Access and barriers to reproductive mental health services. A mixed-methods examination of self-stigmatization, help-seeking motivation and experiences with primary or reproductive healthcare professionals

Objective: Specialized reproductive mental health services help to alleviate symptoms of mental disorders associated with the reproductive system such as menstrual cycle, infertility, pregnancy or birth. However, people by reproductive mental disorders often do not receive the treatment they need or treatment is initiated after a long delay. The current study examined the process of accessing specialized reproductive mental health services in patients (mostly cisgender women) who just attended their first psychotherapy session in these services. Specifically, we examined the role of self-stigmatization related to mental issues as well as experiences with non-mental healthcare professionals and expectations regarding reproductive mental health services. Method: The sample consisted of 106 cisgender female and 3 cisgender male patients who recently attended the specialized reproductive mental health service (called gynecospsychiatry). Data were collected using a mixed-methods design based on validated questionnaires and open-ended text questions in an online survey. Additionally, clinical information was obtained from the treating psychotherapists. T-tests and regression analyses were applied to quantitative data. Open ended questions were analyzed qualitatively using thematic analysis. Results: Quantitatively, self-stigma was not significantly associated with the process of help seeking. Furthermore, our results suggest that merely being approached by primary or reproductive healthcare professionals was not associated with lower levels of self-stigma in our sample. Qualitative-analyses showed two major themes: 1) Not beating around the bush - clear words instead of overlooking or downplaying psychological distress, 2) Wanting to feel understood and accepted as opposed to condemned, judged, and devalued. Conclusion: Based on these findings, recommendations were made for psychotherapists as well as primary or reproductive healthcare professionals about how those affected by reproductive mental disorders can best be supported to seek treatment. Further research is recommended with larger clinical samples of patients with reproductive mental disorders.