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Online resources for perinatal mental illness and stigma

Moore, D. (2017). Online resources for perinatal mental illness and stigma. (Unpublished Doctoral thesis, City, University of London)


Perinatal mental illness is a global health issue with detrimental outcomes for women and their families if left untreated. Unfortunately, many women do not get the treatment they need for many reasons, one often acknowledged reason is that the stigma some women experience inhibits disclosure of their needs to healthcare providers. This thesis looked at Internet resources for women with perinatal mental illness, in particular online forums. It examined how forums might affect stigma and thus disclosure behaviour. This thesis is by prospective publication. Article 1 aimed to describe and interpret qualitative studies regarding forum use and perinatal mental illness stigma. A metasynthesis of five studies identified four key themes: a safe place to talk; virtual support; stigma and identity; and repair of the mother identity (Moore, Ayers & Drey, under review). Article 2 aimed to identify what websites about postnatal mental illness were available and assess them for content and quality. A systematic review of 114 websites evaluated accuracy of information, resources and website quality. Results showed information was largely incomplete and difficult to read; resources were limited and website quality was variable (Moore & Ayers, 2011). Article 3 aimed to determine how women with perinatal mental illness use web based resources. A qualitative interview study (n= 15) found that the anonymity and non-judgemental social support on forums may have made it an acceptable way to challenge internal stigma and that most women described forums as providing a space to discuss stigma and test out disclosing about their illness to others (Moore & Ayers, 2016). Article 4 therefore aimed to identify whether forums for perinatal mental illness reduce stigma and facilitate disclosure. Thematic analysis of 1546 posts over six months on a forum for postnatal mental illness suggested that forum discourse reconstructed ideology of motherhood as compatible with perinatal mental illness. Many women overcame stigma and posted that they had taken advice and disclosed to a healthcare provider (Moore, Ayers, & Drey, 2016). The final article developed and tested a hypothesised model of the relationship between stigma and disclosure about perinatal mental illness. Study 5 developed a questionnaire measure of stigma for perinatal mental illness in order to test the model. Questionnaire items were completed online by women with perinatal mental illness (n=279). Psychometric testing suggested it was a valid scale with three subscales: external, internal and disclosure stigma (Moore, Ayers, & Drey, 2017). Study 6 tested a hypothesised model that stigma would mediate the relationship between forum use and disclosure to healthcare providers. An online survey of women with perinatal mental illness (n=200) who had used forums provided partial support for this hypothesis, with internal stigma mediating the relationship between length of forum use and disclosure (Moore, Drey, & Ayers, 2017). This research highlights the importance of considering the stigma associated with perinatal mental illness and its role in online forum use and disclosure. Overall, findings suggest that forums may facilitate recognition of stigma, which may in turn lead to greater disclosure of symptoms to healthcare providers. However, the relationship between forum use, stigma and disclosure may be more complex than our initial model proposed. Similarly, most participants in these studies were white, well-educated and actively participated in the forums. Future studies would benefit from testing these relationships using longitudinal designs with more representative samples.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Healthcare Services Research & Management
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