Development of the Creating Comfort in Choice Theory of Decision Making Regarding Antidepressant Use in Pregnancy: “The Biggest Decision I’ve Ever Made”

Abstract

Prenatal depression affects approximately 10% to 15% of women. Guidelines recommend supporting women to make informed treatment decisions; however, minimal evidence exists regarding this decision-making process. This study aimed to develop a constructivist grounded theory of prenatal antidepressant treatment decision-making. Semi-structured interviews were conducted with purposively sampled women from the community or specialty clinics (N = 31). Iterative data collection and analysis, theoretical sampling, and member checking supported model sufficiency. In the Creating Comfort in Choice theory that we developed, participants were highly conscious of societal stigma toward mental illness and prenatal medication use, so fear, anxiety, and guilt dominated decision-making. Participants navigated dynamically among three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. “Seeking information” included internal and external processes. In “making sense of information,” participants appraised available evidence. In “self-soothing,” participants engaged in coping strategies to try to alleviate painful emotions. The Creating Comfort in Choice theory can support patient-oriented decision-making regarding prenatal mental healthcare.

Keywords:

• Feminist
• constructivist grounded theory
• decision-making
• antidepressant
• pregnancy
• depression

Acknowledgements

This work was conducted in partial fulfillment of the requirements of CH’s doctoral degree. We thank all members of the Translational Psychiatric Genetics Group for their manifold support, insight, guidance, and commitment. We also extend our gratitude to all the clinicians and administrative staff of the Reproductive Mental Health program, Angela Inglis and Emily Morris in the Adapt clinic, Caitlin Slomp with TPGG for their help with recruitment, as well as the volunteers who assisted with transcription and recruitment. We offer gratitude to the Coast Salish Peoples, including the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations, on whose traditional, unceded, and ancestral territory we had the privilege of working during the completion of this study. Finally, we would like to express our heartfelt appreciation for those who participated in the study; without you, none of this would be possible.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Author Contributions

CH: Conceptualization, investigation, data curation, formal analysis, writing—original draft, visualization, project administration, funding acquisition.

LGB: Conceptualization, formal analysis, writing—review and editing, supervision.

DR: Resources, writing—review and editing.

JA: Conceptualization, formal analysis, writing—review and editing, supervision, resources.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author (JA), upon reasonable request.

Additional information

Funding

This study was funded by the UBC School of Nursing’s Sheena Davidson Nursing Research Fund. CH received salary support from a Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-D), a UBC Killam Doctoral Scholarship, and a UBC Four Year Fellowship Award. JA was supported by the Canada Research Chairs Program, and BC Mental Health and Substance Use Services.