A Structural Model of Stigma, Spiritual Coping, and Mental Health Literacy Influencing Postpartum Mothers’ Mental Health Help-Seeking

Abstract

Introduction: Postpartum mental health problems remain common, yet many mothers do not seek professional support. Stigma, limited mental health literacy, and reliance on coping strategies, including spiritual coping may jointly shape help-seeking decisions, but these factors are rarely tested within a single explanatory model. Objective: To examine a triadic model linking stigma, spiritual coping, and mental health literacy with postpartum mothers’ help-seeking behavior, including the moderating role of spiritual coping. Methods: A cross-sectional analytical study was conducted among 100 postpartum mothers (≤12 months after delivery) recruited from maternal–child health clinics and online parenting communities in West Java, Indonesia. Validated questionnaires assessed stigma, spiritual coping, mental health literacy, and self-reported help-seeking behavior. Data were analyzed using Pearson correlations, hierarchical multiple regression, and structural equation modeling (SEM). Model fit was evaluated using χ²/df, RMSEA, CFI, and TLI. Results: Stigma correlated negatively with help-seeking (r = −0.42, p < .001) and mental health literacy (r = −0.34, p < .01), while mental health literacy correlated positively with help-seeking (r = 0.51, p < .001). In regression analysis, stigma, spiritual coping, and mental health literacy explained 42% of the variance in help-seeking (R² = 0.42, p < .001), with mental health literacy as the strongest predictor (β = 0.41, p < .001), followed by stigma (β = −0.33, p < .001) and positive spiritual coping (β = 0.25, p = .005). SEM showed good fit (χ²/df = 1.87; RMSEA = 0.052; CFI = 0.95; TLI = 0.93) and confirmed direct effects of stigma (β = −0.31, p < .001), mental health literacy (β = 0.44, p < .001), and spiritual coping (β = 0.22, p = .015) on help-seeking. Spiritual coping significantly moderated the stigma–help-seeking relationship (β = 0.18, p = .024), attenuating stigma’s negative effect. Conclusion: Postpartum help-seeking is shaped by the combined influence of stigma, mental health literacy, and spiritual coping, with spiritual coping buffering stigma’s harmful impact. Integrated interventions should reduce stigma, strengthen mental health literacy, and leverage adaptive spiritual resources.