Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Systematic Review
Abstract:
The
postnatal mothers experience mental health challenges which include depression,
anxiety, and stress. Although frequency is markedly higher in low- and
middle-income countries (LMICs), systemic and cultural barriers often impede
help-seeking and access to care, even as various facilitators promote
resilience and recovery. This systematic review aims to assess the barriers and
facilitators to mental health and well-being among postnatal mothers in St.
Vincent and the Grenadines, synthesising findings from both qualitative and
quantitative studies. A thorough, systematic search was conducted in electronic
databases, including EBSCOhost, PubMed, PsycARTICLES, Google Scholar, and
ScienceDirect, for studies published between January 2015 and April 2025.
Studies included in this review are qualitative, quantitative, or mixed
methods. The identified themes were categorized as individual, interpersonal,
organizational, community and societal. The systematic review included eighteen
studies. The main barriers were as follows: (1) Individual: low mental health
literacy, stigma, and fear of judgment; (2) Interpersonal: lack of partner or
family support; (3) Organizational: healthcare systems focused predominantly on infant
physical health, poor provider communication, and fragmented referral pathways;
(4) Community: cultural norms
discouraging disclosure of emotional distress; and (5) Societal: financial constraints,
geographical inaccessibility, and under resourced mental health services. The
main facilitators included: strong social support networks, perceived
self-efficacy, culturally sensitive and integrated care models, peer support programs,
and technology-enabled interventions. By focusing on the unique culture within
regions like the Caribbean, researchers can build a support system that ensures
no mother has to struggle through the postnatal period alone.
References:
[1].
Howard, L. M., Khalifeh, H., 2020,
Perinatal mental health: A review of progress and challenges. World
Psychiatry, 19(3), 313-327, https://doi.org/10.1002/wps.20769.
[2].
Shorey, S., Chee, C. Y. I., Ng, E. D.,
Chan, Y. H., Tam, W. W. S., Chong, Y. S., 2018, Prevalence and incidence of
postpartum depression among healthy mothers: A systematic review and
meta-analysis. Journal of Psychiatric Research, 104, 235-248, https://doi.org/10.1016/j.jpsychires.2018.08.001.
[3].
Fisher, J., Cabral de Mello, M., Patel,
V., Rahman, A., Tran, T., Holton, S., et al., 2012, Prevalence and determinants
of common perinatal mental disorders in low- and lower-middle-income countries:
A systematic review. Bulletin of the World Health Organization, 90(2),
139-149, https://doi.org/10.2471/BLT.11.091850.
[4].
Gelaye, B., Rondon, M. B., Araya, R.,
Williams, M. A., 2016, Epidemiology of maternal depression, risk factors, and
child outcomes in low-income and middle-income countries. Lancet Psychiatry,
3(10), 973-982, https://doi.org/10.1016/S2215-0366(16)30284-X.
[5].
Letourneau, N. L., Dennis, C. L.,
Benzies, K., Duffett-Leger, L., Stewart, M., Tryphonopoulos, P. D., et al.,
2012, Postpartum depression is a family affair: Addressing the impact on
mothers, fathers, and children. Issues in Mental Health Nursing, 33(7),
445-457, https://doi.org/10.3109/01612840.2012.673054.
[6].
Byatt, N., Biebel, K., Friedman, L.,
Debordes-Jackson, G., Ziedonis, D., 2015, Strategies for improving perinatal
depression care in obstetric settings. General Hospital Psychiatry,
37(5), 447-453, https://doi.org/10.3109/0167482X.2012.728649.
[7].
Leahy-Warren, P., McCarthy, G.,
Corcoran, P., 2012, First-time mothers: Social support, maternal parental
self-efficacy and postnatal depression. Journal of Clinical Nursing, 21(3-4),
388-397, https://doi.org/10.1111/j.1365-2702.2011.03701.x.
[8].
