Stigma and Health

What You Don’t Expect When You’re Expecting: Demonstrating Stigma

Against Women With Postpartum Psychological Disorders
Casey A. Schofield, Sophie Brown, Isabelle E. Siegel, and Corinne A. Moss-Racusin
Online First Publication, January 26, 2023. https://dx.doi.org/10.1037/sah0000431

CITATION
Schofield, C. A., Brown, S., Siegel, I. E., & Moss-Racusin, C. A. (2023, January 26). What You Don’t Expect When You’re
Expecting: Demonstrating Stigma Against Women With Postpartum Psychological Disorders. Stigma and Health. Advance
online publication. https://dx.doi.org/10.1037/sah0000431
 Stigma and Health
© 2023 American Psychological Association
ISSN: 2376-6972 https://doi.org/10.1037/sah0000431

What You Don’t Expect When You’re Expecting: Demonstrating Stigma

Against Women With Postpartum Psychological Disorders
Casey A. Schofield1, Sophie Brown1, Isabelle E. Siegel2, and Corinne A. Moss-Racusin1
1
Department of Psychology, Skidmore College
2
Department of Psychology, Rutgers University Camden

We explored whether women with postpartum psychological disorders encounter stigma, and whether the
nature and/or magnitude of that stigma changes as a function of specific postpartum disorder. Participants
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

(N = 430) were randomly assigned to read a brief vignette depicting a new mother experiencing symptoms
This document is copyrighted by the American Psychological Association or one of its allied publishers.

of either no postpartum disorder (control) or postpartum: depression, obsessive–compulsive disorder,

specific phobia, or psychosis. They then completed outcome measures assessing stigma. Results provided
novel evidence of stigma toward individuals experiencing postpartum psychological disorders, such that
women with any postpartum psychological disorder were robustly stigmatized relative to the control.
Further, postpartum psychosis was generally more stigmatized relative to the other disorders. To our
knowledge, these results reflect the first experimental evidence of stigma toward people suffering from
postpartum psychological disorders—stigma that may undermine treatment seeking for conditions with
potentially severe consequences. Implications for postpartum well-being and treatment accessibility are
discussed.

Keywords: stigma, postpartum, depression, anxiety, psychosis

Supplemental materials: https://doi.org/10.1037/sah0000431.supp

To talk about motherhood in any way other than the fulfillment of one’s women experiencing psychological distress has not yet been
life’s vocation is to invite social scorn. (Mukherjee, 2021) established experimentally.
A sizable qualitative literature elucidates the concerns women
The approximately 20% of postpartum women who experience
raise about disclosing their experiences of psychological distress
a psychological disorder (Uguz et al., 2019) find themselves in a
in the postpartum period. In particular, women cite guilt and shame
devastating bind. On the one hand, they can disclose their
as barriers to pursuing needed treatment (Jones, 2019) and report
symptoms in hopes of accessing effective treatment. This choice
fear that disclosing psychiatric symptoms during the postpartum
brings the risk of encountering stigma given that acknowledging
period will result in the enlistment of social services and subse-
psychological suffering violates cultural expectations of mother-
quently their loss of custody rights (Byatt et al., 2013; Megnin-
hood as joyful (Feingold & Lewis, 2020). On the other hand,
Viggars et al., 2015). These concerns extend to the context of
mothers can withhold reporting their distress, a choice with its
their perinatal care, where women express concerns that reporting
own consequences given that untreated psychological suffering
psychiatric symptoms will provoke stigma from health care workers
during the perinatal period can have particularly harmful out-
in particular (Byatt et al., 2013; Moore et al., 2017; Teng et al.,
comes, including maternal mortality (Glazer & Howell, 2021). In
2007). Notably, health care professionals themselves acknowledge
fact, nearly 50% of women with postpartum depression (PPD)
the presence and role of stigma in undermining recognition of
who were referred to a perinatal mental health group had “defi-
perinatal psychological distress. In one study, workers at an ante-
nitely” or “possibly” attempted suicide while postpartum (Healey
natal clinic reported that they felt their clients did not want to receive
et al., 2013), and suicide completion accounts for approximately
screening due to fear of stigmatizing attitudes (Tabb et al., 2015)
10% of maternal mortalities (Mangla et al., 2019). Thus, consid-
and indeed, evidence suggests that many women withhold reporting
ering the scope and impact of psychological distress among
psychiatric symptoms on screening measures (Prevatt & Desmarais,
perinatal women and their families, understanding and addressing
2018). Additional studies suggest that health care providers antici-
barriers to treatment is crucial. That said, while concerns about
pate feeling uncomfortable around women with postpartum psy-
encountering stigma are oft-cited as a barrier to women reporting
chological disorders and thus may unintentionally express stigma.
their psychological distress to perinatal providers (Goodman,
For example, providers report that they expect to feel nervous
2009), the presence and nature of stigma affecting postpartum
around—and have difficulty talking to—women with antenatal
depression (Gawley et al., 2011) and report feeling inadequately
trained for treating perinatal psychological distress (Byatt et al.,
2012). Furthermore, consistent with the larger mental health stigma
Correspondence concerning this article should be addressed to Casey A. literature demonstrating that stigma commonly expresses as a
Schofield, Department of Psychology, Skidmore College, 815 N desire for social distance from the affected individual (Silton
Broadway, Saratoga Springs, NY 12866, United States. Email: et al., 2011), providers indicate that they are likely to avoid treating
cschofie@skidmore.edu these patients if possible (Gawley et al., 2011).

