Targeting Barriers to Care for Pregnant Women at Risk for Depression: Examining The Role of Stigma and the Feasibility of a Web-Based Depression Prevention Program

Depression is common in pregnancy and postpartum, and associated with negative consequences for women, their families, and society at large. Despite evidence-based treatment options, few women receive treatment. In the context of three studies, this dissertation addresses the overall aim to examine strategies to increase treatment engagement among pregnant and postpartum women, including identifying and targeting barriers to depression care and disseminating interventions in innovative ways to overcome barriers. The Public Attitudes About Perinatal Depression study was developed in response to research suggesting that perceived stigma is a barrier to pregnant and postpartum women seeking help for depression. This study examines public attitudes about perinatal depression using 241 participants from Amazon’s Mechanical Turk who completed measures assessing attitudes about, warmth towards, and spontaneous associations with depressed pregnant women, depressed postpartum moms, depressed women, as well as depressed dads-to-be, depressed postpartum dads, and depressed men. Results provide no evidence that people view depressed pregnant or postpartum women more harshly than they view depressed women in general. Limitations and future research directions are addressed. The Depression Screening and Feedback study tested the feasibility and impact of a brief, mailed intervention on depression symptom severity, and examined barriers to help-seeking and actual help-seeking actions among perinatal women with elevated depression symptom severity recruited from a local Obstetrics/Gynecology clinic (n=20). Data collection for this study is ongoing, and results from the data collected to date are presented. Finally, the Mindful Mood Balance for Moms study examines the feasibility and preliminary outcomes of a web-based depression-prevention program for at-risk pregnant women (n=37). Results suggest that the web-based program was feasible, and self-report and interview data nominate areas for further refinement. Contrary to hypotheses, participants did not evidence significant reduction in depression symptom severity. Future studies should address the extent to which this program helps to prevent depressive relapse among this vulnerable population. Together these studies emphasize the continued importance of identifying and targeting barriers to care among at-risk and depressed perinatal women