Dr Helene Mitchell

Job: Senior Lecturer in Psychology

Faculty: Health and Life Sciences

School/department: School of Applied Social Sciences

Research group(s): Centre for Reproduction Research

Address: De Montfort, University, The Gateway, Leicester, LE1 9BH.

T: +44 (0)116 257 7722

E: hmitchell@dmu.ac.uk

W: www.dmu.ac.uk/hls

 

Personal profile

Helene Mitchell is a health psychologist with a specific interest in chronic conditions. Her research has looked at illness representations in arthritis, expectations and their impact on exercise behaviour, and patient experiences of living with a chronic illness. Helene is particularly interested in the impact of osteoarthritis and endometriosis on individuals.

Research group affiliations

Publications and outputs 

  • It was never an option not to breastfeed: Exploring breastfeeding experiences and intentions of multigravidae in Southern Nigeria
    It was never an option not to breastfeed: Exploring breastfeeding experiences and intentions of multigravidae in Southern Nigeria Ogbonna, M.; Williamson, I. R.; Mitchell, H. Exclusive breastfeeding rates are generally modest despite its benefits and pertinence in countries with high childhood morbidity and mortality. In order to understand the complexities of successfully promoting breastfeeding, qualitative research using postmodern research methodologies such as ethnography, grounded theory and interpretative phenomenological analysis, as well as feminist analysis have been employed to explore the experience of breastfeeding by the active participants of breastfeeding-mothers. However, there is a dearth of such studies in developing countries like Nigeria. This study explores accounts of breastfeeding provided by nine pregnant Nigerian women (28-33 years) who had previously breastfed. Participants wereinterviewed, and data were analysed using interpretative phenomenological analysis. Analyses indicated three emergent themes which highlighted women’s experiences of breastfeeding as complex and shaped by proximal and distal influences. Accounts of pain, psychological distress and worries over ‘breast addiction’ were juxtaposed with pride in perceptions of good mothering, connectedness and upholding cultural heritage. Women’s feeding choices were scrutinised and/or stigmatised by family and community members. In the context of feminist ‘‘lens’’, major implication is the potential penalisation for not breastfeeding and hence, a contravention of the right of choice of infant feeding. There is therefore, the need for the incorporation of the right to choose infant feeding methods in breastfeeding campaigns; support for breastfeeding, particularly the inclusion of support for discontinuation; and similar research to explore specific aspects and perspectives on breastfeeding such as those of spouses, to further provide insights that may be useful for the improvement, adaptation and/or development of interventions The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the URI link. Open access article.
  • Conducting dyadic, relational research about endometriosis: A reflexive account of methods, ethics and data analysis
    Conducting dyadic, relational research about endometriosis: A reflexive account of methods, ethics and data analysis Hudson, Nicky; Law, Caroline; Culley, Lorraine; Mitchell, H.; Denny, E.; Raine-Fenning, N. Despite a growing literature on the value of relational data in studies of social phenomena, individuals still commonly constitute the basic unit of analysis in qualitative research. Methodological aspects of interviewing couples, particularly interviewing partners separately, and of conducting dyadic analysis have received scant attention. This article describes the experience of conducting separate interviews with both partners in 22 heterosexual couples (n = 44) in a study of the impact of the gynaecological condition endometriosis. In order to advance current methodological thinking regarding interviewing couples, we describe the dyadic, relational approach employed in designing the study and our specific method of dyadic analysis. We argue that utilising separate interviews with dyadic analysis rather than conducting joint interviews, while not without its ethical, practical and analytical challenges, offers considerable methodological benefits. Such an approach allows a unique relational insight into the impact of chronic illness on couples and how they navigate chronic illness by illuminating both shared and individual interpretations, experiences, understandings and meanings open access article
  • Running out of time: Exploring women’s motivations for social egg freezing
    Running out of time: Exploring women’s motivations for social egg freezing Baldwin, K.; Hudson, Nicky; Culley, Lorraine; Mitchell, H. Objective: Few qualitative studies have explored women’s use of social egg freezing. Derived from an interview study of 31 participants, this paper explores the motivations of women using this technology. Methods: Semi-structured interviews were conducted with 31 users of social egg freezing resident in the UK (n= 23), USA (n=7) and Norway (n=1). Interviews were face to face (n=16), through Skype and Facetime (n=9) or by telephone (n=6). Data were analysed using interpretive thematic analysis. Results: Women’s use of egg freezing was shaped by fears of running out of time to form a conventional family, difficulties in finding a partner and concerns about ‘panic partnering’, together with a desire to avoid future regrets and blame. For some women, use of egg freezing was influenced by recent fertility or health diagnoses as well as critical life events. A fifth of the participants also disclosed an underlying fertility or health issue as affecting their decision. Conclusion: The study provides new insights in to the complex motivations women have for banking eggs. It identifies how women’s use of egg freezing was an attempt to ‘preserve fertility’ in the absence of the particular set of ‘life conditions’ they regarded as crucial for pursuing parenthood. It also demonstrates that few women were motivated by a desire to enhance their career and that the boundaries between egg freezing for medical and for social reasons may be more porous than first anticipated. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • An interpretative phenomenological analysis of experiences of women living with Premenstrual Dysphoric Disorder
