Factors Influencing Psychological Help-Seeking Intention for Women with Perinatal Depression and Their Spouses: A Scoping Review

Introduction

Perinatal depression (PND) can occur during a woman’s pregnancy and the first 12 months after childbirth, encompassing both prenatal and postnatal depression.¹ Women with PND often experience significant physical and psychological distress, manifested as persistent low mood, feelings of worthlessness, and suicidal thoughts. If left untreated, PND can lead to serious consequences across multiple domains: lifelong depression and suicidality in mothers, impaired cognitive and behavioral development in infants, and severely damaged family relationships.^2,3 During the perinatal period, the prevalence of PND varies globally, with estimates ranging from 10% to 15% in high-income countries and 19% to 25% in low- and middle-income countries.^4,5 However, these figures may represent conservative estimates due to inadequate screening practices, suggesting the true incidence might be significantly higher.⁶

Current guidelines recommend psychotherapy as the first line of intervention for mild cases, pharmacological treatments for severe cases, and a combination of both approaches for comprehensive care in all cases.^1,7 Psychotherapy has been proven effective in significantly reducing perinatal depressive symptoms with recognized long-term benefits in fostering peer support, facilitating adjustment to parenthood, and strengthening marital relationships.⁸ Although psychotherapy has been proven as an effective treatment for PND, the proportion of women with PND who seek help from psychological services is still relatively low in countries with abundant resources, estimated to be between 13.6% and 40.0%.^9,10 This heterogeneity in help-seeking rates is largely driven by diverse demographic characteristics, varying levels of mental health literacy, and differential access to healthcare services. Many women either delay seeking professional intervention or avoid it altogether.¹¹ Even when they are referred promptly, many people still refuse to undergo psychotherapy.¹² In addition, women experiencing PND are more likely to prioritize seeking support from their spouse as their primary choice.^13–15 Seeking professional psychological help means that an individual is actively seeking support from healthcare professionals (HCPs) to address mental health issues.¹⁶ Professional psychological support services for women during the perinatal period are usually provided by the obstetric team, which consists of obstetricians, outpatient and inpatient nurses, as well as psychotherapists.

The Theory of Planned Behavior (TPB) serves as the established help-seeking framework for this study. The TPB posits that human behavior is fundamentally driven by behavioral intention, whereby a stronger intention increases the likelihood of the behavior being enacted.¹⁷ To address the low uptake of professional psychological services among women with PND, understanding the precursors to their help-seeking intentions is critical. Consequently, we have explicitly mapped our scoping review questions onto the TPB framework. This theoretical alignment allows us to systematically categorize the factors influencing help-seeking intentions—such as attitudes, subjective norms (including spousal influence), and perceived behavioral control—thereby bridging the gap between intention and actual service utilization.

Several barriers have been identified that are associated with the lower willingness of women to seek professional treatment for PND. These include insecure attachment representations characterized by anxiety and avoidance, indifference towards the stigma related to HCPs, self-perception as an inadequate mother, previous negative treatment experiences, a limited awareness of PND, race, and an income below $10,000.^15,18–22 Among these, spousal support emerges as a pivotal factor. This support can manifest in various ways, such as assisting women in making decisions, encouraging them, or actively taking steps to seek assistance.^14,23,24 Given the crucial role played by spousal support, numerous studies have surveyed both spouses. The results show that the spouse with a higher monthly income and a lower degree of gender role conflict is more likely to encourage the woman to seek professional psychological help in order to cope with PND.²⁵ Conversely, spouses who have a limited understanding of PND and are skeptical about psychological treatments tend to exhibit a lack of supportive behavior.^26,27 Additionally, family-level factors, such as low self-efficacy and negative attitudes toward mental health services, have been shown to deter couples from pursuing professional assistance.^28,29

Although the significant role of partners has been recognized, there remains a crucial gap. Currently, there is no comprehensive review that integrates cross-cultural evidence to explain the factors influencing both women’s and their spouses’ help-seeking intentions for PND. This understanding is crucial in developing targeted intervention programs that encourage couples to seek professional support. This study employed a scoping review rather than a systematic review approach. Systematic reviews are typically used to assess the effectiveness of specific interventions, whereas this study aims to explore the factors influencing couples’ willingness to seek professional psychological assistance. Given the exploratory nature of this research purpose, a scoping review can more flexibly integrate relevant literature and conduct in-depth discussions, rather than focusing on the quantitative synthesis of intervention effects.

