The risks of untreated postpartum depression (PPD) in the United States are higher among low-income ethnic minority mothers. However, research has not adequately investigated barriers to formal help seeking for PPD symptoms among this vulnerable population. We used convenience and purposive sampling strategies to recruit mothers experiencing past-year (the year prior to interview) PPD symptoms (n=14), community key informants (n=11), and service providers (n=12) to participate in focus groups and individual interviews. A grounded theory analysis of these nested perspectives revealed individual, community, and provider-level barriers operating at various stages of the help-seeking process: thinking about symptoms, seeking advice, and rejecting formal care. Although mothers overwhelmingly recommended "talking it out" for other mothers with PPD, an array of attitudinal and instrumental barriers led mothers to choose self-help practices in lieu of formal mental health care.

Background Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids. Yet, MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. In response, this article examines how clinics’ take-home dosing policies have affected patients’ experiences of treatment and lives in general. Methods This article is based on semi-structured, qualitative interviews with a variety of stakeholders in MMT. Interviews explored: reasons for engaging with, or not engaging with MMT; how MMT is conceptualized by patients and treatment providers (e.g., as harm reduction or route to abstinence and/or recovery); experiences with MMT; perception of barriers to MMT (e.g., organizational/regulatory, social) and how MMT might be improved to support peoples’ substance use treatment needs and goals. Results Nearly all of the patients with past or present MMT use were highly critical of the limited access to take-home doses and consequent need for daily or near daily clinic attendance. Participants described how the use of restrictive take-home dose policies negatively impacted their ability to meet day-to-day responsibilities and also cited the need for daily attendance as a reason for quitting or avoiding OAT. Responses also demonstrate how such policies contribute to an environment of cruelty and stigma within many clinics that exposes this already-stigmatized population to additional trauma. Conclusions Take-home dose policies in MMT are not working for a substantial number of patients and are reasonably seen by participants as degrading and dehumanizing. Revision of MMT regulations and policies regarding take home doses are essential to improve patient satisfaction and the quality and effectiveness of MMT as a key evidence-based treatment and harm reduction strategy.

In this study, we used a constructivist grounded theory approach to explore maternal identity negotiations among low-income ethnic minority mothers with postpartum depression (PPD) symptoms. Nineteen mothers were recruited from Women, Infant, and Children clinics located in two coastal cities in the United States to participate in in-depth interviews. Constant comparative analysis revealed that mothers experienced their PPD symptoms and poverty as evidence of maternal failure, but also drew on discourses of maternal self-sacrifice, engagement with their children, and pleasure in mothering to construct a positive sense of self. To negotiate these conflicting versions of self, mothers positively appraised their own mothering in relation to stigmatized "others" and framed their depression as a foreign entity, one that stood outside of a core, authentic sense of self. Through our consideration of the intersecting contexts of poverty and postpartum depressive symptoms, this article adds to the literature on PPD and mothering.

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Low‐income mothers in the U.S. are more likely to experience postpartum depression (PPD) and less likely to seek treatment than their middle‐class counterparts. Despite this knowledge, prior research has not provided an in‐depth understanding of PPD symptoms as they are experienced by low‐income mothers. Through in‐depth interviews, this study investigated low‐income mothers' (n = 19) experiences and explanatory frameworks for their PPD symptoms. Grounded theory analysis uncovered five main categories that linked the participants' PPD symptoms to their lived experiences of mothering in poverty, including: (1) ambivalence, (2) caregiving overload, (3) juggling, (4) mothering alone, and (5) real‐life worry. The analysis further located the core experience of PPD for low‐income mothers as “feeling overwhelmed” due to mothering in materially and socially stressful conditions. These findings challenge the prevailing biomedical discourse surrounding PPD and situate mothers' symptoms in the context of the material hardships associated with living in poverty.