    An interpretative phenomenological analysis of experiences of women living with Premenstrual Dysphoric Disorder Mitchell, H.; Skopaite, B. Objectives: Premenstrual Dysphoric Disorder (PMDD) affects 3-8% of women of reproductive age. Common debilitating symptoms include mood swings, depressed mood, irritability, anger and anxiety, which are often accompanied by lethargy, hypersomnia/insomnia and pain. Individuals and professionals are often unaware of the impact of the disorder on women’s life. This study aimed to gain an insight into the experiences of women living with PMDD and to deepen the understanding of the changes women encounter during their premenstrual phase. Design: Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis (IPA) to explore how women experience and interpret their PMDD. Methods: Eight U.K. based, women with a self-reported history of PMDD for longer than six months, were recruited through Facebook PMDD support groups and were interviewed via Skype. Results: Three themes were identified: ‘the overwhelming nature of the condition’ illustrated how PMDD brought monthly debilitating changes to the women’s lives; ‘the effortful diagnostic journey of PMDD’ illuminated the journey, from the mystical onset of the disorder to the relief when they could ‘put a name on it’; ‘dealing with the monthly hurricane’ revealed the individual coping approaches in dealing with the disorder. Conclusions: Participants illustrated the effect of PMDD on their lives: the struggle to understand the symptoms, the difficulty of getting a medical diagnosis, and strategies to cope with this cyclical condition. This research highlights the importance of raising public awareness and increasing Health Care Professionals’ knowledge about the disorder in to improve women’s quality of life.
  • A qualitative study of the impact of endometriosis on male partners
    A qualitative study of the impact of endometriosis on male partners Culley, Lorraine; Law, Caroline; Hudson, Nicky; Mitchell, H.; Raine-Fenning, N.; Denny, E. STUDY QUESTION What is the impact of endometriosis on male partners of women with the condition? SUMMARY ANSWER Endometriosis significantly impacts men across several life domains and can negatively impact emotional well-being. WHAT IS KNOWN ALREADY Endometriosis has been shown to negatively impact women's quality of life and may strain intimate relationships. Little is known about the impact on male partners. STUDY DESIGN, SIZE, DURATION The ENDOPART study was a cross-sectional, qualitative study of 22 women with endometriosis and their male partners (n = 44) in the UK (2012–2013). PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria: laparoscopic diagnosis of endometriosis; the presence of symptoms for at least a year; partners living together. Data were collected via face to face, semi structured interviews with partners interviewed separately. Data were analysed thematically, assisted by NVivo 10. MAIN RESULTS AND THE ROLE OF CHANCE Men reported that endometriosis affected many life domains including sex and intimacy, planning for and having children, working lives and household income. It also required them to take on additional support tasks and roles. Endometriosis also had an impact on men's emotions, with responses including helplessness, frustration, worry and anger. The absence of professional or wider societal recognition of the impact on male partners, and a lack of support available to men, results in male partners having a marginalized status in endometriosis care. LIMITATIONS REASONS FOR CAUTION Self-selection of participants may have resulted in a sample representing those with more severe symptoms. Couples included are in effect ‘survivors’ in relationship terms, therefore, findings may underestimate the contribution of endometriosis to relationship breakdown. WIDER IMPLICATIONS OF THE FINDINGS The study extends knowledge about the impact of endometriosis on relationships, which thus far has been drawn largely from studies with women, by providing new insights about how this condition affects male partners. Healthcare practitioners need to take a more couple-centred, biopsychosocial approach toward the treatment of endometriosis, inclusive of partners and relationship issues. The findings demonstrate a need for information and support resources aimed at partners and couples. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Economic and Social Research Council (reference ES/J003662/1). The authors have no conflicts of interest. Open Access article
  • Early maladaptive cognitive schema as predictors of acute phase post-stroke depression
    Early maladaptive cognitive schema as predictors of acute phase post-stroke depression Mitchell, H.; Coulthard, Helen; Stalias, M. Post-stroke depression is a leading cause of disability and the identification of risk factors is critical for rehabilitation and prevention initiatives. Early Maladaptive Cognitive Schema (EMS) have been implicated with depression with no known medical cause but not previously explored in post-stroke depression. The overall purpose of the study was to explore the role of EMS in post stroke depression. The Young Schema Questionnaire-Short Form (YSQ-SF) is used to assess EMS, and one objective was the validation of the YSQ-SF in a post-stroke sample. The validated questionnaire was subsequently used to identify EMS as covariates of post-stroke acute phase depression. Further, additional variables of health locus of control, social support and level of disability, among others, were also explored as covariates. The sample consisted of a total of 69 participants (M=64.97, SD=14.72 years old) who were recruited on average 25.10 days (SD=29.61) post-stroke. The theoretical structure of the YSQ-SF was successfully replicated in this post-stroke sample with 68 of the original 75 items having loadings greater than 0.40 and internal consistencies ranging between 0.62 and 0.89, and significant acute phase covariates with acute phase depression were the Failure to Achieve and the Vulnerability to Harm EMS. These findings show promising trends in the involvement of EMS in post-stroke psychopathology which warrants further investigation in this clinical group. (217 words) Summary Stroke is the third most common cause of disability worldwide (Mackay et al., 2004) and post-stroke depression is the most frequent neuropsychiatric disorder affecting acute stroke patients (Caeiro et al., 2006). Post-stroke depression is commonly diagnosed during the acute and subacute phase post-stroke with peak prevalence 3-6 months post-stroke (Newberg et al., 2006) and is associated