sectional study | Internet survey | 1201 | Perinatal depression & anxiety | General public | Female (51%) Male (49%) | N/A | a, b, c, g | l | h, I |
Thorsteinsson 2014 [56] | Australia | Cross sectional study/ Convenience sample | Internet survey | 500 | Postpartum depression | General public | Female (85.4%) Male (14.6%) | 33.73 (9.55) | a, c | i, j | |
Thorsteinsson 2018 [57] | Australia | Randomised controlled trial/ random sampling | Internet survey | 212 | Postpartum depression | General public (Parents) | Female (91.5%) Male (8.5%) | 36.88 (8.71) | l | h | |
Wenze 2018 [58] | United States | Cross sectional study/ Volunteer sample | Internet survey | 241 | Perinatal mental health problems | General public (Parents of twins or higher order multiples) | Female (80.9%) Male (19.1%) | 41.91 (10.79) | h, j, k | ||
Zittel-Palamara 2008 [59] | United States | Cross sectional study/ Convenience sample | Telephone survey | 45 | Postpartum depression | Women who had or were currently experiencing PPD | Female (100%) | 29.8 (7.23) | i, j, k |
Tools to measure perinatal MHL components
Knowledge of PMHP
Knowledge component | Studies (N = 13) | |
---|---|---|
Public | Perinatal women | |
Recognition | ||
More than 50% of participants were able to recognize perinatal mental illness | ||
Less than 50% of participants were able to recognize perinatal mental illness | ||
Symptoms | ||
PPD: negative thoughts about the baby (66.7%); sleeping and eating problems (81.5%); difficulties responding to respond to their partners and other children’s needs (85.3%); difficulties responding to their baby’s needs (77.1%); severe sadness and irritability (57.3%) | Branquinho 2019 [30] | |
PPD: feeling sad/miserable (30.2%); Lack of bonding or worry about bonding with baby (26.2%); feelings of not coping (20.3%); Isolation (20.2%); Feeling tired (16.3%); Feeling stressed/anxious (15.3%); Loss of interest (11.3%); Sleeping problems (10.1%); Low self-esteem (9.8%); Mood changes (9.1%); Anger (8.3%); Weight (7.4%); Irritability (7.1%) | Highet 2011 [18] | |
PPD: Women with PPD find it difficult to respond to their baby’s cues (68.6%); women with PPD find it more difficult to respond to the needs of their partner or other children (79.8%) | Kingston 2014b [17] | |
PPD: sadness (63.2%); frustration/irritability (26.0%); sleep/appetite problems (20.6%); feelings of guilt toward the baby (19.0%); anxiety/fears (12.2%); harm to self or the baby (< 5.0%); hopelessness/helplessness (5.0%); social isolation (< 5.0%) baby blues: same symptoms as PPD (28.1%), not extending 2 weeks (29.9%) | Sealy 2009 [19] | |
PPD: feeling sad/miserable (37.1%); fatigue/sleep problems (23.4%); lack of bonding with baby (19.5%); anger/irritability/aggression (17.2%); social isolation/withdrawal (13.5%); anxiety/panic attacks (12.8%); mood changes (9.3%); weight/appetite changes (8.7%); feelings of not coping (8.4%); loss of interest/pleasure (3.7%); self-esteem/confidence (3.3%) Postnatal anxiety: anxiety/panic attacks (17.1%); fatigue/sleep problems (13.2%); depression/sadness (9.8%); physical symptoms (9.4%); social isolation/withdrawal (8.1%); anger/irritability/aggression (6.9%); exaggerated/constant worrying (6.4%); inability to relax (6.4%); racing/intrusive thoughts (1.5%); obsessive behaviours (1.4%) | Smith 2019 [55] | |
Causes | ||
PPD: Psychosocial causes (financial difficulty, and unsupportive partner and “thinking too much”) (60%) | Azale 2016 [27] | |
PPD: mainly caused by hormonal changes (28%); don’t know (31.7%), depression or anxiety during pregnancy (60.5%) | Branquinho 2019 [30] | |
Perinatal depression / anxiety: inadequate social support (22.2%); physical/hormonal change with pregnancy (19.4%); stress (11.1%); Unemployment (8.3%); Lack of sleep (8.3%); Adjustment to parenting (8.3%); Genetics (5.6%); prior mental health issue (5.6%) (primary cause of the depressive symptoms) | Henshaw 2013 [41] | |
