E-HealthSocial support and online postpartum depression discussion groups: A content analysis
Introduction
Motherhood constitutes a life transition associated with major physical, social and emotional changes for women. Postpartum depression (PPD) falls under the umbrella term, postpartum mood disorder (PPMD), that encompasses a continuum of mental health conditions ranging from ‘baby blues’ to postpartum psychosis [1]. PPD is a non-psychotic depression that occurs within one year of childbirth [2] and has serious health related consequences for the mother and family [3]. The incidence of PPD in Canada ranges from 10% to 16% [4]. History of mental illness, antenatal depression, stressful life events and low social support are strong predictors of PPD [5], [6].
Social support has a positive influence on women's experience of pregnancy, childbirth and postpartum. Peer support and self-care activities are recommended for postpartum mothers experiencing depressive symptoms [7]. Peer support is considered a preventive strategy for PPD among at risk women [8]. A systemic review of the protective effects of postpartum rituals on PPD revealed that welcomed social support was of mental health benefit for new mothers [9].
The availability and increased public use of the Internet has implications for health promotion, health communication and health education. Although social networking is the most commonly reported online activity, approximately 70% of Canadian adults access the Internet to seek health information and almost one-third of Internet users participate in health related blogs or discussion forums. Among Canadian adult users, 74% of women used the Internet to search for information about health or medical conditions, while 66% of men did so [10]. Women, more so than men, use online chat groups to obtain health information (4.1% versus 2.5%) [11]. The results of the Health Information National Trends Study (HINTS) [12] identified participants’ health status as a primary motivator for online social group participation. In fact, web-based support groups offer a virtual ‘community’ space where individuals can dialogue with others who share a common interest or experience similar life experiences [11].
Although individuals access the Internet for health information and social support, health professionals’ knowledge about social support among women who access online PPD support networks is limited. Little is known of the benefits and limitations of online discussion groups for individuals experiencing PPD.
Postpartum women have a high demand for health information and social support from formal and informal sources [13]. Current trends, such as, mothers in the workforce and decreased traditional assistance for postpartum women (i.e., help with housework, care of family members) contributes to the social isolation experienced by some new mothers. Social support for postpartum women is identified as a key buffering factor associated with prevention of depression [14]. Women who report depressive symptoms are less likely to have adequate social support than those who do not report symptoms of PPD. In a characteristic fashion, many symptomatic postpartum mothers may not reveal their depressive symptoms to health care providers [15], [16]. Lack of knowledge of available health services, normalizing symptoms, stigma associated with mental illness, and geographical distance are plausible explanations for the lack of care-seeking among postpartum women with depression [17], [18], [19].
Access to the Internet avails individuals of health information, services, and support when traditional sources are deemed inadequate [20]. The Internet is increasingly recognized as an adjunct to face-to-face support and medical treatment [21], [22], [23]. Online support groups have become a positive means to obtain support and information among individuals who are managing physical and mental health-related conditions [24]. Such groups can provide ‘just in time’ support, overcome geographic barriers, facilitate open discussion of health concerns [25] and reduce social isolation by providing opportunities for sharing information and providing practical advice. Benefits of participating in online support groups include: (1) anonymity; (2) freedom of expression; (3) control over when and how much support one would like to receive, (4) expanding social network, and (5) increased self efficacy and empowerment [26], [27], [28], [29], [30]. The anonymous nature of online groups makes participants, particularly those dealing with health related stigmatization, feel safe [31] and creates an environment for open discussion of topics that may be perceived negatively by others [26], [32]. A systematic review of online health interventions found that participants of online support groups valued the prompt communication among support group members and the convenience of ‘anytime and anywhere’ access to care [33]. Online mental health interventions for adults living in rural communities were effective in reducing their depressive symptoms and their experience of stigmatizing attitudes to depression [21].
One typology of social support distinguishes three categories inclusive of emotional, informational, and instrumental support [34]. Emotional support consists of concern, affection, comforting, and encouragement resulting in sense of belonging and self-worth. Informational support involves advice giving, information sharing and personal knowledge development. Instrumental support reflects tangible assistance such as practical help with daily living. These three elements align with Oakley's (1992) characterization of social support in pregnancy which involves active listening, being non-judgmental, providing information and relevant help [35].
A social support classification [36] developed by examining support measures related to offline social support was adapted to categorize social support messages in online support group for disabled people [37]. The social support typology [36] involves five general categories of social support including information support, emotional support, esteem support, network support, and tangible support. Support among participants in online support groups for Huntington's disease [38]; HIV/AIDS [39]; breast cancer [40]; physical disabilities [37]; bereavement [41], and eating disorders [32] is most commonly informational and emotional types of support.
Engaging in online support forums can provide childbearing women opportunities to obtain support and connect with other mothers [42]. New mothers participating in online support groups reported that in addition to printed materials, online access offered a unique and positive means to obtain information, advice and ongoing support from other women [43]. Women with high risk pregnancies, who use the Internet to learn about other women's experiences, felt validated regarding their feelings about their pregnancy [44]. For women experiencing a problematic pregnancy, traditional sources of information and support may be inadequate and the Internet provides a viable strategy for at risk pregnant women to meet their increased need for information and support. Similarly women experiencing PPD have found comfort in talking about their childbearing experiences with other women with similar experiences [45].
Individual capacity building and well being is linked with Internet use. Online discussion groups generate new forms of social capital characterized by the resources individuals gain through increased social connections [46]. A discourse analysis of an online discussion board on mothering revealed three types of communication strategies: emotional support; instrumental and informal support; and community building/protection, all of which “increased mothers’ social capital” [47].
Exploration of the discourse within online support groups for PPD can illuminate key themes regarding women's concerns after childbirth and increase our understanding of the strategies they use to elicit support. The results may inform health communication platforms for health promotion and health teaching in support of interventions for PPD. The purpose of this study was to explore the perceived value and types of social supports that characterize the discussions women who participate in PPD online support groups.
Section snippets
Method
A directed qualitative content analysis was employed to explore how social support relates to women's experience with PPD or depressive symptoms. A content analysis approach is used to interpret text data from a predominately naturalistic paradigm and is useful in circumstances where existing theory or prior research exists about a phenomenon that is either incomplete or would benefit from further description [48].
Results
A total of 512 postings were collected and analyzed. Most of the participants’ postings pertain to emotional support (41.6%) followed by informational (37.5%) and instrumental support (20.9%).
Discussion
This is the first known study using a content analysis of postings to an online non-moderated social support group to explore the conversations of women experiencing PPD. The results indicated that the online support group offered emotional, informational and instrumental support for participants dealing with PPD. The discussion group participants ‘cared’ for each other and provided a safe place to reveal negative thoughts about motherhood that tend to be viewed as socially objectionable.
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