Email this article Exploring mothers’anxiety experiences and perceptions in accessing mental health support from pregnancy through the first two years postpartum
Abstract
Background: Changes during pregnancy can cause physical and psychological symptoms, such as anxiety. However, many mothers do not undergo mental health condition detection by healthcare professionals, often due to misconceptions or lack of awareness.
Objectives: This study aims to analyze the relationship between mothers’ experiences and perceptions in seeking mental health support during pregnancy and up to two years postpartum.
Methods: The design of this study is a retrospective cohort. The sample consisted of 249 respondents. The research was conducted in December 2024 at Karang Kitri Public Health Center, Sriamur Public Health Center, and the practices of midwives Luvvia Afriansid, Anita, Hj. Fitri, and Srimahi Public Health Center. The dependent variable was the experience of mental health problems, particularly anxiety, from pregnancy until two years postpartum. Statistical analysis was performed using multivariate logistic regression. Mothers’ perceptions of mental health detection were measured using the Mental Health Seeking Questionnaire, and anxiety levels were assessed using the Hamilton Anxiety Rating Scale (HAM-A). The relationship between the two variables was analyzed using multivariate logistic regression.
Results: The analysis showed that prior experience of mental health problems (particularly anxiety) did not significantly affect mothers’ perceptions of the importance of mental health detection (p = 0.142; p > 0.05). However, education level was significantly related to perception (p = 0.023; OR = 0.09), indicating that lower education levels are associated with lower positive perceptions toward mental health detection.
Conclusions: The study revealed no significant relationship between maternal anxiety and perceptions of seeking mental health support, as many mothers experiencing moderate to severe anxiety did not recognize their symptoms as a mental health concern or seek professional helpKeywords
Full Text:
PDFReferences
Sperati A, Passaquindici I, Persico ME, Di Matteo C, Fasolo M, Lionetti F, et al. Maternal depression during the perinatal period: the role of Sensory Processing Sensitivity and social support and its impact on infants’ negative affect. Frontiers in Psychology. 2025 Mar 20;16:1551016.
Alini A, Meisyalla LN, Novrika B. Faktor-faktor yang Berhubungan dengan Kesehatan Mental Ibu Hamil di Desa Pulau Rambai. Jurnal Ners. 2024;8(1):178–86. https://doi.org/10.31004/jn.v8i1.23506
Della Vedova AM, Santoniccolo F, Sechi C, Trombetta T. Perinatal Depression and Anxiety Symptoms, Parental Bonding and Dyadic Sensitivity in Mother–Baby Interactions at Three Months Post-Partum. International Journal of Environmental Research and Public Health. 2023 Feb 27;20(5):4253. https://doi.org/10.3390/ijerph20054253
Pascal R, Casas I, Genero M, Nakaki A, Youssef L, Larroya M, et al. Maternal Stress, Anxiety, Well-Being, and Sleep Quality in Pregnant Women throughout Gestation. Journal of Clinical Medicine. 2023 Nov 26;12(23):7333. https://doi.org/10.3390/jcm12237333
The American College of Obstetricians and Gynecologists. Anxiety and Pregnancy [Internet]. 2024. Available from: https://www.acog.org/womens-health/faqs/anxiety-and-pregnancy
Mei X, Du P, Li Y, Mei R, Wang X, Chen Q, et al. Fear of childbirth and sleep quality among pregnant women: a generalized additive model and moderated mediation analysis. BMC Psychiatry. 2023 Dec 11;23(1):931.
