Pregnancy and becoming a parent are important and exciting events in women’s life. It is natural to experience a range of emotions during this time, with some feelings being mixed or negative. For some women these experiences might affect their day-to-day life and might have long-lasting consequences. These women might be experiencing a perinatal mental health problem. Like any other times in life, pregnant women and new mothers can experience many different types of mental health conditions and the severity can vary. This might be a new mental health problem, but also a condition or an episode of a problem they experienced before pregnancy. Understanding of how many women experience this wide range of mental health problems during pregnancy and after birth is limited. This study will look at women who gave birth in 2016 in England. It will estimate a proportion of women who experienced different types of mental health problems (old and new) during pregnancy and up to 2 years after birth. It will also look how mental health conditions might vary between women of different age and from different communities. Finally, this study will estimate how many women in local areas might be experiencing mental health problems. This study will help to understand the burden of mental health problems in women during pregnancy and after birth across England. The results will contribute to women needs being better reflected in the provision of mental health and care systems across England.
Pregnancy is an important event in the life-course of a women that can have significant impact on the mental health needs of the individual. Existing evidence base has shown the absence of a reliable estimation of perinatal mental health prevalence across England, or how this prevalence may vary across the types of mental health conditions. There is a need to produce more informed estimates of prevalence surrounding perinatal mental health to help us understand mental health needs of women during this period. The purpose of this study is to estimate the prevalence of perinatal mental health conditions in women aged 15 to 55 years in England and at the local population level. The study is exploratory, by determining women with evidence of birth event in the CPRD using a validated algorithm combining live births, still births, and premature births codes indicative for a birth event. Historic medical data 1 year preceding and 2 years following the birth event will be included. A wide range of new and pre-existing mental health conditions will be examined based on diagnosis, and combination of symptoms and/or medication. The main outcome variables are counts and proportion of women with a mental health condition including demographic and socio-economic data. Descriptive analysis will be used to present overall prevalence of perinatal mental health conditions, and variation in prevalence by conditions sub-groups and women characteristics. Adjusted multi-variable logistic regression will be used to assess variables that are significant predictors of mental health conditions prevalence in perinatal period. Synthetic estimation approach will be used to calculate local prevalence estimates. This study will generate evidence about the prevalence of perinatal mental health of women who gave birth based on recent primary care data, representative for the England population.
Primary outcomes: national prevalence of mental health conditions in perinatal period; national prevalence of mental health condition sub-groups in perinatal period; national prevalence of mental health condition in perinatal period by age groups/ ethnicity groups/ deprivation quintiles; local prevalence of mental health conditions in perinatal period
Secondary outcomes: national prevalence of mental health conditions in perinatal period by combination of deprivation quintiles, age groups and ethnicity groups for local estimates purpose.
Amendments – 24 September 2021
The following amendments are requested (including justification for request)
Amended 2 – report prevalence at 1-year follow up post birth
This study aligns the main period prevalence outcome with NHS Long Term Plan - up to 2 years post birth for women experiencing mental health problems during and after pregnancy. Expert reference group advise was that comparison of period prevalence between up to 2 years post birth and up to 1 year (as (secondary outcome measure) would be of value to understand the impact of this change. However, study main findings and local prevalence estimates (primary outcome measures) will be reported based on up to 2 years post birth follow up.
Amendment 3 – addition of region as analytical variable and outcome measure
Evidence suggest* that regional differences in the prevalence of maternal and perinatal mental illness exists with highest prevalence in regions with the most deprivation. Initial analysis from this study shows that regional differences in the prevalence estimates are also present and expert advice was that region is included as:
• Primary outcome measure – regional prevalence of mental health conditions in perinatal period
• In the modelling approach of local prevalence estimates
* Abel KM, Hope H, Swift E, Parisi R, Ashcroft DM, Kosidou K, et al. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. The Lancet Public Health. 2019;4(6):e291-e300. (https://doi.org/10.1016/S2468-2667(19)30059-3)
Gabriele Price - Chief Investigator - Office for Health Improvement and Disparities
Gabriele Price - Corresponding Applicant - Office for Health Improvement and Disparities
Arvinder Duggal - Collaborator - Office for Health Improvement and Disparities
Cam Lugton - Collaborator - Office for Health Improvement and Disparities
Holly Hope - Collaborator - University of Manchester
Jianhe Peng - Collaborator - Office for Health Improvement and Disparities
Kathryn Abel - Collaborator - University of Manchester
Katie Dowden - Collaborator - Office for Health Improvement and Disparities
Louis Thackray - Collaborator - Office for Health Improvement and Disparities
Matthew Wickenden - Collaborator - NHS England
Sarah Dunsdon - Collaborator - NHS England
Danny Yip - Collaborator - Office for Health Improvement and Disparities
Louise Howard - Collaborator - King's College London (KCL)
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record