A Thematic Analysis of Stigma and Disclosure for Perinatal Depression on an Online Forum

My Story of Depression: A Content Analysis of Autobiographic Videos on Douyin

Autobiographical accounts on social media could play an essential role in shaping the public's understanding of illnesses and dispelling illness-related stigma. This study examined how people living with depression describe their illness experiences on Douyin, China's leading video-sharing platform, through content analysis. It finds that most videos were created by young women who have lived with the illness for over three years. The top three topics were patient psychology, experience sharing, and knowledge and medical advice. These videos provided an overall non-stigmatizing portrayal of depression, with more than 80% of the influencers using challenge cues. However, stigma cues contributed to the virality of the videos. The theoretical and practical implications of the study were discussed.

Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study

BACKGROUND

Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors.

METHODS

A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors.

FINDINGS

Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help.

CONCLUSION

Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.

Effect of Behavioral Activation for Women with Postnatal Depression: A Systematic Review and Meta-Analysis

Evidence shows that behavioral activation (BA), a simple form of psychological therapy, is as effective as the more complex psychological therapy-cognitive behavioral therapy (CBT)-in treating general depression. However, it remains unclear whether BA when compared with treatment-as-usual (TAU) has greater contributions in reducing postnatal depression. This systematic review compared the effect of BA versus TAU in reducing depression symptoms among postnatal women. Five databases (MEDLINE, Embase, Emcare, Cochrane Library, and PsycINFO) were searched. Risk of bias was assessed using the Cochrane Collaboration's 'risk-of-bias 2 tool'. A random-effects meta-analysis was conducted to examine the effect of BA on postnatal depression. Of 2844 initial studies, only two randomized control trials (RCTs) met the inclusion criteria. The overall quality of evidence of these two RCTs was low. When compared to TAU, meta-analysis showed that BA was associated with reduced depression symptoms in postnatal women (standard mean difference -0.56; 95% confidence interval -0.76 to -0.37). This review suggests that BA might be more effective than TAU for alleviating postnatal depression. However, due to concerns about evidence quality, these findings should be interpreted cautiously.

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

Background

In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs'/HVs' decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs'/HVs' referral decisions is unexplored.

Aim

To understand MWs'/HVs' decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision.

Methods

Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs (n = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas.

Findings

Three themes were identified from the interviews that impacted on MWs'/HVs' PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.Questionnaire response rate 13.1% (n = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women's mental health; the most reported barriers were stigma associated with mental ill-health and women's perceived fear of child removal.

Conclusion

Fundamental to MWs'/HVs' decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs'/HVs' referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.

To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening

This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation "against instrument-based depression screening using a questionnaire with cut-off score to distinguish 'screen positive' and 'screen negative' administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth)." While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for "de-implementation" of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.

Experiences with Family Planning amongst Persons with Mental Health Problems: A Nationwide Patient Survey

High rates of unintended pregnancies in patients with mental health problems reflect the unmet need for tailored family planning. This study aims to explore aspects of family planning that are especially challenging for patients experiencing health problems by obtaining the perspective of (former) patients and those with close relationships with the (former) patients. In August 2021, members of a Dutch national mental health panel, consisting of (former) patients and close ones, were invited to respond to a 34-question online survey that included questions on four domains: reproductive history, decision making, parenting, and sexuality. This study has revealed the severe and adverse impact of mental health problems across all of the four domains of reproductive health and family planning, which the questions specifically targeted. Based on these results, we recommend discussing family planning with all patients experiencing or at risk for mental health problems and their partners. These discussions should address a desire to have children, (involuntary) childlessness, uncertainties about parenting and sexuality, while remaining considerate of experienced taboos.

Emotional difficulties, coping strategies, and help-seeking patterns among Czech perinatal women

OBJECTIVE

To understand both, women´s perception of emotional difficulties in perinatal period and their related coping strategies. Further, we mapped and analysed help-seeking patterns utilized by these women to overcome their emotional difficulties. This study serve as an important piece of information for women-centred innovations in perinatal mental health care in Czechia, and more broadly in the region of Central and Eastern Europe.

DESIGN

A qualitative study with an exploratory and descriptive approach using thematic analysis.