with higher rates of morbidity, mortality and poor rehabilitation outcomes (Newberg et al., 2006; Whyte et al., 2006). Psychosocial factors associated with post-stroke depression include an external health locus of control (Thomas et al., 2006; Johnston et al., 1999), and lack of a social network and tangible support (Glymour et al., 2008; Huang et al., 2010; Salter et al., 2010). Demographic variables include gender and race, with women being at increased risk of depression post-stroke (Paolucci et al., 2005; Zhang et al., 2013) as well as white, non-Hispanic patients (Jia et al., 2010). Further, some medical/illness factors including lesion location (Allman, 1991; Caeiro et al., 2006), aphasia (Thomas et al., 2006), and level of impairment on activities of daily living (Hilari et al., 2010) increase risk for depression. Schemas are mental structures that are created through experience and guide our response to our environment (Tuddenham, 1966; Berlyne, 1957). Young, Klosko & Weishaar (2003) presented 15 Early Maladaptive Cognitive Schema (EMS), which fit into 5 higher order domains, and are said to be the core of psychopathology and the result of adverse childhood experience. The Young Schema Questionnaire Short Form (YSQ-SF) is a 75-item questionnaire used to assess EMS. The psychometric properties of the YSQ-SF have been assessed in undergraduate and various clinical samples and translated into multiple languages (Wellburn et al., 2000; Lachenal-Chevallet et al., 2006; Cui et al., 2011; Calvete et al., 2005). The YSQ-SF appears sound for research and clinical practice, however the psychometric properties have not previously been assessed in a post-stroke clinical sample. The main objectives of this research were to assess the factor structure of the YSQ-SF in a post-stroke population, and to incorporate EMS as potential risk factors in the acute phase post-stroke. Sixty-nine post-stroke patients with an average age of 64.97 years (SD=14.72) were recruited 25.10 days (SD= 29.61) post stroke. The BDI, YSQ-SF, Social Support Questionnaire, Barthel Index, and Multidimensional Health Locus of Control were administered and demographic variables of gender, location of stroke, marital status, ethnicity, living arrangements, level of education, occupation, and previous history of psychopathology were collected. Cross-sectional analyses included a factor analysis for the validation of the YSQ-SF, and a regression identifying covariates of depression. Due to the sample size and recommendations for a factor analysis, the factor structure was assessed using the higher order domain breakdown creating an acceptable item to participant ratio for each domain. Domain 1: Disconnection/Rejection 2.76:1, Domain 2: Impaired Autonomy 3.45:1, Domain 3: Impaired Limits 6.9:1, Domain 4: Other-Directedness 6.9:1, and Domain 5 Overvigilance 6.9:1. The results of the current study yielded a successful replication of the YSQ-SF, validating all 15 EMS with 68 out of the original 75 items. Factor loadings were greater than 0.40, and internal consistencies ranged between 0.62 and 0.89, with 10 of the 15 schema over the accepted 0.70 level. Overall, the factor structure and underlying construct of each EMS was not compromised in this sample and despite sample size limitations the current results are consistent with previous research of Welburn et al. (2002), Lachenal-Chevallet et al. (2006), and Cui et al. (2011) who replicated the theoretical structure with a range between 59 and 70 of the 75 items and between 13 and 15 of the original 15 schemas. Of all the variables collected only the EMS of Failure to Achieve and Vulnerability to Harm were significant in the regression model. As both variables increased, depression scores increased. The EMS of Failure to Achieve has been positively correlated with depression in previous studies and in Wegener et al. (2003) the greater the decrease in the Failure to Achieve EMS was associated with greater symptom reduction in patients with major depressive disorder. Overall, EMS have not previously been explored in a post-stroke population and the results show promising trends in the influence and involvement of EMS in post-stroke psychopathology. EMS warrant further investigation in this clinical group that is highly vulnerable to such influences mainly for rehabilitation and prevention purposes, such as the use of the YSQ-SF as a screening instrument and the use of Schema Therapy as a new potential treatment modality for post-stroke depression.
  • A Survey of the Endometriosis Clinical Nurse Specialist (CNS) Role in British Society for Gynaecological Endoscopy (BSGE) Registered Centres.
    A Survey of the Endometriosis Clinical Nurse Specialist (CNS) Role in British Society for Gynaecological Endoscopy (BSGE) Registered Centres. Norton, Wendy; Mitchell, H.; Holloway, Debby Endometriosis is a life challenging disorder that affects over 1.5 million women in the UK – around 1 in 10 women (Royal College of Nursing, 2015a). Given the uncertain and enigmatic nature of the condition and an average of 7.5 years from the onset of symptoms to diagnosis, endometriosis has a significant impact on women’s lives across a wide range of domains, including family life, work and social life, and quality of life more generally. Endometriosis not only has physical implications but can lead to significant amounts of distress amongst women. A patient-centred approach is required to manage this condition, for which there is no cure. The role of the Endometriosis CNS is complex and demands a range of clinical, management and leadership skills. This role represents one of the first health service provision commissions to have stipulated that a service must have a nurse within the team. It is recognised that as this is a developing role, not all nurses have the full skills set required to meet all components outlined in the Royal College of Nursing skills and knowledge framework, and anecdotal evidence suggests there is disparity amongst the CNS roles across BSGE centres. However, this new post has yet to be evaluated. Our study will be the first to explore the Endometriosis CNS role and the perceived benefits of this role for patient care. This presentation reports the findings from a nationwide survey of CNSs in BSGE centres exploring the current roles and responsibilities being undertaken. This study will add to the portfolio of endometriosis research currently being undertaken by the DMU Centre for Reproduction Research.
  • Exploring the lived experiences of mothers with Ankylosing Spondylitis
