Overcoming Barriers to Postpartum Depression Care in Rural Communities

Announcer:
You’re listening to Advances in Women’s Health on ReachMD. On this episode, we’ll hear from Dr. Elizabeth Mollard, who’s an Assistant Professor at the University of Nebraska Medical Center College of Nursing. She’ll be discussing the unique challenges clinicians face in treating postpartum depression in rural communities. Here’s Dr. Mollard now. 

Dr. Mollard: 
There are several challenges to treating postpartum depression in rural communities. One of the major ones is that there’s often more of a stigma related to mental health in rural communities. As you can imagine, if you know everyone in your community—you know your pharmacist, maybe you’re friends with your healthcare providers outside of work, or it’s just a small tight-knit community—sometimes it can be more difficult to have your private information or at least feel like people throughout your community may know some of the struggles that you’re facing, so we do see a bigger issue with stigma. And with that, that sometimes discourages women from seeking the care that they need. 

Another issue we face in all rural communities for all healthcare needs, but especially for mental health, is that we just have a lack of access to healthcare, so we have less healthcare providers. And then the ones that we do have are often really overloaded because they’re taking care of everything that is going on in the community. So sometimes mental health concerns can move to the back burner so that more immediate concerns like emergencies, illnesses, and things like that are focused on more.

So screening plays a really important role in addressing postpartum depression in rural communities. We know that people are taking their babies in for well-child checks after they give birth. We know that women are going to their postpartum visits. Not all women are going to bring up mental health concerns, especially in rural communities where there may be a larger stigma associated with mental health. So we do know that the more screening that we perform—there’s been plenty of studies on that in both rural and urban communities—the more postpartum depression that we’re able to detect. So implementing screening obviously at the postpartum visits for women is really important, but there’s also been several initiatives that can improve the screening process. We could screen mothers during their pediatric well child visits, and we know that this is also able to catch more cases of postpartum depression. 

Some of the most effective interventions for treating postpartum depression in rural communities are going to be based on the particular rural culture that someone is living in. We have to realize that what’s going to work in an urban community isn’t always going to work in a rural community, and we also have to recognize that each rural community has its own cultural differences. So what we really want to do is to play on the strengths of the community. That’s kind of a broader thing. It’s not as easy of an intervention.

But there are also some great things happening with what are called community health workers, and so this is something that also taps into the rural culture. A community health worker is someone who is from that community who does a lot of health promotion activities within the community; they’re not necessarily doing formal medical care, but they can do home visits to check in and they can help individuals access resources. They’re often seen as trusted members of the community because they are from there, and so that’s a way to increase access to care. Additionally, we now have more telehealth options, which are really important for rural communities, and to make those work, we have to be sure that we are able to get good internet access.

Announcer:
That was Dr. Elizabeth Mollard talking about how we can improve the management of postpartum depression in rural communities. To access this and other episodes in our series, visit Advances in Women’s Health on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!