Wallace K, Araji S. An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period. Journal of Mental Health & Clinical Psychology. 2020 Nov 1;4(4):47–56. https://doi.org/10.29245/2578-2959/2020/4.1221
Ayers S, Sinesi A, Meade R, Cheyne H, Maxwell M, Best C, et al. Prevalence and treatment of perinatal anxiety: diagnostic interview study. BJPsych Open. 2025 Jan;11(1):e5. https://doi.org/10.1192/bjo.2024.823
Liu Y, Guo N, Li T, Zhuang W, Jiang H. Prevalence and Associated Factors of Postpartum Anxiety and Depression Symptoms Among Women in Shanghai, China. Journal of Affective Disorders. 2020 Sep;274:848–56. https://doi.org/10.1016/j.jad.2020.05.028
Hastanti H, Budiono B, Febriyana N. Primigravida Memiliki Kecemasan Yang Lebih Saat Kehamilan. Indonesian Midwifery and Health Sciences Journal. 2021 Jun 23;3(2):167–78. https://doi.org/10.20473/imhsj.v3i2.2019.167-178
Wallace K, Araji S. An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period. Journal of Mental Health & Clinical Psychology. 2020 Nov 1;4(4):47–56. https://doi.org/10.29245/2578-2959/2020/4.1221
Matsas A, Panopoulou P, Antoniou N, Bargiota A, Gryparis A, Vrachnis N, et al. Chronic Stress in Pregnancy Is Associated with Low Birth Weight: A Meta-Analysis. Journal of Clinical Medicine. 2023 Dec 14;12(24):7686. https://doi.org/10.3390/jcm12247686
Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020 Oct;19(3):313–27. https://doi.org/10.1002/wps.20769
Hennessey EMP, Swales DA, Markant J, Hoffman MC, Hankin BL, Davis EP. Maternal anxiety during pregnancy predicts infant attention to affective faces. Journal of Affective Disorders. 2024 Jan;344:104–14. https://doi.org/10.1016/j.jad.2023.09.031
Thi LM, Manzano A, Ha BTT, Vui LT, Quynh-Chi NT, Duong DTT, et al. Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study. International Journal for Equity in Health. 2024 Aug 16;23(1):163. https://doi.org/10.1186/s12939-024-02250-z
Place JMS, Renbarger K, Van De Griend K, Guinn M, Wheatley C, Holmes O. Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Frontiers in Global Women’s Health. 2024 May 24;5:1335437. https://doi.org/10.3389/fgwh.2024.1335437
Prihartanti T, Khodijah Parinduri S, Masitha Arsyati A. Evaluasi Pelaksanaan Program Upaya Kesehatan Jiwa Di Puskesmas Sindang Barang Kota Bogor Provinsi Jawa Barat Tahun 2020. Promotor. 2021 Oct 20;4(4):380–94. https://doi.org/10.32832/pro.v4i4.5605
PoiData.io. How many Psychiatric hospitals are in Indonesia? PoiData.io; 2025.
Munira L, Liamputtong P, Viwattanakulvanid P. Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study. Belitung Nursing Journal. 2023 Apr 18;9(2):110–7. https://doi.org/10.33546/bnj.2521
Wahdi AE, Astrini YP, Setyawan A, Fine SL, Ramaiya A, Li M, et al. Mental health service use among adolescents in three low- and middle-income countries: An analysis of the National Adolescent Mental Health Surveys. Child and Adolescent Psychiatry and Mental Health. 2025 Jul 31;19(S1):84.
Nielsen-Scott M, Fellmeth G, Opondo C, Alderdice F. Prevalence of perinatal anxiety in low- and middle-income countries: A systematic review and meta-analysis. Journal of Affective Disorders. 2022 Jun;306:71–9. https://doi.org/10.1016/j.jad.2022.03.032
Yang L, Sun J, Nan Y, Waqas A, Nisar A, Wang D, et al. Prevalence of perinatal anxiety and its determinants in mainland China: A systematic review and meta-analysis. Journal of Affective Disorders. 2023 Feb;323:193–203. https://doi.org/10.1016/j.jad.2022.11.075
Rinne GR, Hartstein J, Guardino CM, Dunkel Schetter C. Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review. Psychoneuroendocrinology. 2023 Jul;153:106115. https://doi.org/10.1016/j.psyneuen.2023.106115
Hantsoo L, Jagodnik KM, Novick AM, Baweja R, Di Scalea TL, Ozerdem A, et al. The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions. Frontiers in Endocrinology. 2023 Dec 12;14:1295261. https://doi.org/10.3389/fendo.2023.1295261
Peterson GF, Espel EV, Davis EP, Sandman CA, Glynn LM. Characterizing prenatal maternal distress with unique prenatal cortisol trajectories. Health Psychology. 2020 Nov;39(11):1013–9.
Irwin JL, Meyering AL, Peterson G, Glynn LM, Sandman CA, Hicks LM, et al. Maternal prenatal cortisol programs the infant hypothalamic–pituitary–adrenal axis. Psychoneuroendocrinology. 2021 Mar;125:105106.
Womack SR, Murphy HR, Arnold MS, Duberstein ZT, Best M, Qiu X, et al. Timing sensitivity of prenatal cortisol exposure and neurocognitive development. Development and Psychopathology. 2024 Nov 6;1–14.