Methods

Study Design

This study used a scoping review methodology^30,31 to identify the factors influencing the psychological help-seeking intentions of women with PND and their spouses. It can summarize the findings of research obtained from existing literature to identify knowledge gaps and make suggestions.³² This scoping review followed Arksey and O’Malley’s methodological framework,³³ which includes five steps: (1) identifying the research question, (2) searching relevant studies, (3) selecting studies, (4) charting the data, and (5) collating, summarizing and reporting the results. This scoping review followed reporting guidelines outlined in the PRISMA-ScR checklist.³⁴ Although the review protocol was not prospectively registered, all methodological steps were performed in accordance with PRISMA-ScR guidelines.

Identifying the Research Question

The research question for this review were, “What factors influence the psychological help-seeking intentions of women with PND and their spouses?”

Searching Relevant Studies

The search terms and search strategy were initially identified through consultation with our study team and finally formulated by integrating expert opinions obtained from two library information experts at two different institutions. Both themes and free words were used. The search terms are formulated using the PIC_O principles (see Table 1).

Table 1 The PICo Concept of This Review

The CINAHL, Web of Science, PubMed, Embase and PsycINFO databases were searched for studies from their inception until May 2025. Following PICo principles, subject terms-(“peripartum period”, “depressive disorder”, “depression”, “perinatal depression”, “depression, postpartum”, “prenatal depression”, “antepartum depression”, “postpartum depression”, “postnatal depression”) and (“help-seeking behavior”, “psychological help-seeking intention”, “seeking psychological help”, “professional psychological assistance”, “professional psychological help”, “formal help”, “mental help-seeking”, “mental health services”, “mental health needs”) were employed in the literature search (the search terms and strategy used was outlined in Appendix A). Additionally, the reference lists of the included studies were screened for further relevant studies.

Selecting Studies

This review focused on articles that examined the factors influencing the decision of women with PND and/or their spouses to seek professional help in managing the condition. The participants were women with PND and/or their spouses, all of whom were aged 18 years or over. The search was restricted to English-language papers published in peer-reviewed journals, without limitations on publication date or setting. Quantitative, qualitative and mixed-method studies were all included.

Firstly, all references from the searches were imported into NoteExpress 2.0 and duplicates were removed. Two researchers (QH-Z and YL-M) independently screened the titles and abstracts to assess their adherence to the eligible criteria. The second stage involved three researchers (QH-Z, YL-M and SY-Z) examining the full texts to assess eligibility. The results were then discussed within the research team where disagreements and inconsistencies were resolved.

Charting the Data

Data were extracted by one reviewer (QH-Z) and checked for accuracy by two other reviewers (YL-M and SY-Z). The extracted data included: study aim(s), author, year and country of study, design, setting, participants (women with PND and/or their spouses), research tool, theoretical framework, and factors influencing participants’ intention to seek professional psychological assistance in managing PND. A Mixed Methods appraisal tool (MMAT) was employed to evaluate the quality of primary studies. MMAT includes two researchers (QH-Z and YL-M) independently screening questions applicable to all types of study designs. The MMAT was used to assess the quality of the selected studies in this scoping review. It encompasses five categories of study designs: qualitative research, quantitative randomized controlled trials, quantitative non-randomized studies, quantitative descriptive studies, and mixed methods research. Each study was evaluated against five design-specific criteria, rated as either “Yes” (met the criterion) or “No” (did not meet the criterion or unclear).^35,36 Consistent with the descriptive nature of scoping reviews, these ratings were not used to exclude studies or weight effect estimates, but rather to contextualize the narrative synthesis. Detailed quality assessments are provided in Table 2.

