'This review provides a useful summary of clinical practice guidelines on psychosocial and psychological assessment and intervention during the perinatal period. The overview of each guideline will be particularly useful for busy NHS clinicians working in perinatal services.'
Implications for practice and research:
-Many maternal suicides occur after 42 days post partum, suggesting a need for targeted suicide prevention for late maternal suicides.
-Improved data linkage between suicide and maternal deaths could inform service design and commissioning but requires integration with suicide prevention theory to design and deliver effective suicide prevention interventions.
To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
'provision of community perinatal mental health teams is associated with increased mental health service access and reduced post-partum relapse, as well as reductions in pre-term birth. However, higher rates of stillbirth and neonatal death in regions where such teams are provided show that investment in mental healthcare alone cannot be assumed to influence the pregnancy risks known to be higher in women with mental health conditions.'
Commentary on Exploring Black and South Asian women’s experiences of help-seeking and engagement in perinatal mental health services in the UK. Frontiers in Psychiatry, 2023
Overall, this was a well-designed and careful study with important findings for women of a child-bearing age who may be sensitive to hormonal changes in reference to their depression.
Predicting the course and complications of perinatal depression through the identification of clinical subtypes has been previously undertaken using the Edinburgh Postnatal Depression Scale and has the potential to improve the precision of care and improve outcomes for women and their children. https://onlinelibrary.wiley.com/doi/10.1002/cpp.2893?af=R
Healthcare professionals need increased awareness and knowledge of the risk of perinatal mental illnesses among migrant women, and mental health should be routinely discussed in maternity and other healthcare services that serve women who are migrants.
This review, alongside evidence of the barriers marginalised women face when accessing perinatal mental healthcare (Pilav et al., 2022), demonstrates the importance of ensuring that prospective service investment and development projects make provisions for marginalised mothers. This is especially important considering recent investment in perinatal mental health services through the NHS Long Term Plan, to ensure all mothers are adequately supported. Example provisions include: training on stigma and culturally competent approaches for professionals, or adapted interventions which are co-produced by lived experience experts (Darwin et al., 2022; Pilav et al., 2022).
The prevalence of postnatal depression in fathers is likely to be close to the prevalence of postnatal depression in mothers. Beyond the detrimental consequences for the father, paternal postnatal depression negatively affects the well-being of the mother and the development of the child. Paternal postnatal depression is not commonly understood and there is a lack of assessment and support for new fathers experiencing mental health issues, but the importance of paternal mental health is increasingly recognised. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
There is increasing interest in the role of choline in brain development, including its possible role in promoting mental health and preventing mental illness. Choline is an essential micronutrient in fetal brain maturation. In more than 90% of pregnant women, choline intake has been found to be lower than the daily-recommended dose. The aim of this article is to review what is known about the effects of maternal choline supplementation on fetal brain development, early child development and mental health. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Mother and father depression symptoms often co-occur, and together can have a substantial impact on child emotional well-being. Little is understood about symptom-level mechanisms underlying the co-occurrence of depression symptoms within families. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Besides the moderation analyses, the study provides further evidence for the association of prenatal stress and children’s subsequent psychopathological symptoms. It therefore emphasises the need for early supportive interventions aimed at mothers who report a high burden of prenatal stressors. The reduction of modifiable prenatal stressors (e.g. lack of social support, work stress, burden of internalising symptoms, substance consumption) would likely have long-lasting positive effects on children’s mental health and might be feasible within the scope of interventions targeting mothers’ well-being. Such interventions could include support groups for pregnant mothers or short-team (maybe even group- or internet-based) cognitive behavioural interventions.
Population-level screening for parental childhood maltreatment could be a tool to identify families who might be in need of support to reduce the risk of adverse outcomes in children. This could also be useful in terms of safeguarding since research has found that parents with a history of childhood maltreatment (particularly emotional or physical abuse) had a higher risk of abusing their own children (Bert et al., 2009), as well as higher levels of anger, and more violent physical discipline toward infants (Altemeier et al., 1986).
Previous research has suggested that some women are at increased risk of postpartum depression (PPD) because of an extra sensitivity to fluctuating hormones before and after parturition. This may particularly apply to women with endocrine disease, characterised by a less than optimal capability to self-regulate the hormonal feedback system. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
it suggests that there is an emerging evidence base for the use of CBT for perinatal depression specifically. The finding that different formats of CBT (e.g., in person and remote) are effective is especially relevant, considering recent changes in how clinical care is delivered as a consequence of the COVID-19 pandemic, though it is worth noting that internet-based interventions were associated with the highest attrition rate.
The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians.
Women are predisposed to maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children. The uptake of mental healthcare by British mothers of African/Caribbean origin is low due to the lack of access to culturally appropriate care. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
This study identified elevated rates of depression and anxiety in pregnant individuals, as measured during the COVID-19 pandemic. Though elevated insomnia and sleep problems were reported, they did not differ significantly from pre-COVID pregnancy samples.
Financial difficulties, social isolation, risk of COVID-19 infection, and relationship difficulties experienced as a result of the pandemic were found to be related to elevated mental health symptoms. Results also indicated a detrimental effect of negative cognitive appraisal and a protective effect of greater access to social support.
These results highlight the impact of the pandemic on the wellbeing of pregnant individuals, and indicate areas for focus when developing intervention and support measures.