Dennis, C.-L., Hodnett, E., Kenton, L.,
Weston, J., Zupancic, J., Stewart, D. E., et al., 2009, Effect of peer support
on prevention of postnatal depression among high-risk women: Multisite
randomized controlled trial. BMJ, 338, a3064, https://doi.org/10.1136/bmj.a3064.
[9].
Page, M. J., McKenzie, J. E., Bossuyt,
P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al., 2021, The PRISMA
2020 statement: An updated guideline for reporting systematic reviews. BMJ,
372, n71, https://doi.org/10.1136/bmj.n71.
[10]. Adams,
Y. J., Miller, M. L., Agbenyo, J. S., Ehla, E. E., Clinton, G. A., 2023,
Postpartum care needs assessment: Women's understanding of postpartum care,
practices, barriers, and educational needs. BMC Pregnancy and Childbirth,
23(1), 502, https://doi.org/10.1186/s12884-023-05813-0.
[11]. Ahmed,
A., Bowen, A., Feng, C. X., 2017, Maternal depression in Syrian refugee women
recently moved to Canada: A preliminary study. BMC Pregnancy and Childbirth,
17(1), 240, https://doi.org/10.1186/s12884-017-1433-2.
[12]. Ash,
M. J., Woods-Jaeger, B., Udoetuk, S., Livingston, M. D., Sales, J. M., 2025,
Barriers and facilitators to accessing mental health supports among black
perinatal women: Application of the patient-centered access framework. Journal
of Racial and Ethnic Health Disparities, 1-11, https://doi.org/10.1007/s40615-025-02428-3.
[13]. McLeish,
J., Ayers, S., McCourt, C., 2023, Community-based perinatal mental health peer
support: A realist review. BMC Pregnancy and Childbirth, 23(1), 570,
[14]. https://doi.org/10.1186/s12884-023-05843-8.
[15]. Al
Nasr, R. S., Altharwi, K., Derbah, M. S., Gharibo, S. O., Fallatah, S. A.,
Alotaibi, S. G., et al., 2020, Prevalence and predictors of postpartum
depression in Riyadh, Saudi Arabia: A cross-sectional study. PLoS ONE,
15(2), e0228666, https://doi.org/10.1371/journal.pone.0228666.
[16]. Place,
J. M. S., Renbarger, K., Van De Griend, K., Guinn, M., Wheatley, C., Holmes,
O., 2024, Barriers to help-seeking for postpartum depression mapped onto the
socio-ecological model and recommendations to address barriers. Frontiers in
Global Women's Health, 5, 1335437, https://doi.org/10.3389/fgwh.2024.1335437.
[17]. Dimidjian,
S., Goodman, S. H., Felder, J. N., Gallop, R., Brown, A. P., Beck, A., 2016,
Staying well during pregnancy and the postpartum: A pilot randomized trial of
mindfulness-based cognitive therapy for the prevention of depressive
relapse/recurrence. Journal of Consulting and Clinical Psychology,
84(2), 134-145, https://doi.org/10.1037/ccp0000068.
[18]. Gidey,
S., Tefera, F., Ababiya, T., Fissehatsion, F., Teka, B., Zergaw, R., et al.,
2025, Prevalence and associated factors of postpartum depression among
postpartum mothers in Addis Ababa, Ethiopia. American Journal of Psychiatry
and Neuroscience, 13(2), https://doi.org/10.11648/j.ajpn.20251302.12.
[19]. Grote,
N. K., Katon, W. J., Russo, J. E., Lohr, M. J., Curran, M., Galvin, E., et al.,
2015, Collaborative care for perinatal depression in socioeconomically
disadvantaged women: A randomized trial. Depression and Anxiety, 32(11),
821-834, https://doi.org/10.1002/da.22405.
[20]. Uzobo,
E., Ogeh, V. I., Teibowei, B. J., 2022, Prevalence and coping strategies of
postnatal depression among women in Bayelsa State, Nigeria. Africa Journal
of Nursing and Midwifery, 24(1), https://doi.org/10.25159/2520-5293/9457.