Table 2 Quality Criteria of the Included Studies Using the MMAT

Collating, Summarizing and Reporting the Results

At this stage, the findings of the included studies were summarized descriptively and numerically, and an inductive content analysis⁵⁸ was performed Microsoft Excel was used throughout the process to synthesize the data and identify recurring and unique content.

Firstly, one researcher (QH-Z) read all studies, annotated them and identified broad topic categories through a predefined form coding influencing factors. These codes represented common phrases and findings that were consistent across studies about the factors that influence the psychological help-seeking intentions of women with PND and their spouses. Additional studies were mapped to the previously identified categories, with new categories added as new influencing factors emerged. These codes were iteratively grouped into relevant categories based on their overall focus (eg, women with PND and their spouses’ views on psychotherapy or the current situation of perinatal psychological services utilization). These factors, based on study recommendations, were not mutually exclusive, and each study mapped to multiple categories. To establish trustworthiness, the second researcher (YL-M) independently reviewed a further 20% of the included papers and created their own categories. Any discrepancies, disagreements or unique findings were discussed with a third independent researcher (SY-Z) or the review team to reach a consensus. Secondly, development and discussion of these influencing factors took place with the review team, where the wording of factors and final grouping were discussed.

Ethics Statement

This study is a scoping review of previously published studies. Therefore, it was exempt from ethical approval.

Results

Literature Search results

Our initial search of the five databases yielded 2025 records. Following the removal of 825 duplicates, we were left with a total of 1200 records for the preliminary screening of titles and abstracts. Subsequently, 1148 records were excluded based on the eligibility criteria. The full text of 3 studies could not be obtained. Of the 49 records shortlisted for full text screening, 24 were further excluded, resulting in 25 studies to be included in this review. Additionally, through the screening of references during or after the full-text review, we identified and added 10 additional studies. Consequently, a total of 35 studies were incorporated in the final analysis. The detailed systematic search and selection process, as well as the reasons for excluding studies, are outlined in Figure 1.

Figure 1 Flowchart of the study selection process.

Characteristics of Included Studies

All included studies were published between 2008 and 2025. Geographically, the studies were predominantly conducted in North America, Europe and Asia, with the majority (n=6) conducted in the America, followed by China, Canada and Portugal. There were nineteen quantitative studies,^{9,14,19,20,23,25,29,47–55,59–61} thirteen qualitative studies,^{15,18,27,37–46} and three mixed-method studies.^21,56,57 A majority of these studies (n=26) focused on perinatal women, while a smaller number investigated spouses (n=2), and the fewest explored within couples (n=3). In addition, 4 studies conducted surveys on HCPs (eg, nurse midwives and social workers) and the families of women.

Quality of Included Studies

All studies have effectively addressed their research questions using appropriate research methods. In qualitative studies, the data sources, collection, analysis and interpretation are all coherent and consistent. These studies employed purposive, convenience or snowball sampling. Data was collected through focus group interviews or individual interviews. Data analysis involved content analysis,^{15,18,40,43,44} thematic analysis,³⁸ interpretative phenomenological analysis,^27,41,42,45 framework analysis,³⁷ modified analytic induction⁴⁶ and grounded theory analysis.³⁹ In the quantitative research, the measurements and statistical analysis were both appropriate. However, ten studies^{9,14,19,20,25,48,50,52,60,61} were cross-sectional online studies. Given that participants in the online survey were self-selecting, those who participated may be more interested in the topic of help-seeking. Therefore, the sample may not fully represent the entire research population, and the general applicability of the research results should be considered. All three mixed-method studies provided an adequate rationale for using a mixed-methods design to address the research question and adequately interpreted the integration of qualitative and quantitative components.

Scoping Themes

The factors influencing the willingness of women with PND and their spouses to seek professional psychological help were synthesized into five scoping themes: 1) demographic factors, 2) knowledge factors, 3) social psychological factors, 4) attitude factors, and 5) psychological service provider-related factors. Figure 2 illustrates scoping themes. Table 3 presents the characteristics of the studies included in this review.

Table 3 Overview of Included Studies

Figure 2 Factors influencing the intention of women with PND and their spouses to seek professional psychological assistance.

