Who decides to follow the referral advice after a positive postpartum depression screening result? Reflections about the role of sociodemographic, health, and psychological factors from psychological consultations – a cross-sectional study

Postpartum depression (PPD), a common and severe mental health problem, affects about 13–20 % of new mothers. Despite the psychological intervention's effectiveness, referral uptake rates among affected women are low. In the article, we aim to characterise those new mothers who adhered to referral advice after a positive PPD screening result. 9161 women had taken part in a midwife-led PPD screening. Those who scored equal to or more than ten points on the Edinburgh Postnatal Depression Scale (EPDS) were referred for psychological consultations (12 %, n = 1109). We used data gathered during the realization of a PPD prevention programme. The following measures were used: EPDS, a sociodemographic and health data survey, and psychological consultation cards. We found that only 85 (8 %) of referred mothers later enrolled in psychological consultations. Those mothers who adhered to the referral advice had higher EPDS (total score) and EPDS – 3A anxiety scores than mothers who did not contact a psychologist. Moreover, they had a higher gestational age at birth and, on average, fewer children. More PPD symptoms, C-section experience, self-assessed good financial situation and a postgraduate higher education degree were predictors of seeking help. A mother's decision to follow the referral advice is crucial in mental health prevention and should be treated as an addition to a separate step 2: referral in a 3-step PDD management process, with identification constituting a step 1, and intervention - a step 3. • Approximately 92% of women with a positive PPD screening result did not take up the referral. • The mother's decision to follow the referral advice is crucial in mental health prevention and should be treated, along with the referral itself, as a separate step 2 in a 3-step PDD management process: screening, a mother’s decision to uptake the referral, and the availability of the peripartum mental health services. • Public health professionals should explore what mothers with PPD risk need and how these needs could be met.