1
 2 SCHOFIELD, BROWN, SIEGEL, AND MOSS-RACUSIN

In addition to citing shame related to experiencing a psychologi- hoc analyses comparing each of the vignettes on all dependent
cal disorder, women frequently report worry that openness about measures.
their mental health symptoms will result in being perceived as a
“bad mother” (Canty et al., 2019; Flynn et al., 2010; Frankhouser & Method
Defenbaugh, 2017; Kantrowitz-Gordon, 2013; Mollard et al., 2016).
This concern may be particularly insidious, given that the social Methods, hypotheses, and analyses were preregistered on Open
prescriptions for mothers are particularly high. Indeed, the term Science Framework (https://osf.io/g4cyf1). This study (title: “Dem-
“intensive mothering” was coined to acknowledge the widely held onstrating Stigma Towards Postpartum Psychological Disorders”)
belief that (among other things) the role of motherhood should was approved by the institutional review board at Skidmore College.
be self-sacrificing and bring fulfillment (Hays, 1996). In this way,
receiving a label of a postpartum psychological disorder potentially Participants
evokes “twofold stigma,” in which women encounter prejudice
both on account of experiencing a psychological disorder and As noted in the preregistration, prior to data collection we
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

for failing to meet the cultural expectations of a “good mother” conducted an a priori power analysis using GPower software, which
This document is copyrighted by the American Psychological Association or one of its allied publishers.

