Community Mental Health Journal

, Volume 54, Issue 1, pp 92–101 | Cite as

Attachment and Mental Help-Seeking in the Perinatal Period: The Role of Stigma

  • Ana Fonseca
  • Mariana Moura-Ramos
  • Maria Cristina Canavarro
Original Paper
First Online:
Received:
Accepted:

Abstract

This study aimed at (1) examining how women’s attachment representations influence their intentions to seek formal help for their emotional problems, either directly or by affecting attitudes towards professional help-seeking (stigma and psychological openness), and (2) examining whether these effects are moderated by the presence of clinically significant psychopathological symptoms. A cross-sectional online survey including 226 women during the perinatal period was conducted. Results showed that, when clinically significant psychopathological symptoms were present, women’s more insecure attachment representations were associated with lower intentions to seek professional help, and this influence occurred throughout a decrease in women’s indifference to stigma associated with mental healthcare. These results support both the intra and interpersonal nature of the help-seeking process, and highlight the importance of implementing stigma reduction strategies (e.g., awareness campaigns, health professional’s non-judgmental questioning of emotional difficulties), particularly in women with clinically significant psychopathological symptoms.

Keywords

Attachment representations Formal help-seeking intentions Perinatal period Psychological openness Stigma 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

This study is part of the Relationships, Development & Health Research Group of the R&D Unit Cognitive-Behavioral Center for Research and Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra (PEst-OE/PSI/UI0730/2014).

Funding

Ana Fonseca and Mariana Moura-Ramos were supported by post-doctoral grants from the Portuguese Foundation for Science and Technology (SFRH/BPD/93996/2013 and SFRH/BPD/87514/2012, respectively).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

Ethical standards and procedures for research with human beings (e.g., Helsinki Declaration, World Medical Association 2001; American Psychological Association 2010) were followed, and this study was approved by the Institutional Review Board of the Faculty of Psychology and Educational Sciences of the University of Coimbra.

Informed Consent

Informed consent was obtained from all participants included in the study.

