Pregnancy Related Depression & Anxiety Services

1 in 7 mothers and 1 in 10 dads will experience some type of pregnancy related depression or anxiety (PRDA). We want to hear your voice! Nobody understands the experiences, feelings and needs of PRDA like those who have lived it. We would like to learn from you about what was helpful, what wasn’t, and what you wish was available.

The following are some of the symptoms that may be experienced around the birth of a child.

·         Frequent crying, sadness, worry, anger, feelings of worthlessness or hopelessness
·         Lack of energy for everyday tasks and trouble sleeping even when the baby is asleep
·         Sense of stress that interferes with daily life
·         Loss of interest in food or preoccupation with eating
·         Loss of interest in self-care or lack of pleasure in most or all activities
·         Loss of concentration or difficulty making decisions
·         Excessive worry about the baby or feeling disconnected from the baby
· In some cases, thoughts of suicide or harming yourself or the baby

Question Title

* 1. Who were the best supports for you while experiencing PRDA – select all that apply

Partner

Family

Friends

Doctor

Church

Home Visitor

School

MOPS ( Mothers of Preschoolers)

Therapist/Councilor

Other

Other (please specify)

Question Title

* 2. Other parents have found these services to be helpful. Please select any that you would be interested in, rating from not interested to very interested.

	Not Interested	Somewhat interested	Not sure	Somewhat interested	Very Interested
Parent to Parent Support Groups	Parent to Parent Support Groups Not Interested	Parent to Parent Support Groups Somewhat interested	Parent to Parent Support Groups Not sure	Parent to Parent Support Groups Somewhat interested	Parent to Parent Support Groups Very Interested
Counseling/Educational Group	Counseling/Educational Group Not Interested	Counseling/Educational Group Somewhat interested	Counseling/Educational Group Not sure	Counseling/Educational Group Somewhat interested	Counseling/Educational Group Very Interested
Individual therapy/counseling	Individual therapy/counseling Not Interested	Individual therapy/counseling Somewhat interested	Individual therapy/counseling Not sure	Individual therapy/counseling Somewhat interested	Individual therapy/counseling Very Interested
Coping strategies and self-care	Coping strategies and self-care Not Interested	Coping strategies and self-care Somewhat interested	Coping strategies and self-care Not sure	Coping strategies and self-care Somewhat interested	Coping strategies and self-care Very Interested

Question Title

* 3. If you attended a support group would you prefer, in person, by phone, on Facebook or other?

Question Title

* 4. Are there any obstacles to obtaining supports?
If yes, what were they? Select all that apply.

Transportation

Hours

Money

Childcare

Fear of being judged or reported

Just didn't want to

Other

None

Other (please specify)

Question Title

* 5. Is there anything else that you feel we should know that was not included in this survey?

Question Title

* 6. Would you be willing to join in a focus group to talk about your experience and what services would meet your needs?
If yes, contact information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 7. Would you like a member of our Maternal Wellness team to contact you about services in our area?
If yes, what is the best way for us to contact you.

Phone Call

Text

Facebook

Not interested in being contacted

Question Title

* 8. Contact information for question 7.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. Who were the best supports for you while experiencing PRDA – select all that apply

Question Title

* 2. Other parents have found these services to be helpful. Please select any that you would be interested in, rating from not interested to very interested.

Question Title

* 3. If you attended a support group would you prefer, in person, by phone, on Facebook or other?

Question Title

* 4. Are there any obstacles to obtaining supports? If yes, what were they? Select all that apply.

Question Title

* 5. Is there anything else that you feel we should know that was not included in this survey?

Question Title

* 6. Would you be willing to join in a focus group to talk about your experience and what services would meet your needs? If yes, contact information

Question Title

* 7. Would you like a member of our Maternal Wellness team to contact you about services in our area?If yes, what is the best way for us to contact you.

Question Title

* 8. Contact information for question 7.

* 4. Are there any obstacles to obtaining supports?
If yes, what were they? Select all that apply.

* 6. Would you be willing to join in a focus group to talk about your experience and what services would meet your needs?
If yes, contact information

* 7. Would you like a member of our Maternal Wellness team to contact you about services in our area?
If yes, what is the best way for us to contact you.