Support for mild to moderate perinatal mental health difficulties: What Works for Who, And In What Circumstances PATHS Study: Perinatal Mental Health Access and Support

Background: During pregnancy and the first postnatal year (the perinatal period), about 20% of mothers/birthing people and 10% of fathers/non-birthing parents, experience mental health difficulties, frequently anxiety and depression. There is good evidence on the effectiveness of interventions for mild-moderate perinatal mental health (PMH) difficulties, and barriers to accessing care. However, little is known about what is currently being offered relative to this evidence, which interventions work best for whom, or the extent this varies by ethnicity and social deprivation. Aim: To understand what interventions for mild to moderate PMH difficulties work, for whom and under what circumstances, and how we can reduce disparities in access to these. Research questions: What are the range, features and outcomes of interventions being delivered nationally to support parents with mild-moderate PMH difficulties? What are the pathways to accessing interventions for mild-moderate PMH difficulties? What are the factors that contribute to disparities in access for different populations and how are these being addressed? Methods: A Realist Evaluation Approach to determine what works for whom, how, and in what circumstances, applying an exploratory sequential mixed-methods design in three linked work packages (WP): WP1: Stakeholder Engagement Stakeholder consultation through two online workshops with approximately 20 stakeholders (providers and recipients of care) across different settings (e.g., voluntary, community, family hubs, and NHS), and a mapping exercise to understand what current services are being provided, by whom, and the pathways between these, nationally. We will develop and pilot a mixed-methods survey to collect data on these interventions. WP2: Mixed-Methods Survey and Secondary Data Analysis 1) National survey with providers across different settings on the type and features of interventions being provided, who is accessing these, and what outcomes do they have on parents mental health. 2) Secondary data analysis of linked routine NHS Talking Therapies (NHSTT) and maternity care to investigate access and engagement with NHSTT among parents during the perinatal period, pathways to care, intervention type and delivery, and impact on mental health outcomes. WP3: Mixed-Methods Case Studies in Three Regions Realist interviews with: women/birthing people (n=10) and fathers/non-birthing parents (n=5) experiencing PMH difficulties, and providers (n=10) in each area. Purposive sampling using maximum variation, to ensure a diverse sample, regional spread, and to identify areas of good practice. We will request process and outcome data in each region. Analysis and Synthesis: Quantitative will be analysed in STATA and descriptive statistics on the types, frequency, access, and outcomes of interventions produced. Regression analysis will determine relationships between organisational and sociodemographic factors (e.g., ethnicity, social deprivation) and outcomes. We will produce an initial logic model, to describe potential context-mechanism-outcome configurations, which will be tested and refined in WP3 using Framework Analysis. Impact: We will disseminate a range of outputs (e.g., policy reports and briefings, newsletters, academic papers and presentations). Findings will help inform policy and healthcare decisions on the provision of interventions for mild-moderate PMH difficulties, and configuration of care. In the longer-term, it will increase access and improve mental health among parents with mental health difficulties.