Meg, a high school student, got pregnant at fifteen. Apparently, this came as a shocker to her peers, parents, teachers, and even to herself. Consequently, Meg panicked and had difficulties concentrating on tasks and even entertained thoughts of suicide. She, however, carried the pregnancy to full term. But, after the delivery, she persistently had generalised worry for the well-being of her baby, lost appetite and felt overwhelmed with demands and chores of looking after her baby.
A concerned friend reached out to Meg and asked her how it felt to have a baby. Meg retorted, “I feel very weird. I think my experiences are worrisome. During pregnancy, I felt very miserable, now after delivery, I feel numb and lack emotional connection with myself and even my baby. It scares me.” So, doesn’t Meg’s experience sound like the natural pregnancy and post-delivery experiences? Why should it bother anyone? Well, most people certainly think it is normal and that it shouldn’t bother anyone, but they are wrong. Many people have similar experiences. According to Paulson & Bazemore (2010), such experiences occur in up to one in ten women and one in twenty men during pregnancy and in more than one in seven new mothers and up to one in ten new fathers.
Meg’s feelings are medically termed as perinatal depression, which includes prenatal depression, postpartum depression and postpartum psychosis. These are characterized by a persistent sense of confusion and anxiety that people may have as a result of physical and emotional changes that occur to women during pregnancy and after the birth of their infant.
Studies show that 15% to 20% of women experience depression after childbirth (Marcus, Flynn, Blow & Barry, 2003; PSI, 2016). Further revelations show that these percentages are exacerbated by poverty and adolescent parenthood. 53.6% of adolescent mothers have depressive symptoms in their first year postpartum (Cox et al. 2008). According to Cox et al. (2008), a positive correlation exists between maternal depressive symptoms and a decreased maternal care-taking ability, which applies in particular to adolescent mothers who have less confidence in their capacity to interact with and care for their children. Social support, including family, friends, peers, and health/social professionals who are a good source of information, concrete help, esteem, and understanding was also found to have an association with perinatal depression among adolescents.
Despite the alarming rate of perinatal depression, only a handful of people with these symptoms seek medical care. Indicative figures put it at more than 13% of persons with perinatal depression receiving any formal treatment for it (Marcus, Flynn, Blow & Barry, 2003). Pregnant and postpartum women are less likely to seek mental health services. Among Latino Americans, a high rate of perinatal depression is reported with a low mental health treatment seeking attitude (Berreza & Nicholas, 2015). Of interest, is the fact that for those who sought help, it was not from a professional, but rather from a family member.
Only a minority of adolescents and young adults with depression seek help from a qualified professional (Wilson, Deane, Marshall & Dalley, 2009). A school-based cross-sectional survey of youth aged 15–16 years that was conducted in Norway revealed that, of those with symptoms of mental illnesses, only a third sought professional help (Zackrison, Rodje & Mykletun, 2006). Similar conclusions were found in a Dutch study of 1120 adolescents aged 11-18 years. It was revealed that only 13% of adolescents with mental illnesses were referred for mental health services (Zwaanswjik et al., 2003). Findings from an American study support the notion that adolescents with mental illnesses may be reluctant to seek help. A study of 3092 young adults aged 15-24 years revealed that 39% of the males and 22% of females would not seek professional help for mental health issues (Dower, Lucke, & Raphael, 2000).
The reluctance of adolescents and young adults to seek help for mental illnesses is recognised as a challenge to early intervention (Rickwood, Deane & Wilson, 2007). Stigma and embarrassment are often cited as significant barriers to help-seeking among adolescents with depression. Additionally, inability to discern the symptoms of depression have also been cited a potential barrier to health seeking behaviour (Gulliver, Griffifths & Christensen, 2010).
On one hand, lack of accessibility to professional help has also been cited as a barrier to help-seeking behaviours among adolescents with mental health problems. In Kenya, this lack of accessibility is the biggest barrier, since Kenya only has about 88 psychiatrists with a population of over forty-two million. On the other hand, the help-seeking negating effect for mental illnesses may also be as a result of some common processes, which have been referred to as automatic processes by Wilson and colleagues. They opine that adolescents’ first response to a problem is to do what is easiest and that which they have done before. Since most adolescents have not sought medical help for mental health issues from a qualified professional, they are likely to be reluctant to look for that help even when in need (Wilson, Deane, Marshall, & Dalley, 2009).
A U.S.-based study found that the tendency of reluctance to seek professional help for mental health issues among young adults increases if they have parental support. A possible contributing factor may be that most adolescents surveyed indicated they needed to talk to their parents before considering professional help. The study further revealed that as young people progressed through adolescence, they tend to seek advice from friends before seeking professional help (Lee, Freisa, Walker, Colman & Donlan, 2012).
