(PS10-91) A Qualitative Investigation of Emotion Dysregulation in Perinatal Mental Health

Background:  Mood and anxiety disorders are highly prevalent during pregnancy and the postpartum (i.e., the perinatal period) with consequences to parental health and infant psycho-social development. Proper identification and treatment can mitigate negative outcomes, but these disorders tend to be under-diagnosed and under-treated. Gaining a better understanding of the core symptoms and processes that underlie perinatal mental disorders is a critical step toward improving screening and treatment practices. One maintenance and risk factor shared across mood and anxiety disorders is emotion dysregulation (ED; maladaptive emotional reactivity and emotion regulation). Despite evidence demonstrating an elevated risk of ED and associated mental health concerns during the perinatal period, existing research relies on questionnaires and physiological markers of distress, which do not capture individuals' insights about their experience.

Purpose: Our study aimed to develop a comprehensive qualitative understanding of 1) how perinatal individuals with elevated ED experience, understand, and regulate their emotions and 2) the factors associated with vulnerability to perinatal ED.

Methods: Perinatal individuals (n = 16) were recruited from referrals to the Women’s Health Concerns Clinic within St. Joseph’s Healthcare, Hamilton. Participants who endorsed ED completed a semi-structured qualitative interview developed to capture information from three main themes: 1) emotional reactivity, 2) emotion regulation, and 3) change in emotional experience during the perinatal period. Interview data was analyzed using a directed content analysis. Prior research and existing theory of ED were used to create a deductive coding matrix of key ED constructs and inductive coding was used to capture participant’s unique experience of ED in the perinatal period.

Results: Participants described heightened emotional reactivity during the perinatal period (Theme 1), characterized by rapid mood changes and heightened intensity of anger, anxiety, sadness, shame, hopelessness, and joy. Participants reported difficulties regulating intense emotions (Theme 2) and described a lack of helpful emotion regulation strategies and an increased reliance on unhelpful regulation strategies (e.g., suppression and rumination). All participants described an increase in ED during the perinatal period (Theme 3). Factors identified as driving vulnerability for negative emotions included unmet expectations of support (e.g., availability of social support), unmet self-expectations (e.g., ability to cope with new responsibilities in the postpartum), and compromised needs following childbirth (e.g., deficits in sleep, support, exercise, and time for self).

Conclusions: These findings enhance our understanding of symptom presentations of ED specific to the perinatal population. Moreover, this research may help define treatment targets and improve clinicians’ ability to tailor treatment to this understudied and highly vulnerable population. The findings further support the potential benefit of interventions aimed at regulating intense emotions as well as support services to address compromised needs.