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

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. 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. 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. 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. • This is one of the first investigations of mental imagery in the perinatal period. • Depression had a strong relationship with negative imagery and none with positive imagery. • Mental imagery had a stronger relationship with depression than with anxiety. • Verbal cognitive processes had a stronger relationship with anxiety than with depression. • The appraisal of future imagery was seemingly linked to its valence.