Table 1.

Barriers and recommendations for help-seeking for PPD, mapped onto the socio-ecological model.

Level of the socio-ecological model	Description of level on the socio-ecological model	Barriers to PPD Help-seeking	Recommendations to address Barriers
Individual level	An individual's demographic information has the capacity to influence health outcomes, including an individual's gender, religion, race, ethnicity, age, socioeconomic status, and sexual orientation. Additionally, an individual's attitudes, beliefs, behaviors, and level of knowledge shape their health status.	•Detrimental beliefs on help-seeking •Lack of knowledge •Resistance to pharmaceutical treatments •Time management concerns	•Awareness campaigns •Social media toolkits •Warmlines and hotlines •Faith-based support •Patient decision-making aids •Telehealth and text-messaging services
Interpersonal level	An individual's formal and informal relationships are determining factors of health status. These may include family, peer, and patient-provider relationships.	•Negative views or low awareness of PPD among family & friends •Healthcare providers who lack warmth or dismiss symptoms	•Online support forums for moms and dads •Peer mentoring programs •Group prenatal care
Organizational/institutional level	Institutions have the power to shape individuals’ behaviors and attitudes, thereby contributing to health status, due to organizational characteristics, regulations, rules, operations, and cultural expectations within the institution.	•Lack of culturally competent care and language support services •Lack of time and/or privacy with provider •Lack of healthcare accessibility, referral protocol, and follow-up •Inadequate Medicaid coverage	•Screenings for and awareness of risk factors for perinatal mood & anxiety disorders during pregnancy and the postpartum •Perinatal psychiatric consultation services •Utilization of community health workers •Provision of informational and emotional support for infant care •Practice readiness assessments, such as PREPD
Community/structural level	The environment around individuals influences health behavior and health status. The community environment includes norms, access to resources, and the built environment, including buildings, parks, greenspace, and city-wide infrastructure.	•Unsupportive community norms or cultural models of maternal role •Lack of transportation •Lack of childcare •Workforce shortages •Shame, embarrassment, and stigma	•Community events (e.g., Climb Out of the Darkness walks) •Recognition of World Maternal Mental Health Day •Co-location of mental health and medical services •Culturally diverse, peer support groups (online or in-person)
Societal/public policy level	Laws, policies, and allocation of funding are instrumental in determining health outcomes.	•Inadequate insurance coverage •Immigration status •Poverty	•Comprehensive reimbursement systems •Medicaid expansion •Enhanced screening and referral services •Affordable and accessible childcare