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
Danny Yip - Collaborator - Office for Health Improvement and Disparities
Holly Hope - Collaborator - University of Manchester
Kathryn Abel - Collaborator - University of Manchester
Louis Thackray - Collaborator - Office for Health Improvement and Disparities
Louise Howard - Collaborator - King's College London (KCL)
Matthew Wickenden - Collaborator - NHS England
Sarah Dunsdon - Collaborator - NHS England
Practice Level Index of Multiple Deprivation Domains