(Thomas et al., 2014). Previous experimental demonstrations of established that, assuming a small to medium ( f = 0.20) effect size
stigma affecting women who violate cultural expectations of “good and five groups between subjects, N = 400 participants yielded
mother” suggest that such violations evoke concerns about the 91% power. Recognizing that some participants would be excluded
child’s wellness and the mother’s competence, as well as decrease due to failed attention/manipulation check, we intended to recruit
the perceived likeability of the mother (Moss-Racusin et al., 2020, a slightly larger sample (N = 450). Four hundred forty-five parti-
Study 1). The goal of the present study is to provide the first cipants consented into the project via mTurk. In order to be eligible
experimental test of whether the presence of postpartum psycho- for the study participants had to have a ≥98% approval rate for
logical disorders elicit such stigma, as well as the inclination to previous Human Intelligence Tasks and be located within the United
enlist social services. Further, this study explores whether the States. A total of 15 participants were excluded from analyses for
failing to meet the preregistered criteria of (a) passing the crucial
presence of psychological symptoms provokes anticipated discom-
manipulation check in which they were expected to accurately
fort interacting with the mother and a desire to avoid closeness
identify the symptom presentation described in the vignette from
(i.e., “social distance”). Finally, given that previous work in this area
a list of options, or (b) passing two of the three attention checks in
traditionally focuses narrowly on PPD, the present study explores
which they were expected to respond with a particular answer (e.g.,
how stigma may differ across a number of postpartum psychological
“The answer to this question is 4. Please choose 4.”). The final
conditions including depression, obsessive–compulsive disorder,
sample (N = 430, 50.5% female) reported an average age of 40.5
psychosis, and specific phobia. These disorders range in prevalence
(SD = 13.6) and the following racial identities: 77.7% White, 11.4%
among postpartum people, with depression being the most common
Asian, 7% Black/African American, 3% bi/multiracial, 1%
(17.22%; Wang et al., 2021), followed by obsessive–compulsive
unknown or “other.”
disorder (2.7%–9%; McGuinness et al., 2011) and specific phobia
(4.8%; Fawcett et al., 2019), and psychosis being the least common
(0.1%–0.2%; Monzon et al., 2014). Materials
Experimental demonstrations of stigma are crucial to affirming
Stimulus Materials
the experiences of women who fear (and encounter) these attitudes,
as well as to informing future work designed to better understand— To manipulate postpartum psychological disorder, we created
and ultimately address—the role that stigma plays as a treatment a vignette depicting a new mother’s postpartum experience. The
barrier. In the present study, participants were randomly assigned to vignettes presented a woman experiencing symptoms of either
read a vignette that described a newly postpartum woman experienc- postpartum: depression (PPD), obsessive–compulsive disorder
ing either symptoms of one of the aforementioned conditions or a (PPOCD), psychosis (PPP), anxiety (PPA; specific phobia of
control depicting no psychological distress. We expected results driving), or no psychological disorder (control condition; see
to indicate that women experiencing postpartum psychological Supplemental Materials). All vignettes were developed by a clinical
disorders encounter stigma, such that a woman demonstrating psychologist with training and clinical experience in postpartum
symptoms would be viewed as less competent and likable than a mental health. The vignettes were designed such that word length
woman who is not experiencing symptoms, and that participants and postpartum circumstances (i.e., name, age, marital status, first
would express greater desire for social distance, anticipated dis- pregnancy) were kept consistent across conditions, while each
comfort, and risk to the child with a symptomatic woman compared vignette captured diagnostic criteria for each of the clinical condi-
to a control. In light of women’s concerns that disclosing their tions (i.e., reflect symptoms that are consistent with having met
symptoms will result in the enlistment of social services (and the clinical significance for the relevant disorder). Of note, diagnostic
potential for related custody loss), we also included a behavioral labels were not provided to participants, thus while they are reading
measure of whether participants flagged the vignette for potential depictions of postpartum psychological disorders, they are not
follow-up with social services, expecting higher rates of flagging for
1
symptomatic vignettes versus the control. Finally, given insufficient Due to space constraints, results for female communality prescriptions
and the Likert item assessing how likely participants were to involve
preexisting evidence to warrant a priori hypotheses regarding rela- authorities are not reported in the current article. Notably, both measures
tive differences in stigma between postpartum psychological con- yielded results consistent with reported results and preregistered study
ditions, we intended to explore these differences in a series of post hypotheses.
 POSTPARTUM PSYCHOLOGICAL DISORDER STIGMA 3

explicitly told that a psychological disorder is being depicted (or scales, items were converted to z scores and subsequently calculated
what form of disorder is represented). as an item mean. Example items include “It seems like this would
be a safe situation for Maya’s baby” (reverse scored) and “I would
Maternal Competence be concerned for this baby’s safety.” Higher item means indicated
greater levels of perceived risk to the child (α = .96).
To evaluate perceptions of maternal competence, participants
responded to six items modified from Rudman et al. (2012). Enlisting Authorities
Example items include “How likely is it that Maya has the
necessary skills to be a good mother?” and “Did Maya strike To evaluate whether participants were inclined to enlist authori-
you as a competent mother?” Higher item means indicate greater ties (e.g., social services), participants responded to a single (yes/no)
maternal competence (α = .97). item created for the purposes of this research which read “Please
indicate whether this description warrants enlisting the appropriate
Maternal Likability authorities (e.g., Child Protective Services)? NOTE: indicating ‘yes’
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automatically flags this for additional review and possible enlist-

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To evaluate likability of the mother, participants responded to ment of relevant agencies.”

