The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review

BACKGROUND

The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood.

AIMS

To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period.

METHOD

A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form.

RESULTS

Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support.

LIMITATIONS

Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible.

CONCLUSION

Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.

Narratives of Mothers Whose Children Had Been Sexually Abused: Maternal Reactions and Comprehension Regarding Child and Adolescent Sexual Abuse

Child and adolescent sexual abuse is considered to be a serious public health concern and a devastating form of violence with serious physical, mental, and behavioral consequences in the short and long term. This qualitative study aimed to identify maternal reactions to the disclosure of sexual violence and explore the comprehension regarding child and adolescent sexual abuse held by the mothers of child victims. Twelve mothers were interviewed, whose children had experienced a situation of sexual abuse and were receiving psychosocial care in a municipality in southern region of Brazil. The collected data were organized and analyzed using the principles of Grounded Theory with the Atlas.ti 7.5.7 software. From the analysis of the narratives, three main categories emerged: mothers with positive reactions, mothers with ambivalent reactions, and mothers with negative reactions. Mothers that presented positive reactions believed the report and supported their children, showing a comprehension that sexual abuse can occur in different ways and not only when there is penetration. The participants that had ambivalent reactions oscillated between maintaining or breaking off the relationship with the perpetrator of the violence, expressed initial disbelief regarding the report of the abused child, and had a comprehension that sexual abuse could be a form of affection. Mothers that had a negative reaction to the disclosure of abuse presented a contradictory narrative, minimizing the effects of the violence and placing the victims at fault regarding the abuse suffered. The importance of considering the possible relationships between the maternal comprehensions regarding child and adolescent sexual abuse and the reactions of these mothers during the professional intervention was demonstrated.