Maternal mental health

Introduction

Having a child is a significant life event which affects women both physically and mentally. Maternal health refers to the health of women in the perinatal period of 20 weeks before birth and up to one year after birth. 

Examples of maternal mental illness include antenatal depression, postnatal depression, maternal obsessive compulsive disorder, postpartum psychosis and post-traumatic stress disorder (PTSD). These illnesses can be mild, moderate or severe, requiring different kinds of care or treatment (Maternal Mental Health Alliance, 2014).

Depression and anxiety affects between 10% and 20% of women at some point during pregnancy and for the first year after birth, with around 13% -15% of women experiencing common mental health problems such as perinatal depression and anxiety.  

About half of all cases of perinatal depression and anxiety go undetected and the biggest barrier to providing better support to women experiencing poor mental health in the perinatal period is the low level of identification of need. The Falling Through the Gaps report (2015) concludes women who have depression or anxiety during pregnancy or in the year after giving birth are not having their needs recognised and not getting the support they need as a result. Maternal mental illness also has important consequences infant health and future behaviour and learning which have negative impacts on life outcomes throughout the life course into adulthood

Key inequalities and risk factors

There is a large body of evidence which show a small but significant association between perinatal mental illness and an increased risk of poor psychological and developmental outcomes for the child (Stein, et al., 2014) such as child behaviour, social skills, learning, emotional development and attachment disorders. 

Poor outcomes for the mother include taking inadequate care of herself, sleeping poorly, using illicit substances or failing to gain a sufficient amount of weight (World Health Organisation, 2013).

A number of risk factors exist including:

  • Economic deprivation - A strong correlation exists between high levels of economic deprivation, living in poverty or homelessness and the onset of maternal mental illness
  • Age at pregnancy - There is evidence showing that young maternal age is associated with an increased risk of postnatal depression
  • Ethnicity - There has been limited evidence on perinatal mental illness in black and minority ethnic (BME) women. Some BME women experience significantly higher levels of psychological distress in the perinatal period. These conditions may be chronic and are often linked with other health problems
  • Previous maternal or newborn physical or mental health - present or current history of mental health problems in pregnancy or postnatally, including previous birth trauma, low birth weight, giving birth to a pre-term baby, still birth, etc. as well as a personal or family history of mental illness 

Clinical management and service guidance for maternal mental health published by NICE also recommends consideration of:

  • Vulnerable women – including those who are abused, have sought asylum, have English as an additional language, are misusing drugs and alcohol
  • Physical or mental health issues - There may be limitations or restrictions on taking certain medications during pregnancy or whilst breastfeeding which could make physcial or mental health conditions difficult to manage
  • Learning disabilities or acquired cognitive impairments - may reduce an individual's ability to understand or cope with the phases of pregnancy and develop or engage with any care plan

Specialist guidance around service provision for pregnant women with complex social factors (NICE, 2010) including substance misuse, recent arrival as a migrant, asylum seeker or refugee status, difficulty speaking or understanding English, age under 20, domestic abuse, poverty and homelessness.

Facts, figures and trends

Perinatal mental illness

Perinatal mental health refers to the mother’s mental health in the antenatal period up to the birth and for a year after the baby is born.  The Joint Commissioning Panel for Mental Health (2012) estimated the numbers of women affected by perinatal mental illnesses in England each year:

  • Postpartum psychosis – 2 per 1,000 maternities – approximately 1,380 women
  • Chronic serious mental illness – 2 per 1,000 maternities – approximately 1,380 women
  • Severe depressive illness – 30 per 1,000 maternities – approximately 20.640 women
  • Post traumatic stress disorder – 30 per 1,000 maternities – approximately 20,640 women
  • Mild to moderate depressive illness and anxiety state – 100-150 per 1,000 maternities – approximately 86,020 women
  • Adjustment disorders and distress – 150-300 per 1,000 maternities – approximately 154,830 women

The Maternal Mental Health infographic presents this information visually.

Detection rates have improved, but GPs cited insufficient knowledge, information, continuity of contact and resources to support informed discussion on perinatal mental illness and that practical guides available for women would be helpful as part of a systematic approach to support.

In Bracknell Forest, there is no baseline data or trends in perinatal mental health problems assessed antenatally or postnatally, as this data is collected on individuals who are then referred by local midwifery and health visiting teams to ‘Introducing Access to Psychological Therapy’ services (IAPT) commissioned by CCGs.

However, using the rates above as a guide and based on the 2014 live birth rate (1,510), implies approximately 4% of women in Bracknell Forest experienced severe perinatal mental health issues whilst the majority (680 or 45%) women had issues adjusting, anxiety, low mood or feelings of depression. A survey by Royal College of Midwives reported that levels of low mood and depression could even be as high as 60% as large numbers of women hide or underplay their symptoms.

From October 2015 anonymised postcode level data on risk is being collected by health visiting teams allowing better targeting of prevention and treatment services. The introduction of the Maternity and Children’s Dataset will improve data on all aspects of maternal and child need and service provision.

