Barriers to postpartum depression treatment among Indigenous Bedouin women in Israel: A focus group study

Postpartum depression (PPD), a common mental health problem among mothers worldwide, is higher among minority women. However, little is known about barriers faced by minority women when accessing mental health care services (MHCS) for PPD treatment. Drawing on McLeroy et al (Health Education Quartely 15: 351, 1988) ecological model, the current study explores barriers to mental health services among pregnant and postpartum minority Bedouin women in southern Israel. We conducted eight focus groups (FGs) in Arabic with 75 Bedouin women recruited using snowball sampling. Participants completed a socio-demographic questionnaire at each FG. Discussions were recorded and transcribed verbatim. Next, we conducted simultaneous thematic analysis and coded transcripts into conceptual categories based on the ecological model. We found multiple barriers that manifest at different levels (individual, family, organisational, economic, and public policy) and interact to limit Bedouin women's access to PPD treatment. At the individual level, factors included: women's negative attitudes toward PPD, women's societal status, grand multipara, gender, and limited knowledge about PPD; at the family level: low awareness among husbands and other family members regarding PPD symptoms and treatment, and lack of social support; at the organisational level: lack of culturally appropriate (health care services) HCSs, lack of PPD screening, and lack of PPD detection by family physicians; at the community level: economic barriers and poverty, stigmatisation of mental health problems, polygamy, and multiple births; finally, at the public policy level: residence in unrecognised villages lacking basic infrastructure. Our study thus sheds light on multilevel barriers impacting PPD prevention and treatment among Bedouin women. Policies and intervention programmes should seek to remove these barriers and protect Bedouin women and their children from the consequences of PPD.