Suffering in silence: Accessing mental health care and repetitive transcranial magnetic stimulation (rTMS) for peripartum depression - A qualitative study

Peripartum depression (PPD) is a prevalent and serious mental health disorder that is often underdiagnosed and undertreated due to limited effective and safe treatment options. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive treatment for PPD, yet awareness among patients is low. This study aims to identify barriers and facilitators to accessing mental health treatment, particularly rTMS, for PPD. We conducted 36 interviews with individuals who experienced depressive symptoms during the peripartum period and health providers, followed by a descriptive interpretive thematic analysis. Key risk factors identified include personal (i.e., age), clinical (i.e., traumatic birth), situational (i.e., COVID-19, homelessness), and social (i.e., discrimination, domestic abuse). Five themes emerged regarding barriers and facilitators: 1) the need for mom-centered care, 2) systemic challenges, 3) the importance of mental health education, 4) stigma and custody concerns, and 5) challenges in accessing care. Eighty-three percent of participants were unaware of rTMS, but following a brief description, 75% were willing to receive or refer to rTMS if it was available to them. Addressing systemic and access-related concerns is crucial to ensuring patients with PPD have access to safe, effective, and accessible treatments.