Mental imagery and mental health in first-time expectant mothers: A mixed-methods investigation

Introduction
Identifying key cognitive processes that drive distress in the perinatal period will enable the development of mechanism-focused interventions. One cognitive process that offers promise is mental imagery. First-time expectant mothers experience future-focused mental imagery when considering the transition to parenthood. This study aimed to investigate the relationship between future-focused imagery and mental health difficulties in the prenatal period and shed light on the content of perinatal mental imagery.

Methods
This was a cross-sectional observational study. Sixty pregnant women expecting their first child completed a survey including measures of depression, anxiety, mental imagery and repetitive negative thinking. They responded to open-ended questions about the content of future imagery of parenthood. Data were analysed using linear regressions, network analysis and content analysis.

Results
Intrusive future-focused imagery was significantly associated with depression (β = 0.22) and anxiety (β = 0.03). The network analysis depicted relationships between anxiety-depression (0.40), anxiety-repetitive negative thinking (0.29), and depression-intrusive future-focused imagery (0.26). Depression had a strong relationship with negative imagery but no association with positive imagery. Content analysis suggested a link between imagery appraisal and emotion, for example, an imagery appraisal of ‘I won't cope’ or ‘I will be able to cope’ was linked to feeling overwhelmed and trapped or apprehensive and happy, respectively.

Discussion
Mental imagery seemingly played a more important role for depression, whereas repetitive negative thinking, a verbal cognitive process, had a stronger link with anxiety. Targeting negative mental imagery could be a valuable intervention target for pregnant women experiencing symptoms of depression.