An exploration of illness beliefs in mothers with postnatal depression
Introduction
Low mood occurring in the postnatal period encompasses childbirth mood disorders from the baby blues to serious psychiatric illness, affecting 10–20% of mothers after childbirth (e.g., Hopkins et al., 1984). Studies indicate that clinical symptoms of mood disturbances following childbirth are not significantly different from illnesses that affect women at other times in their lives but certain aspects may be more pronounced (Kumar and Robson, 1984, Cox et al., 1993). Although postnatal mental disorders are important to understand and improve because they can significantly impact on both the functioning of the family and the child's long-term emotional and cognitive development (Murray et al., 1996; Hay et al., 2001), it is particularly important to keep mothers central in care because they suffer.
Historically, it has been difficult to identify or treat PND and this may be linked to several factors: some mothers may dismiss it as the ‘baby blues’; others may feel ashamed to admit they are not enjoying motherhood especially at a time that is supposed to be joyous (Beck, 1993). Additionally, some may worry that social services will remove their baby from their care (Edwards and Timmons, 2005). Over the last 40 years there has been a wealth of research into PND and the psychosocial risk factors associated with its development (e.g., Boyce and Hickey, 2005, Yelland et al., 2010, Woolhouse et al., 2011). Qualitative designs have frequently been used to capture the voices of mothers. In a metasynthesis of 18 qualitative studies, Beck (2002) identified four over-arching themes to conceptualize PND: incongruity between expectations and reality of motherhood, spiraling downward, pervasive loss and making gains. Although these existing studies provided valuable insight into maternal experiences of PND, no research has sought to examine mothers' beliefs about their PND. Understanding patient beliefs about their condition can be a useful way of predicting behaviour and outcomes.
Leventhal's self-regulatory model (SRM; Leventhal et al., 1984) has been used extensively to examine health beliefs; postulating that illness cognitions have key dimensions: identity, cause, timeline, consequences and cure/control. According to this model, patients create illness dimensions once symptoms are experienced and these determine coping, help-seeking behaviours (including accessing formal and informal support) and treatment adherence. The SRM has been employed successfully to assess patient beliefs in various chronic medical conditions, such as chronic fatigue syndrome (Moss-Morris et al., 1996), atopic dermatitis (Wittkowski et al., 2007) and rheumatoid arthritis (Treharne et al., 2005).
The SRM has also been used to explore illness beliefs in mental health problems. Illness perceptions have been explored using standardized measures (e.g., the Illness Perception Questionnaire, IPQ; Weinman et al., 1996) within anorexia nervosa (Holliday et al., 2005), psychosis (Broadbent et al., 2008), and depression (Brown et al., 2001, Fortune et al., 2004). The IPQ has also been modified for patients with psychosis/schizophrenia (Lobban et al., 2003, Watson et al., 2006) and their carers (Barrowclough et al., 2001). Although these studies indicate the applicability of illness perceptions across a range of mental health difficulties, their limitations have also been highlighted. In schizophrenia not all SRM variables had any relation to their outcome variables (Barrowclough et al., 2001). As it is important to consider that the underlying beliefs of those with mental health difficulties may differ from those patients with physical conditions, it is important to develop more sophisticated ways of investigating these; with qualitative methodologies being a valuable tool. Few qualitative studies have addressed this area. Existing findings demonstrate that patients with mental health difficulties form cognitive representations of their condition (Pollack and Aponte, 2001, Kinderman et al., 2006), but applying health models to mental health is not straightforward. In patients with anorexia nervosa beliefs about their illness were not static and their accounts transcended the SRM dimensions (Higbed and Fox, 2010). Researchers have recommended that significant modifications to these health models are needed to make them applicable to mental health problems and to capture a full understanding and the complexity of perceptions (Kinderman et al., 2006, Higbed and Fox, 2010). Thus, further studies using qualitative methodologies need to be undertaken to add strength to these findings.
Exploring mothers' views of their PND is crucial because it may lead to opportunities to better support them and tailor interventions more appropriately. This study set out to explore illness beliefs in mothers with PND to develop a theoretical understanding of these illness beliefs.
Section snippets
Participants
Following ethical approval, participants were recruited via two perinatal services in the North West of England, UK. Participants received information about the study prior to giving informed consent. Inclusion criteria were: either (1) women diagnosed with depression post-birth (diagnoses had been provided by General Practitioners, health visitors or psychiatrists for inpatients), or (2) women whose depression started in pregnancy and continued after birth. Women with babies up to 24 months
Participant characteristics
A purposive sample of 11 participants took part in the study, with a mean age of 29.4 years and their babies' mean age was 8.9 months. Mothers scored between 12 and 23 on the EPDS, indicating that three participants were bordering on and the others were experiencing major depressive symptoms at the time of the interview. All participants were of white British ethnicity. One participant was diagnosed with depression during pregnancy and remained depressed following the birth of her baby. Two
Discussion
Although, there is a growing literature on illness perceptions in mental health, this is the first study to directly investigate illness perceptions in PND and develop a theoretical understanding of these beliefs. The overall sense from participants' narratives was that these beliefs are often complex and are often in a state of flux. It was evident that mothers were experiencing internal struggles as they strived to be good mothers but believed that having PND meant that they were not good
Acknowledgements
We are indebted to staff at the Mother and Baby Unit and Trafford Perinatal Support Team who supported the recruitment. We are especially grateful to the women who gave up their time to take part in the study and shared their difficult and emotional experiences.
References (49)
- et al.
When life starts to take the life out of you: women's experiences of depression following childbirth
Midwifery
(2007) - et al.
Couples' experiences of postnatal depression: a framing analysis of cultural identity, gender and communication
Social Science and Medicine
(2006) - et al.
Illness beliefs in schizophrenia
Social Science and Medicine
(2006) - et al.
A review of models of illness in mental health
Review of Clinical Psychology
(2003) - et al.
Illness perceptions: a new paradigm for psychosomatics?
Journal of Psychosomatic Research
(1997) - et al.
An investigation of models of illness in carers of schizophrenia patients using the Illness Perception Questionnaire
British Journal of Clinical Psychology
(2001) The lived experience of postpartum depression: a phenomenological study
Nursing Research
(1992)Teetering on the edge: a substantive theory of postpartum depression
Nursing Research
(1993)Predictors of postpartum depression: an update
Nursing Research
(2001)Postpartum depression: a meta-synthesis
Qualitative Health Research
(2002)
Psychosocial risk factors to major depression after childbirth
Social Psychiatry and Psychiatric Epidemiology
Unmet needs and treatment seeking in high users of mental health services: the role of illness perceptions
Australian and New Zealand Journal of Psychiatry
Primary care patients' personal illness models for depression: a preliminary investigation
Family Practice
Grounded Theory
Constructing Grounded Theory
Being reborn: the recovery process of postpartum depression in Taiwanese women
Journal of Advanced Nursing
Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study
Family Practice
Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept
British Journal of Psychiatry
A controlled study of the onset, duration and prevalence of postnatal depression
British Journal of Psychiatry
Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale
British Journal of Psychiatry
Grounding Grounded Theory
A qualitative study of stigma among women suffering postnatal illness
Journal of Mental Health
Evolving guidelines for publication of qualitative research studies in psychology and related fields
British Journal of Clinical Psychology
Illness representations in depression
British Journal of Clinical Psychology
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