    Exploring the lived experiences of mothers with Ankylosing Spondylitis Syed, H.; Mitchell, H. Ankylosing Spondylitis (AS) is a chronic, inflammatory condition. Symptoms include joint pain, stiffness and fatigue, with onset often occurring during young adulthood. The onset and complexity of the condition can potentially disrupt plans to start a family and make caring for young children difficult. There is currently limited research that focuses on the impact of AS on women with young children. The aim of this study was to explore the experiences of mothers with AS, focusing on the physical, psychological and social effects of the condition. Ten participants were recruited via an advert on the National Ankylosing Spondylitis Society (NASS) website. They were aged between thirty one and forty two, had been diagnosed with AS for between two and twenty five years, and had at least one child under the age of eleven. In-depth, semi-structured interviews were conducted; nine participants were interviewed by telephone, and one via Skype. Interviews ranged in length from twenty two minutes to eighty three minutes. Data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA). Three inter-related themes were found; uncertainty of the future, guilt associated with AS, and maintaining control. The findings demonstrated the significant impact AS can have on all spheres of life for the participants and their families. Due to the physical limitations and the unpredictability of the condition individuals were unable to maintain previous levels of activity. This made it difficult to make plans and prevented them from fulfilling their perceived parental role which resulted in feelings of frustration and guilt. For many participants there was a sense of an ongoing battle with the condition due to their inability to continue with tasks that were previously taken for granted. However, participants described their journeys of adjustment to establish and maintain control and bring a sense of normality back into their lives. This was achieved by modifying daily tasks such as carrying and changing babies, and increasing activities that they could do with their children that did not exacerbate their pain. Additionally, some participants felt that having AS had influenced their parenting styles and had made them mentally stronger and more compassionate. This study highlights the issues faced by women with AS who have young children, whilst acknowledging the positive aspects of parenting whilst living with the condition. Signposting parents with AS to sources of support and providing information on performing tasks
  • ‘We needed to change the mission statement of the marriage’: biographical disruptions, appraisals and revisions among couples living with endometriosis
    ‘We needed to change the mission statement of the marriage’: biographical disruptions, appraisals and revisions among couples living with endometriosis Hudson, Nicky; Culley, Lorraine; Law, Caroline; Mitchell, H.; Denny, E.; Raine-Fenning, N. The concept of biographical disruption has been widely applied in sociological explorations of chronic illness and has been subject to much theoretical scrutiny, reflection and development. However, little attention has been given to the impact of biographical disruption beyond the individual level. This article explores the concept from a dyadic perspective, utilising data from an exploratory, qualitative study (ENDOPART) that investigated the impact of endometriosis on women and their male partners. In total, 22 couples participated in in-depth, semi-structured, face-to-face interviews. The women and their partners were interviewed separately and, in most cases, simultaneously, by different interviewers. Data analysis was informed by an interpretivist relational approach, foregrounding the meanings participants applied to their experiences, treating interviews as accounts, and exploring partners’ accounts in relation to one another. Two analytic approaches generated several themes for exploration in the context of the concept of biographical disruption: sex and intimacy; planning for and having children; working lives and social lives. The article argues that biographical disruptions are social and inter-relational processes and discusses how couples living with endometriosis negotiated these disruptions, how they were appraised and how lives and expectations were revised as a result. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Treatment decision-making and support needs in heterosexual couples living with endometriosis
    Treatment decision-making and support needs in heterosexual couples living with endometriosis Mitchell, H.; Hudson, Nicky; Culley, Lorraine; Law, Caroline; Denny, E.; Raine-Fenning, N. Endometriosis impacts upon a range of domains including intimate relationships. However, previous research has focused on the woman at the expense of her partner who may also be negatively affected by the condition and its treatment. Couples were interviewed to provide in-depth data on living with endometriosis, either as patient or partner. This paper focuses on decision-making regarding management, and couples’ information and support needs. Twenty-two heterosexual couples, together for at least 12 months, and where the woman had laparoscopically-diagnosed endometriosis, were recruited via NHS clinics, support groups and snowball sampling. Separate, in-depth, face-to-face interviews (n=44) were conducted and transcribed verbatim. Data were analysed thematically and dyadically. Treatment decisions had implications for both partners. The majority of couples reported discussing surgical and medical options together, with men being described as ‘largely supportive’. However, whilst women reflected on living with and managing the condition in the longer term, men reported a desire for a cure and, for some partners, hysterectomy was perceived as a way to “fix” endometriosis. Healthcare professionals need to consider the role of partners in treatment decision-making and be aware that within the couple unit patients and partners may have differing views about how endometriosis should be treated. Signposting to support groups and relevant information, along with couple-focused information that highlights the effect of endometriosis on relationships, would be welcomed by patients and their partners. In addition, men highlighted the need for advice on how best to support their partner and cope with living with endometriosis themselves.

