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Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.

Moore, D., Drey, N. & Ayers, S. (2017). Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.. JMIR Mental Health, 4(1), e6.. doi: 10.2196/mental.5926


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.

Publication Type: Article
Additional Information: © Donna Moore, Nicholas Drey, Susan Ayers. Originally published in JMIR Mental Health (, 20.02.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Publisher Keywords: Internet; depression; female; mood disorder; postpartum; social stigma
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RT Nursing
Departments: School of Health Sciences > Healthcare Services Research & Management
School of Health Sciences > Nursing
Text - Published Version
Available under License Creative Commons: Attribution 2.0.

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