Mental health problems in pregnancy and the postnatal period can have long-term
negative effects on women and their children. A key barrier to helping women in this period is
the low level of identification of mental health problems. Depression has commonly been
screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but
women may experience a broad range of symptoms of distress not captured by these measures.

The research reported in this dissertation was designed to address several aims. The first
strand aimed to explore women’s experiences of postnatal mental health problems and how they
conceptualise their symptoms. The focus of the first qualitative study was the lived experience
of 17 women who had experienced psychological distress in the first postnatal year, and used
interpretative phenomenological analysis. The second qualitative study used thematic analysis
with the same sample to explore different symptoms of distress and women’s experiences of
being assessed for these.

The second strand reviewed and evaluated currently existing measures of commonly
reported affective symptoms with a view to informing future assessment. A systematic review
found a lack of measures of anxiety designed for or validated sufficiently with perinatal women.
Factor analyses of the EPDS then explored the structure of depression and anxiety symptoms in
the perinatal period in the Avon Longitudinal Study of Parents and Children (N = 11,195 –
12,166). Results suggested symptom clusters of anhedonia, depression and anxiety. Finally,
validity of the CORE-10, a short measure of psychological distress was evaluated in a sample of
366 pregnant women. The CORE-10 showed promising psychometric properties. Anxiety was
the most reported symptom. Overall findings suggest that perinatal women need to be assessed
for a variety of mental health problems and that further work is needed to identify the most
effective assessment tool and process.

Posttraumatic growth describes positive changes following challenging events.
Although such changes are well documented there remain a number of important areas
for further research, some of which are addressed in this thesis. In particular, this thesis
aimed to clarify the relationship between growth and adjustment following health
events, explore growth in different cultures (UK and Africa), and examine growth
following childbirth using a prospective design.
First, two systematic reviews were carried out to examine (i) growth following
health events and (ii) maternal wellbeing in African women. The first meta-analytic
review found that growth following cancer and HIV/AIDS was associated with higher
levels of positive mental health, higher subjective physical health, and lower levels of
negative mental health. Moderating variables were time since the event, age, ethnicity,
and type of negative mental health outcome. The second review found that maternal
psychological problems in African women have a similar or slightly higher prevalence
than reported in developed countries. Risk factors were broadly comparable although
some culture-specific factors were also found.
Three research studies were conducted. The first study qualitatively explored 55
Gambian women’s experiences of pregnancy, childbirth, and the postnatal period.
Thematic analysis identified five themes: (1) transition to adulthood, (2) physical
difficulties, (3) value of children in relation to others, (4) children as a strain, and (5)
going through it alone. Prospective studies of growth following childbirth were then
carried out in the UK (N=125) and The Gambia (N=101). Women completed
questionnaires during their third trimester of pregnancy and up to 12 weeks after birth.
A proportion of women in both countries reported growth following childbirth. In the
UK, higher levels of growth were associated with caesarean sections and prenatal
posttraumatic stress symptoms. In The Gambia, higher growth was associated with
lower income, lower education, and higher postnatal social support.