Identifying Barriers to the Assessment and Referral of Postpartum Depressive Symptoms in Maternal Healthcare: Patient Perceptions of Screening Procedures and Symptom Detection

Author

Quinn Michelle Tompkins, Florida Institute of TechnologyFollow

Date of Award

9-2025

Document Type

Doctoral Research Project

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Patrick J. Aragon

Second Advisor

Brian Fisak

Third Advisor

Heidi Hatfield Edwards

Fourth Advisor

Lisa A. Steelman

Abstract

Postpartum depression (PPD) is a critical, global public health concern, profoundly affecting the well-being of mothers, infants, and families. Research has suggested that PPD may affect as many as 59% of pregnancies worldwide (Byatt et al., 2015). Despite its impact, standards for postpartum follow-up care remain highly variable across professional bodies, particularly with respect to the timing and scope of mental health assessment during later stages of the postpartum period (Al Hadi et al., 2022; Bauman et al., 2020; Earls, 2019; Long et al., 2018; USPSTF, 2019; Yang et al., 2024). Research has suggested that many mothers exit postpartum appointments with their mental health needs inadequately assessed, leading to adverse outcomes for all parties involved. On average, existing literature demonstrates that only 20% of women who screen positive for depression receive referrals to subsequent mental health services (Venkatesh et al., 2016). Disparities in screening practices are exacerbated by systemic healthcare limitations, sociocultural barriers, and challenges faced by low-income and minority populations, thus increasing both the incidence of PPD in these populations and obstacles to receiving comprehensive treatment.

Thus, the present study sought to evaluate the presence of standard mental health screening into postpartum care systems, specifically aiming to identify patient perceptions of screening and referral efforts from both obstetric and general populations. Participants were composed of 167 individuals who completed an online questionnaire broadly assessing personal screening and referral experiences during their respective pregnancies. Early, positive postpartum depression screens were found to significantly predict later positive postpartum depression screens, although estimation was limited by small sample size. Demographic and psychosocial variables such as race/ethnicity, social support, and history of psychological diagnoses were not found to be significant predictors of either increased or decreased depressive symptom experience during pregnancy and/or postpartum. Referral rates to mental health services for symptomatic mothers were found to exceed expected rates found within the current literature, and utilization rates amongst those referred for mental health services did not significantly differ from the hypothesized rate (Byatt et al., 2015; Lee-Carbon et al., 2022; Venkatesh et al., 2016). All mothers referred to mental health services reported attending these follow-up appointments, exceeding hypothesized rates. Finally, delivery type (i.e., medically complicated vs. medically uncomplicated) did not significantly predict screening frequency or follow-up attendance.

Recommended Citation

Tompkins, Quinn Michelle, "Identifying Barriers to the Assessment and Referral of Postpartum Depressive Symptoms in Maternal Healthcare: Patient Perceptions of Screening Procedures and Symptom Detection" (2025). Theses and Dissertations. 1602.
https://repository.fit.edu/etd/1602