Barriers to Seeking and Accepting Treatment for Perinatal Depression: A Qualitative Study in Rio de Janeiro, Brazil.

Few studies have investigated the reasons why pregnant and puerperal women fail to seek or accept treatment for perinatal depression in low- and middle-income countries, where there is a high prevalence of this disorder. To help fill this gap, this study investigated the factors influencing the decision not to seek or to refuse treatment for perinatal depression in a low-income community in Rio de Janeiro, Brazil. Qualitative research was conducted in two primary health care units in Rio de Janeiro, Brazil in 2017-2018. Five focus groups were held with 26 women. Convenience sampling was used, and the sample size was determined by data saturation. A content analysis methodology was used to identify theme categories to objectively describe the group's manifest contents. Ten categories were obtained: stigma and misconception, self-image as a mother, socioeconomic stigma, lack of knowledge, lack of a health service approach to mental health, difficulty recognising depression symptoms, fear of children being removed, negative reaction to patient referral, denial of the problem and previous experience with the care unit. Perinatal depression is permeated with stigma and prejudice, and there is a belief that women with depression are unable to be good mothers. It is important to conduct programmes disseminating information about perinatal depression and implementing an approach that includes routine consultations so that women can access perinatal mental health services.