Megan Reay - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: Service improvement
Postnatal Depression
Perinatal Mental Health
Eating Disorders
SEED
Men's mental health
Longstanding Eating Disorders
Paternal Mental Health

Critical Review of the Literature Abstract
Objective: Antenatal groups have gained popularity worldwide and have been shown to result in improvements in physical health outcomes for both the mother and baby (Ickovics et al., 2007; Lathrop, 2013). However, the same improvements have not been seen in parental mental health following antenatal groups. A previous systematic review reported that, although the quantitative outcome measures did not identify improvements in parental mental health following antenatal groups, the qualitative literature did identify improvements in wellbeing following antenatal groups (Wadephul et al., 2016). The current review aimed to understand the qualitative literature describing parents’ experiences of attending antenatal groups to understand the discrepancy between the quantitative and qualitative data. It also aimed to explore whether Yalom and Leszcz’s (2005) group process factors could offer a framework to understand the qualitative literature on antenatal groups.
Design: A systematic search of the literature was conducted using six databases (PsycINFO, Web of Science, Medline, PubMed, Embase and CINAHL). The search identified 4744 papers, of which 29 met the inclusion and exclusion criteria and were included in the review. Included papers were rated for quality using the Standards for Reporting Qualitative Research (O’Brien et al., 2014) and analysed using thematic synthesis (Thomas & Harden, 2008).
Measurements and Findings: Data analysis identified four themes, made up of ten sub-themes. These were: self-efficacy; social support; personal growth; and person-centred care. These are described in detail, including illustrative quotes and relationship to theory.
Key Conclusions and Implications for Practice: This review identified that parents-to-be describe several benefits of attending antenatal groups which are not routinely measured using standardised questionnaires. Yalom and Leszcz’s (2005) theory offered an explanation for the benefits described in the self-efficacy and social support themes, and partly explained the benefits within the personal growth theme. However, the theory did not offer an explanation for the benefits captured in the person-centred care theme. Limitations, clinical implications and directions for future research are discussed.
Service Improvement Project Abstract
Objective:Recovery rates for people with eating disorders are low; fewer than half recover and many develop longstanding eating disorders (L-ED). L-ED are often referred to as “SEED” (severe and enduing eating disorders) although this remains controversial and is not acknowledged in United Kingdom (UK) treatment guidance. The lack of agreement on how to define and support these patients means care is often inconsistent between services. This service improvement project aimed to generate recommendations for a lifespan L-ED pathway by understanding how to identify patients with L-ED; how to better support this group; and what proportion of the caseload could benefit from the pathway.
Method: A literature review was completed to create a provisional definition of L-ED. This was used to identify suitable patients with L-ED to take part in interviews and to recruit staff who work with patients with L-ED to take part in focus groups. Framework analysis was used to analyse the data. The qualitative analysis and literature searches were combined to create recommendations and a definition of L-ED which was used to establish how many patients could benefit from the pathway.
Results: The literature review identified twenty-seven papers which described L-ED using the terms “SEED”, “chronic” and “longstanding”. The literature frequently used a duration criterion as well as persistent symptoms, low weight, previous treatment failure, low quality of life and low motivation to recover. The results of the framework analysis were mostly consistent with this literature. However, participants disliked the term “SEED” and preferred to have no label, or use “longstanding” instead. The majority of the data was grouped into four themes and thirteen subthemes which described how to support patients with L-ED.
Conclusions: The project produced a set of recommendations for a tailored pathway for those with L-ED. These included promoting a hopeful message and establishing a consistent, available MDT with peer support. Involvement in the pathway should not result in a label or diagnosis of “SEED”, nor should it prevent access to recovery focused interventions. Other recommendations, implications and limitations are discussed.
Theoretically Driven Research Project Abstract
Background:Approximately 10% of fathers experience postnatal depression, yet fathers are not routinely offered support in the same way as mothers. Men are also less likely than women to seek help for depression due to barriers including stereotypical masculine norms and stigma. This research explored barriers to psychological help-seeking (PHS) amongst fathers with paternal perinatal depression (PPD).
Method: Data was collected using an online survey. Initially, fathers with PPD were compared to men experiencing depression at another time of their life in terms of their attitudes to seeking psychological help; conformity to masculine norms; self-stigma; and awareness of services. Secondly, a proposed model of PHS amongst fathers with PPD was evaluated. Finally, additional barriers to PHS for paternal postnatal depression were explored qualitatively.
Results and Conclusions: No between group differences were found which suggests that the existing literature into barriers to PHS for male depression may also apply to fathers. The results highlighted the need for better awareness of PPD, and better access to services. Limitations, implications for policy, and directions for future research are discussed.