PPD: Biological causes (35.4%); Unprepared for transition to parenthood (30%); Lack of support (21.8%); Not coping with infant’s demands (17.8%); Stress/pressure (15.9%); Fatigue/lack of sleep (11.4%) | Highet 2011 [18] | |
Prenatal depression / anxiety: history of anxiety or depression (57.2%) PPD: prior episodes of anxiety or depression in pregnancy (60.9%) | Kingston 2014b [17] | |
Perinatal depression: Stress (80.5%); Hormonal changes (73.1%);state of mind (69.5%); pregnancy (65.8%); lack of sleep (46.3%); difficulty adjusting to being pregnant (43.9%); hereditary (43.9%); own behavior (39.0%); marriage or relationship problems (31.7%);other people (23.2%); having additional child (17.1%) | O‘Mahen 2009 [49] | |
PPD: feeling unsupported (61.7%); being isolated (61.7%); exhaustion (31.7%); physical health factors (45%); lack of time/ space for self (66.7%); material circumstances (55%); illness/death of loved one (26.7%); baby temperament (26.7%); hormones/biology (31.7%); tendency to depression (15%) | Small 1994 [54] | |
PPD: biological causes (34.5%); change of lifestyle (12.2%); lack of support (8.5%); not coping with parenting (9.0%); stress/pressure (7.0%); fatigue/lack of sleep (6.4%) | Smith 2019 [55] | |
PPD: hormonal changes (91%); lack of sleep (88%); lack of social support (75%); day-to-day problems (54%); difficult baby (52%); genetic tendency (47%); marital problems (45%); unprepared for parenthood (45%); uninformed about parenthood (42%); financial problems (41%); low self-esteem (39%); single parent status (39%); traumatic events (37%); obstetric factors (37%); nervous person (24%); virus or infection (13%) | Thorsteinsson 2014 [56] | |
First aid / Self-help | ||
Performing religious activities, discussing with significant others, thinking less about the problem, being relaxed (most frequently mentioned factors) | Azale 2016 [27] | |
Prevention | ||
Mental health treatment would be effective in preventing future mental health problems (58.7%) | Logsdon 2018a [45] | |
Intervention | ||
PPD: professional help (92.1%); psychological intervention (77.6%); help from GP (67.0%); supplements and vitamins (4.3%); support of family and friends (5.6%) | Branquinho 2019 [30] | |
Prenatal depression: partner assistance (96%); Vitamins / minerals (86%); Counselling (80%); Naturopath (49%): special diet (40%); Antidepressants (22%) PPD: Counselling (93%); partner assistance (93%); Vitamins / minerals (78%); Antidepressants (54%); Naturopath (49%); Special diet (45%) | Buist 2005 [32] | |
PPD: Counselling (19.4%); Support group (15.6%); Antidepressants (15.5%); Talking and listening (12.1%); Psychotherapy (9.6%); Family support (7.7%); Doctor / GP; (6.6%); Don’t know (9.9%) | Highet 2011 [18] | |
PPD and baby blues: Only PPD requires professional treatment (41.4%); PPD and baby blues require professional treatment (40.8%) PPD: physician/obstetrician (85.2%); Psychiatrist/mental health worker (18.4%); local health unit (11.9%) | Sealy 2009 [19] | |
PPD: counselling/psychological therapy (37.7%); antidepressants (29.5%); support group; (6.5%); family support/friends (11.6%); GP/Medical professional (7.3%); help with domestic/childcare tasks (5.5%); talking and communication (3.4%); Exercise (4.0%); don’t know (26.9%) | Smith 2019 [55] |
Recognition
Symptoms
Causes
Interventions
Stigmatising attitudes and beliefs regarding PMHP
Authors | Stigmatizing attitudes and beliefsa | Levels of stigmab |
---|---|---|
Branquinho 2019 [30] | It is normal to have PPD (17.6%); women with postpartum depression cannot be good mothers (11.4%); postpartum depression is not a sign of weakness (disagreement 11.6%); women know, by nature, how to look after a baby (23.8%); women have postpartum depression because they have unrealistic expectations about caring for a baby (12.1%) | |
