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Title: Women with bipolar disorder and pregnancy : factors influencing their decision-making regarding treatment
Author: Dolman, Clare
ISNI:       0000 0004 7970 1124
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2019
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Background: Women with bipolar disorder (BD) face an increased risk of suffering a severe episode of illness in the perinatal period, requiring them to make difficult choices regarding pregnancy. Decisions are made more difficult by a lack of research, particularly on the teratogenicity of psychotropic drugs. The studies in this thesis aimed to explore women's views on making these decisions, together with the views of health professionals who treat them. Methods: 1) a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness (SMI); 2) a qualitative study of women with BD's views on pregnancy via individual interviews and an online forum; and 3) qualitative studies of health professionals' views via a focus group and Individual interviews. Results: The review identified 23 studies on the views of women with SMI, and eight papers on professionals' views. Themes identified included guilt, stigma and problems with service provision. In the second study (21 women interviewed, 50 internet contributors), centrality of motherhood, contextual factors, stigma and fear were major themes. Fear and stigma were among themes echoed in the studies with perinatal specialists (11) and general psychiatrists (14). The idea of a decision aid was broadly welcomed by all three groups. Conclusions: This thesis highlights the complexity of the challenges facing women with BD when they have children and the ways in which issues such as stigma and fear mitigate against the establishment of a meaningful therapeutic relationship with health professionals. Improved access to information and specialist advice is needed and research on the possible usefulness of a decision aid would be helpful. It is further suggested that many health professionals would benefit from more training on this topic to better understand the particular importance of BD in the perinatal period and to reduce stigmatizing attitudes.
Supervisor: Howard, Louise Michele Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available