Demographic Factors

Nineteen studies^{9,20,23,25,29,39,43–45,47,49–52,54,55,57,60,61} investigated the relationship between demographic factors and the propensity of women with PND and their spouses to seek professional psychological assistance.

The likelihood of seeking professional psychological help was significantly correlated with various factors, such as being a woman with PND in the 30–39 age group,⁶¹ residing in urban,⁵⁵ possessing a higher educational qualification,^29,51 experiencing major depression,^20,51,52 having a previous mental health history⁹ and history of psychological help-seeking behavior,⁴⁷ having the C-section experience,⁵¹ and receiving encouragement from family.^{23,40,44,50,55} However, Fonseca et al’ study⁹ reached the opposite conclusion. Women with a history of psychological treatment were less likely to seek help when they experienced PND. Being pregnant or married are significant predictors of a woman’s reluctance to seek assistance for PND.⁹ Two studies^43,45 report that the immigrant status has hindered women from seeking help. Immigrant women experience a greater sense of social isolation; thus, they tend to seek help from their families rather than from mental health services.⁴⁵ Immigration issue is also closely linked to insurance coverage. Due to the cost of medical treatment, women tend to postpone seeking help.⁴³ Women^20,51 or their spouses^25,29 with higher monthly incomes or stable financial situations exhibit a stronger inclination towards utilizing mental health services to cope with PND. Five studies focusing on women^{23,45,49,57,61} and one focusing on parents of multiples⁶⁰ found that time constraints are linked to a lower intention to seek professional psychological help. Two studies^39,54 have found that financial problems significantly influence the reluctance of women and their spouses to seek mental health services, particularly if they do not have health insurance.

Knowledge Factors: Knowledge of PND and Psychotherapy

The knowledge factors encompassed awareness of PND and comprehension of psychotherapy. These factors impacted the couples’ ability to recognize depressive symptoms and their decision to undergo psychotherapy. Fourteen studies^{14,15,18,21,27,37,38,40,41,46,47,55,57,59} revealed that women suffering from PND often lack an understanding of PND, which impedes their ability to distinguish between “sad/ distress” and “depressed”, and to identify the symptoms of PND. Conversely, they tend to normalize depression,^{14,21,40,47,55,57} attributing it to a normal part of pregnancy and delivery,⁵⁹ new parental stress,⁴¹ hormonal change¹⁵ or a temporary issue.³⁷ One report emphasized that failure to properly recognize PND caused women and spouses to either dismiss their wives’ emotional challenges or incorrectly attribute them to the pressures of parenthood or a typical reaction to pregnancy.²⁷ Five studies indicated that participants’ awareness of psychotherapy significantly impacted their propensity to pursue professional psychological assistance and their ultimate decision to engage in psychotherapy. Of these studies, four emphasized women’s negative reactions to psychological help services, primarily due to a lack of awareness of mental health services^15,18 or concerns that medication might adversely affect fetal health.^41,59 Similarly, one study involving spouses corroborated these findings.²⁷

Attitude Factors: Perspectives on PND Screening, Psychotherapy, and the Obstetric Team Responsibilities

Regarding the attitude-related factors, they can be classified into several categories: views on postpartum depression screening, psychotherapy, and the responsibilities of the obstetric team. These perceptions influence the decisions of women and their spouses to undergo screening and psychological treatment.

One study explored the factors associated with attitudes towards PND screening, finding that spouses are often exhibit unsupportive attitudes, believing that their wives do not require screening and viewing it as a waste of time and resources.²⁷

Seven studies^{27,29,44,47,52,55,61} have explored factors associated with attitudes towards psychotherapy. Three studies of women with PND showed that perceived need and recognition of the benefits of psychotherapy promoted women’s intention to seek professional psychological help.^52,55 Conversely, women with PND who require psychological support often have negative attitudes. They may believe that psychotherapy is ineffective,⁴⁷ or that the help they are seeking is inadequate.⁶¹ They may also assume that their depression will improve over time.^44,47 Spouses who believe that psychotherapy is ineffective tend to be reluctant to seek professional psychological support.²⁷ Additionally, study on couples found that negative attitudes weakened couples’ intention to seek professional psychological support.²⁹