Branquinho 2020 [31] | Attitudes towards PPD: M = 2.52; SD = 0.51c; Indifference to stigma: M = 0.76; SD = 0.73d | |
Dunford 2017 [34] | Indifference to stigma: M = 21.11; SD = 7.53e | |
Fonseca 2018 [37] | Indifference to stigma: M = 3.29; SD = 0.75d | |
Highet 2011 [18] | It is normal to be depressed during pregnancy (agree / strongly agree: 52%); it is normal to have PPD (agree / strongly agree: 24%); knowing how to look after a baby comes naturally to women (agree / strongly agree: 19%) | |
Smith 2019 [55] | It is normal to be depressed during pregnancy (agree / strongly agree: 32%); postnatal depression is a normal part of having a baby (agree / strongly agree: 18.5%); knowing how to look after a baby comes naturally to women (agree / strongly agree: 21.6%) | |
Thorsteinsson 2018 [57] | Pre-intervention personal stigma (averaged across groups): M = 6.69f; Pre-intervention perceived stigma (averaged across groups); M = 17.14f |
Help-seeking for PMHP
Authors | Outcomes | ||
---|---|---|---|
Intention to seek help | Attitudesa Preferred /recommended source of help | Preferred treatment | |
Ayres 2019 [26] | 36.2% | ||
Azale 2016 [27] | Perceived need for treatment:71.6% | *Informal: husband (61.3%); Formal: general health professional (any) (12.7%) | Modern medicine (49.8%) |
Barrera 2015 [28] | * Informal: partners (82.5%); family members (75.5%); Formal: health providers (49.4%) | ||
Bina 2014 [29] | *Professional help users (24%): mental health professional (71%) Informal help users (62.5%): family and friends (approx. 50%) | ||
Buist 2005 [32] | *Informal: family (50%); Formal: GP (29.2%) | ||
Branquinho 2020 [31] | Help-seeking propensity: M = 3.19; SD = 0.61b | ||
DaCosta 2018 [33] | *All women: family doctor/general practitioner (9.7%) Women EPDS> = 10: family doctor/general practitioner (19.2%) | ||
Dunford 2017 [34] | Help-seeking propensity: M = 21.46; SD = 6.29b | ||
Fonseca 2015 [35] | Willingness to seek professional help for psychological problems: 38.4% | ||
Fonseca 2017 [36] | Intention to seek professional help: M = 4.48; SD = 1.60d | ||
Fonseca 2018 [37] | Intention to seek professional help: M = 4.48; SD = 1.59d | ||
Goodman 2009 [39] | Obstetric practitioner or mental health practitioner at obstetrics clinic (69.4%) | Individual psychotherapy (72.5%) | |
Goodman 2013 [40] | Interested in professional mental health services: 78.3% | PPD prevention: mindfulness approach (MBCT) (47.46%) | |
Henshaw 2013 [41] | Informal: friend or family member (83.3%); Formal: counsellor/psychologist (58.3%) | ||
Highet 2011 [18] | Full sample: Informal: friends and family (32%); Formal: doctor (52%); Family / friends (male: 21,1; female: 43,1); GP (male: 32%; female: 21%) | ||
Holt 2017 [42] | *GP (69.6%); psychologist/counsellor (52.2%)f | ||
Kingston 2014a [44] | Informal: partner (17.7%); Formal: family doctor (38.9%) | Talking to doctor or midwife (81.6%); counselling (79.8%); peer support (73.2%); parenting help (70.3%); diet/ nutritional supplements (63.2%); phone support (52.9%) | |
Logsdon 2018a [45] | M = 3.8; SD = 1.2e | First inclination: psychological treatment (73.9%) | |
Logsdon 2018b [46] | Baseline CG:11.5%; Baseline IG:11.9% | ||
Mirsalimi 2020 [47] | Informal: friends / family members (27.2%); Formal: psychologist (42.1%) | ||
O’Mahen 2008 [48] | Mental health specialist (85.1%); primary care physician (68.8%); obstetrician (62.5%); pastor (60.5%) | Family/friend support (89.6%); therapy (76.4%); antidepressant; (68.7%); case management (62.5%) | |
Patel 2011 [50] | Combination of medication and counselling (55%) | ||
Prevatt 2018 [51] | OB-Gyn (53.4%) | ||
Ride 2016 [52] | 77% | Pregnant women: individual counselling; Breastfeading women: Meditation; Yoga or Exersice; Non-breastfeeding women: combinded counselling and Medication. Individual counselling was consistently the highest ranked guideline-recommended treatment.g | |
