Yuill, C., Sinesi, A., Meades, R., Williams, L. R., Delicate, A., Cheyne, H., … & Walker, J. J. (2024). Women’s experiences and views of routine assessment for anxiety in pregnancy and after birth: A qualitative study. British Journal of Health Psychology, 29(4), 958-971. https://doi.org/10.1111/bjhp.12740

Key Takeaways

Perinatal anxiety is prevalent, affecting about 20% of women, yet it is often under-recognized.
The study aimed to explore women’s experiences and views on routine assessment for anxiety during pregnancy and after birth.
The study involved semi-structured interviews with 41 pregnant or postnatal women, analyzed using Sekhon et al.’s acceptability framework and inductive coding.
Women generally viewed routine assessment for perinatal anxiety as positive and acceptable, but its success depended on how well it was informed and personalized.
The study highlights the importance of informed and personalized approaches to perinatal anxiety assessment, embedded in continuous care.

Pregnant woman visits her gynecologist in the medical office. Female doctor talks with woman expecting a baby.

Rationale

This study is justified because perinatal anxiety is prevalent, affecting about 20% of women, yet it is often under-recognized.

Effective assessment tools are crucial for identifying and supporting women experiencing perinatal anxiety, but these tools must be acceptable to the women being assessed.

Previous research has shown that perinatal anxiety is experienced by approximately 20% of women, and routine mental health assessment during antenatal care is generally acceptable.

However, women may be reluctant to disclose mental health problems due to stigma and potential barriers to accessing support and treatment.

This study aimed to explore women’s experiences and views on routine assessment for anxiety during pregnancy and after birth to better understand the factors influencing the acceptability of these assessments.

Research questions:

What are women’s experiences with routine assessment for perinatal anxiety?
How acceptable do women find routine assessment for perinatal anxiety?
What are women’s views on the use of questionnaires and other assessment tools for perinatal anxiety?

Method

The study employed a qualitative approach, conducting semi-structured interviews with 41 women during pregnancy or within 6 weeks of giving birth.

The interviews were designed to gather in-depth information about women’s experiences with perinatal mental health assessments and their views on the acceptability of the assessment measures.

Thematic analysis was used to analyze the interview data, employing both deductive coding based on Sekhon et al.’s framework and inductive coding for emergent themes.

Sample

The study participants were 41 women in varying stages of pregnancy or within six weeks postpartum.

The women were recruited from England and Scotland through various UK organizations and methods, including social media, antenatal groups, and baby events.

The sample included women with diverse experiences of anxiety and depression, with 46% scoring above the NICE recommended cutoffs for probable depression and/or anxiety.

Results

The study revealed three key themes related to women’s experiences and views of routine assessment for perinatal anxiety:

Theme 1: Raising awareness and improving support

Women viewed routine assessment as a valuable tool for raising awareness about perinatal mental health and normalizing discussions about anxiety during care.

They felt that assessment could improve support for women experiencing anxiety during pregnancy and after birth.

A participant highlighted the potential of assessment to increase self-awareness, stating:

“Even if you did just do the questionnaire and didn’t talk about it, even if it wasn’t really expanded, it would make me more self-aware of my mental health, it would become quite normal then for me maybe to become a bit more self-aware.”

Theme 2: Surveillance and stratifying care

Women expressed concerns about the potential for surveillance and stratification associated with routine assessment.

They preferred completing assessments privately and in their own time, rather than under the observation of a clinician.

There were concerns that assessment scores could be used to “gatekeep” access to further support, potentially limiting access for some women.

A participant emphasized the preference for privacy during assessment, stating:

“I would rather do it when they weren’t there, because otherwise I’d be aware of the time pressure, and I’d be trying to read through it quickly, … whereas if they left it with me, I’d be able to do it at a time that’s convenient to me.”

Theme 3: Personalizing care and building trust

Women emphasized the importance of personalized care and trust in the context of perinatal anxiety assessment.

They wanted clear information about why questions were being asked and what the outcome of the assessment would be.

They valued assessments that were connected to further care, such as personalized conversations with clinicians or referrals to support services.

Building trust with clinicians was seen as crucial for navigating difficult subjects and experiences.

A participant highlighted the importance of trust and personalized care, stating:

“It’s that thing of the healthcare professional being the person that’s going to decide what happens next. I think that’s probably quite scary in terms of the mental health side of things. So I think there’s something about having a clear rationale as to why you’re being asked to do something, and also then what the potential next steps are and some sense that you have a bit of control in that.”

Insight

This study found that women generally see routine anxiety assessments during pregnancy and after birth as a good thing.

They believe these assessments can help raise awareness about mental health and provide better support for women who are struggling.

However, the study also found that it’s important how these assessments are done.

Women want to feel like they are being treated as individuals, not just a number, and they want to trust the people giving the assessments. They also don’t want to feel like they are being monitored or judged.

This study is particularly informative because it gives us a deeper understanding of how women feel about these assessments.

It highlights the importance of making assessments feel personal and building trust between women and healthcare providers. This is something that hasn’t been fully explored in previous research.

Future research could explore how different assessment methods impact women’s experiences and how to best integrate these assessments into routine care.

Clincial Implications

Based on these findings, it’s clear that we need to move away from a “one-size-fits-all” approach to perinatal anxiety assessments.

Healthcare providers need to be trained to conduct assessments in a way that is sensitive, informative, and builds trust.

Future research could explore how different assessment methods impact women’s experiences and how to best integrate these assessments into routine care.

It’s also important to investigate how to make these assessments more accessible and effective for women from diverse backgrounds.

Strengths

Qualitative study design allowing for in-depth exploration of experiences and views
Inclusion of participants across the perinatal period
Use of established coding frameworks for data analysis

Limitations

Limited generalizability due to the sample’s predominantly white, highly educated, and employed demographic.
Potential for self-selection bias due to the recruitment methods.

References

Sekhon, M., Cartwright, M., & Francis, J. (2017). Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Services Research, 17(1), 88.