Both the women and their spouses believe that they believed the obstetric team should not address psychological issues. Due to a poor understanding of the team’s scope of responsibilities, they decline prompt PND screening and referral services.^27,37,56

Social Psychological Factors: Stigma and Self-Efficacy

Stigma

Eighteen studies involving women with PND and their spouses reported that these individuals had low intentions of seeking professional psychological help, primarily due to stigma. This stigma is inversely related to help-seeking attitudes.⁴⁸ This finding is consistent with the Theory of Planned Behavior (TPB), which states that positive attitudes are crucial in determining behavioral intentions and subsequent actions. The stigma hindering women and their spouses’ intention to seek professional psychological help for PND can be categorized into three distinct forms: public stigma,^{18,29,39,41,45,46,49,54,55,57,60} self-stigma,^19,21,25 and stigma stemming from traditional cultural beliefs.^{15,38,39,42,45,53}

Thirteen studies highlight that prevailing stereotypes about depression lead to a reduced inclination among women with PND to seek professional psychological help. These women are embarrassed to talk about their personal matters and afraid that their families might disapprove of them receiving treatment.⁴⁹ They are anxious about being perceived as overreacting or trivializing their concerns about motherhood.¹⁸ They were also apprehensive about being labelled “mad”⁵⁷ or “bad/ crazy mothers”.^39,41,45,46 Four studies revealed that women with PND and their spouses often avoid seeking help for fear of being judged negatively or being labelled with a mental illness.^14,29,44,54 The reluctance of parents of multiples to pursue professional psychological assistance is linked to the stigma associated with seeking mental healthcare during periods stereotypically perceived as happy.⁶⁰ Conversely, one study indicated that women who express concern about their friends’ perceptions are actually more likely to seek help at health facilities,⁵⁵ suggesting that this social apprehension may paradoxically drive their engagement with healthcare services.

Studies have shown that women who experienced self-stigma, harbored unrealistic expectations. Consequently, these women were indifferent towards psychological assistance services.^19,21 Another study²⁵ found that spouses exhibiting high levels of gender-role conflict, such as dimensions of success, power and competition, and restricted emotionality tended to experience increased stigma and were less likely to seek professional help.

The stigma caused by culture included traditional postpartum customs and deeply rooted cultural beliefs. One study¹⁵ have reported that women experiencing PND who have immigrated to the United States often hesitate to seek professional psychological assistance due to the stigma associated with cultural traditions. For Chinese-American women, distinct postpartum cultural traditions can act as a barrier to seeking professional help. Additionally, these women tend to view both depression and seeking professional help as signs of weakness.¹⁵ Five studies^{38,39,42,45,53} have found that stigma caused by deeply rooted cultural beliefs prevents postpartum women from seeking formal assistance. Depressed Chinese women are reluctant to seek help because they adhere to the Chinese cultural concept of “don’t wash your dirty linen in public”³⁸ or “face (getting ahead through social achievement)”.⁵³ In Hispanic culture, women have been regarded as the cornerstone of family integrity, meaning that seeking mental health services is not culturally appropriate.⁴⁵ Family ethics mean that Latina women suffering from PPD will not seek help unless their husbands give their consent. They tend not to disclose to their families that they are receiving psychological counselling, in order to avoid being humiliated or judged by others for discussing personal matters with outsiders.³⁹ Although PPD women are aware that they need external support and professional assistance, they do not seek help due to due to Nigerian cultural expectations that require women to remain resilient and strong.⁴²

Self-Efficacy

Four studies^29,39,41,61 have emphasized the impact of self-efficacy on women’s intention to reveal their emotional issues, as well as their capacity and inclination to seek and utilize mental health services. Low self-efficacy can result in women being unaware of the location and types of psychological services available, meaning they are unable to seek assistance.^39,41,61 Studies involving women with PND and their spouses have also shown that couples with lower self-efficacy tend to acquire less knowledge and have poorer coping abilities. This directly contributes to their reduced willingness to seek professional psychological help.²⁹

