One in five women experience mental health problems during or after pregnancy, yet fewer than one in ten are referred to specialist care, and anxiety disorders are especially likely to be missed. This matters because untreated perinatal anxiety does not just harm the mother—72% of the £8.1 billion annual cost of perinatal mental health problems in the UK comes from long-term effects on the child. Current NHS services focus heavily on depression, leaving women with anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder without clear care pathways. The research team will follow 1,600 women through pregnancy and two years after birth, tracking who gets what care, what it costs, and whether it works. They will also interview 60 women and 60 health professionals to understand why services are underused and what would make them acceptable. If this succeeds, NHS commissioners will have concrete evidence on how to redesign perinatal mental health services so that women with anxiety disorders are identified, referred, and treated as routinely as those with depression. That could shift the current pattern where most women with perinatal mental health problems receive no care at all.
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Background: Perinatal mental health (PMH) problems affect one in five women and cost the UK £8.1 billion for every year of births, with 72% of this cost due to the long-term impact on the child. Currently only 30-50% of women with PMH problems are identified and 7% referred to specialist care. The majority of women with PMH problems therefore do not access care and this may be particularly the case for women with mild to moderate PMH problems or those with less commonly recognised problems, such as anxiety, obsessive compulsive disorder or post-traumatic stress disorder. Despite this, there is no quantitative research with nationally representative samples looking at care and health service use for perinatal anxiety and associated disorders. Health service use can be affected by many factors, such as whether anxiety is identified, what services are available and whether they are accessible, and whether they are acceptable to women. To improve access to care the NHS continues to invest in PMH services but there is little UK-wide research on how these services are being used by women. Aims: To examine what care is offered to and accessed by women experiencing perinatal anxiety and associated disorders; the impact and cost of that care; as well as inequalities and regional variation from the perspectives of women and healthcare personnel. Methods: This will be achieved through five connected work packages (WP). WP1 will determine the health service utilisation, self-report experiences and outcome measures, and health inequalities of women with and without perinatal anxiety and associated disorders. We will follow up an existing cohort of 1600 women who are currently being followed through pregnancy by the MAP study (HS&DR 17/105/16) at 6, 12 and 24 months after birth. In WP2 we will examine mental health history and health service utilisation in more detail, and examine concordance with self-report measures, by extracting data from primary care records for a subsample of 44 women diagnosed with anxiety or associated disorders during pregnancy or after birth. WP3 will explore women’s preferences for, perceptions of and acceptability of care they were offered/received, and regional variation through in-depth qualitative interviews with a purposive subsample of 60 women. WP4 will explore views on and barriers to management of perinatal anxiety and associated disorders and how to develop pathways for optimal care through in-depth qualitative interviews with a purposive sample of 60 health professionals working with perinatal women (e.g. maternity, primary care, health visiting and mental health services) or commissioning services. In WP5 we will determine the costs of health service use for women with and without perinatal anxiety and associated disorders through embedded health economic measures in WP1, WP2 and WP3. Anticipated impact: This study will lead to recommendations for accessible, integrated care that is acceptable to women. It will assist NHS commissioners and providers in the design and transformation of services for perinatal women. This will increase the chances for women to receive better care to improve maternal and child outcomes.
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