SETTING

Online survey consisting of open-ended questions mapping women´s perception of emotional difficulties in perinatal period and their related coping strategies and help-seeking patterns.

PARTICIPANTS

Two hundred women self-reporting emotional difficulties in perinatal period, from whom 108 (54 %) stated that they had sought professional help with their emotional difficulties.

FINDINGS

Two themes were identified in the analysis of women´s perception of emotional difficulties including Experience of symptoms of mental disorders, and Mother-child relationship. Three themes were identified in the analysis of women´s coping with these difficulties (Personal resources, External resources, and No coping strategy used). Four themes were identified in the analysis of help seeking patterns utilized by study participants (Mental health specialists, Physicians of the first line of contact, Midwifes, and Peer consultants).

KEY CONCLUSIONS

Emotional difficulties of perinatal women stemmed in both, general symptoms of mental disorders and specific concerns connected to mother-child relationship. Therefore, the perinatal mental health services should cover both topics, preferably by a multidisciplinary team. Women search information about perinatal mental health, so thus, easy to reach valid resources are needed. Finally, Czech perinatal women experiencing emotional difficulties utilize various help-seeking patterns. Some of them naturalistically utilize integrated stepped care even when it is not systematically established.

COVID vaccine stigma: detecting stigma across social media platforms with computational model based on deep learning

The study presents the first computational model of COVID vaccine stigma that can identify stigmatised sentiment with a high level of accuracy and generalises well across a number of social media platforms. The aim of the study is to understand the lexical features that are prevalent in COVID vaccine discourse and disputes between anti-vaccine and pro-vaccine groups. This should provide better insight for healthcare authorities, enabling them to better navigate those discussions. The study collected posts and their comments related to COVID vaccine sentiment in English, from Reddit, Twitter, and YouTube, for the period from April 2020 to March 2021. The labels used in the model, "stigma", "not stigma", and "undefined", were collected from a smaller Facebook (Meta) dataset and successfully propagated into a larger dataset from Reddit, Twitter, and YouTube. The success of the propagation task and consequent classification is a result of state-of-the-art annotation scheme and annotated dataset. Deep learning and pre-trained word vector embedding significantly outperformed traditional algorithms, according to two-tailed P(T≤t) test and achieved F1 score of 0.794 on the classification task with three classes. Stigmatised text in COVID anti-vaccine discourse is characterised by high levels of subjectivity, negative sentiment, anxiety, anger, risk, and healthcare references. After the first half of 2020, anti-vaccination stigma sentiment appears often in comments to posts attempting to disprove COVID vaccine conspiracy theories. This is inconsonant with previous research findings, where anti-vaccine people stayed primarily within their own in-group discussions. This shift in the behaviour of the anti-vaccine movement from affirming climates to ones with opposing opinions will be discussed and elaborated further in the study.

Support from friends moderates the relationship between repetitive negative thinking and postnatal wellbeing during COVID-19

BACKGROUND

Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postnatal psychological wellbeing - potentially intensifying RNT.

OBJECTIVE

We examined whether perceived social support (from friends, family, and a significant other) played a moderating role in the relationship between RNT and maternal postnatal anxiety and depressive symptoms.

METHODS

A sample of women (N = 251) who had given birth in the preceding 12 months completed an online battery of standardised measures during the COVID-19 'lockdown' of May 2020.

RESULTS

As predicted, social support moderated the relationship between RNT and depression such that the association between RNT and depression was stronger for women who reported lower levels of social support. Interestingly, this finding emerged for social support from friends only; for support from family and significant other, social support did not play a moderating role. Further, and unexpectedly, overall social support did not moderate the relationship between RNT and postnatal anxiety, however, social support from friends was a significant moderator.

CONCLUSIONS

High levels of perceived social support from friends (but not family or significant others) buffered the effects of RNT on depression and anxiety during the postpartum period. Strategies to bolster peer social support may be a valuable inclusion in interventions to prevent and treat postnatal depression and anxiety.

A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic

Background

Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021;  Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress.

Methods

As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms.

Results

Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes.

Conclusions

This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.