Syahfitri W, Putra DP. Kesehatan Mental Warga Binaan di Lembaga Pembinaan Khusus Anak. JRTI (Jurnal Riset Tindakan Indonesia). 2021 Nov 13;6(2):226.
Corchero-Falcón MDR, Gómez-Salgado J, García-Iglesias JJ, Camacho-Vega JC, Fagundo-Rivera J, Carrasco-González AM. Risk Factors for Working Pregnant Women and Potential Adverse Consequences of Exposure: A Systematic Review. International Journal of Public Health. 2023 Feb 16;68:1605655.
Abdelhafez MohsenMA, Ahmed KarimAM, Ahmed NashwaAM, Ismail M, Mohd Daud MNB, Ping NPT, et al. Psychiatric illness and pregnancy: A literature review. Heliyon. 2023 Nov;9(11):e20958. https://doi.org/10.1016/j.heliyon.2023.e20958
Green EC, Murphy EM, Gryboski K. The Health Belief Model. In: Sweeny K, Robbins ML, Cohen LM, editors. The Wiley Encyclopedia of Health Psychology [Internet]. 1st ed. Wiley; 2020 [cited 2025 Mar 13]. p. 211–4. Available from: https://onlinelibrary.wiley.com/doi/10.1002/9781119057840.ch68
Mbiydzenyuy NE, Qulu LA. Stress, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis, and aggression. Metabolic Brain Disease. 2024 Jul 31;39(8):1613–36. https://doi.org/10.1007/s11011-024-01393-w
Ruffaner-Hanson C, Noor S, Sun MS, Solomon E, Marquez LE, Rodriguez DE, et al. The maternal-placental-fetal interface: Adaptations of the HPA axis and immune mediators following maternal stress and prenatal alcohol exposure. Experimental Neurology. 2022 Sep;355:114121. https://doi.org/10.1016/j.expneurol.2022.114121
Leng LL, Yin XC, Ng SM. Mindfulness-based intervention for clinical and subthreshold perinatal depression and anxiety: A systematic review and meta-analysis of randomized controlled trial. Comprehensive Psychiatry. 2023 Apr;122:152375.
Mikolajkow A, Małyszczak K. Biological factors and consequences of pregnancy-related anxiety – What do we know so far? Psychiatria Polska. 2022 Dec 31;56(6):1289–314. https://doi.org/10.12740/PP/144138
Mahini E, Hakimi S, Shahrokhi H, Salahi B, Baniadam KO, Ranjbar F. Evaluation of factors related to maternal anxiety during pregnancy among women referred to Tabriz primary care centers. BMC Psychiatry. 2023 May 10;23(1):329. https://doi.org/10.1186/s12888-023-04823-8
Franke K, Van Den Bergh BRH, De Rooij SR, Kroegel N, Nathanielsz PW, Rakers F, et al. Effects of maternal stress and nutrient restriction during gestation on offspring neuroanatomy in humans. Neuroscience & Biobehavioral Reviews. 2020 Oct;117:5–25. https://doi.org/10.1016/j.neubiorev.2020.01.031
Szyf M. Perinatal stress and epigenetics. In: Handbook of Clinical Neurology [Internet]. Elsevier; 2021 [cited 2025 Sep 3]. p. 125–48. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780128201077000082
Savitri EN, Hayati EN, Daryanti MS. Scoping Review: Layanan Perinatal Mental Health oleh Bidan di Negara ASEAN. Jurnal Kesehatan Manarang. 2022 Aug 25;8(2):115. https://doi.org/10.33490/jkm.v8i2.479
Daehn D, Rudolf S, Pawils S, Renneberg B. Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public – a systematic review. BMC Pregnancy Childbirth. 2022 Dec;22(1):574.
Ismail NA, Kusumaningtyas I, Firngadi MSK. Self-diagnose is associated with knowledge and attitude towards mental illness of university students in Indonesia. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2023 Nov 28;59(1):162.