Psychological Service Provider-Related Factors

Fifteen studies analyzed the association between psychological provider-related factors and the intention of women with PND and their spouses to seek professional psychological assistance. These factors included the individuals’ previous treatment experiences,^{21,37,38,41,42} the obstetric team’s attitudes,^23,43 their attention to maternal mental health,^{18,19,44,45,56} logistical barriers to care (eg, long distance,^38,44,60 lack childcare,^23,39,45,60 accessibility of mental health services,^{23,38,43,44,49,60} the obstetric team’s professionalism in PND^38,39 and the lack relevant policies³⁸).

The obstetric team mentioned that mental health was associated with women’s help-seeking intention during the perinatal period.⁵⁶ Notably, women and their spouses have consistently reported that the obstetric team prioritizes infant health, breastfeeding, and family planning, while neglecting their mental health.^18,19,44,45 Previous treatment experiences are closely tied to women’s trust in HCPs. HCPs are often time-pressd³⁸ and sometimes neglect, misinterpret or normalize women’s psychological issues.^21,41 Consequently, women are reluctant to disclose their psychological problems. Similarly, Malaysian women have expressed dissatisfaction with nurses who failed to adequately explain the purpose of the Hepatitis B vaccination, and instead provided unrelated details regarding infant positioning.³⁷ Consequently, these women are distrustful of treatment recommendations offered by HCPs. Women have also noted that the attitude of HCPs influences their engagement with mental health services. Encouragement and empathetic listening from HCPs serve as key facilitators.²³ The obstetric team makes efforts to build a trusting relationship with women, respecting their individual backgrounds and providing personalized services, which encourages them to utilize services.⁴³ In terms of logistical barriers to care, issues such as long distances and service availability have prevented women from obtaining timely psychological assistance.^18,43,44,60 The lack of childcare was also significant, preventing women from attending appointments assistance.²³ Furthermore, the presence of psychiatrists within the obstetric setting facilitates women’s access to mental health care services during their perinatal visits.⁴⁹ It has been reported that the obstetric team lacks the competency to select assessment tools and identify PND.³⁹ Due to a lack of training, the team stated that they had limited knowledge of PND and were unaware of the screening and referral.³⁸ In the absence of clear policies, the team did not proactively offer PND screening and referral.³⁸

Discussion

This scoping review synthesized existing literature to identify the key factors that influence women with PND and their spouses’ intention to seek professional psychological help. Help-seeking intentions among women with PND and their spouses are shaped by an interplay of knowledge, attitudes, social-psychological influences, and characteristics of service providers.

Traditional Postpartum Customs and Deeply Rooted Cultural Beliefs Have Created Stigma That Diminishes Women’s Intention to Seek Professional Psychological Assistance

The postpartum period is a critical phase in a mother’s life, during which specific cultural traditions are observed to ensure her well-being. However, it is precisely these traditions that perpetuate deeply ingrained biases against women, affecting their attitudes towards professional psychological assistance and resulting in missed optimal windows for intervention.^15,62 For example, Chinese women are expected to follow the tradition of “sitting the month”, which entails restrictions on bathing and physical activity, alongside isolation from the outside world for a month after childbirth.⁶³ Similarly, Vietnamese women observe postpartum customs that closely parallel these practices.⁶⁴ Failing to adhere to these customs can lead to significant social stigma, including being labeled an unfit mother or a weak woman.^15,45 Although Chinese and Korean women living in the United States have access to widely available psychological counselling services, like other Asian populations, they often adhere to Confucian values (eg, saving face) and view mental illness as a result of being “weak-minded” or “defective”.^15,65 Given the profound impact of cultural values and traditional customs on women’s intention to seek professional psychological assistance, community education should prioritize family-centered education. For instance, in Latin America, knowledge about postpartum depression should be widely disseminated among family members to transform them into supporters. In regions with specific postpartum customs such as South Korea and China, interventions should be integrated with local postpartum convalescence practices. HCPs serving diverse populations must understand childbearing traditions across different cultural backgrounds to deliver culturally competent care, thereby avoiding stereotypes and enhancing the practical efficacy of global perinatal mental health care services.

