Perinatal trajectories of help-seeking stigma and correlates: a prospective cohort study

Help-seeking stigma (stigma of seeking professional psychological help) is a major barrier to perinatal mental health service use. However, longitudinal evidence on heterogeneous stigma trajectories and their baseline correlates remains limited.

Pregnant women were recruited in the second trimester from four hospitals in two Chinese cities and completed stigma assessments at four time points (second trimester, third trimester, 1 month postpartum, and 3 months postpartum). Latent growth curve modelling assessed mean change and inter-individual variability. Growth mixture modelling identified latent trajectory classes. Baseline correlates of class membership were examined using R3STEP classification-adjusted multinomial logistic regression.

Of 1,250 enrolled women, 1,063 (85.0%) completed all assessments. Mean stigma remained stable, but significant heterogeneity was observed in both intercept and slope. Four trajectories were identified: low and decreasing (29.4%), moderate and stable (45.4%), high and increasing (18.3%), and moderate and rapidly increasing (6.9%). Compared with the moderate and stable class, elevated depressive symptoms at baseline (second trimester; EPDS ≥ 10) were associated with higher odds of the high and increasing class (adjusted odds ratio [aOR] = 2.46, 95% CI 1.63-3.71) and lower odds of the low and decreasing class (aOR = 0.50, 95% CI 0.30-0.84). More positive help-seeking attitudes and higher resilience were associated with lower odds of high and increasing and moderate and rapidly increasing trajectories. Unmarried/divorced status was associated with higher odds of the two increasing trajectories.

Mean-level stability in help-seeking stigma concealed clinically meaningful heterogeneity, with some women showing persistently moderate stigma and others following increasing trajectories over time. Baseline depressive symptoms, help-seeking attitudes, resilience, and marital status may support risk stratification within routine antenatal and early postpartum contacts, enabling targeted low-burden stigma-reduction and referral navigation to improve linkage to perinatal mental health care.