How do women’s self-report symptoms impact on identification of perinatal mental health problems?

Abstract

Purpose -Perinatal depression is common and increases the risk of adverse outcomes for both the mother and child. Despite regular contact with midwives and GPs during the perinatal period less than 50% of women with depression are identified and treated. A number of reasons for this have been proposed, however failure of health professionals to recognise the symptoms women present with may contribute. The aims of this paper are twofold; (1) to explore women's self-report symptoms of perinatal depression and (2) understand how the symptoms women present with might impact on identification.Design/methodology/approach -Women were invited to post their experiences of perinatal depression on one of two on-line discussion forums over a nine month period. Data were analysed using a process of deductive thematic analysis informed by cognitive behavioural theory.Findings -Women's symptoms were presented using five headings; triggers (for perinatal depression), thoughts; moods; physical reactions and behaviours. Women believed having a previous mental health problem contributed to their depression.Women's self-report symptoms included intrusive and violent thoughts; emotional responses including fear, worry and anger and somatic symptoms including insomnia and weight changes. Women also reported aggressive behaviour and social withdrawal as part of their depressive symptomatology.Symptoms women present with may negatively impact on identification as they often over-lap with those of pregnancy; may not be included in the criteria for mental health assessment and may involve undesirable and socially unacceptable behaviour making disclosure difficult. Research limitations/implications -

Professional issues in maternal mental health scale (PIMMHS): The development and initial validation of a brief and valid measure

“…Question 7, which relates to emotional issues not being ones that women should really discuss with midwives, may be related to a now relatively consistent acceptance by midwives in their role in PMH 4,18 , making this question somewhat redundant. Questions 8 and 9 on the antenatal clinic environment, may not be dissimilar being underpinned by the general acceptance and the growing acknowledgement of the range of PMHP 42,43 and value of identifying women with potential PMHP in the antenatal period 5,44 , albeit problems often still remain with effective and consistent identification 8 , as well as good record keeping 4 . The potential value and utility of the PIMMHS-Emotion and PIMMHS-Training sub-scales may be inferred by the findings of the validity and reliability observations.…”

“…Midwives are in a unique and ideal position to effectively identify women at risk and facilitate early intervention 7 . However, a multitude of factors, including reluctance of women to disclose how they are feeling, lack of recognition of the signs of PMHPs by women and healthcare professionals 8 , and a reluctance of professionals to identify affected women because of lack of skills or resources, contribute to failure in recognition and treatment 4,9,10 . Failure to disclose may well be linked to both stigma and culture.…”

Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross‐sectional survey

“…Accurate assessment is difficult because mothers may present with transdiagnostic (McGorry, Hartmann, Spooner, & Nelson, ), atypical (Coates, Visser, & Ayers, ), socially unacceptable (Jarrett, ) or subclinical symptoms (Kingston et al, ), or may not want to talk about how they feel, as they fear involvement of social services (Dennis & Chung‐Lee, ; Fonseca, Gorayeb, & Canavarro, ) . The overlap between the signs and symptoms of mental illness and the perceived inevitable consequences of looking after a new baby such as fatigue, anxiety and social withdrawal (Bilszta, Ericksen, Buist, & Milgrom, ; Oddy, Rowe, & Fisher, ) can compromise the ability of both mothers and health professionals to recognise MHPs.…”