|dc.description.abstract||Background and Aims:
Mental health difficulties during the perinatal period (pregnancy to 1 year postnatal)
are commonplace and are associated with significant impacts for mothers and
infants. There is an acknowledgement that more needs to be understood about
perinatal mental health, particularly during pregnancy, and that service and
treatment options need to be improved.
Women’s lived experience of difficulties during pregnancy, particularly when
experiencing moderate to severe mental health difficulties, is a little researched
A need for wider treatment options than medication alone has been highlighted and
Peer Support Interventions (PSIs) are often considered within this area. Despite this,
there is yet to be a review of their effectiveness to date that also considers women’s
views of such interventions. Therefore, this thesis aimed to systematically review
literature focused on women’s views of PSIs and their effectiveness. In addition, it
also aimed to explore the lived experience of women with moderate to severe
difficulties with their mental health during pregnancy, with a focus on trying to
establish any psychological needs/needs they may have.
A mixed methods systematic review was conducted to meet the aims on PSI
interventions. This involved searching electronic databases, quality assessment of
included papers and summarising results, including a meta-synthesis for qualitative
findings. The empirical project, on women’s lived experiences, utilised an
Interpretative Phenomenological Analysis approach to explore the lived experience
of women experiencing moderate to severe mental health difficulties during
pregnancy. Semi-structured interviews were conducted with 11 women recruited via
a specialist perinatal mental health service.
Thirteen studies were included in the review. Results highlighted the heterogeneity
of types of PSIs and methodologies employed to evaluate these. Most studies
focused on PSIs for the postnatal period and were often aimed at depression. There
was a lack of research on PSIs targeted antenatally, or for other types of mental
health difficulties. There was tentative evidence for the use of telephone based PSIs
in reducing depressive symptomatology postnatally, but less evidence for the use of
other types of PSI, or for interventions during pregnancy. The qualitative evidence
highlighted the acceptability of PSIs to women and a meta-synthesis of qualitative
research identified a number of themes representing women’s views of PSIs.
From the empirical project, several Superordinate themes were identified: Need for
acceptance, Need for awareness, Search for explanations, What helped, Emotional
intensity, Societal influences and Service provision. Within these a range of
emergent themes were also found. These themes highlighted possible psychological
needs and other needs during this time, as well as providing a greater
understanding of women’s lived experience.
There is a need for more research to establish effectiveness of PSIs during
pregnancy and of other modes of delivery and to build on existing findings on the
effectiveness of telephone based PSIs. Women viewing PSIs as highly acceptable
for perinatal mental health difficulties, should cause services to consider their use, or
other opportunities for sharing of peer advice/information.
Themes identified from the empirical project highlight the need for greater
awareness and acceptance of mental health difficulties during pregnancy, as well as
the impact of societal influences on women during this time, and the role clinicians
and services could play in achieving greater awareness. Small changes within
services could help raise awareness levels and help women feel less isolated.||en