Although the emotional numbing component was excluded in the DSM-5 criteria for posttraumatic stress disorder, research has shown that when studying mothers who have been exposed to trauma, emotional numbing is more predictive of parenting stress than other posttraumatic stress disorder symptoms. Although this assessment shows strong reliability (Cronbachs alpha = 0.92), and participants from the pilot study found the measure to be easy to understand, this assessment is still not used in clinical or medical settings as often as it is used in research settings. The researchers that have utilized the CTSB have been able to identify various limitations with the pilot study, including the lack of diversity in the sample demographic characteristics (93% White postpartum women) as well as the self-report nature of the assessment which could lead to underreporting of symptoms. Another assessment that has also been used in research more often than in clinical or medical settings is the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ), which has since been modified into the Perinatal Posttraumatic Stress Disorder Questionnaire-II (PPQ-II), with the modified version being a 14-item scale which does not address all the necessary diagnostic criteria. Further research and development are needed to create a more accurate assessments and screening tools that can differentiate among posttraumatic stress disorders, postpartum/childbirth-related posttraumatic stress disorder, and postpartum depression so that the most adequate treatment interventions and options can be implemented as quickly as possible.
There are also attitudinal barriers to seeking treatment, including stigma. Interpersonal relationships with friends and family, as well as institutional and financial obstacles serve as help-seeking barriers. The history of mistrust within the United States healthcare system or negative health experiences can influence ones willingness and adherence to seek postpartum depression treatment. Cultural responses must be adequate in PPD healthcare and resources. Representation and cultural competency are crucial in equitable healthcare for PPD. Different ethic groups may believe that healthcare providers will not respect their cultural values or religious practices, which influences their willingness to use mental health services or be prescribed antidepressant medications. Additionally, resources for PPD are limited and often dont incorporate what mothers would prefer. The use of technology can be a beneficial way to deliver mothers with resources because it is accessible and convenient. Epidemiology
North America
United States
Within the United States, the prevalence of postpartum depression was lower than the global approximation at 11.5% but varied between states from as low as 8% to as high as 20.1%. The highest prevalence in the US is found among women who are American Indian/Alaska Natives or Asian/Pacific Islanders, possess less than 12 years of education, are unmarried, smoke during pregnancy, experience over two stressful life events, or whos full term infant is low-birthweight or was admitted to a Newborn Intensive Care Unit.