References

  1. Abrams, L. S., Dornig, K., & Curran, L. (2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qualitative Health Research, 19, 535–551. doi: 10.1177/1049732309332794.CrossRefPubMedGoogle Scholar
  2. Alexander, R., Feeney, J., Hohaus, L., & Noller, P. (2001). Attachment style and coping resources as predictors of coping strategies in the transition to parenthood. Personal Relationships, 8, 137–152. doi: 10.1111/j.1475-6811.2001.tb00032.x.CrossRefGoogle Scholar
  3. American Psychological Association (2010). Publication Manual of the american psychological association. London: American Psychological Association.Google Scholar
  4. Areias, M., Kumar, R., Barros, H., & Figueiredo, E. (1996). Comparative incidence of depression in women and men, during pregnancy and after childbirth: Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers. British Journal of Psychiatry, 169, 30–35. doi: 10.1192/bjp.169.1.30.CrossRefPubMedGoogle Scholar
  5. Augusto, A., Kumar, R., Calheiros, J., Matos, E., & Figueiredo, E. (1996). Post-natal depression in an urban area of Portugal: Comparison of childbearing women and matched controls. Psychological Medicine, 26, 135–141. doi: 10.1017/S0033291700033778.CrossRefPubMedGoogle Scholar
  6. Barney, L., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40, 51–54. doi: 10.1080/j.1440-1614.2006.01741.x.CrossRefPubMedGoogle Scholar
  7. Ben-Porath, D. (2002). Stigmatization of individuals who receive psychotherapy: An interaction between help-seeking behavior and the presence of depression. Journal of Social and Clinical Psychology, 21, 400–413. doi: 10.1521/jscp.21.4.400.22594.CrossRefGoogle Scholar
  8. Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010). Women’s experience of postnatal depression: Beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing, 27, 44–54.Google Scholar
  9. Bowlby, J. (1969). Attachment and loss: Vol. 1. attachment. New York: Basic Books.Google Scholar
  10. Brennan, K., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult romantic attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York: Guilford Press.Google Scholar
  11. Britt, T., Greene-Shortridge, T., Brink, S., Nguyen, Q., Rath, J., Cox, A., … Castro, C. (2008). Perceived stigma and barriers to care for psychological treatment: Implications for reactions to stressors in different contexts. Journal of Social and Clinical Psychology, 27, 317–335. doi: 10.1521/jscp.2008.27.4.317.CrossRefGoogle Scholar
  12. Callister, L. C., Beckstrand, R. L., & Corbett, C. (2011). Postpartum depression and help-seeking behaviors in immigrant Hispanic women. Journal of Obstetrics Gynecological and Neonatal Nursing, 40, 440–449. doi: 10.1111/j.1552-6909.2011.01254.x.CrossRefGoogle Scholar
  13. Cepeda-Benito, A., & Short, P. (1998). Self-concealment, avoidance of psychological services, and perceived likelihood of seeking professional help. Journal of Counseling Psychology, 45, 58–64. doi: 10.1037/0022-0167.45.1.58.CrossRefGoogle Scholar
  14. Collins, N., & Feeney, B. (2000). A safe haven: An attachment theory perspective on support seeking and caregiving in intimate relationships. Journal of Personal and Social Psychology, 78, 1053–1073. doi: 10.1037/0022-3514.78.6.1053.CrossRefGoogle Scholar
  15. Cox, J., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786. doi: 10.1192/bjp.150.6.782.CrossRefPubMedGoogle Scholar
  16. Dennis, C. L., & Chung-Lee, L. (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33, 323–331. doi: 10.1111/j.1523-536X.2006.00130.x.CrossRefPubMedGoogle Scholar
  17. Diener, M., & Monroe, J. (2011). The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review. Psychotherapy, 48, 237–248. doi: 10.1037/a0022425.CrossRefPubMedGoogle Scholar
  18. Dozier, M. (1990). Attachment organization and treatment use for adults with serious psychopathological disorders. Development and Psychopathology, 2, 47–60. doi: 10.1017/S0954579400000584.CrossRefGoogle Scholar
  19. Fonseca, A., Gorayeb, R., & Canavarro, M. C. (2015). Women׳s help-seeking behaviours for depressive symptoms during the perinatal period: Socio-demographic and clinical correlates and perceived barriers to seeking professional help. Midwifery, 31, 1177–1185. doi: 10.1016/j.midw.2015.09.002.CrossRefPubMedGoogle Scholar
  20. Fonseca, A., Silva, S., & Canavarro, M. C. (in press). Inventário de Attitudes face à Procura de Serviços de Saúde Mental: Estudo das Características Psicométricas [Inventory of attitudes towards seeking mental health services: Psychometric properties]. Psychologica.Google Scholar
