Cannabis policy priorities and public health: a survey of elected officials in California.

Perinatal mental health problems are a major public health concern worldwide. Meta-analytic evidence indicates a substantial prevalence of perinatal depression [] and anxiety–depression comorbidity [], with adverse consequences for maternal health [, ], infant development [–], family functioning [], and socioeconomic consequences [, ]. Evidence-based professional psychological care, such as counselling and psychotherapy, can reduce symptoms and improve outcomes for mothers, infants, and families [, ]. Nevertheless, utilization of professional psychological services during the perinatal period remains low. In a Ghanaian study, 18.9% of pregnant women reported self-initiated mental health help-seeking [], whereas in a Chinese study of perinatal women with depressive symptoms, only 11.3% had sought psychological help []. This gap between burden and service use underscores the need to identify modifiable barriers to engagement with perinatal mental health care. Help-seeking stigma (stigma of seeking professional psychological help; SSPPH) is a key barrier to engagement with mental health care [–]. Help-seeking stigma refers to perceived or anticipated negative social evaluation associated with seeking professional help, as well as the internalization of these judgements as shame, self-devaluation, and reduced self-esteem [, ]. It typically includes public stigma (perceived stereotypes and discriminatory attitudes from others) as well as self-stigma (internalized negative beliefs about oneself) [–]. During the perinatal period, help-seeking stigma may be intensified by fears of negative judgment, misunderstanding, or negative social evaluation from others [, ]. Higher stigma may delay or discourage engagement with professional psychological care [, , ], with possible implications for the timely recognition and treatment of perinatal mental health problems. Characterizing how help-seeking stigma changes during the perinatal transition may help inform strategies to improve service engagement, particularly among women with elevated mental health need. Despite growing interest in stigma, evidence in perinatal populations remains limited and is dominated by cross-sectional designs. Prior studies have examined mental health literacy, stigma, and broader social influences on help-seeking during the perinatal period [–]. Studies in China suggest that help-seeking stigma among pregnant women is generally mild to moderate and is associated with higher levels of depressive symptoms, lower perceived social support, and some maternal characteristics, including age, education, and parity-related factors []. Related work has also shown that attitudes toward professional psychological help-seeking vary across sociodemographic and psychosocial groups []. However, cross-sectional designs cannot capture within-person change across the perinatal transition, and mean-level longitudinal trends may still mask clinically meaningful heterogeneity. In particular, women following increasing-stigma trajectories across pregnancy and postpartum may be missed when only average trends are considered, hindering early identification of those at risk of not engaging with care.