Preferences and Barriers to Counseling for and Treatment of Intimate Partner Violence, Depression, Anxiety, and Posttraumatic Stress Disorder Among Postpartum Women: Study Protocol of the Cross-Sectional Study INVITE

The cross-sectional study INVITE (INtimate partner VIolence care and Treatment prEferences in postpartum women) aims to examine treatment and counseling preferences and barriers in relation to the experience of intimate partner violence (IPV), depression and anxiety, and (childbirth-related) posttraumatic stress disorder (PTSD) among postpartum women in Dresden, Germany. Currently, the INVITE study consists of an interim sample of N = 1,787 participants with n = 891 completed interviews. Recruitment is ongoing, targeting a community sample of at least N = 4,000 women who complete various quantitative questionnaires via telephone interviews at 3-4 months postpartum. The differences in rates of IPV, postpartum depression and anxiety, and/or (childbirth-related) PTSD as well as treatment and counseling preferences and barriers between affected and non-affected women will be assessed. Further, predisposing variables, past and present stress exposure, enabling resources, as well as past and present health will be examined as predictors of service preferences and barriers. In this study protocol, the theoretical background, methods, as well as preliminary results regarding sociodemographic characteristics and birth-related factors of the interim sample are presented and discussed in terms of their socio-political relevance. Simultaneously assessing IPV, postpartum depression and anxiety, and (childbirth-related) PTSD will facilitate exploring comorbidities and concomitant special needs of affected women. Results of the INVITE study will therefore set the ground for well-aimed development and improvement of treatment and counseling services for the respective target groups by informing health care professionals and policy makers about specific preferences and barriers to treatment. This will yield the possibility to tailor services to the needs of postpartum women.

Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study

BACKGROUND

Anxiety disorders and depression during pregnancy are highly prevalent. Hospitalized pregnant women with high maternal or fetal risk represent a particularly vulnerable population often excluded from research samples. Screening for mental health disorders is not routinely offered for this particular patient group. Electronic mindfulness-based interventions constitute an accessible, convenient, and cost-effective mental health resource but have not yet been evaluated for acceptance in inpatient settings. To date, little is known about the needs and perceptions of this group of women.

OBJECTIVE

The aim of this study was to examine whether a brief electronic mindfulness-based intervention (eMBI) is accepted among hospitalized high-risk pregnant women. We assessed personal motivation and barriers, experiences, usability requirements, and overall acceptance of the eMBI, as well the specific needs and demands of patients with high-risk pregnancies regarding mental health services.

METHODS

An exploratory pilot study with a mixed-methods study design was carried out among 30 women hospitalized with a high obstetric risk. The study participants were given access to an eMBI with a 1-week mindfulness program on how to deal with stress, anxiety, and depressive symptoms. Semi-structured interviews were conducted with the 30 participants and analyzed using systematic content analysis. In addition, acceptance and usability were assessed via questionnaires.

RESULTS

Study findings showed a high level of acceptance of the eMBI. Most of the respondents were satisfied with the usability and considered the eMBI program to be helpful. The greatest barriers to using the eMBI were a general negative attitude toward using apps, preference for personal contact, or no current need for psychotherapy. Participants criticized the lack of awareness of mental health issues during pregnancy and expressed a need for low-threshold treatment offers, especially during hospitalization.

CONCLUSIONS

There is a strong need for mental health services in pregnancy care, especially for pregnant women with risk profiles. An eMBI offers an acceptable means of providing mental health support for hospitalized women with a severe obstetric risk.

Pilot Testing a Brief Partner-Inclusive Hybrid Intervention for Perinatal Mood and Anxiety Disorders

The necessity of hybrid and more accessible options for perinatal mood and anxiety disorders (PMADs) has taken on increased urgency in the wake of the COVID-19 pandemic and its lasting impacts. In the New Family Wellness Project (NFWP), participants engage in a hybrid in-person and teletherapy six-session intervention for new parents early in their postpartum period. This small, phase 1 clinical research examined early outcomes of the NFWP's cognitive behavioral intervention on adverse mental health outcomes (i.e., perinatal depression and anxiety, overall mental illness symptoms) and adaptive outcomes and protective factors (i.e., relational health, social support, flourishing, self-efficacy). Despite a small sample size (N = 12), paired t-tests yielded significant effects for improvements in mental health symptoms at posttest, as well as marginally significant improvements in postpartum anxiety and self-efficacy. Findings suggest the brief, partner-inclusive, hybrid intervention shows promise for further study. Lessons learned from this small phase 1 clinical study and recommendations for revising the intervention prior to future trials are discussed.

