Proposed research looks to improve understanding of perinatal anxiety (PNA) and its effects. The term “perinatal anxiety” refers to anxiety (excessive worrying, restlessness, nervousness) that occurs during pregnancy and/or up to 12 months after birth. During this period, women are at greater risk of experiencing common mental health disorders. Our research will help raise awareness about this and support healthcare decisions, which is of further importance given that COVID-19 pandemic has resulted in higher number of pregnant women experiencing mental health problems.
The applicants have already carried out research which examined the experiences of diagnosis and treatment of PNA. We found that knowledge among healthcare professionals is often limited about PNA. This is likely to have negative effects on care women receive.
We propose using information from a large national database of anonymised patient records to select a group of women to compare. This group will include women who are pregnant and those who are not, women with children and those without and women with PNA and those without. We will assess the following:
- the role of pregnancy and anxiety in terms of health and healthcare use;
- whether the children of these women experience different patterns of healthcare use;
- whether women with PNA can be grouped according to background factors (age, deprivation), pregnancy details (gender, delivery method and outcome), lifestyle choices, other medical conditions;
- groups at greatest risk of increased healthcare use and those more likely to experience severe mental health problems.
Up to one in five women experience a common mental health disorder during the perinatal period, defined as the period from the start of pregnancy to 12 months after delivery.
PNA is associated with a range of adverse outcomes; the literature however has predominantly focused on child-related outcomes. It is important that the overall and specific healthcare and medication utilisation burden are considered in women with PNA, and their children, as well as identification of more severe mental health conditions.
The objectives are
(a) Estimate healthcare utilisation, diagnoses of new mental health disorders, self-harm and suicide among women with and without PNA
(b) estimate healthcare utilisation among children of women with and without PNA
(c) Describe the characteristics of women with and without PNA
A population-based cohort study of women with perinatal anxiety will be matched to up to 4 women from each of the two comparison groups of women: i) with anxiety outside of the perinatal period, and ii) perinatal period without anxiety. Cox-proportional hazard models will be used to ascertain association of PNA with mental health disorders, self-harm and suicide. Poisson regression models will be used to estimate association of PNA with healthcare utilisation of women and their children.
Understanding the extent and burden of both short- and long-term consequences and patient characteristics that identify those at high risk is essential to select subgroups likely to benefit from early, targeted interventions. Our proposed study will more generally raise the profile of PNA amongst women and healthcare professionals, which should result in earlier identification, and more timely access to care, which in turn would lead to improved maternal and child health outcomes, with savings to the NHS. This is in line with NICE recommending further research into primary care interventions for women with PNA.
Maternal outcomes
Healthcare utilisation: (1) number of primary care clinical encounters, defined as the total number of coded entries in CPRD including consultations with GPs, nurse practitioners, physician associates, healthcare assistants, and other administrative entries within the pregnancy and the first 6 months, 6-12 months, 12-24 months following the delivery date; (2) the number of different medications prescribed (e.g. based on number of different drug substances) within the same time periods; (3) the total number of referrals to specialist care (e.g. mental health services, other hospital specialties); (4) mental health crisis team and hospital admissions (including mother and baby unit). Use will be made of HES APC linked data to ascertain hospital admissions.
Time to diagnosis of another mental health disorder, self-harm and suicide: mental health disorders that will be considered will include: depression, PTSD, bipolar disorder and psychosis. Suicide is a relatively rare outcome and the analysis may only be descriptive for this outcome. Relevant Read-code lists will be used from existing literature or from https://www.keele.ac.uk/mrr/ and will be reviewed by the clinician co-applicants and updated if needed.
Child outcomes (among women who have given birth)
Healthcare utilisation: Number of primary care clinical encounters, defined as the total number of coded entries in CPRD including consultations with GPs, nurse practitioners, physician associates, healthcare assistants, and other administrative entries within the first 6 months, 6-12 months, 12-24 months following the delivery date; (2) the number of different medications prescribed (e.g. based on number of different drug substances) within the same time periods; (3) the total number of referrals to specialist care (e.g. mental health services, other hospital specialties).
Immunisation rates: Child immunisation (from birth) uptake will be compared between children of the two groups of women.
Milica Bucknall - Chief Investigator - Keele University
James Bailey - Corresponding Applicant - Keele University
Carolyn Chew-Graham - Collaborator - Keele University
Charlotte Archer - Collaborator - University of Bristol
Dahai Yu - Collaborator - Keele University
David Kessler - Collaborator - University of Bristol
Holly Smith - Collaborator - University College London ( UCL )
Irene Petersen - Collaborator - University College London ( UCL )
Katrina Turner - Collaborator - University of Bristol
Kelvin Jordan - Collaborator - Keele University
Tom Kingstone - Collaborator - Keele University
Victoria Silverwood - Collaborator - Keele University
Holly Smith - Collaborator - University College London ( UCL )
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD Aurum Pregnancy Register