Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Mood Disorders | Research article

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

Authors: Virginia Harrison, Donna Moore, Lisa Lazard

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
2.
go back to reference Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry [Internet]. 2013 [cited 2018 Dec 12];70(5):490–498. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23487258. Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry [Internet]. 2013 [cited 2018 Dec 12];70(5):490–498. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​23487258.
8.
go back to reference Giardinelli L, Innocenti A, Benni L, Stefanini MC, Lino G, Lunardi C, et al. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health [Internet]. 2012 [cited 2018 Dec 12];15(1):21–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22205237. Giardinelli L, Innocenti A, Benni L, Stefanini MC, Lino G, Lunardi C, et al. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health [Internet]. 2012 [cited 2018 Dec 12];15(1):21–30. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​22205237.
9.
go back to reference Glasheen C, Richardson GA, Fabio A. A systematic review of the effects of postnatal maternal anxiety on children. Arch Womens Ment Health. 2010;13(1):61–74.CrossRef Glasheen C, Richardson GA, Fabio A. A systematic review of the effects of postnatal maternal anxiety on children. Arch Womens Ment Health. 2010;13(1):61–74.CrossRef
10.
go back to reference Leach LS, Poyser C, Fairweather-Schmidt K. Maternal perinatal anxiety: A review of prevalence and correlates. Clin Psychol. 2017;21(1):4–19.CrossRef Leach LS, Poyser C, Fairweather-Schmidt K. Maternal perinatal anxiety: A review of prevalence and correlates. Clin Psychol. 2017;21(1):4–19.CrossRef
12.
go back to reference Accortt EE, Wong MS. It is time for routine screening for perinatal Mood and Anxiety Disorders in obstetrics and gynecology settings. Obstet Gynecol Surv. 2017;72(9):553–68.CrossRef Accortt EE, Wong MS. It is time for routine screening for perinatal Mood and Anxiety Disorders in obstetrics and gynecology settings. Obstet Gynecol Surv. 2017;72(9):553–68.CrossRef
13.
go back to reference Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Series Perinatal mental health 1 Non-psychotic mental disorders in the perinatal period [Internet]. Vol. 384, www.thelancet.com. 2014 [cited 2018 Dec 12]. Available from: www.thelancet.com. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Series Perinatal mental health 1 Non-psychotic mental disorders in the perinatal period [Internet]. Vol. 384, www.​thelancet.​com. 2014 [cited 2018 Dec 12]. Available from: www.​thelancet.​com.
16.
go back to reference Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Höfler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: A prospective-longitudinal study. J Affect Disord. 2015;175:385–95.CrossRef Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Höfler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: A prospective-longitudinal study. J Affect Disord. 2015;175:385–95.CrossRef
23.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-V). 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-V). 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef
28.
go back to reference Harrison V, Proudfoot J, Wee PP, Parker G, Pavlovic DH, Manicavasagar V. Mobile mental health: Review of the emerging field and proof of concept study. J Ment Heal. 2011;20(6):509–24.CrossRef Harrison V, Proudfoot J, Wee PP, Parker G, Pavlovic DH, Manicavasagar V. Mobile mental health: Review of the emerging field and proof of concept study. J Ment Heal. 2011;20(6):509–24.CrossRef
32.
go back to reference Ashford MT, Ayers S, Olander EK. Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK. Heal Soc Care Community. 2017;25(3):1257–64.CrossRef Ashford MT, Ayers S, Olander EK. Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK. Heal Soc Care Community. 2017;25(3):1257–64.CrossRef
35.
36.
go back to reference O’Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, et al. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med [Internet]. 2014 [cited 2019 may 29];44(8):1675–1689. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24148703. O’Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, et al. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med [Internet]. 2014 [cited 2019 may 29];44(8):1675–1689. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​24148703.
38.
40.
go back to reference Coates R, de Visser R, Ayers S. Not identifying with postnatal depression: a qualitative study of women’s postnatal symptoms of distress and need for support. J Psychosom Obstet Gynecol [Internet]. 2015 [cited 2018 Dec 12];36(3):114–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26135567. Coates R, de Visser R, Ayers S. Not identifying with postnatal depression: a qualitative study of women’s postnatal symptoms of distress and need for support. J Psychosom Obstet Gynecol [Internet]. 2015 [cited 2018 Dec 12];36(3):114–21. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​26135567.
43.
go back to reference Wardrop AA, Popadiuk NE. The Qualitative Report Women’ s Experiences with Postpartum Anxiety: Expectations, Relationships, and Sociocultural Influences Recommended APA Citation. Qual Rep [Internet]. 2013 [cited 2018 Dec 13];18(3):1–21. Available from: https://nsuworks.nova.edu/tqr/vol18/iss3/2. Wardrop AA, Popadiuk NE. The Qualitative Report Women’ s Experiences with Postpartum Anxiety: Expectations, Relationships, and Sociocultural Influences Recommended APA Citation. Qual Rep [Internet]. 2013 [cited 2018 Dec 13];18(3):1–21. Available from: https://​nsuworks.​nova.​edu/​tqr/​vol18/​iss3/​2.