Sleath 2005 [53] | Wait and get over it naturally (83.6%); counseling from a mental health professional (57.6%)h | ||
Small 1994 [54] | * Informal: friends (70%); partner (66.7%); Formal: GP (65%), maternal and child health nurse (55%) | ||
Smith 2019 [55] | Women who would not seek help for PPD: 3.8% | Informal: family/friends (male: 19%; female: 53%); Formal: doctor (male: 43.3%; female: 50.7%) | |
Thorsteinsson 2014 [56] | Informal: family (70%); friends (68%); Formal: GP (96%); counsellor (86%); community health nurse (75%); telephone counselling service (71%); social worker (60%); internet (54%); psychiatrist (53%) | Family support (88%); support group (85%); counselling/psychotherapy; (81%); relaxation/time to self (76%); sleep (74%), exercise (74%); antidepressant medication (56%); improved diet (51%) | |
Thorsteinsson 2018 [57] | Help-seeking propensity (averaged across groups): M = 2.92; SD = 1.73c | ||
Wenze 2018 [58] | 47.8% interested in mental health treatment in the perinatal period (for stress: 32.1%; for depression: 18.8%; for anxiety: 21.9%) | Preference Ranking: 1. Individual therapy (47.9%) | |
Zittel-Palamara 2008 [59] | OB/Gyn (73.3%); psychiatrist (73.3%); psychologist (71.1%); primary care physician (71.1%); social workers (66.7%); paediatricians (60%); midwives (57.8%); spiritual assistance (64.4%) | Individual counselling (84.4%); medication (73.3%); In-person support group (73.3%); hospital inpatient (68.9%); online support group (66.7%) |
Authors | Structural Barriers* | Individual barriers (Knowledge/Attitude)* | Facilitators | |
---|---|---|---|---|
Ayres 2019 [26] | Lack of time; no one to look after child while attending appointment | Encouragement by family Encouraged by midwife / GP / obstetrician | ||
Azale 2016 [27] | Fear of cost (56.0%); distance (50.4%) | Problem would get better by itself (76.1%); wanting to solve the problem by herself (66.7%) | Strong social support; perceived physical cause; perceived higher severity; perceived need for treatment; PHQ score; disability a | |
Barrera 2015 [28] | Non-help seekers: I figured that it would pass (83.8%); I didn’t think others would understand; (77.0%); I didn’t think anyone could help me (67.4%), I didn’t know what I was feeling (65.0%), I didn’t think it was that important (59.4%), I was afraid of my feelings (53.5%); I was ashamed of my feelings (50.2%); I was embarrassed of my feelings (49.8%) | current major depressive episode; income a | ||
Bina 2014 [29] | High confidence in mental health professional, higher levels of depressive symptomsa | |||
DaCosta 2018 [33] | Being too busy (26.1%); waiting time too long (18%); cost (22.6%); not available at time required (10.4%) | Not having gotten around to it (46.1%); deciding not to seek care (24.3%); not knowing where to go (19.1%); felt help would be inadequate (16.5%) | Less severe depressive symptoms; prior consultation for mental healtha | |
Dunford 2017 [34] | Shame proneness significantly predicted negative attitudes towards help-seekingb | |||
Fonseca 2015 [35] | Not be able to afford treatment (63.7%); do not have time to go to psychology and/or psychiatry appointments (51.9%); have sanctions for missing work to go to psychology and /or psychiatric appointments; (38.6%); do not have means to travel to psychology and/or psychiatry appointments (19.3%). | Attitudinal barriers: thinking that no one will be able to help me deal with my problems (47.4%); being afraid of what my family and/or friends might think of me (32.2%); being ashamed to talk to with health professional (36.8%); being afraid that other people discover I attend psychology and / or psychiatric appointments (33.3%) Knowledge barriers: do not know if my problems are a reason to ask for help (76%); do not know what the best treatment options is (96.2%), do not know where to seek treatment (39.2%) | Higher age; single/divorced; history of psychiatric problems and treatmenta | |