Click here to view a full listing of Helene Mitchell's publications and outputs.

Research interests/expertise

  • Psychology of chronic illness including Illness cognitions, expectations, experiences and self-managment

Areas of teaching

  • Health Psychology MSc:
  • Understanding and managing chronic conditions (module leader, PSYC5603)
  • Research methods for health psychologists (PSYC5605)
  • Dissertation supervision (PSYC5608)
  • Psychology undergraduate programme
  • Psychology of chronic illness (module leader, PSYC3077)
  • Project supervision (PSYC3000)
  • Further research methods for psychologists (PSYC2013)
  • Empirical psychology seminars (PSYC1094)

Membership of external committees

  • British Psychological Society – Chartered psychologist (from Summer 2008)
  • British Health Professionals in Rheumatology – Member

Conference attendance

  • British Society for Rheumatology/British Health Professionals in Rheumatology 21 – 23 April 2010, Birmingham. Co-chair of oral presentation session.
  • British Psychological Society Division of Health Psychology, 15–17 September 2010, Belfast.
  • Psychological Society Division of Health Psychology, 14–16 September 2011, Southampton.

Consultancy work

Psychological factors in chronic illness

Current research students

  • Maria Stalias (full-time international student, 2nd supervisor)
  • Kylie Baldwin (full-time student, 2nd supervisor)

Externally funded research grants information

Endopart: Improving the well-being of couples, ESRC small grants section, qualitative study. Start 01/01/12, end 31/12/12. CI, collaborators: Lorraine Culley, Nicky Hudson (both DMU), Elaine Denny (Birmingham City University), Nick Raine-Fenning (University of Nottingham)

Professional esteem indicators

  • Arthritis Care and Research, Rheumatology (Reviewer)
  • British Health Professionals in Rheumatology (BHPR) Reviewer
Helene Mitchell

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