UNDERSTANDING AND IMPROVING BARRIERS TO TREATMENT AND CARE OF POSTPARTUM DEPRESSION

Background: Postpartum depression (PPD) is a multifaceted and complex issue that impacts not only the mother, but also the infant and social system and may influence how healthcare is accessed. Compounding the effects of PPD are comorbidities such as perinatal substance use. Utilization of substances during pregnancy can increase feelings of anxiety and depression, result in cognitive and physiological consequences for the infant and impair relationships with healthcare providers. Purpose: The studies completed for this dissertation revealed current concerns regarding PPD within the context of screening practices, perinatal substance use and rural practice implications. Methods: Three studies were conducted. Study one was comprised of a systematic review that sought to address barriers and facilitators to PPD screening within the well-child setting. Study two utilized a knowledge, attitude and practice survey tool to assess for potential implicit bias surrounding perinatal substance use among Maternal-Child providers within the state of Montana. Study three built upon these two studies through individual interviews with women who had positive perinatal substance use screens or who self-reported mental health concerns, to identify risk and protective factors for seeking care for PPD. Results: The systematic review described multiple barriers and facilitators to PPD screening within the well-child setting. Concerns regarding time, appropriate training and poor referral opportunities were noted as barriers to screening in this setting. Facilitators were shown to be utilization of electronic prompts within charting systems, and familiarization of PPD screening tools. Study two demonstrated that participants (N=97) had an overall professional understanding of the effects and implications of perinatal substance use. This knowledge appeared to influence attitudes and practices of participants in such a way as to provide competent and unbiased care towards women who use substances while pregnant. The final study allowed interview participants (N=7) the opportunity to share their stories through narrative inquiry. Overall study themes included: family history of mental health concerns and/or substance use, stigmatization around mental health or substance use, lack of awareness surrounding PPD, and isolation. Conclusions: This dissertation sought to offer insight into barriers and facilitators to seeking and receiving care for PPD. Throughout this work, emphasis was placed on the implications of factors such as rurality and vulnerability in regards to their relationship with PPD screening and healthcare access. Findings of this work support the need for additional research focusing on perinatal substance use and PPD. Specifically, this work provides a foundation for future studies to emphasize the interaction between people with perinatal substance use disorder, their healthcare providers, and the healthcare system. Additionally, this study promotes educational interventions to support screening for PPD and lays a foundation for further research and quality improvement projects aimed at improved PPD screening