The silent struggle after childbirth – barriers and facilitators to help-seeking for postpartum depression and anxiety

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Abstract Background The postpartum period makes mothers particularly vulnerable to mental health disorders such as postpartum depression and anxiety. Despite the high prevalence of these disorders, help-seeking for them remains critically low, leaving many women without adequate support. Therefore, the aim of this study was to examine the extent to which different factors associated with help-seeking intentions and actual help-seeking behaviors for mental health disorders among postpartum women. We also examined how these factors differed between groups of women with symptoms of postpartum depression, postpartum anxiety, symptoms of both disorders, and women without clinical symptoms. Methods We used data from a cross-sectional study in Dresden, Germany, with data from N = 4,624 women collected via telephone interviews between 2021 and 2024. Multiple linear regression models were used to examine predictors of help-seeking intention ( n = 4,554) in all the groups, while logistic regression models ( n = 778) were used to investigate predictors of actual help-seeking behavior among women with symptoms of postpartum depression and/or anxiety. Results For the different factors, results varied between help-seeking intention and actual help-seeking behavior. Negative health beliefs were found to have the most negative effect on help-seeking intention for all groups. Help-seeking intentions were lower among women with a migrant background who had symptoms of either postpartum depression or anxiety, among women with lower knowledge of services who were not clinically affected, and lower among women with symptoms of postpartum depression who had not used mental health services before. Recognition of a mental disorder was by far the most important factor associated with higher actual help-seeking behavior for all groups. Higher income and older age were factors associated with higher actual help-seeking behavior among women with symptoms of postpartum depression. Conclusions This study identified factors associated with help-seeking for postpartum depression and anxiety. The findings suggest that routine screening for postpartum depression and anxiety to address the lack of recognition of mental disorders, as well as targeted awareness campaigns to support positive health beliefs, are needed and can improve help-seeking. Tailored interventions for at-risk groups, such as low-income or migrant women, could improve postpartum mental health care.

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