six items modified from Rudman et al. (2012). Given that items were Procedure. Participants chose to participate in our experiment
on different scales, five items were first converted to z scores and titled, “How People Form First Impressions from Written Descrip-
then calculated as an item mean. Example items include “How much tions” on mTurk. Participants were told that they would read a
did you like Maya?” and “Is Maya someone you would want description picked at random from a large database containing
to get to know better?” Higher scores indicate greater likability written descriptions of real people dealing with a wide variety of
(α = .94). situations. After consenting, participants were randomly assigned to
read one of the five vignettes. Participants then responded to
Desire for Distance measures (presented in a randomized order) and provided demo-
graphic information. Survey completion took participants, on aver-
To evaluate the degree to which participants preferred social age, 11.8 min. They were debriefed and compensated $1.00.
distance from the target mother, participants responded to four items
created for the purposes of the current research. Example items Results
include “To what extent would you be inclined to avoid Maya?” and
“If you were having a social gathering, would you invite Maya?” There were no differences between conditions on self-reported
Higher item means indicated greater desire for distance (α = .86). demographic characteristics (including age, education, gender, race,
or parenthood status; all ps > 0.16). Each Likert scale was submitted
Anticipated Discomfort to a one-way between subjects analysis of variance, whereas the
behavioral outcome was analyzed with chi-square (all ps < .001; see
To evaluate whether participants anticipated feeling uncomfort- Table 1 for details).
able with the target mother, participants responded to four items
created for the purposes of the current research. Example items Competence Perceptions
include “To what extent would you feel comfortable around Maya?”
and “To what extent do you anticipate feeling awkward around As expected, there was a significant main effect of condition ( p ≤
Maya?” Higher item means indicated more anticipated discomfort .001, η2 = .51), with post hoc tests revealing that mothers with
(α = .93). psychological disorders were viewed as less competent relative to
the mother in the control condition (all ps < .001). Although the
Perceived Risk Posed to Child mother with PPD and the mother with PPOCD were not viewed
as significantly different from one another ( p = .99), they were
To evaluate whether the target mother was viewed as being a viewed as significantly less competent than the mother with PPA
danger to her child, participants responded to five items modified ( ps < .001). Further, the mother with PPP was viewed as signifi-
from Thomas et al. (2016). Given that questions were on different cantly lower in competence than all other mothers (all ps < .001).

Table 1
Means, Standard Deviations, and F Test Results of Dependent Variables by Disorder Condition

Postpartum Postpartum Postpartum

depression PPOCD anxiety psychosis Control
Dependent variable M (SD) M (SD) M (SD) M (SD) M (SD) F η2 p

Maternal competence 3.57 a

(1.17) 3.67 a
(1.45) 4.56 b
(1.47) 2.39 c
(1.28) 6.19 d
(0.82) 109.1 .51 <.001
Likability −0.04ab (0.63) −0.13a (0.76) 0.20b (0.73) −0.88c (0.84) 0.85d (0.50) 68.3 .39 <.001
Desire for distance 3.23a (1.26) 3.83b (1.51) 2.97a (1.37) 5.33c (1.37) 1.93d (0.92) 81.1 .43 <.001
Anticipated discomfort 3.77a,b (0.84) 4.03a (0.98) 3.58b (0.90) 4.63c (0.81) 2.97d (0.66) 45.4 .30 <.001
Risk 0.16a (0.58) 0.44b (0.64) −0.42c (0.70) 1.01d (0.42) −1.16e (0.34) 200.1 .65 <.001
Note. PPOCD = postpartum obsessive–compulsive disorder. Means sharing the same superscript do not differ significantly ( p > .05) within rows.
 4 SCHOFIELD, BROWN, SIEGEL, AND MOSS-RACUSIN

Likability Perceived Risk to Child

As expected, there was a significant main effect of condition ( p ≤ As expected, there was a significant main effect of condition ( p ≤
.001, η2 = .51), with post hoc tests revealing that mothers with .001, η2 = .65), with post hoc tests revealing that mothers with
psychological disorders were all viewed as less likable relative to psychological disorders elicited greater concerns about risk to the
the mother in the control condition (all ps < .001). Although the child than the mother in the control condition (all ps < .001). The
mother with PPD was not viewed differently from the mother with risk to the child of a mother with PPA was viewed to be significantly
PPOCD ( p = .90) or PPA ( p = .16), the mother with PPOCD was less relative to the mothers with PPD or PPOCD ( ps < .001), and
viewed as significantly less likable than the mother with PPA ( p = the risk to the child of a mother with PPD was viewed as signifi-
.02). Further, the mother with PPP was viewed as significantly cantly less than the child of a mother with PPOCD ( p = .009).
lower in likability than all other mothers (all ps < .001). Further, the mother with PPP elicited greater perceived risk
compared to all other mothers (all ps < .001).
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Desire for Distance