Postnatal mental health

Postnatal depression is not uncommon, with 10 to 15 in every 100 women currently experiencing some form of the illness (Royal College of Psychiatrists, 2013).  Based on the borough's 2014 live birth rate (1,510), this implies a range of 150 to 227 women potentially affected.

Postnatal depression develops after pregnancy. Symptoms normally develop and emerge around 4-6 weeks after birth, but in some cases can take many months (NHS, 2013). Postnatal depression is an often overlooked and under diagnosed condition that can emerge as a result of a number of predictors. Strong predictors of postnatal depression are depression/anxiety during pregnancy, stressful life events, poor social support or a history of mental illness. Moderate and small predictors include childhood stress, poor self esteem, single marital status, lower socioeconomic status and negative cognitive attributions.

Impact of maternal mental illness

Mental illness relapse or recurrence is well recognised and is estimated to be between 33-55%. A relationship exists between maternal mental illness, low birth weight and giving birth to a pre-term baby. Perinatal mental illness remains a leading cause of maternal death with half of deaths caused by suicide.

Maternal mental health problems are associated children presenting to social care, this is particularly the case where the mother is a sole carer.

Not only can maternal mental illness cause mothers to disconnect and become unresponsive to their baby’s needs, it can also affect the future of the infant in terms of behaviour, learning and emotional development. Children of depressed mothers can develop less playful, more distractible and bad behavioural habits. In addition they can show lower social skills in social settings and their development of intelligence and learning can be affected (WHO, 2013).

Want to know more?

Antenatal and Postnatal Mental Health - Clinical Management and Service Guidance (NICE, 2014 updated 2015) -  makes recommendations for the prediction, detection and treatment of mental health disorders in women during pregnancy and the postnatal period. It includes advice on the care of women with an existing mental health disorder who are planning a pregnancy, and on the organisation of mental health services. It also recommends that a clinical network should be established for perinatal mental health services, managed by a coordinating board of healthcare professionals, commissioners, managers, service users and carers.

Antenatal and postnatal mental health overview (NICE, 2016) – a range of resources intended to provide a clear statement of successful (and unproven) approaches for prevention and treatment in maternal mental including identification and assessment, management and treatment.

Best start in life: promoting good emotional wellbeing and mental health for children and young people (Local Government Association, 2016) - examples of councils that are looking at innovative ways to provide support with a focus on children and families rather than static services, as well as more information about the scale of the problem and what steps can be taken.

Better Mental Health For All - A public health approach to mental health improvement (Faculty of Public Health, 2016) – This report focuses on what can be done individually and collectively to enhance the mental health of individuals, families and communities by using a public health approach. It is intended as a resource for public health practitioners to support the development of knowledge and skills in public mental health.

Falling Through the Gaps (Centre for Mental Health, 2015) - a comprehensive analysis and review of evidence on maternal mental health, who is affected, in what ways, to what extent and the resulting negative outcomes for mothers, children and families. The review makes recommendations on how services can better respond to needs seting out examples of various interventions.

Healthy child programme: rapid review to update evidence (Public Health England, 2015) - looks at engagement with women including verbal interaction, emotional sensitivity and physical care, at all postnatal contacts to determine the best advice, information, support and treatment for identified mental health problems.

Key facts and trends in mental health 2016 (NHS Confederation: Mental Health Network) - provides an overview of the major trends in the mental health sector. Compiled from a wide range of sources, the factsheet sets out available data relating to investment in services, trends in morbidity, suicide and homicide rates, service activity, use of mental health legislation, mental health of children and young people, service user experience, inequalities experienced by people with mental health problems and workforce and staff satisfaction.

Maternal Mental Health Pathway (Department of Health, 2012) – a  tool builds on good practice and evidence drawn from the professions to support the implementation of national guidelines for maternal mental health; midwives and health visitors receive regular training into the detection of mental illnesses and how to proceed with a suspected suffering patient.  It sets out aspirations for service delivery and indicators and ways of measuring outcomes to assess improvement. It outlines our aspirations for service delivery.

Maternal mental health: Improving emotional wellbeing in postnatal care (Royal College of Midwives, 2014) – sets the case for support for women with the onset and progression of preventable mental illnesses through early detection, support through informed choices about treatment and appropriate referral. The document is supported by the views and experiences of affected women and examples of how services and support might respond.

Supporting public health; children, young people and families (PHE, updated 2016) - guidance to support local authorities and providers in the commissioning and delivery of services across the highest impact health and wellbeing outcomes for children and young people through the 0-19 healthy child programme.

 

This page was created on 27 February 2014 and updated on 16 June 2016.  Next review due October 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Maternal Mental Health. Available at: jsna.bracknell-forest.gov.uk/starting-well/maternity/maternal-mental-health (Accessed: dd Mmmm yyyy)

 

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