A qualitative study of women's views on the acceptability of being asked about mental health problems at antenatal booking appointments

Abstract

ObjectiveTo explore women's views on the acceptability of being asked about mental health problems at antenatal booking. DesignQualitative study. SettingBrief semi-structured qualitative interviews were conducted with women in a private setting at a hospital, or at women's homes. Interview discussions centered around three key questions: "What was it like for you answering the questions about your mood?", "Were there any questions you found upsetting, distressing or confronting?" and "Did the midwife give you some feedback about your answers?" MeasurementsInterviews were audio-recorded, transcribed verbatim, and analysed using thematic and framework approaches. ParticipantsAn ethnically diverse sample [32% white British/Irish, 68% non-white, non-British] of 52 women living in the study area. Findings ACCEPTED MANUSCRIPTMost women found mental health enquiry acceptable. A smaller proportion reported difficulties and many of these women had a past or current mental health problem and/or a history of abuse. These women reported difficulty due to the emotional responses triggered by the questions and the way disclosures were handled. In general, women wanted to be asked clear questions about mental health problems, to have sufficient time to discuss issues, and to receive responses from midwives which were normalising and well-informed about mental health. ConclusionsThis study highlights that women want midwives to ask clearly-framed questions about mental health problems [addressing past and current mental health concerns], and valued responses from midwives that were normalising, well-informed and allowed for discussion. Implications for PracticeTraining should be provided to midwives on how to appropriately respond to women's distress during mental health enquiry, and on referral to support services.

Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: ‘Its Important, but How These Discussions Are Held Is Critical’

“…Our findings are similar to those previously identified by British (Yapp et al, 2019) and Australian women in pregnancy (Rollans et al, 2013), that it is acceptable to ask about mental health but that this can cause discomfort and distress, particularly where there is a history of abuse. Women noted that the approach used by the person asking impacted on their disclosure, and that they wanted to be asked clear questions, have sufficient time to discuss issues, and receive responses which were validating and well-informed (Yapp et al, 2019). A study in the United States similarly reported that many women might not characterize their experiences as 'trauma' and prefer the use of less stigmatizing words such as 'hurt' (White et al, 2016).…”

Perinatal mental health: a review of progress and challenges

“…Routine enquiry into mental health may require careful consideration of how to prepare the maternity environment, particularly for mental health task‐shifting initiatives in LMICs 178 . In HICs, most women welcome the opportunity to talk about mental health 179 , and there are no differences in acceptability of different modes of screening tool (e.g., paper vs. iPad) 179,180 , as long as women are given the opportunity to talk and are referred appropriately 179 . Some women, however, particularly those with mental health problems or histories of trauma, find disclosure difficult and routine enquiry less acceptable 179,180 .…”

“…In HICs, most women welcome the opportunity to talk about mental health 179 , and there are no differences in acceptability of different modes of screening tool (e.g., paper vs. iPad) 179,180 , as long as women are given the opportunity to talk and are referred appropriately 179 . Some women, however, particularly those with mental health problems or histories of trauma, find disclosure difficult and routine enquiry less acceptable 179,180 . In LMICs, there may be additional cultural barriers and stigma 181,182 .…”

Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

“…Existing reviews have examined fathers' support needs and preferences, and their experiences as a partner of a woman who is accessing universal perinatal services and specialist perinatal mental health services (50,53,54); these have not however explicitly addressed fathers' own mental health assessment. To date there is a strong evidence base on the validity and acceptability of methods to identify maternal perinatal mental health difficulties (55)(56)(57)(58). In contrast, there is an identified lack of research on fathers' "perceptions and receptiveness" to "routine mental enquiry or screening" (pp.…”