Understanding University Students' Experiences, Perceptions, and Attitudes Toward Peers Displaying Mental Health-Related Problems on Social Networking Sites: Online Survey and Interview Study

BACKGROUND

College students' mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health-related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems.

OBJECTIVE

This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support.

METHODS

We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea.

RESULTS

Of the 226 survey respondents, 150 (66.4%) reported that they recognized signs of a mental health problem on their friends' SNS posts. However, a considerable number of respondents (62/150, 41.3%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online.

CONCLUSIONS

Drawing on these results, we provide implications that could explain the construction of students' perceptions regarding their peers' mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns.

Dread and solace: Talking about perinatal mental health

Perinatal mental health issues are a global public health challenge. Worldwide, it is estimated that 10% of pregnant women, and 13% of women who have just given birth, experience a mental disorder. Yet, for many reasons - including stigma, limited access to services, patients' lack of awareness about symptoms, and inadequate professional intervention - actual rates of clinical and subclinical perinatal mental health issues are likely higher. Studies have explored experiences such as postpartum depression, but few involve a wider-ranging exploration of a variety of self-reported perinatal mental health issues through personal narrative. We conducted 21 narrative interviews with women, in two Canadian provinces, about their experiences of perinatal mental health issues. Our aim was to deepen understanding of how individual and cultural narratives of motherhood and perinatal mental health can be sources of shame, guilt, and suffering, but also spaces for healing and recovery. We identified four predominant themes in women's narrative: feeling like a failed mother; societal silencing of negative experiences of motherhood; coming to terms with a new sense of self; and finding solace in shared experiences. These findings are consistent with other studies that highlight the personal challenges associated with perinatal mental health issues, particularly the dread of facing societal norms of the 'good mother'. We also highlight the positive potential for healing and self-care through sharing experiences, and the power of narratives to help shape feelings of self-worth and a new identity. This study adheres to the expectations for conducting and reporting qualitative research.

A Newly Developed Online Peer Support Community for Depression (Depression Connect): Qualitative Study

Background

Internet support groups enable users to provide peer support by exchanging knowledge about and experiences in coping with their illness. Several studies exploring the benefits of internet support groups for depression have found positive effects on recovery-oriented values, including empowerment. However, to date, little attention has been paid to user narratives.

Objective

This study aims to capture the user perspective on an online peer support community for depression with a focus on the modes of user engagement and the benefits users derive from participation in the forum.

Methods

In this qualitative study, we conducted 15 semistructured interviews with users of Depression Connect, a newly developed online peer support community for individuals with depression. Combining a concept-driven and a data-driven approach, we aimed to gain insight into what users value in our Depression Connect platform and whether and how the platform promotes empowerment. We performed a thematic analysis to explore the merits and demerits reported by users by using theoretical concepts widely used in internet support group research. In the subsequent data-driven analysis, we sought to understand the relationship between different styles of user engagement and the participants’ experiences with the use of Depression Connect. Data analysis consisted of open, axial, and selective coding. To include as diverse perspectives as possible, we opted for purposive sampling. To verify and validate the (interim) results, we included negative cases and performed member checks.

Results

We found participation in Depression Connect contributes to a sense of belonging, emotional growth, self-efficacy, and empowerment. “Getting too caught up” was the most frequently reported negative aspect of using Depression Connect. The deployment and development of three participation styles (ie, reading, posting, and responding) affected the perceived benefits of Depression Connect use differentially, where the latter style was central to enhancing empowerment. “Being of value to others” boosted the users’ belief in their personal strength. Finally, Depression Connect was predominantly used to supplement offline support and care for depression, and it mainly served as a safe environment where members could freely reflect on their coping mechanisms for depression and exchange and practice coping strategies.

Conclusions

Our findings shed new light on user engagement processes on which internet support groups rely. The online community primarily served as a virtual meeting place to practice (social) skills for deployment in the offline world. It also allowed the members to learn from each other’s knowledge and experiences and explore newly gained insights and coping skills.

Polybrominated Diphenyl Ether Serum Concentrations and Depressive Symptomatology in Pregnant African American Women

(1) Polybrominated diphenyl ethers (PBDEs) were widely produced in the United States until 2004 but remain highly persistent in the environment. The potential for PBDEs to disrupt normal neuroendocrine pathways resulting in depression and other neurological symptoms is largely understudied. This study examined whether PBDE exposure in pregnant women was associated with antenatal depressive symptomatology. (2) Data were collected from 193 African American pregnant women at 8–14 weeks gestation. Serum PBDEs and depressive symptoms were analyzed and a mixture effect was calculated. (3) Urban pregnant African American women in the Southeastern United States had a high risk of depression (27%) compared to the National average. Increased levels of PBDEs were found. BDE-47 and -99 exposures are significantly associated with depressive symptomatology in the pregnant cohort. The weighted body burden estimate of the PBDE mixture was associated with a higher risk of mild to moderate depression using an Edinburgh Depression Scale cutoff score of ≥10 (OR = 2.93; CI 1.18, 7.82). (4) Since antenatal depression may worsen in postpartum, reducing PBDE exposure may have significant clinical implications.

What YouTube narratives reveal about online support, counseling entrance, and how Black Americans manage depression symptomatology

This manuscript explores the depression disease management of Black Americans (N = 50) who post their experiences on YouTube. The narratives garnered five themes: (1) personal and national histories as a barrier to treatment and contributor to depression, (2) utilizing the social network as informal counseling and as the catalyst for formal counseling, (3) long-term undiagnosed depression management and mismanagement, (4) advocating to destigmatize and treat depression, and (5) positive experiences initiating and engaging in treatment. Novel findings include how participants discuss narratives in third person, the importance of the Youtube community, and advocacy to destigmatize and treat depression.

Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic

Problem

Prenatal depression and anxiety are linked to poor maternal and infant outcomes. We need to understand predictors of poor mental health to identify at-risk women, and targets for support.

Background

Previous research has demonstrated a relationship between low levels of perceived social support, and depression and anxiety in pregnant women. However, there is a lack of research into the factors that may mediate this relationship.

Aim

As social distancing measures (e.g., lockdown) are likely to negatively affect women’s perceived support in the prenatal period, we investigated the relationship between perceived social support and both anxiety and depression in UK-based pregnant women during the COVID-19 pandemic. Further, we examined two potential mediators that may contribute to psychological symptoms: repetitive negative thinking and loneliness.

Methods

We administered a battery of online measures to a sample of pregnant women (N = 205) between May-June 2020, during the first peak of the pandemic in the UK, when perceived social support was likely to be low.

Results

Consistent with predictions, perceived social support was significantly negatively related to depression, anxiety, loneliness and repetitive negative thinking. Furthermore, repetitive negative thinking and loneliness mediated the relationship between perceived social support and both depression and anxiety. Moreover, perceived social support and loneliness were associated with specific types of online behaviours.

Conclusions

Taken together, the findings shed light on the processes through which social support may exert its effects on depression and anxiety and highlight potential therapeutic targets for interventions which aim to prevent and treat mood disorders in perinatal cohorts.

Understanding farmers' naturalistic decision making around prophylactic antibiotic use in lambs using a grounded theory and natural language processing approach

