Access and barriers to treatment and counseling for postpartum women with and without symptoms of (CB-)PTSD within the cross-sectional study INVITE.

backgroundAlthough childbirth is frequently described as a positive experience, the transition to parenthood can be challenging and many postpartum women suffer from mental health problems. Nevertheless, the utilization of treatment and counseling services remains low. To improve this, it is necessary to examine the likelihood of and barriers to help-seeking among postpartum women. There is a paucity of research on postpartum posttraumatic stress disorder (PTSD), that addresses these issues, especially when considering both types of postpartum PTSD, namely childbirth-related PTSD (CB-PTSD) and general PTSD (gPTSD). Thus, we examined differences in the likelihood of and barriers to help-seeking between postpartum women with CB-PTSD, gPTSD, and women who were not affected by clinically relevant symptoms of these two mental health problems.

methodsData from the cross-sectional study INVITE were used, consisting of n = 3,875 telephone interviews with women between 6 weeks and 6 months after childbirth. CB-PTSD was assessed using the City Birth Trauma Scale and gPTSD using a short version of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5. Women were asked about their likelihood of and specific barriers to help-seeking through self-developed questionnaires. Analyses of covariance were conducted to examine group differences and multiple regression analyses to investigate associations between symptom severity and the likelihood of help-seeking.

resultsGroups did not differ in their likelihood of help-seeking. Additionally, the severity of the symptoms did not predict the likelihood of help-seeking. Post-hoc comparisons revealed more overall barriers among women with CB-PTSD compared to non-affected women. Concerning different types of barriers, women affected by CB-PTSD or gPTSD reported more instrumental barriers than non-affected women. More barriers related to fears about treatment and stigmatization were only reported by women with CB-PTSD compared to non-affected women but not by women with gPTSD. Significant associations with socio-demographic confounders were found in all analyses.

conclusionsReducing instrumental barriers, e.g. through outreach services or financial subsidies, seems to be key in order to improve access to services for postpartum women with CB-PTSD or gPTSD. Since women with CB-PTSD reported more fears about treatment and stigmatization, education about CB-PTSD among perinatal women and health professionals may also be important.