Sexual orientation-related disparities in perinatal mental health among a prospective cohort study

Treatment and counselling preferences of postpartum women with and without symptoms of (childbirth-related) PTSD: findings of the cross-sectional study INVITE

BACKGROUND

Post-traumatic stress disorder (PTSD) in the postpartum period is a prevalent yet under-researched mental health condition. To date, many women who suffer from postpartum PTSD remain unrecognized and untreated. To enhance the accessibility of help for these women, it is crucial to offer tailored treatment and counselling services that align with their needs. This study aimed to understand how support preferences differ between women with and without postpartum PTSD, considering the two subgroups of postpartum PTSD: childbirth-related PTSD (CB-PTSD) and general PTSD (gPTSD).

METHODS

This study used data from the cross-sectional INVITE study, comprising telephone interviews with N = 3,874 women conducted six weeks to six months after childbirth. The City Birth Trauma Scale (City BiTS) was used to assess CB-PTSD, while the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) was used to assess gPTSD. Service preferences and preferred modes of service provision were measured with self-developed questionnaires. Analyses of variance were used to identify differences between groups.

RESULTS

The support services (family-)midwives and family, friends, or colleagues and the service provision mode as in person communication were preferred most by women across groups. The analyses revealed that women with CB-PTSD had lower overall preferences for services compared to women without postpartum PTSD. Women with CB-PTSD also showed less preference for psychotherapeutic services (e.g. outpatient treatment, inpatient clinics) compared to women without postpartum PTSD. Regarding modes of service provision, women with gPTSD had a higher preference for all service modes compared to women with CB-PTSD and those without postpartum PTSD, with a stronger preference for both direct (e.g. in person, video conference) and delayed communication (e.g. chat, e-mail).

CONCLUSION

This study was the first to explore the support preferences of women experiencing symptoms of postpartum PTSD. Findings suggest that women differ in their preferences, contingent upon the subgroup of postpartum PTSD. According to women's overall preferences, the expansion and further training of (family-)midwife services is recommended. By tailoring support services accordingly to women's preferences, it may be possible to bridge the treatment gap for postpartum PTSD and to improve the well-being of affected women and their families.

Health Equity and Perinatal Mental Health

PURPOSE OF REVIEW

Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth.

RECENT FINDINGS

People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.

"Saying 'I'm not okay' is extremely risky": Postpartum mental health, delayed help-seeking, and fears of the child welfare system among queer parents

Parent mental health challenges in the postpartum and early parenthood have profound implications for parent, child, and family well-being. Little research has focused on postpartum mental health challenges and barriers to help-seeking among queer birthing people, including members of this community who may be particularly vulnerable to mental health difficulties, such as queer cis women partnered with men, trans/nonbinary parents, and queer parents who are young, low-income, and/or of color. This mixed-methods study of queer parents (n = 99), all of whom were assigned female at birth (AFAB) and gave birth to a child within the past several years, explores parents' postpartum mental health difficulties and perceived barriers to seeking help. Using a structural stigma framework, this study found that participants reported high rates of postpartum mental health difficulties (89%) and reported various barriers to seeking support including fears of discrimination and being deemed "unfit" by providers, which might lead to child welfare system involvement. Young parents and low-income parents were particularly fearful of child welfare system contact and potential child removal. Factors that encouraged help-seeking (e.g., desire to be a good parent; partner pressure to seek help) and implications for family practitioners are discussed.