Rural women with postpartum depression: Their views on services and interventions

Postpartum depression (PPD) is a universal mental health issue affecting up to 19% of new mothers within the first three months after birth (Beck, 2008a). Despite abundant research, PPD remains poorly defined, findings are inconsistent regarding prevention and treatment strategies, the dearth of qualitative research leaves many questions unanswered (Beck, 2008a, 2008b; Registered Nurses of Ontario [RNAO], 2005), Canadian studies are under-represented and rural context is scarcely addressed.;Thus, this qualitative study describes and explores the perceptions of 12 rural women from north-eastern Ontario who self-identified as having PPD on the accessibility, adequateness, and appropriateness of services and interventions for PPD. Services for PPD were most often inaccessible, unavailable and inadequate. Barriers and bridges to access, support services needed, and the appropriateness of services accessed were described. Being depressed and rural, fear of stigma, and inadequate emotional support posed significant barriers whereas self-identifying with PPD, family support and professional awareness were essential to access. They needed trained volunteers, mentors, emotional support from family and government funding to meet their basic need for self-care. They recognized the need to recruit and retain professionals, provide them with opportunities for continued education, and make changes to hospital services through a person-centered, partnership model of care. Their struggle to connect, bridge service gaps, and overcome their discouragement with inadequate treatment led to their development of inner strength and rural resilience. They value creative approaches to PPD, involving mentors and storytelling. The findings have significant implications for nursing education, rural nursing practice, policy development and future research.