The routine use of antibiotics for prevention of disease in neonatal lambs has been highlighted as inappropriate, yet research suggests that many farmers in the UK still carry out this practice. The aim of the study was to understand farmers' naturalistic decision-making around prophylactic antibiotic use in lambs. Data from 431 posts by 133 different users of an online discussion forum were analysed quantitatively using natural language processing and qualitatively using a grounded theory approach. Results from the qualitative analysis identified five categories that influenced farmers risk perceptions around prophylactic antibiotic use in lambs: anticipated regret, negative emotions and experiential avoidance; economic considerations; farmer identity; perception of capability; and perception of social judgement. Natural language processing analysis of the posts by the study group were compared to posts on topics unrelated to antibiotic use by control groups from the same forum to understand the underlying style and tone within the text. Analytical thinking and authenticity scores were significantly lower in the study group compared to the control groups (P < 0.01). Words relating to cognitive processes were significantly higher in the study group compared to the control groups (P < 0.01). Results of the qualitative and quantitative analysis were integrated to assess the fit of the data and enhance findings from either method alone. The key findings were the identification of reasons why farmers used antibiotics prophylactically in neonatal lambs. Farmers disassociated the use of oral antibiotics in neonatal lambs from other types of antibiotics within sheep farming. Farmers used the concept of luck and uniqueness to justify their prophylactic antibiotic use. This may explain farmers' low analytical thinking scores as this reflects a more personal style of thinking as farmers express their thoughts on antibiotic use on an individual basis. Farmers' felt that they did not have the capabilities to control neonatal disease without antibiotics during busy periods and this was exacerbated by external economic constraints. For farmers' who used antibiotics for therapeutic use, fear of social judgement was an important factor in their perceptions of risk around antibiotic use. The high frequency of negations and conjunctions suggested feelings of moral duty. As such, antibiotic use has developed into a symbol of their good farming identity which conflicted with the identity held by those who used antibiotics prophylactically. These results can be used to inform knowledge exchange around prophylactic antibiotic use in lambs to improve antibiotic stewardship in the sheep farming sector.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.

Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy

In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours.

Perinatal Mental Healthcare Needs Among Women at a Community Hospital

OBJECTIVE

Mental health problems affect up to 20% of women during pregnancy and the postpartum period. This study aimed to describe the mental health services and resources accessed by women with perinatal mental health problems (PMH) and to identify their unmet mental health care needs and preferences for support, as well as the barriers to accessing this support.

METHODS

Participants were 18 years of age or older and spoke English or French. Consent was obtained 24 hours after delivery (T0) to screen for symptoms of depression and anxiety at 2 weeks postpartum (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Scale (GAD-7). Women with a positive screen (EPDS ≥10 or GAD-7 ≥10) were sent informational resources and were followed-up by telephone at 4 months postpartum (T2) to determine their use of these and other resources, their unmet needs, and their preferences for other resources or services.

RESULTS

Seventy-three out of 344 participants (21.2%) screened positive, of whom 57 (78%) completed the T2 interview. Of those interviewed, 28% had used the informational resources provided by the study. Although 25% had consulted a health professional for mental health care, 37% had unmet mental health care needs. Preferences for additional support included web-based resources (30%), telephone support (28%), and booklets (25%). Lack of time (38%) and lack of childcare (23%) were the main barriers to seeking help.

CONCLUSIONS

Web- and telephone-based approaches have the potential to address the most common barriers to access support for women experiencing perinatal mental health problems.

Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study

Background

Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs.

Objective

The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay.

Methods

A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R).

Results

We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention.

Conclusions

Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy.

A meta-synthesis of women's experiences of online forums for maternal mental illness and stigma

Perinatal mental illness affects 15% of women; however, only half of these women access treatment. Some women with untreated perinatal mental illness may continue to suffer with mental illness after the perinatal period. Evidence suggests that one barrier to accessing treatment is stigma. Forums may provide an acceptable place for women to converse about the stigmatised symptoms of maternal mental illness. Reducing stigma may increase treatment uptake. This study aimed to review and synthesise the qualitative research on maternal mental illness forums and stigma so that stigma can be addressed and treatment improved. A meta-synthesis was conducted to describe and interpret qualitative studies regarding forum use and maternal mental illness stigma. A systematic search of seven electronic databases and Google Scholar was performed. Additional references were collected through screening references of the identified studies. Five studies were identified that reported women's experiences of online forums for maternal mental illness and stigma. The synthesis identified four key themes: (1) a safe place to talk; (2) virtual support; (3) stigma and identity; and (4) repair of the mother identity. Stigma maybe reduced by forum discourse that reconceptualises what is to be a "good mother" and separates stigma and maternal identity. This synthesis provides a novel and more detailed framework for the stigma of maternal mental illness and forum use. This suggests forums may enable women to explore their dual identity and repair their maternal identity, and this may reduce stigma. Healthcare providers could discuss forum use with their clients.