Faozi BF, Wijaya M, Sukandar H. Relationship characteristic of midwife in pregnancy services and patient satisfaction In Public Health Center, Soreang, Bandung. JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery). 2022 May 31;10(1):48. http://dx.doi.org/10.21927/jnki.2022.10(1).48-54
Amarasinghe, Agampodi. Help-seeking intention for depression and suicidal ideation during pregnancy and postpartum in rural Sri Lanka, a cross-sectional study. RRH [Internet]. 2022 Sep 5 [cited 2025 Mar 13]; Available from: https://www.rrh.org.au/journal/article/7273
Dubreucq M, Dupont C, Lambregtse-Van Den Berg MP, Bramer WM, Massoubre C, Dubreucq J. A systematic review of midwives’ training needs in perinatal mental health and related interventions. Frontiers in Psychiatry. 2024 Apr 22;15:1345738. https://doi.org/10.3389/fpsyt.2024.1345738
Ravaldi C, Mosconi L, Crescioli G, Lombardo G, Russo I, Morese A, et al. Are midwives trained to recognise perinatal depression symptoms? Results of MAMA (MAternal Mood Assessment) cross-sectional survey in Italy. Archives of Women’s Mental Health. 2024 Aug;27(4):567–76. https://doi.org/10.1007/s00737-024-01439-z
Wang WL, Hung HY, Chen YR, Chen KH, Yang SN, Chu CM, et al. Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta‐Analysis and Metaregression of Randomized Controlled Trials. Litscher G, editor. Evidence-Based Complementary and Alternative Medicine. 2020 Jan;2020(1):2654353. https://doi.org/10.1155/2020/2654353
Marshman A, Saunders E, Chaves D, Morton Ninomiya ME. Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review. Midwifery. 2023 Feb;117:103544. https://doi.org/10.1016/j.midw.2022.103544
Hassan NA, Izzati N, - R, Arifin SRM, Samsudin SB. Healthcare Practitioners’ Knowledge And Awareness On Perinatal Depression In Kuantan, Pahang, Malaysia. International Journal of Psychosocial Rehabilitation. 2020 Feb 28;24(04):2530–7. http://dx.doi.org/10.37200/IJPR/V24I4/PR201360
Basrowi RW, Wiguna T, Samah K, Djuwita F Moeloek N, Soetrisno M, Purwanto SA, et al. Exploring Mental Health Issues and Priorities in Indonesia Through Qualitative Expert Consensus. Clinical Practice & Epidemiology in Mental Health. 2024 Nov 7;20(1):e17450179331951. https://doi.org/10.2174/0117450179331951241022175443
Kuipers YJ, Beeck EV, Cijsouw A, Van Gils Y. The impact of motherhood on the course of women’s psychological wellbeing. Journal of Affective Disorders Reports. 2021 Dec;6:100216. http://dx.doi.org/10.1016/j.jadr.2021.100216
Trang DTH, Ha BTT, Vui LT, Chi NTQ, Thi LM, Duong DTT, et al. Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy and Planning. 2024 Jun 3;39(6):541–51.
Zhu Z, Wang H, Zhu T, Wang Z, Shen Y, Xiong C, et al. Mental health service utilization among pregnant and postpartum women: status, determinants, and insights from a mixed-methods study. BMC Public Health. 2025 May 26;25(1):1942.
Rinne GR, Hartstein J, Guardino CM, Dunkel Schetter C. Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review. Psychoneuroendocrinology. 2023 Jul;153:106115. https://doi.org/10.1016/j.psyneuen.2023.106115
Xue W, Cheng KK, Liu L, Li Q, Jin X, Yi J, et al. Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study. BMC Pregnancy Childbirth. 2023 Apr 5;23(1):230.
Baldisserotto ML, Miranda Theme M, Gomez LY, Dos Reis TBQ. Barriers to Seeking and Accepting Treatment for Perinatal Depression: A Qualitative Study in Rio de Janeiro, Brazil. Community Ment Health J. 2020 Jan;56(1):99–106. https://doi.org/10.1007/s10597-019-00450-4
Ransing R, Kukreti P, Deshpande S, Godake S, Neelam N, Raghuveer P, et al. Perinatal depression–knowledge gap among service providers and service utilizers in India. Asian Journal of Psychiatry. 2020 Jan;47:101822. https://doi.org/10.1016/j.ajp.2019.10.002
Dutta GK, Sarker BK, Ahmed HU, Bhattacharyya DS, Rahman MdM, Majumder R, et al. Mental healthcare-seeking behavior during the perinatal period among women in rural Bangladesh. BMC Health Services Research. 2022 Dec;22(1):310.
Sajjad A, Shah S, Abbas G, Aslam A, Randhawa F, Khurram H, et al. Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan. PeerJ. 2024 Jul 18;12:e17711. https://doi.org/10.7717/peerj.17711
Refbacks
- There are currently no refbacks.
Jurnal Ners dan Kebidanan Indonesia (JNKI) indexed by:
