Prevalence and factors associated with antenatal depression, anxiety, and ways of coping with mental health problems among pregnant mothers, and feasibility assessment of an intervention to improve antenatal mental well-being in the Colombo Regional Director of Health Services area

Background: Pregnancy is a period of profound psychological and emotional change, during which many women experience heightened vulnerability to mental health challenges. While global research has explored the prevalence of antenatal depression and anxiety, little is known about how pregnant mothers in Sri Lanka cope with these challenges.
This study aimed to explore the coping strategies employed by pregnant women in the Colombo Regional Director of Health Services (RDHS) area to manage stress and mental health problems during pregnancy.
Methods: A qualitative study was conducted using in-depth interviews and key informant interviews. Twenty-five pregnant mothers across all trimesters were purposively selected along with six key informants including public health midwives (PHMs), nursing sisters, and medical officers.
Thematic analysis, following Braun and Clarke’s framework, was used to analyze data, ensuring triangulation and investigator validation to enhance rigor.
Results: Thematic analysis revealed a diverse range of coping strategies, including both adaptive and maladaptive patterns. Many mothers relied on passive coping, such as avoidance of stressors, silent endurance, or religious and spiritual practices. Positive reframing and seeking social support were used by some mothers but were less common. Key informants reported a dominant pattern of avoidance and highlighted the low mental health literacy among mothers and their families.
Stigma, limited awareness of mental health services, and underutilization of active problem-solving approaches emerged as critical barriers.
Conclusion: Pregnant mothers in Colombo employ a mix of adaptive and maladaptive coping strategies, with a strong reliance on passive mechanisms that may increase emotional distress over time. There is an urgent need to strengthen maternal mental health education, promote active coping skills, and integrate culturally sensitive interventions with routine antenatal care.