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

## TL;DR

This study explores why people with peripartum depression struggle to access mental health care, including a treatment called rTMS, and finds that awareness and systemic issues are major barriers.

## Contribution

The study identifies specific barriers and facilitators to accessing mental health treatment, particularly rTMS, for peripartum depression through qualitative analysis of patient and provider interviews.

## Key findings

- Eighty-three percent of participants were unaware of rTMS, but 75% expressed willingness to use it after a brief explanation.
- Five key themes emerged regarding barriers and facilitators to mental health care access, including stigma, systemic challenges, and the need for mom-centered care.
- Risk factors for PPD include personal, clinical, situational, and social factors such as traumatic birth, homelessness, and domestic abuse.

## Abstract

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 non-invasive 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.