Determinants of Postpartum Mental Health Counseling Utilization in a National Sample of U.S. Mothers

Background: Despite the high prevalence of mental disorders after childbirth such as postpartum depression, scarce research has investigated the determinants of access to postpartum mental healthcare. This study examined the predisposing, enabling, and need factors associated with mental health counseling utilization after childbirth.

Methods: We used data from the Listening to Mothers II Survey; a national survey of mothers who delivered single babies in U.S. hospitals in 2005.The study sample included 1,573 women, ages 18-45 years.

Results: Logistic regression analyses showed that mothers with scores of 14 or greater on the Postpartum Depression Screening Scale-Short Form were more likely to use mental health counseling (OR: 4.63) than those with lower scores. Latinas were less likely to utilize mental health counseling (OR: 0.39) than Whites. Women who worked full-time prenatally were less likely to use mental health counseling (OR: 0.63) than non-working women. Mothers with household incomes of $50,000-$75,000 were more likely to utilize mental health counseling (OR: 2.53) than those with incomes less than $25,000. Mothers who reported that pain interfered quite a bit in their lives the first two months postpartum were more likely to use mental health counseling (OR: 2.28) than those with no pain interference. Findings were similar by race, income and prenatal employment when regression analyses were restricted to mothers who met the depression threshold.

Conclusions: This study identified inadequate access to mental health counseling among Latinas, low income mothers, and women working full-time. Thus, mental health policy interventions that target these at-risk groups are warranted.