Be a Mom's Efficacy in Enhancing Positive Mental Health among Postpartum Women Presenting Low Risk for Postpartum Depression: Results from a Pilot Randomized Trial

In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom’s efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom’s efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.

Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

BACKGROUND

The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research in this area means that work is needed to better understand women's experience of PNA, so that potential targets for intervention can be identified and possible barriers to support overcome. This study aimed to qualitatively explore women's experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA.

METHODS

Women who were either pregnant or within one-year postpartum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed.

RESULTS

Five key themes emerged in relation to women's experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the 'perfect mum' was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort.

CONCLUSIONS

This work provides unique insight into potential sources of anxiety for women in the perinatal period, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Overcoming Alzheimer's Disease Stigma by Leveraging Artificial Intelligence and Blockchain Technologies

Alzheimer's disease (AD) imposes a considerable burden on those diagnosed. Faced with a neurodegenerative decline for which there is no effective cure or prevention method, sufferers of the disease are subject to judgement, both self-imposed and otherwise, that can have a great deal of effect on their lives. The burden of this stigma is more than just psychological, as reluctance to face an AD diagnosis can lead people to avoid early diagnosis, treatment, and research opportunities that may be beneficial to them, and that may help progress towards fighting AD and its progression. In this review, we discuss how recent advents in information technology may be employed to help fight this stigma. Using artificial intelligence (AI) technologies, specifically natural language processing (NLP), to classify the sentiment and tone of texts, such as those of online posts on various social media sites, has proven to be an effective tool for assessing the opinions of the general public on certain topics. These tools can be used to analyze the public stigma surrounding AD. Additionally, there is much concern among individuals that an AD diagnosis, or evidence of pre-clinical AD such as a biomarker or imaging test results, may wind up unintentionally disclosed to an entity that may discriminate against them. The lackluster security record of many medical institutions justifies this fear to an extent. Adopting more secure and decentralized methods of data transfer and storage, and giving patients enhanced ability to control their own data, such as a blockchain-based method, may help to alleviate some of these fears.

Personal information and public health: Design tensions in sharing and monitoring wellbeing in pregnancy

Mobile technologies are valuable tools for the self-report of mental health and wellbeing. These systems pose many unique design challenges which have received considerable attention within HCI, including the engagement of users. However, less attention has been paid to the use of personal devices in public health. Integrating self-reported data within the context of clinical care suggests the need to design interfaces to support data management, sense-making, risk-assessment, feedback and patient-provider relationships. This paper reports on a qualitative design study for the clinical interface of a mobile application for the self-report of psychological wellbeing and depression during pregnancy. We examine the design tensions which arise in managing the expectations and informational needs of pregnant women, midwives, clinical psychologists, GPs and other health professionals with respect to a broad spectrum of wellbeing. We discuss strategies for managing these tensions in the design of technologies required to balance personal information with public health.

Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence-based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.

What are women stressed about after birth?

BACKGROUND

Having a baby is associated with a variety of stressors, change, and adjustment. This study aimed to identify what women find stressful during the early postpartum period in contemporary Western society.

METHODS

Women (n = 148) 6-12 weeks postpartum wrote anonymously about a situation they found stressful as part of the Health after Birth Trial (HABiT) of expressive writing. Transcripts were analyzed for categories of stressors and cross-cutting themes.

RESULTS

Five categories of stressors were identified. Stressors in pregnancy, labor, and the early postpartum period (49.3%) included physical and emotional difficulties, and insensitive treatment by health professionals. Stressors related to adjusting to life with a baby (35.8%) included difficulties coping with a new baby, parenting, juggling responsibilities, changes to physical health, and loneliness. Stressors related to the baby's health (32.4%) included infant digestive problems, acute health problems, long-term impact, and neonatal intensive care unit experiences. Stressors related to breastfeeding (23.7%) included pressure to breastfeed, feeling like a 'bad mum' for not breastfeeding, or wanting to breastfeed and not being able to. Other stressors related to changing relationships (18.2%): with their partner, children, and other family members. Cross-cutting themes that emerged in different stressor categories were women making negative self-appraisals (eg, a bad mum, failure), feeling guilty, and lack of support from others.