  21. Fraley, R. C., Niedenthal, P. M., Marks, M. J., Brumbaugh, C. C., & Vicary, A. (2006). Adult attachment and the perception of emotional expressions: Probing the hyperactivating strategies underlying anxious attachment. Journal of Personality, 74, 1163–1190. doi: 10.1111/j.1467-6494.2006.00406.x.CrossRefGoogle Scholar
  22. Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. doi: 10.1111/j.1467-9280.2007.01882.x.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G., … Miller, W. (2005). Perinatal depression: Prevalence, screening accuracy and screening outcomes. In Evidence report/technology assessment (Vol. 119). RockVille, MD: Agency for Healthcare Research and Quality.Google Scholar
  24. Goodman, J. H. (2009). Women’s attitudes, preferences and perceived barriers to treatment for perinatal depression. Birth, 36, 60–69. doi: 10.1111/j.1523-536X.2008.00296.x.CrossRefPubMedGoogle Scholar
  25. Griffin, D., & Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430–445. doi: 10.1037/0022-3514.67.3.430.CrossRefGoogle Scholar
  26. Have, M., de Graaf, R., Ormel, J., Vilagut, G., Kovess, V., Alonso, J., & Investigators, t. E. M. (2000). Are attitudes towards mental help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders. Social Psychiatry and Epidemiology, 45, 153–163. doi: 10.1007/s00127-009-0050-4.CrossRefGoogle Scholar
  27. Henderson, J., & Redshaw, M. (2013). Anxiety in the perinatal period: Antenatal and postnatal influences and women’s experience of care. Journal of Reproductive and Infant Psychology, 31, 465–478. doi: 10.1080/02646838.2013.835037.CrossRefGoogle Scholar
  28. Hill, C., Satterwhite, D., Larrimore, M., Mann, A., Johnson, C., Simon, R., ... Knox, S (2012). Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style. Counselling and Psychotherapy Research, 12, 13–24. doi: 10.1080/14733145.2011.629732.CrossRefGoogle Scholar
  29. Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Pscyhological Methods, 3, 424–453. doi: 10.1037/1082-989X.3.4.424.CrossRefGoogle Scholar
  30. Kingston, D., Tough, S., & Whitfield, H. (2012). Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry and Human Development, 43, 683–714. doi: 10.1007/s10578-012-0291-4.CrossRefPubMedGoogle Scholar
  31. Kline, R. (2005). Principles and practice of structural equation modeling (2nd ed.). New York: Guilford Press.Google Scholar
  32. Lopez, F., & Brennan, K. A. (2000). Dynamic processes underlying adult attachment organization: Toward an attachment theoretical perspective on the healthy and effective self. Journal of Counseling Psychology, 47, 283–300. doi: 10.1037/0022-0167.47.3.283.CrossRefGoogle Scholar
  33. Mackenzie, C., Knox, V., Gekoski, W., & Macaulay, H. (2004). An adaptation and extension of the attitudes toward seeking professional psychological help scale. Journal of Applied Social Psychology, 34, 2410–2435. doi: 10.1111/j.1559-1816.2004.tb01984.x.CrossRefGoogle Scholar
  34. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18, 16–20. doi: 10.1111/j.1467-8721.2009.01598.x.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Manos, R. C., Rusch, L., Kanter, J. W., & Clifford, L. (2009). Depression self-stigma as a mediator of the relationship between depression severity and avoidance. Journal of Social and Clinical Psychology, 28, 1128–1143. doi: 10.1521/jscp.2009.28.9.1128.CrossRefGoogle Scholar
  36. Mikulincer, M., & Florian, V. (1995). Appraisal and coping with a real-life stressful situation: The contribution of attachment styles. Personality and Social Psychology Bulletin, 69, 1203–1215. doi: 10.1177/0146167295214011.CrossRefGoogle Scholar
  37. Mikulincer, M., & Florian, V. (1998). The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 143–165). New York: Guilford.Google Scholar
  38. Mikulincer, M., & Shaver, P. R. (2005). Mental representations of attachment security: Theoretical foundation for a positive social psychology. In M. W. Baldwin (Eds.), Interpersonal cognition (pp. 233–266). New York: The Guilford Press.Google Scholar
  39. Moran, P. (2007). Attachment style, ethnicity and help-seeking attitudes among adolescent pupils. British Journal of Guidance & Counselling, 35, 205–218. doi: 10.1080/03069880701256627.CrossRefGoogle Scholar
  40. Moreira, H., Martins, T., Gouveia, M. J., & Canavarro, M. C. (2015). Assessing adult attachment across different contexts: Validation of the Portuguese version of the experiences in close relationships–relationship structures questionnaire. Journal of Personality Assessment, 97, 22–30. doi: 10.1080/00223891.2014.950377.CrossRefPubMedGoogle Scholar
