Moore Donna, Drey Nicholas, Ayers Susan
Centre for Maternal and Child Health, School of Health Sciences, City, University of London, London, United Kingdom.
School of Health Sciences, City, University of London, London, United Kingdom.
JMIR Ment Health. 2017 Feb 20;4(1):e6. doi: 10.2196/mental.5926.
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.
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.
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.
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.
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.
围产期精神疾病是一个全球性的健康问题；然而，许多患有这种疾病的女性并未得到康复所需的治疗。减少围产期精神疾病污名化的干预措施有可能使女性向医疗保健提供者披露自己的症状，从而获得治疗。有许多针对围产期精神疾病的在线论坛，成千上万的女性使用这些论坛。初步研究表明，在线论坛可能会促进求助行为，这可能是因为它们在挑战污名方面发挥了作用。本研究借鉴这些发现和理论概念，提出了一个论坛使用、污名和披露的模型。
本研究测试了一个模型，该模型测量了污名在在线论坛使用与向医疗保健提供者披露情感症状之间的中介作用。
对200名怀孕或有5岁以下子女且认为自己正经历心理困扰的女性进行了一项基于网络的调查。通过社交媒体招募女性，问题涉及论坛使用情况、围产期精神疾病污名、向医疗保健提供者的披露、抑郁和焦虑症状、披露的障碍以及人口统计学信息。
通过内部污名，论坛使用时长对症状披露有显著的正向间接效应，b = 0.40，偏差校正加速（BCa）95%置信区间为0.13 - 0.85。长期使用论坛的用户报告的内部污名水平更高，在控制抑郁和焦虑症状时，更高的内部污名与向医疗保健提供者披露症状相关。
内部污名介导了论坛使用时长与向医疗保健提供者披露之间的关系。研究结果表明，论坛有可能使女性认识并揭示自己的内部污名，这反过来可能会导致向医疗保健提供者更多地披露症状。临床医生可以将患者推荐到值得信赖且有管理的在线论坛，这些论坛有助于表达围产期精神疾病污名并促进向医疗保健提供者的披露。
