The study aims to investigate the rate of mental health problems up to five years after birth. This will inform investment of £365 million in perinatal mental health as part of the Five year Forward View for Mental Health. The study will also determine whether there has been a change in the rate of mental health conditions in pregnancy over time and investigate factors associated with mental health problems in pregnancy and up to five years after giving birth.
This is a retrospective cohort study of women's post-partum mental health diagnoses using CPRD pregnancy register data and GP practice READ codes for mental health problems in the 5 years after birth. This will be identified through either a prescription for medications associated with mental health diagnoses identified, and/or a diagnosis of a mental health condition within the pregnant and 5 year post-partum period. The list of included codes were created in conjunction with academic clinicians and secondary care physicians who are specialists in perinatal mental health disorders. This will allow us to inform the debate about if a newly proposed two year postpartum ‘cut-off’ for access to Perinatal Mental Health (PMH) services is sufficient.
Maternal demographic, clinical and sociodemographic factors will be summarised. For categorical variables, counts and percentages will be reported. For numeric variables means and standard deviations or medians and interquartile ranges will be reported, where appropriate.
For our primary outcome (incidence of maternal mental health disorders in pregnancy and the 5 years postpartum), all analysis will be conducted at an aggregate level and monthly variation in the data will be assessed to explore any effect of seasonality.
Multilevel logistic regression models, clustered by maternal delivery episode, will be fitted to investigate predictors of maternal morbidity and mortality among women from different minority backgrounds. Regression models will be adjusted to account for maternal socio-demographic characteristics and pre-existing medical co-morbidity.
Logistic regression (at cohort entry) and cox regression models will be fitted to identify the rate of maternal mental health disorders at entry and to the subsequent prediction of risk of developing a mental health disorder during the study period (pregnancy through until 5 years post-partum). Both models will be adjusted to account for maternal sociodemographic characteristics, pre-existing medical co-morbidity and neonatal outcomes.
Incidence rate of mental health disorder in pregnancy and each of the first five years after giving birth.
Eleanor JONES - Chief Investigator - University of Birmingham
Jamie-Rae Tanner - Corresponding Applicant - St Helens & Knowsley NHS Trust
Eleanor JONES - Collaborator - University of Birmingham
Lauren Carson - Collaborator - University of Birmingham
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Pregnancy Register