Donna Moore

A review of postnatal mental health websites: help for healthcare professionals and patients

The internet offers an accessible and cost-effective way to help women suffering with various types of postnatal mental illness and also can provide resources for healthcare professionals. Many websites on postnatal mental illness are available, but there is little information on the range or quality of information and resources offered. The current study therefore aimed to review postnatal health websites and evaluate their quality on a variety of dimensions. A systematic review of postnatal health websites was conducted. Searches were carried out on four search engines (Google, Yahoo, Ask Jeeves and Bing) which are used by 98% of web users. The first 25 websites found for each key word and their hyperlinks were assessed for inclusion in the review. Websites had to be exclusively dedicated to postnatal mental health or have substantial information on postnatal mental illness. Eligible websites (n = 114) were evaluated for accuracy of information, available resources and quality. Results showed that information was largely incomplete and difficult to read; available help was limited and website quality was variable. The top five postnatal mental illness websites were identified for (1) postnatal mental illness sufferers and (2) healthcare professionals. It is hoped these top websites can be used by healthcare professionals both for their own information and to advise patients on quality online resources.

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

Background Perinatal mental illness is a global health concern; however, many women do not get the treatment they need to recover. Some women choose not to seek professional help and get no treatment because they feel stigmatized. Online forums for various health conditions, including perinatal mental health, can be beneficial for members. Little is known about the role that online forums for perinatal mental illness play in reducing stigma and subsequent disclosure of symptoms to health care providers and treatment uptake. Objective This study aimed to examine stigma and disclosure in forums and describe any potential disadvantages of forum use. Methods An online forum for mothers was examined and 1546 messages extracted from 102 threads from the antenatal and postnatal depression section. These messages were subjected to deductive systematic thematic analysis to identify common themes regarding stigma and disclosure of symptoms and potential disadvantages of forum use. Results Two major themes were identified: stigma and negative experiences of disclosure. Stigma had 3 subthemes: internal stigma, external stigma, and treatment stigma. Many women were concerned about feeling like a “bad” or “failed” mother and worried that if they disclosed their symptoms to a health care provider they would be stigmatized. Posts in response to this frequently encouraged women to disclose their symptoms to health care providers and accept professional treatment. Forum discourse reconstructed the ideology of motherhood as compatible with perinatal mental illness, especially if the woman sought help and adhered to treatment. Many women overcame stigma and replied that they had taken advice and disclosed to a health care provider and/or taken treatment. Conclusions Forum use may increase womens disclosure to health care providers by challenging their internal and external stigma and this may strengthen professional treatment uptake and adherence. However, a few posts described negative experiences when disclosing to health care providers.

Virtual voices: social support and stigma in postnatal mental illness Internet forums

Abstract Many women with postnatal mental illness do not get the treatment they need and this is often because stigma prevents disclosure. The purpose of this study was to explore online social support for postnatal mental illness, how women experience stigma and potential disadvantages of using Internet forums. Interviews were conducted with fifteen participants who had suffered postnatal mental illness and had used forums. Systematic thematic analysis identified common themes in relation to social support, stigma and disadvantages of using forums. Most women felt they benefited from visiting forums by developing a shared understanding and discourse about their illness. Findings suggest future research should investigate if women benefit from using online social support provided by forums, if use challenges stigma and further explore potential concerns about using forums.

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.

A review of websites for perinatal anxiety: Advice for healthcare professionals and users (Preprint)

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.

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

Abstract 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.

Have I got PND? A thematic analysis of an online forum for antenatal/postnatal depression

Background: Early research in attachment hypothesized that parents’ state of mind regarding attachment explained the intergenerational transmission of attachment from parent to child. Meta-analyses found that there was not always a direct link between the two. As a result, many researchers began investigating ways to better understand intergenerational attachment, including examining the caregiving system. Research so far has utilized methodologies that are primarily interview based, which can be time and cost prohibitive. In order to address the need for a simpler method, the Caregiving Experiences Questionnaire (Brennan, George, & Solomon, 2013) was developed and validated in a US population. The questionnaire includes 5 scales which are associated with caregiving representation defensive processes: one organized secure scale, two scales of organized insecurity, and two scales of disorganized insecurity. Aim and Objectives: The aim of this study was to collect data which examined the cross-cultural validity and reliability of the measure for use in the UK. The wording of two items was changed to better reflect the British English language. Method: Mothers of children aged 1.5-5 years (n = 88) who spoke British English as their first language and were living in the UK were recruited online. They completed the Caregiving Experiences Questionnaire, the Child Behaviour Checklist (Achenbach & Edelbrock, 1990) and the Parenting Stress Index – Short Form (Abidin, 1995). Results: Some scales were more reliable than others, Cronbach’s alphas for the defensive processing scales ranged from .44-.79. Correlations between measures were found in the hypothesized directions, but not all were significant. Interpretation: An overrepresentation of security in the current sample might have affected reliability and validity. Conclusions: Further research with a more diverse sample might determine if this measure is valid for use in a UK population. References: Abidin, R. R. (1995). Parenting stress index (3rd ed.). Odessa, FL: Psychological Assessment Resources. Achenbach, T. M., & Edelbrock, C. (1990). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: University of Vermont Department of Psychiatry. Brennan, J., George, C., & Solomon, J. (2013) The Caregiving Experiences Questionnaire: Age 1 1/2 to 5 years. Unpublished manuscript. Oakland, CA: Mills College