Self-Stigma Affect the Psychological Help-Seeking Intentions of Women with PND and Their Spouses

Self-stigma involves internalizing shame or negative perceptions about one’s mental health. Women with PND often face self-stigma when seeking professional psychological help, as utilizing mental health services contradicts their aspirations to be ideal, self-sufficient mothers, thereby intensifying their guilt.^19,21,39 Similarly, men experience self-stigma because seeking help violates traditional male norms.²⁵ Driven by ideals of success and restrictive emotionality (gender role conflict), men view vulnerability as a threat to their masculinity.^25,66 These stigmas manifest in gender-specific coping mechanisms. Women tend to employ emotion-focused or ruminative coping, whereas men often adopt problem-focused or avoidance strategies. For men, this avoidance significantly diminishes not only their own willingness to seek help but also their likelihood of recommending professional assistance to their wives.^25,67 Because the decision to seek help is highly interdependent, high self-stigma in either partner lowers the couple’s overall intention to seek treatment. This hesitation delays clinical interventions and exacerbates gender differences in treatment responses, as evidenced by the Esketamine study showing women recover faster from non-suicidal self-harm than men.⁶⁸ Given these findings, clinical interventions should adopt a couple-based approach, as help-seeking decisions are highly interdependent. Reducing maternal self-stigma requires simultaneously addressing male stigma rooted in gender role conflicts. Specifically, psychoeducation should challenge restrictive masculine norms and reframe help-seeking as a proactive coping strategy. Multidisciplinary psychosocial intervention measures led by obstetricians, nurses and mental health professionals should be incorporated into routine perinatal care. Early involvement of men in this process can mitigate stigma, foster spousal support, and ultimately improve help-seeking behaviors for both partners.

Couples are Commonly Influenced by Financial Problems and Time Constraints

Financial problems and time constraints are prevalent barriers that discourage women and their spouses from pursuing professional psychological assistance. In terms of financial problem, couples facing financial constraints^20,29 or lacking health insurance^39,45,64 demonstrate lower willingness seek psychological help. During the perinatal period, parents often require substantial financial resources for childcare. Consequently, those with lower incomes tend to experience financial strain.⁶⁰ As previous studies have indicated, many individuals lack knowledge of PND.^69,70 Without recognizing severe PND, they are reluctant to seek psychological services. Time constraints are a pivotal factor in women’s and their spouses’ decisions to seek professional psychological support. Indeed, parents must invest significant time in fulfilling their parenting responsibilities. Women strongly prefer a facility that integrates physical and mental health evaluations, ideally coupled with childcare services, to help mothers with PND manage their time more efficiently.^23,49,60

Limited Knowledge of PND and Psychotherapy is a Key Factor That Reduces Couples’ Intention to Seek Professional Psychological Help

Researches have demonstrated that couples lacking knowledge about PND are unable to identify and interpret its symptoms as abnormal.^18,71 Despite experiencing symptoms such as sadness, crying, sleep disturbances, or body image anxiety, women often attribute these to normal reactions to pregnancy and view them as temporary emotional issues.^27,37 Moreover, under societal pressure to conform to idealized parental roles, new parents are likely to attribute these symptoms to the natural challenges of the postpartum period.^15,27 This lack of knowledge not only diminishes their initial intention to seek help, but also hinders their access to actual psychological services. Few studies in this review revealed that both women and their spouses lacked knowledge about psychotherapy, which in turn influenced their attitudes towards it and their actual help-seeking behaviors. For instance, they were concerned about the teratogenic effects of the medication²⁷ and believed that psychological treatments were ineffective.⁴⁷ This review found that the majority of women with PND and their spouses in both developed and developing countries are unaware of PND. This impairs their ability to recognize symptoms and seek treatment. Therefore, it is incumbent upon the obstetrical team to actively promote awareness of PND among couples during routine antenatal and postnatal consultations. Failing to do so would mean missing a significant opportunity to educate and screen these women.¹⁸ Given that the knowledge of PND is positively correlated with knowledge of psychotherapy, and those unfamiliar with PND are less motivated to learn, it is necessary to provide education on both PND and psychotherapy concurrently.

