Factors influencing adherence to psychological intervention referrals: a study of 35,390 women who screened positive for postpartum depression between 2016 and 2020 in Shenzhen, Southern China

Background Postpartum Depression (PPD) is a significant public health issue in China. Despite the launch of a universal PPD screening and intervention programme in Shenzhen, Southern China, there remains a substantial gap between the number of women who screened positive and were referred for psychological interventions and those who actually presented at mental health institutions for further evaluation and treatment. To inform enhancements of the programme, this study sought to understand the factors influencing adherence to intervention referrals among women with positive PPD screening results. Methods Using a retrospective study design, data from the programme management information system was analysed. The sample comprised 35,390 women who gave births in Shenzhen and screened positive for PPD between January 2016 and December 2020. Chi-square test and stepwise logistic regression were employed to determine factors affecting intervention uptake, with a p -value of less than 0.05 indicating statistical significance. Results The study found that although referral messages were given to 85.9% of women with positive PPD screening results, only 16.1% of them received psychological interventions. High school education (OR = 1.266, 95% CI: 1.1602 ~ 1.38), anxiety (OR = 1.126, 95% CI: 1.048 ~ 1.210) and depressive symptoms (OR = 1.054, 95% CI: 0.968 ~ 1.145) during pregnancy, as well as bottle (OR = 1.368, 95% CI: 1.218 ~ 1.535) and mixed feeding (OR = 1.110, 95% CI: 1.043 ~ 1.181) were positively associated with treatment engagement. Conversely, women with high level of depressive symptoms after childbirth (OR = 0.892, 95% CI: 0.836 ~ 0.953), and temporary (OR = 0.860, 95% CI: 0.800 ~ 0.924) or floating residence (OR = 0.628, 95% CI: 0.550 ~ 0.713) were less likely to seek mental health support. Conclusions This study is, to date, the largest quantitative investigation of its kind in China. It contributes to a better understanding of the factors influencing intervention-seeking behaviours among women who screened positive for PPD. The main findings underline the necessity for tailored interventions that cater to the specific needs and circumstances of different groups of women. It is crucial to encourage treatment engagement through strategies such as psychoeducation, addressing stigma, and providing supportive resources.