The purpose of this study is to understand mental health literacy (MHL) (Jorm, 2000) in lower income women postpartum and share participant experiences of recognizing and seeking help for depressive symptoms. Focus group textual data were received from 25 participants who completed a weight and psychosocial health longitudinal study. Iterative content data analysis using Jorm's framework provided thematic understandings descriptive of MHL. Women recognized behavioral changes indicating mental distress, but fears prevented them from seeking help, and some resorted to risky behaviors. This framework could guide providers to identify women who may benefit from early intervention for postpartum depressive symptoms.
Health literacy, defined by the Institute of Medicine (IOM) as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan & Parker 2000, p. 6), is linked to improved health outcomes and decreased health care costs (IOM, 2004). Efforts to enhance health literacy have concentrated in part on conveying knowledge to the public that enables individuals to identify, prevent, and treat common physical ailments.
Less emphasis, however, has been placed on increasing public knowledge of how to prevent or recognize mental disorders and cope with their symptoms (Jorm 2012). In an effort to focus attention on this neglected aspect of health, Jorm et al. (1997) articulated the concept of mental health literacy described as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (p. 182). Mental health literacy empowers those experiencing mental disorders to proactively seek assistance and participate in symptom management (Jorm 2012).
This empowerment may be beneficial for women suffering from postpartum depression. Only about 40% of women with depression are diagnosed by health care providers, and a significant portion of women do not receive treatment for their depressive symptoms (Ko, Farr, Dietz, & Robbins 2012). Providing the knowledge and skills necessary for women to recognize postpartum depression and obtain effective treatment may minimize the significant adverse effects of this disorder on women, infants, and family members (Letourneau et al. 2012). This is critical with the overall prevalence of postpartum depression in the United States reported to be between 7 and 20% (Gavin et al. 2005). Lower socioeconomic status increases the risk for postpartum depression (Centers for Disease Control, Prevention [CDC] 2009), and high levels of stress stemming from financial concerns and a lack of resources may exacerbate symptoms of depression.
Relatively little research has addressed postpartum depression within a mental health literacy framework despite the potential benefits such research could supply for women and their health care providers. Given the paucity of literature on mental health literacy about postpartum depression, further study of this topic is important to women's health care. For this study, we used Jorm's (2000) framework of mental health literacy to explore the knowledge, beliefs, and attitudes of lower income women in regard to recognizing and managing postpartum depressive symptoms. This conceptual framework encompasses the following components of mental health literacy:
The application of Jorm's (2000) framework enabled us to gain a broad understanding of knowledge and beliefs about postpartum depression within the framework of mental health literacy in a group of lower income postpartum women. Such understanding is essential to improving mental health care of new mothers. Our findings suggest that participants did not have the optimal levels of mental health literacy required to proactively meet their own mental health needs during the postpartum period. Interventions developed to enhance the mental health literacy of childbearing women will play a critical role in improving their mental health status. Use of Jorm's (2000) mental health literacy framework could serve as an effective guide for psychiatric mental health nurses and other providers to use in identification of women in this high-risk population who would benefit from education, increased surveillance, and early intervention for postpartum depressive symptoms.
