Table 2.

Summary of study characteristics

Study: authors, year, location		Study aim	Sample description	Method	Data collection	Method of analysis	Overview of identified themes
Studies investigating women’s perspectives only (in reverse chronological order)
1	Stockley (2018) UK	Examine women’s experiences during the onset and early days of PP	Seven women—all identified as having PP Aged Time since onset: 2–22 years	Advertised on Action on Postpartum Psychosis (APP)	Face-to-face semi-structured interviews (20–49 min)	IPA (Smith et al. 2009)	1. What’s happening?: sleep deprivation and anxieties and losing touch with reality 2. ‘Lack of recognition of the seriousness’: keeping up appearances and misinterpretation 3. Breast is best?: difficulties and anxieties related to feeding 4. ‘Trauma’: both prior to and during birth
2	Roberts et al. (2018) UK	How the EastEnders PP storyline and increase in public awareness were received by women recovered from PP	Nine women—fully recovered from PP Time since onset: at least 12 months	Advertised on APP	Face-to-face (n = 1) and telephone (n = 8) semi-structured interviews (43–97 min)	TA (Braun and Clarke 2006)	1. Public education: PP as a hidden illness, importance of improving understanding 2. Stigma: viewed as deep rooted 3. Disclosure: difficulty sharing experience of PP, storyline facilitated disclosure 4. Reassurance: they were not alone 5. Family relationships: largely negative impact on family, including distress and trauma—storyline as a vehicle to understanding PP from their perspective
3	Plunkett et al. (2017) UK	Explore the role of the baby in recovery from PP	Twelve mothers experienced PP Aged 23–56 years Time since onset: 2 months–26 years	Advertised on website forums (n = 9) and MBU (n = 3)	Face-to-face (n = 5) and telephone (n = 7) semi-structured interviews (22–52 min)	TA (Braun and Clarke 2006)	1. The baby has a role in recovery: motivated mothers to get better 2. The baby is a barrier: responsibility of caring created emotional distress; societal expectations delayed help-seeking 3. Baby facilitates recovery: physical contact reduced distress and increased maternal self-efficacy
4	Glover et al. (2014) UK	Gain further insight into women’s experiences of PP and the context in which they make sense of it	Seven women Aged 25–45 years All diagnosed with PP in the last 10 years	Specialist psychiatry services for mothers and babies	Semi-structured interviews Location not specified (approximately 1 h)	TA (Braun and Clarke 2006)	1. The path to PP: negative perception of birth experience and sense of detachment 2. Unspeakable thoughts and unacceptable self: unbearable thought content 3. Snap out of it: women felt dismissed and judged, exacerbated distress 4. Perceived causes: PP unavoidable vs ‘snap out of it’: an unpreventable illness
5	McGrath et al. (2013) UK	Develop a theoretical understanding of recovery from psychosis following childbirth	Twelve women Aged 26–45 years Time since onset: 4 months–23 years	MBU (n = 2) and online advertisements (n = 10)	Face-to-face (n = 11) and telephone (n = 1) semi-structured interviews (37–110 min)	Constructivist grounded theory (Charmaz 2006)	Recovery conceptualised as a parallel process 1. The process of recovery: from ‘immobilisation’ (unable to make use of active strategies) to recognising changes and accepting loss self-efficacy and hope 2. Evolving an understanding: dynamic process, recognise mismatch in expectations 3. Strategies for recovery: initially felt powerless and tried to conceal symptoms 4. Sociocultural context
6	Posmontier and Fisher (2013) USA	Understand the experience of PP in an Orthodox Jewish woman	One Orthodox Jewish woman Time since onset of PP: 2 years	Not specified	Unstructured Telephone interview (1.5 h)	Structural analysis (Gee 1991)	First day: birth and Shavuos (Jewish holiday), Second day: the symptoms begin—a sleepless night and a sense of dread Third day: coming home Fourth day: Shabbos psychosis—more agitated, directive and loss of trust The aftermath: making sense of experience
7	Heron et al. (2012) UK	Explore women’s experiences of the process of recovery and their beliefs about the services needed	Five women—regarded themselves as fully recovered Time since onset: 3–20 years	Expressed interest in conducting research via APP	Service user led face-to-face semi-structured interviews (19–45 min)	Grounded analytic induction approach (Silverman 2006)	1. Unmet expectations: psychological enormity and sense of loss 2. Ruminating and rationalising: a need to integrate periods of lost time and confusion 3. Social recovery: building networks 4. Medical support: considered vital 5. Information needs: should be tailored 6. Family functioning: support seen as pivotal 7. Giving recovery time: not always linear
8	Engqvist et al. (2011) Anonymous data	Gain a deeper insight into women’s experiences of PP, as described in narratives published on the internet	Ten personal narratives taken from the Internet Of 28, 10 met the DSM-IV criteria for PP	Internet search for narratives written by women who describe PP	Internet as a data source (306–4140 words)	Content analysis (Krippendorff 2004)	1. Unfulfilled dreams: shattered expectations 2. Enveloped by darkness: women felt an overwhelming fear, were in an unreal world and experienced disorganised thinking 3. Disabling symptoms: lonely, suspicious, loss of sleep and self-destructive behaviours 4. Being abandoned: all felt distrusting and detached from others