Service Providers Play a Vital Role in Encouraging Women’s Willingness to Seek Professional Psychological Support for PND

This review found that service provider-related factors significantly influence women’s intentions to seek professional psychological help for PND. An obstetric team’s attentiveness to women’s mental health is positively associated with their propensity to seek professional psychological help. Bennett et al’s found that prenatal care providers frequently discuss depression with pregnant women. If these women experience psychological distress, up to 61% are likely to turn to their obstetricians for help.⁵⁶ Furthermore, whether women trust the obstetric team and are willing to accept psychological assistance services is influenced by the team’s professionalism, which directly shapes their early treatment experiences.³⁷ If women’s uncertainty is not alleviated by the advice they receive, they are likely to lose trust in the obstetric team’s care. Therefore, in addition to enhancing their ability to provide maternal and infant healthcare, obstetric teams need training in mental healthcare services. This will ensure comprehensive physical and mental healthcare services are delivered.

Limitation

This scoping review has several limitations that must be taken into consideration. Firstly, restricting the search to English-language articles may have resulted in the exclusion of relevant studies published in other languages. Secondly, although data extraction was verified by a second reviewer and discrepancies were resolved by a third, the process did not meet the recommended standard of independent dual extraction. Thirdly, although results stem from a variety of geographical areas around the globe, the majority of studies were conducted in America, Portugal and China. Consequently, the identified influencing factors were skewed towards specific traditional cultures and medical practices. Fourthly, even though the primary focus was on women with PND and their spouses, we incorporated data from HCPs and other caregivers to enrich contextual understanding; this ancillary inclusion, while broadening the scope, may also have introduced heterogeneity that was not systematically examined.

Implications for Clinical Practice

This scoping review incorporates the perspective of spouses and summarizes the intentions of women with PND and their spouses to seek professional psychological help. To translate these findings into clinical practice, HCPs should implement targeted educational strategies and psychological interventions to support both partners, thereby increasing couples’ willingness to seek help.

Firstly, given that knowledge influences couples’ help-seeking intentions, mental health education should be implemented throughout the perinatal period. Obstetric teams should deliver this education to couples and their support companions, as improving health literacy can reduce stigma. Secondly, community-based care should be highly prioritized, with psychological interventions integrated into local postpartum rehabilitation practices. To improve global perinatal mental health services, HCPs should understand diverse cultural fertility traditions to provide culturally sensitive care. Thirdly, obstetric teams should expand their maternal and infant care responsibilities. Obstetricians should actively screen for PND and enhance adherence to standardized clinical guidelines to ensure early detection and timely referral. Furthermore, obstetric nurses should establish peer support groups to offer consultations and extend health education. These intervention measures can provide necessary support to affected women and their spouses, ultimately enhancing their mental health literacy.

Conclusion

This review outlines the factors that affect women with PND and their spouses’ willingness to seek professional psychological help. These factors include couples’ knowledge of PPD, which often leads them to prioritize parenting and physical health over mental well-being, along with stigma, time constraints, financial barriers, and the expertise and efficiency of the obstetric team. Therefore, integrating these factors is essential for developing dyadic interventions targeting the woman-spouse unit, to foster mutual support and facilitate their joint engagement in psychological assistance. As a crucial gateway for clinical practice and policy, obstetric teams require both maternal and mental health training. Policy should expand their scope of responsibilities to integrate standardized PND screening,⁷ obstetrician-led psychological counseling, alongside nurse-led health education and support groups. These structured interventions will significantly enhance couples’ mental health awareness, alleviate time constraints, and optimize postpartum management. Finally, since these influencing factors are deeply rooted in national, historical, and cultural contexts, and given the variations in perinatal mental health service guidelines and cultural differences across regions, each country should formulate standardized psychological care norms for obstetric teams, as well as medical insurance coverage, that align with its own national conditions.