DISCUSSION

Our findings emphasize the importance of exploring stressors and psychological well-being with women to provide support, help women's adjustment postpartum, and ensure interventions are offered when appropriate.

Perinatal depression care pathway for obstetric settings

Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.

Advice for Health Care Professionals and Users: An Evaluation of Websites for Perinatal Anxiety

BACKGROUND

Many websites are available with information and resources for perinatal anxiety; however, there is limited research on the quality and content of these sites.

OBJECTIVE

This study aims to identify what sites are available on perinatal anxiety, identify any information and therapeutic advice given, and review its accuracy and website design.

METHODS

We conducted an evaluation of websites for perinatal anxiety. Eligible websites (N=50) were evaluated for accuracy of information, resources for mothers, website quality, and readability.

RESULTS

Information was often incomplete and focused on symptoms rather than risk factors or impact of untreated perinatal anxiety. Websites often had information on treatment (46/50, 92%), but much less on screening (19/50, 38%). Most sites provided at least some resources to support mothers (49/50, 98%), but active, guided support was infrequent (25/50, 50%). Website quality was extremely variable and mostly difficult to read (42/50, 84%).

CONCLUSIONS

This study recommends the top 4 websites on perinatal anxiety for health care professionals and users. There is a need for websites to be developed that provide accurate, evidence-based information that women can relate to with quality support resources. Furthermore, these sites should be easy to use and readable.

Content validation of a questionnaire measuring basic perinatal depression knowledge

Perinatal depression (PND) screening is encouraged in healthcare settings. We aimed to develop and content validate a basic PND knowledge questionnaire for use among pharmacists and potentially other primary healthcare professionals (HCPs). A six-item questionnaire was developed. Twenty-five perinatal mental health experts were invited to participate in content validation by completing the questionnaire and assessing its content validity. A content validity index (CVI) score above 0.8 was indicative of content validity. Expert comments may inform items' deletion or revision. Between November 2016 and February 2017, ten experts participated. For five out of six items, the CVI score was 0.9 or 1.0. Two experts selected "I think none are correct" for one item regarding the onset of postpartum depression. Comments reflected the lack of consensus in the literature surrounding onset periods and prevalence rates and informed minor modifications to three of six questions and seven of 24 response options. The CVI for the questionnaire was 0.83.Content validation of a questionnaire measuring basic PND knowledge resulted in modifications. Comments about PND onset and prevalence indicated the need for consistency when defining and measuring these constructs. This questionnaire may be used among pharmacists and other HCPs.

A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study

BACKGROUND

Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening.

OBJECTIVE

The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy.

METHODS

This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis.

RESULTS

The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement.

CONCLUSIONS

This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies.

Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units

Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) "putting up" with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.

The City MISS: development of a scale to measure stigma of perinatal mental illness

OBJECTIVE

This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women.

BACKGROUND

Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma.

METHOD

A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale.

RESULTS

The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity.

CONCLUSION

The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model

BACKGROUND

Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure.

OBJECTIVE

This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers.

METHODS

A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information.

RESULTS

There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety.

CONCLUSIONS

Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and moderated online forums that facilitate expression of perinatal mental illness stigma and promote disclosure to health care providers.

Behavioral health support and online peer communities: international experiences

Online peer support communities play an important part in many people's experience of healthcare. They can be particularly significant in behavioral health/mental health due to the difficulties that people may experience in accessing face to face care for these conditions. There is considerable diversity of practice in service management, target group, and moderation practices of online peer support communities. People using the communities also appear to have diverse aims and experiences. This heterogeneity contributes to a relative lack of data about the value and effectiveness of online peer support in behavioral health, although there is significant research into some aspects of these communities. The digital behavioral health service Big White Wall was launched in the UK in 2007, and in the US in 2015, and is focused on delivering moderated peer support. There are considerable differences in health systems between the two countries, and this has been reflected in different experiences of implementation. The value of online peer support could be maximized if systemic challenges to implementation and adoption were addressed more effectively.