Enlisting Authorities
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As expected, there was a significant main effect of condition ( p ≤

As expected, there was a significant main effect of condition, p =
.001, η2 = .43), with post hoc tests revealing that mothers with
χ2(4) = 199.79, p < .001, in terms of the likelihood that the
psychological disorders elicited greater desire for social distance
participant suggested that authorities should potentially be enlisted
than the mother in the control condition (all ps < .001). Although
in this child’s care. In order to evaluate whether this likelihood
the mother with PPD and the mother with PPA were not viewed
varied as a function of condition, we conducted a series of one-
as significantly different from one another ( p = .68), they elicited
sample t tests to determine whether the likelihood of enlisting
significantly greater desire for social distance than the mother with
authorities differed significantly from zero, with a conservative
PPOCD ( ps < .05). Further, the mother with PPP elicited greater
Bonferroni correction (critical α = .01). This test was nonsignificant
desire for distance compared to all other mothers (all ps < .001).
for the control ( p = .32) but significant for all conditions in which
the mother had a psychological disorder (PPA: p = .009, PPD,
Anticipated Discomfort PPOCD, and PPP: ps < .001, see Figure 1).

As expected, there was a significant main effect of condition ( p ≤

Discussion
.001, η2 = .65), with post hoc tests revealing that mothers with
psychological disorders elicited greater anticipated discomfort than To our knowledge, this study represents the first experimental
the mother in the control condition (all ps < .001). Although the demonstration of the presence and form of stigma affecting women
mother with PPD was not viewed differently from either the mother who experience postpartum psychological disorders. In support of
with PPOCD ( p = .28) or PPA ( p = .61), the mother with PPOCD study hypotheses, women with a postpartum psychological disorder
was viewed as more likely to elicit discomfort than the mother with elicited negative reactions across all measured dimensions com-
PPA ( p = .006). Further, the mother with PPP elicited greater pared to the woman with no disorder. Of note, this included an
anticipated discomfort compared to all other mothers (all ps < .001). increased likelihood of potentially enlisting authorities in her

Figure 1
Percent of Participants “Flagging” Vignette for Potential Enlistment of Social Services, by
Condition

Note. PPA = postpartum anxiety; PPD = postpartum depression; PPOCD = postpartum obsessive–
compulsive disorder; PPP = postpartum psychosis.
 POSTPARTUM PSYCHOLOGICAL DISORDER STIGMA 5

child’s care. Moreover, results revealed that stigmatizing attitudes motherhood). Previous work has demonstrated a relationship
were most pronounced for PPP compared to other psychological between holding an intensive motherhood ideology and symptoms
disorders. of psychological distress (Rizzo et al., 2013), a finding the authors
Given that postpartum psychological distress is common (Uguz dubbed “the parenthood paradox.” Importantly, if beliefs that
et al., 2019), underrecognized (Ko et al., 2012), and undertreated motherhood should be intensive (i.e., self-sacrificing, child-
(Dennis & Chung-Lee, 2006), experimentally documenting the centered, and joyful) simultaneously drive risk for both psychologi-
presence of stigma is an important initial step in identifying the cal distress and stigma surrounding this distress, then it will be
role that this potential barrier to treatment may play in timely crucial for future work to focus efforts on dismantling the presence
identification and intervention. Future work testing whether such and impact of this ideology within perinatal care and community
stigma presents similarly among perinatal health care workers will contexts.
be important in light of evidence that concerns about encountering This study was not without limitations. First are questions
stigma in health care settings particularly undermine disclosure about external validity––it is unclear to what extent responses to
(Moore et al., 2017). Further, this is the first experimental study vignettes in an online experiment capture people’s attitudes and
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