Fonseca 2018 [37] | For women with significant psychological symptoms: women’s more insecure attachment representations (anxiety and avoidance) were associated with lower intentions to seek professional helpf | |||
Ford 2019 [38] | Logistics of attending appointment; logistics of getting an appointment c | Fear of stigma; willingness to seek help c | Interpersonal relationship with healthcare professionals (healthcare professionals being empathetic and non-judgemental, having my voice heard in discussions and decisions about treatment, opportunity to build trust and respect with healthcare professionals); support from friends and family (partners who encourage women to seek help)d | |
Goodman 2009 [39] | Cost (22.6%); no time (64.7%), no childcare (33.2%); if there were a charge, I might not be able to afford it (18.8%) | Stigma (42.5%); would not know where to find such services (26.2%) | ||
Goodman 2013 [40] | Coste | Belief that prayer would be sufficient to help prevent depressione | Severity of illness (33%), pragmatics (e.g., cost, location), (29%); knowledge; social support (19%), professional encouragement (7%) | |
Holt 2017 [42] | I thought I would be able to manage on my own (11.1%); I felt I should be able to manage on my own (11.1%); I did not think I needed help; (6.7%); I did not want people to know I wasn’t coping (6.1%) | antenatal anxiety, previous history of depression; self-esteema | ||
Kim 2010 [43] | Patient level: Lack of time (25%); Used other support (25%); spontaneous improvement of symptoms (13%) Provider level: provider unavailability (56%); unresponsive provider (25%) Patient / provider interaction: Poor match to patient need (31%); patient provider fit (31%); phone tag (31%), System level: Cost/insurance mismatch (56%); geographic mismatch (19%) | Patient level: recognition of one’s own need for treatment (14%) Provider level: treatment availability (21%) System level: Cost/insurance mismatch (21%) Additional factors: referrals tailored to patient needs; (29%); specific encouragement to engage in treatment; (21%); geographic match (21%), active facilitation of the referral process (14%) | ||
Logsdon 2018a [45] | Attitudes towards help-seeking: seeking psychological help carries a social stigma (34.8%); people will see them in a less favourable way if they were receiving mental health treatment (23.9%); people who seek psychological treatment are generally liked less by others (34.8%); people should work out their own problems with psychological counselling as the last resort (30.4%) | More positive attitudes towards seeking professional psychological help, less social support; less perceived controla | ||
O’Mahen 2008 [48] | 1.Structural Barriers (1. insurance; 2. inability to pay; 3. transportation; 4. inadequate childcare)g | 2. Knowledge (1. not sure who to contact; 2. Do not know what treatment might be best for me) 3.Attitudes (1. lack of expressed motivation; 2. hopelessness about treatment working)g | ||
O’Mahen 2009 [49] | Belief that symptoms would last a long timea | |||
Prevatt 2018 [59]l | Time constraints (18%) | Stigma (19%); lack of motivation (16%) | Social support, stressa | |
Ride 2016 [52] | Costm | High social support; high levels of education; childcare; higher efficacy, past experience of treatmentm | ||
Wenze 2018 [58] | Lack of time (16.6%) | |||
Zittel-Palamara 2008 [59] | Tried to find assistance but was unable to find resources (15.6%); PPD symptoms made it difficult to take action (13.3%), comments from health care professional that ‘this is normal’ (13.3%) | Not being sure who to speak to (15.6%), lack of PPD education (13.3%); pressure from family and friends (e.g., ‘it is normal, you are fine’) (13.3%) |