[21]. Milgrom,
J., Danaher, B. G., Gemmill, A. W., Holt, C., Holt, C. J., Seeley, J. R., et
al., 2016, Internet cognitive behavioral therapy for women with postnatal
depression: A randomized controlled trial of MumMoodBooster. Journal of
Medical Internet Research, 18(3), e4993, https://doi.org/10.2196/jmir.4993.
[22]. Oladeji,
B. D., Gureje, O., Bello, T., 2025, "You just have to pray about it":
Exploring mental health help-seeking barriers among young mothers in Belize. International
Journal of Mental Health Systems, 19(1), 5, https://doi.org/10.26633/RPSP.2025.3.
[23]. Shorey,
S., Ng, E. D., 2019, Evaluation of a technology-based peer-support intervention
program for preventing postnatal depression (part 2): Qualitative study. Journal
of Medical Internet Research, 21(8), e12915, https://doi.org/10.2196/12915.
[24]. Zhu,
Z., Wang, H., Zhu, T., Wang, Z., Shen, Y., Xiong, C., et al., 2025, Mental
health service utilization among pregnant and postpartum women: Status,
determinants, and insights from a mixed-methods study. BMC Public Health,
25(1), 1942, https://doi.org/10.1186/s12889-025-23132-1.
[25]. Fonseca,
A., Monteiro, F., Pacheco, A., Santos, L., 2015, Acceptability of e-mental
health interventions among perinatal women: A mixed-methods study in Portugal. Journal
of Affective Disorders, 188, 59-67, https://doi.org/10.1192/bja.2024.23.
[26]. Letourneau,
N., Stewart, M., Dennis, C. L., Hegadoren, K., Duffett-Leger, L., Watson, B.,
2011, Effect of home-based peer support on maternal-infant interactions among
women with postpartum depression: A randomized, controlled trial. International
Journal of Mental Health Nursing, 20(5), 345-357, https://doi.org/10.1111/j.1447-0349.2010.00736.x.
[27]. Meireles,
L. G. V., Peñacoba, C., Écija, C., Gutiérrez, L., Arribas, C., Catalá, P.,
2025, Perspectives on perinatal support and maternal mental health: A
qualitative cross-cultural study in Spain and Brazil. Psychiatry
International, 6(2), 70, https://doi.org/10.3390/psychiatryint6020070.
[28]. Webb,
R., Uddin, N., Ford, E., Easter, A., Shakespeare, J., Roberts, N., et al.,
2021, Barriers and facilitators to implementing perinatal mental health care in
health and social care settings: A systematic review. The Lancet Psychiatry,
8(6), 521-534, https://doi.org/10.1016/S2215-0366(20)30467-3.
[29]. World
Health Organization, 2013, WHO recommendations on postnatal care of the mother
and newborn. Geneva: World Health Organization, https://pubmed.ncbi.nlm.nih.gov/24624481/.
[30]. Zlotnick,
C., Johnson, S. L., Miller, I. W., Pearlstein, T., Howard, M., 2001, Postpartum
depression in women receiving public assistance: Pilot study of an
interpersonal-therapy-oriented group intervention. American Journal of
Psychiatry, 158(4), 638-640, https://doi.org/10.1176/appi.ajp.158.4.638.
[31]. Le,
H. N., Perry, D. F., Stuart, E. A., 2011, Randomized controlled trial of a
preventive intervention for perinatal depression in high-risk Latinas. Journal
of Consulting and Clinical Psychology, 79(2), 135-141, https://doi.org/10.1037/a0022492.
[32]. Khademi,
K., Kaveh, M. H., 2024, Social support as a coping resource for psychosocial
conditions in postpartum period: A systematic review and logic framework. BMC
Psychology, 12(1), 301, https://doi.org/10.1186/s40359-024-01814-6.