9	Robertson and Lyons (2003) UK	Explore women’s experiences of PP and gain understanding into living through and past the illness	Ten women Aged 28–44 years Diagnosed with PP in the last 10 years	Subsample from a previous genetic study	Face-to-face semi-structured interviews (40–90 min)	Grounded theory principles (Glaser and Strauss 1967)	1. A separate form of mental illness 2. Loss: women felt powerless 3. Relationships and social rules: all time and effort focussed on the baby Higher order concepts: 1. Living with emotions: guilt and loss 2. Regaining and changing self: feeling like themselves again, marker for recovery
Studies including family members’ perspectives (in reverse chronological order)
10	Holford et al. (2018) UK	Consider the lived experiences of partners of women who have had PP and the impact that it has had on their lives	Eight male partners Aged 30–49 years All partners experienced PP in the last 10 years and longer than 6 months since onset.	Advertised on APP	Face-to-face (n = 1), telephone (n = 4) and skype (n = 3) semi-structured interviews	IPA (Smith et al. 2009)	1. Loss: unmet expectations, resulting in grief and a sense of abandonment 2. Powerlessness: general lack of control 3. United vs. individual coping 4. Hypothesising and hindsight: benefit of reflection to make sense 5. Barriers to accessing care and unmet needs: poor understanding and empathy 6. Managing multiple roles 7. Positive changes from PP
11	Boddy et al. (2016) UK	Explore fathers’ experiences during their partners’ MBU admission for PP	Seven men during partners’ admission to an MBU Aged 23–42 years	Two MBUs whilst partners were receiving inpatient care	Face-to-face semi-structured interviews (40–84 min)	IPA (Smith et al. 2009)	1. ‘What the f*** is going on?’ - PP as an unexpected arrival - Not feeling heard 2. ‘Time to figure out how your family works’: - Holding the fort - Loss and reconnection - Adjustment to family life
12	Wyatt et al. (2015) UK	Explore how women and their significant others make sense of their experience of PP and their relationships	Seven women with PP and significant other Women aged 28–33 years, significant other: 29–39 years Time since onset: 5 months–4 years	Dyads identified through a perinatal service (n = 1) and social media (n = 6)	Dyad face-to-face semi-structured interviews (60–85 min)	IPA (Smith et al. 2009)	1. ‘She wasn’t herself’: threatened relationships through loss of ‘normal’ self 2. Invalidation and isolation: distress felt unrecognised or minimised 3. ‘The worst life can throw at us’: shared perceptions of trust and respect after PP 4. A double-edged sword: understanding the influence of relationships on PP
13	Engqvist and Nilsson (2014) Sweden	Explore the recovery process of PP and conclusion of hospital care from the perspective of women and next of kin	Seven women with PP and six next of kin Women aged 44–62 years, time since onset: 7–32 years Next of kin aged 39–72, time since onset: 6 months–19 years	Contact initiated via an interview at a local radio station and snowball sampling	Face-to-face semi-structured interviews (45–90 min)	Content analysis (Graneheim and Lundman 2004)	1. The recovery: ‘Return to life’ - The turning point: from being trapped - Own recovery: returning strength - Social recovery: ability to socialise 2. Supporting circumstances: to regain their health—relatives’ and friends’ support, professional support and support through medication 3. Light in the tunnel of darkness: an internal decision to get well
14	Engqvist and Nilsson (2013a) Sweden	Explore accounts of the first days and early signs of PP from the perspectives of women and next of kin	Seven women with PP and six next of kin Women aged 39–60 years, time since onset: 7–32 years Next of kin age unknown, time since onset: 5 months–19 years	Contact initiated via an interview at a local radio station, and snowball sampling	Face-to-face semi-structured interviews (45–90 min)	Content analysis (Graneheim and Lundman 2004)	Main theme: shades of black with a ray of light—darkness, despair and suffering, next of kin viewed PP as incomprehensible 1. Loss of sleep: exhaustion 2. Being in an unreal world 3. From wanting the baby to not wanting the baby: gave rise to guilt and shame 4. Infanticidal ideation: did not trust self 5. Suicidal ideation: complete darkness
15	Doucet et al. (2012) Canada and USA	Explore the support needs, preferences, accessibility to resources, and barriers to support	Nine women and eight fathers/partners Mean age of women: 34.7 years, mean age of men: 36.3 years Time since onset: up to 10 years	Purposive sampling—community and hospital agencies	Face-to-face (n = 8) and telephone (n = 9) semi-structured interviews (45–120 min)	TA (Braun and Clarke 2006)	1. Support needs: relating to generic parenting needs and serious mental illness 2. Support preferences: informational from professionals and emotional support from informal networks 3. Availability and accessibility: nonexistence of specialist support, majority of support provided by family 4. Barriers to support: health service barriers and lack of knowledge about PP