In summary, adolescents with depression experience inhibiting factors that alter their help-seeking behaviour for mental illnesses. These factors include both health, economic and social barriers. By and large, most of the reported data have focused on the health seeking behaviour of the reluctance of adolescents with depression, and less is known about the help-seeking behaviour for adolescents with perinatal depression. Reviewed studies suggest the need to leverage on the societal support system and existing health care system to improve the health seeking behaviours of adolescents with perinatal depression.
Disclaimer/Notice: The names included in this document have been changed to protect the persons and their family’s privacy.
Barrera, A. Z., & Nichols, A. D. (2015). Depression help-seeking attitudes and behaviors among an Internet-based sample of Spanish-speaking perinatal women. Rev Panam Salud Publica, 37(3). Retrieved from http://www.scielosp.org/pdf/rpsp/v37n3/v37n3a04.pdf
Committee opinion, number 630, may 2015. (2015). . Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric Practice/co630.pdf?dmc=1&ts=20160512T0037382489
Cox, J. E., Mitchell, A., Woods, E. R., Valenzuela, J., Buman, M., & Natalie, J. P. (2008). Depression, parenting attributes, and social support among adolescent mothers attending a teen tot program – journal of pediatric and adolescent gynecology. Journal of Pediatric and Adolescent Gynecology, 21(5), 275–281. doi:10.1016/j.jpag.2008.02.002
Depression during pregnancy & Postpartum | Postpartum support – PSI. (2016). Retrieved May 23, 2016, from http://www.postpartum.net/learn-more/depression-during-pregnancy-postpartum/
Donald, M., Dower, J., Lucke, J., & Raphael, B. (2000). The Queensland young people’s mental health survey. Retrieved from http://files.eric.ed.gov/fulltext/ED457424.pdf
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. doi:10.1186/1471-244x-10-113
Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243. doi:10.1037/a0025957
Lee, J., Friesen, B. J., Walker, J. S., Colman, D., & Donlan, W. E. (2012). Youth’s help-seeking intentions for ADHD and depression: Findings from a national survey. Journal of Child and Family Studies, 23(1), 144–156. doi:10.1007/s10826-012-9700-3
Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in Obstetrics settings. Journal of Women’s Health, 12(4), 373–380. doi:10.1089/154099903765448880
Offer, D., Howard, K. I., Schonert, K. A., & Ostrov, E. (1991). To whom do adolescents turn for help? Differences between disturbed and Nondisturbed adolescents – journal of the American academy of child & adolescent psychiatry. Journal of the American Academy of Child & Adolescent Psychiatry, 30(4), 623–630. doi:10.1097/00004583-199107000-00015
Perinatal depression. (2006, August ). Retrieved May 23, 2016, from https://www.health.ny.gov/community/pregnancy/health_care/perinatal/perinatal_depression.htm
Reid, V., & Meadows-Oliver, M. (2007). Postpartum depression in adolescent mothers: An integrative review of the literature. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners., 21(5), 289–98. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17825726
Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? The Medical Journal of Australia, 7, 35. Retrieved from https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems
Weissman, M. M., & Olfson, M. (1995). Depression in women: Implications for health care research. Articles, 269(5225), 799–801. doi:10.1126/science.7638596
Wilson, C. J., Deane, F. P., Marshall, K. L., & Dalley, A. (2009). Reference tools. Journal of Youth and Adolescence, 39(4), 343–356. doi:10.1007/s10964-009-9436-6
Women’s longitudinal study finds postnatal depression predictor. (2013, August ). Retrieved May 12, 2016, from Hunter Medical Research Institute, https://hmri.org.au/news-article/womens-longitudinal-study-finds-postnatal-depression-predictor
Yap, M. B. H., Wright, A., & Jorm, A. F. (2010). The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Social Psychiatry and Psychiatric Epidemiology, 46(12), 1257–1265. doi:10.1007/s00127-010-0300-5
Zachrisson, H. D., Rödje, K., & Mykletun, A. (2006). Utilization of health services in relation to mental health problems in adolescents: A population based survey. , 6, . Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1386725/
Zwaanswijk, M., & Van Der Ende, M. S., Jan (2003). Factors associated with adolescent mental health service need and utilization – journal of the American academy of child & adolescent psychiatry. Journal of the American Academy of Child & Adolescent Psychiatry, 42(6), 692–700. doi:10.1097/01.CHI.0000046862.56865.B7