  41. Muzik, M., & Borovska, S. (2010). Perinatal depression: Implications for child mental health. Mental Health in Family Medicine, 7, 239–247.PubMedPubMedCentralGoogle Scholar
  42. Nam, S., & Lee, S. (2015). The role of attachment and stigma in the relationship between stress and attitudes toward counseling in South Korea. Journal of Counseling & Development, 93, 212–224. doi: 10.1002/j.1556-6676.2015.00197.x.CrossRefGoogle Scholar
  43. O’Mahen, H. A., & Flynn, H. A. (2008). Preferences and perceived barriers to treatment for depression during the perinatal period. Journal of Women’s Health, 17, 1301–1309. doi: 10.1089/jwh.2007.0631.CrossRefPubMedGoogle Scholar
  44. Pais-Ribeiro, J., silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225–237. doi: 10.1080/13548500500524088.CrossRefGoogle Scholar
  45. Rholes, W. S., Simpson, A., Campbell, L., & Grich, J. (2001). Adult attachment and the transition to parenthood. Journal of Personality and Social Psychology, 81, 421–435. doi: 10.1037//O022-3514.81.3.421.CrossRefPubMedGoogle Scholar
  46. Rickwood, D., Deane, F., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Australian e-Journal for the Advancement of Mental Health, 4, 1–34.CrossRefGoogle Scholar
  47. Rickwood, D., & Thomas, K. (2012). Conceptual measurement framework for help-seeking for mental health problems. Psychology Research and Behavior Management, 5, 173–183. doi: 10.2147/PRBM.S38707.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Shaffer, P., Vogel, D. L., & Wei, M. (2006). The mediating roles of anticipated risks, anticipated benefits, and attitudes on the decision to seek professional help: An attachment perspective. Journal of Counseling Psychology, 53, 442–452. doi: 10.1037/0022-0167.53.4.442.CrossRefGoogle Scholar
  49. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445. doi: 10.1037//1082-989X.7.4.422.CrossRefPubMedGoogle Scholar
  50. Silva, S. (2015). Intenções e comportamentos efetivos de procura de ajuda das mulheres para lidar com dificuldades emocionais: Barreiras e facilitadores no período perinatal [Women’s help-seeking intentions and behaviors for mental health problems during the perinatal period: Barriers and facilitators]. Unpublished Master Dissertation, University of Coimbra.Google Scholar
  51. Simpson, J. A., Rholes, W. S., Campbell, L., Tran, S., & Wilson, C. (2003a). Adult attachment, the transition to parenthood, and depressive symptoms. Journal of Personality and Social Psychology, 84, 1172–1187. doi: 10.1037/0022-3514.84.6.1172.CrossRefPubMedGoogle Scholar
  52. Simpson, J. A., Rholes, W. S., Campbell, L., & Wilson, C. (2003b). Changes in attachment orientations across the transition to parenthood. Journal of Experimental Social Psychology, 39, 317–331. doi: 10.1016/S0022-1031(03)00030-1.CrossRefGoogle Scholar
  53. Simpson, J. A., Rholes, W. S., & Nelligan, J. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434–446. doi: 10.1037/0022-3514.62.3.434.CrossRefGoogle Scholar
  54. Tronick, E., & Reck, C. (2009). Infants of depressed mothers. Harvard Review of Psychiatry, 17, 147–156. doi: 10.1080/10673220902899714.CrossRefPubMedGoogle Scholar
  55. Vogel, D. L., & Wei, M. (2005). Adult attachment and help-seeking intent: The mediating roles of perceived social support and psychological distress. Journal of Counseling Psychology, 52, 347–357. doi: 10.1016/j.jpsychores.2007.11.011.CrossRefGoogle Scholar
  56. Vogel, D. L., & Wester, S. R. (2003). To seek help or not to seek help: The risks of self-disclosure. Journal of Counseling Psychology, 50, 351–361. doi: 10.1037/0022-0167.50.3.351.CrossRefGoogle Scholar
  57. Woolhouse, H., Brown, S., Krastev, A., Perlen, S., & Gunn, J. (2009). Seeking help for anxiety and depression after childbirth: Results of the Maternal Health Study. Archives of Women’s Mental Health, 12, 75–83. doi: 10.1007/s00737-009-0049-6.CrossRefPubMedGoogle Scholar
  58. World Medical Association (2001). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization, 79, 373–374.PubMedCentralGoogle Scholar
  59. Zhao, W., Young, R., Breslow, L., Michel, N. M., Flett, G. L., & Goldberg, J. O. (2015). Attachment style, relationship factors, and mental health stigma among adolescents. Canadian Journal of Behavioural Science. doi: 10.1037/cbs0000018.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Ana Fonseca
    • 1
  • Mariana Moura-Ramos
    • 1
  • Maria Cristina Canavarro
    • 1
  1. 1.Research Group “Relações, Desenvolvimento, & Saúde”, CINEICC – Cognitive and Behavioral Center for Research and Intervention, Faculty of Psychology and Educational SciencesUniversity of CoimbraCoimbraPortugal

Personalised recommendations