Study probes barriers to mental health aid for low-income women

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A new UCLA study explores the reasons why many low-income women suffering from postpartum depression (PPD) do not seek help from formal mental health services, and how the barriers to such services for these women might be overcome. 

The project was conducted by Laura Abrams, assistant professor of social welfare at the UCLA School of Public Affairs, and UCLA social welfare Ph.D. candidate Katrina Dornig. Abrams and Dornig explored symptom recognition, informal and formal help-seeking for PPD symptoms, and attitudes toward mental health services among low-income mothers from ethnic minority backgrounds.
 
While previous research has shown low rates of seeking mental health services during the postpartum period among low-income and ethnic minority mothers, the authors cite a lack of understanding about the reasons. "The long-term goal of this project is to increase the number of low-income mothers receiving prompt assessment and treatment for PPD and [to learn] how these barriers might be overcome," says Abrams.
 
PPD is a serious mental health condition that is estimated to affect 13 to16 percent of new mothers and often goes undetected, say the authors. Untreated PPD is linked to a number of negative consequences for mothers, babies, and families - for example, difficult maternal-infant bonding, cognitive and emotional delays for children, an increased risk of maternal substance abuse and increased risks of child abuse and neglect.
 
Research methods for the study included in-depth, individual interviews and focus groups with low-income mothers (including mothers living with PPD and key community informants), as well as focus groups with Los Angeles-area health and social service providers.
 
Abrams and Dornig report that depression experiences in their sample were severe, including "suicidal ideation, compromised parenting, persistent isolation, and emotional instability." In addition, mothers living with PPD were most likely to reach out to a trusted family friend, who often recommended that the women access a medical provider. However, among the women who did contact a primary care provider, these contacts often ended in "dead ends" in terms of their actually obtaining mental health treatment. In the absence of formal treatment, mothers relied on self-help, religious or spiritual practices, and family and friends in trying to cope with their symptoms.
 
Barriers to mental health service use include:


  • Mothers tend to "normalize" or deny their symptoms, and providers often do not assess them for PPD. 


  • Mothers in the sample considered the mental health providers in their past experience to have been uncaring and too medication focused, making the mothers less willing to seek help for PPD.


  • Low-income mothers face instrumental barriers such as cost or insurance regulations that prevent them from considering the use of formal mental health services.


  • Even when instrumental barriers are removed, stigmas and culturally informed beliefs about motherhood, mental illness, depression and PPD present women with significant obstacles to seeking treatment from mental health professionals.


  • Religious beliefs can facilitate help-seeking from clergy, yet they can also prevent mothers from seeking help through formal mental health venues.

 
Abrams and Dornig offer the following practice recommendations:


  • Providers should adopt destigmatizing, nonmedical language, such as framing mental health treatment as "talking with a trusted or caring person."


  • Mental health and general medical practitioners should educate mothers with PPD symptoms about the range of treatment options and avoid the "medication first" model of care for PPD.


  • Providers treating PPD or offering referrals should explore mothers' past experiences with treatment and their current preferences for care.


  • Providers need extensive training concerning the interpretation of PPD symptoms and treatment preferences for mothers of diverse cultures.


  • Medical, mental health and social service providers in various settings need consistent guidelines for and training in the implementation of standard PPD assessment tools.

 
The full report is available online at: http://faculty.spa.ucla.edu/abrams.
 
The UCLA School of Public Affairs was founded in 1994 to educate the next generation of practitioners and academic researchers in the "problem-solving professions" - public policy, social welfare, and urban planning. The school is one of the largest and most dynamic of its kind in the nation
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