title: Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Maternal and Child Health, School of Health Sciences, City, University of London, London, United Kingdom.
authors.forename: Donna
authors.identifier: http://orcid.org/0000-0001-6733-9461
authors.initials: D
authors.lastname: Moore
authors.affiliation: School of Health Sciences, City, University of London, London, United Kingdom.
authors.forename: Nicholas
authors.identifier: http://orcid.org/0000-0003-0752-9049
authors.initials: N
authors.lastname: Drey
authors.affiliation: Centre for Maternal and Child Health, School of Health Sciences, City, University of London, London, United Kingdom.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-6153-2460
authors.initials: S
authors.lastname: Ayers
keywords: Internet; depression; female; mood disorder; postpartum; social stigma