demonstrating that the potency of stigmatizing attitudes may vary behaviors in the world, underscoring the importance of future work
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as a function of disorder for perinatal women, such that negative measuring expressions of stigma in the context of mother’s lives
attitudes were particularly pronounced for psychosis relative to (e.g., health care, workplace, and interpersonal interactions). In
anxiety. This finding is consistent with previous work demonstrat- particular, given the crucial role that clinical providers play in
ing that expressions of stigma for psychosis may be uniquely terms of assessing and ensuring appropriate intervention, it may
intense relative to other psychological disorders (Lee et al., 2016; be of particular import to determine if (and how) stigma operates
Svensson & Hansson, 2015), and underscores the challenges that among perinatal care providers. That said, the measure of
women negotiate when contending with this particular form of intention to enlist authorities does provide initial evidence that
psychological distress during the postpartum period. In short, the learning about symptoms may motivate real-world action. In addi-
risk of encountering negative judgements as a result of disclosing tion, the control condition in this project intentionally reflected
are especially high at a time when women are particularly in acute cultural expectations of new motherhood (i.e., happiness), and
need of intervention, support, and monitoring (Feingold & Lewis, thus it remains unclear to what extent results reflect stigma that
2020). That said, it is important to note that the vignette depicting occurs as a violation of those expectations versus as a result of
PPP was singular in that it included the presence of infanticidal symptoms of psychological disorder, or as a result of “twofold
ideation. While the present design intended to capture the impact stigma” evoked at the intersection of these two stigmatized identi-
and form of stigma affecting women negotiating this particularly ties. That is, the control condition arguably depicts a positive
harrowing form of distress (and one that may be associated with postpartum experience, making this in initial demonstration a
especially high barriers to disclosure), this approach undermines relatively liberal test of the presence of stigma. For this reason, it
our ability to disentangle stigma affecting women with PPP versus may be important for future work to employ a control that captures
stigma affecting women with infanticidal delusions. Of further a less idealized postpartum experience (such as one that conveys a
note, infanticide ideation is a real but relatively rare symptom in violation of idealized motherhood expectations without psychologi-
PPP (8%–9%; Kamperman et al., 2017; Sit et al., 2006), under- cal disorder) in order to distinguish the separate contributions
scoring the potential import of future work exploring the impact of made by the presence of psychological disorder versus expectation
stigma affecting people with PPP in the absence of this particular violations in terms of producing twofold stigma. Last, it will be
symptom. Further, while the intensity of stigma affecting other crucial for future work to address the limitation that little is known
forms of psychological distress was less pronounced, evidence of about the multitude of meaningful intersections that may further
stigma did exist across postpartum psychological disorders, shape stigma affecting postpartum families, including marginalized
highlighting that the impact of postpartum psychological disorder racial, gender, and economic identities. On a similar note, relatively
stigma is widespread. In fact, given that postpartum anxiety (PPA) little is known about how mental health stigma attitudes vary across
presentations may evoke different expressions of stigma than communities; such work exploring the potential role and relation-
what was measured in the current project (e.g., expressions of ship between participant identity and stigma attitudes may help to
invalidation and minimizing; Curcio & Corboy, 2020; Schofield inform where targeted interventions may be particularly meaningful.
& Ponzini, 2020), this project may have underestimated the
intensity of stigma affecting women presenting with anxiety (and
Conclusion
related) disorders.
While these results experimentally document the presence of Approximately, one in five new mothers will experience a
stigma, they do not establish the role of stigma as a barrier to psychological disorder (Uguz et al., 2019). Nonetheless, evidence
symptom disclosure and treatment. In fact, our understanding of suggests that psychological disorders during the perinatal period
the role of stigma as a treatment barrier relies predominantly on are routinely overlooked (Ko et al., 2012), despite frequent medical
descriptive and correlational work, highlighting the value of future encounters during this time. While an oft-cited explanation for
prospective longitudinal work directly establishing the nature of these conditions being overlooked is that women have reservations
this relationship. Similarly, while initial work has begun to explore about disclosing related to fear of stigma, the presence and form
approaches to addressing stigma (affecting women with PPD; of stigma affecting postpartum women has not previously been
Ruybal & Siegel, 2017, 2019), these efforts will benefit from further established experimentally. Results of the present study establish
understanding the potential mechanisms by which this stigma that—compared to a woman who presents consistent with the
expresses (including the potential role of violations of intensive expectations of intensive motherhood—postpartum women
 6 SCHOFIELD, BROWN, SIEGEL, AND MOSS-RACUSIN

experiencing symptoms of psychological disorders suffer a range Mental Health, 16(3), 237–245. https://doi.org/10.1007/s00737-013-
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