46.
go back to reference Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs [Internet]. 2007 [cited 2018 Dec 20];16(6):1000–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17518876. Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs [Internet]. 2007 [cited 2018 Dec 20];16(6):1000–11. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​17518876.
50.
go back to reference Cox J, Holden J, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh postnatal Depression scale. Br J Psychiatry. 1987;150:1–2.CrossRef Cox J, Holden J, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh postnatal Depression scale. Br J Psychiatry. 1987;150:1–2.CrossRef
52.
go back to reference Meades R, Ayers S. Anxiety measures validated in perinatal populations: A systematic review. J Affect Disord. 2011;133(1–2):1–15.CrossRef Meades R, Ayers S. Anxiety measures validated in perinatal populations: A systematic review. J Affect Disord. 2011;133(1–2):1–15.CrossRef
59.
go back to reference Somerville S, Dedman K, Hagan R, Oxnam E, Wettinger M, Byrne S, et al. The perinatal Anxiety screening scale: development and preliminary validation. Arch Womens Ment Health. 2014;17(5):443–54.CrossRef Somerville S, Dedman K, Hagan R, Oxnam E, Wettinger M, Byrne S, et al. The perinatal Anxiety screening scale: development and preliminary validation. Arch Womens Ment Health. 2014;17(5):443–54.CrossRef
60.
go back to reference Fallon V, Halford JCG, Bennett KM, Harrold JA. Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood. Arch Womens Ment Health. 2018;21(2):181–91.PubMed Fallon V, Halford JCG, Bennett KM, Harrold JA. Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood. Arch Womens Ment Health. 2018;21(2):181–91.PubMed
62.
go back to reference Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: A systematic review. J Affect Disord. 2016;190:543–50.CrossRef Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: A systematic review. J Affect Disord. 2016;190:543–50.CrossRef
63.
go back to reference Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, et al. CALM pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health. 2014;17(5):373–87.CrossRef Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, et al. CALM pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health. 2014;17(5):373–87.CrossRef
64.
go back to reference Ashford MT, Olander EK, Rowe H, Fisher JR, Ayers S. Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial. JMIR Ment Heal [Internet]. 2018 [cited 2019 Mar 4];5(2):e19. Available from: http://mental.jmir.org/2018/2/e19/. Ashford MT, Olander EK, Rowe H, Fisher JR, Ayers S. Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial. JMIR Ment Heal [Internet]. 2018 [cited 2019 Mar 4];5(2):e19. Available from: http://​mental.​jmir.​org/​2018/​2/​e19/​.
65.
go back to reference Law KH, Jackson B, Guelfi K, Nguyen T, Dimmock JA. Understanding and alleviating maternal postpartum distress: perspectives from first-time mothers in Australia. Soc Sci Med. 2018 May;204:59–66.CrossRef Law KH, Jackson B, Guelfi K, Nguyen T, Dimmock JA. Understanding and alleviating maternal postpartum distress: perspectives from first-time mothers in Australia. Soc Sci Med. 2018 May;204:59–66.CrossRef
69.
go back to reference Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963. Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963.
71.
go back to reference Lazarus K, Rossouw PJ. Mother’s expectations of parenthood: The impact of prenatal expectations on self-esteem, depression, anxiety, and stress post birth. Int J Neuropsychother. 2015;3(2):102–23. Lazarus K, Rossouw PJ. Mother’s expectations of parenthood: The impact of prenatal expectations on self-esteem, depression, anxiety, and stress post birth. Int J Neuropsychother. 2015;3(2):102–23.
76.
77.
go back to reference Dennis C-L, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart DE, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ [Internet]. 2009 [cited 2019 may 29];338:a3064. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19147637. Dennis C-L, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart DE, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ [Internet]. 2009 [cited 2019 may 29];338:a3064. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​19147637.
78.
86.
go back to reference Harrison V, Moore D. Supporting perinatal anxiety in the digital age: an exploration of stressors and support. In: Abstracts of papers and posters presented at 39th Annual SRIP Conference. 2019 5-6; City University of London. Journal of Reproductive and Infant Psychology; 2019 37(5), e1-e48, DOI: https://doi.org/10.1080/02646838.2019.1673570. Harrison V, Moore D. Supporting perinatal anxiety in the digital age: an exploration of stressors and support. In: Abstracts of papers and posters presented at 39th Annual SRIP Conference. 2019 5-6; City University of London. Journal of Reproductive and Infant Psychology; 2019 37(5), e1-e48, DOI: https://​doi.​org/​10.​1080/​02646838.​2019.​1673570.
Metadata
Title
Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies
Authors
Virginia Harrison
Donna Moore
Lisa Lazard
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02990-0

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue