POSTPARTUM DEPRESSION IN PRIMARY HEALTH CARE: SCREENING, BARRIERS TO DIAGNOSIS AND CONTINUITY OF CARE

Abstract

Postpartum depression is an important maternal health problem and may remain unrecognized even when women maintain contact with health services. This study aims to analyze evidence regarding postpartum depression screening in Primary Health Care, barriers to diagnosis, and factors related to continuity of care. A narrative review was conducted using a structured PubMed/MEDLINE search and targeted consultation of journals and repositories, covering publications from 2020 to October 2026. The thematic synthesis comprised 20 original studies with different designs and health care settings. The studies showed that incorporating standardized instruments and repeated screening opportunities, including during infant well-child visits, increases the identification of depressive symptoms. However, losses were observed between a positive screening result, clinical assessment, referral, and access to treatment. Stigma, difficulty recognizing symptoms, fear of judgment, social and logistical constraints, insufficient professional training, workload, lack of protocols, and weak coordination with mental health services were recurrent barriers. Training, supervision, protocols, and workflow reorganization improved process indicators, although they did not necessarily result in proportional improvements in clinical outcomes. Screening should therefore be integrated into a longitudinal care pathway connecting identification, diagnostic assessment, treatment, and follow-up within Primary Health Care.