New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, and in partnership with the University of Exeter and the London School of Hygiene & Tropical Medicine, has found that women with a history of severe mental illness face a lower risk of relapse after giving birth in regions where they have access to a community perinatal mental health team (CPMHT).
The research, published in Lancet Psychiatry, is the first of its kind to evaluate the effectiveness of CPMHTs, and suggests that women with access to specialist support have a reduced risk of acute relapse after birth, but also highlights the importance of the need for mental health services to work more closely with maternity services.
CPMHTs were rolled out in England from 2016 as part of a unique national initiative to improve the access to specialists for women with perinatal mental health problems and overall mental health outcomes. Women with a history of severe mental illness such as bipolar disorder and severe depression are at greatly increased risk of relapse in the first few months after birth and CPMHTs aim to improve access to preventive care during pregnancy in addition to treating new episodes of mental illness during pregnancy and after birth. However, little research has been conducted into exploring the effectiveness of such CPMHT care.
This study identified 70,323 women who had given birth to a single baby, and who had contact with a secondary mental healthcare service in the ten years immediately before their pregnancy. Researchers followed this group to establish how many experienced acute relapses in their mental health after birth – defined as either being admitted to a psychiatric hospital, or being cared for by a crisis resolution team.
Researchers found that access to care significantly improved – 24.2% of women accessed care during pregnancy in areas where a CPMHT was available compared to 17.9% in areas where no CPMHT was available. In addition, an acute relapse after birth was found in 1117 (3·6%) of 31 276 women where a CPMHT was available and in 1745 (4.5%) of 39 047 women where one was unavailable.
Prof Heather O’Mahen, Professor in perinatal clinical psychology, University of Exeter, one of the study’s senior co-authors said, “Pregnant and postnatal women can face many barriers to mental health care. The government’s investment in CPMHTs has made a real difference in their ability to access needed treatment.”
Prof Louise Howard, Professor Emerita of Women’s Mental Health and one of the study’s senior authors from King’s IoPPN said, “The period after birth can be a time of increased risk for women with severe mental illness such as those with bipolar disorder or a history of severe depression. It is very encouraging to see that having a community perinatal mental health team in an area is associated with significantly reduced rates of relapse after birth – a time when mothers want and need to be well, and at home with their infants”.
Conversely, the researchers found that women in regions with CPMHTs were at an increased risk of undergoing stillbirth, neonatal death, and giving birth to babies small for their gestational age.
Prof Dharmintra Pasupathy, co-author, Professor of Maternal and Fetal Medicine, University of Sydney said, “There is no simple interpretation that we can give for these associations but it may be that more intensive psychiatric support available in a region may negatively affect the midwifery and obstetric support that women with severe mental disorders receive during pregnancy and childbirth. This is something that we urgently need to study in greater depth as the full facts are not clear.”
Dr Ipek Gurol-Urganci, the lead author, Associate Professor of Health Services Research, London School of Hygiene and Tropical Medicine said, “The results of this study highlight the value of the data that the NHS routinely collects on the care they provide. Without these national data, it would not have been possible to evaluate the role of CPMHTs, a unique approach to provide support to women with severe mental illness during pregnancy and after birth.”
This study was possible thanks to funding from the National Institute for Health and Care Research.
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Community perinatal mental health teams and associations with perinatal mental health and obstetric and neonatal outcomes in pregnant women with a history of secondary mental health care in England: a national population-based cohort study (DOI10.1016/S2215-0366(23)00409-1) (Ipek Gurol-Urganci, Julia Langham, Emma Tassie, Margaret Heslin, Sarah Byford, Antoinette Davey, Helen Sharp, Dharmintra Pasupathy, Jan van der Meulen, Louise M Howard, Heather A O’Mahen) was published in Lancet Psychiatry.
About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience
King’s College London is amongst the top 35 universities in the world and top 10 in Europe (THE World University Rankings 2023), and one of England’s oldest and most prestigious universities.
With an outstanding reputation for world-class teaching and cutting-edge research, King’s maintained its sixth position for ‘research power’ in the UK (2021 Research Excellence Framework).
King's has more than 33,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff. The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s is a leading centre for mental health and neuroscience research in Europe. It produces more highly cited outputs (top 1% citations) on psychiatry and mental health than any other centre (SciVal 2021), and on this metric has risen from 16th (2014) to 4th (2021) in the world for highly cited neuroscience outputs. In the 2021 Research Excellence Framework (REF), 90% of research at the IoPPN was deemed ‘world leading’ or ‘internationally excellent’ (3* and 4*). World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness, neurological conditions, and other conditions that affect the brain.
www.kcl.ac.uk/ioppn | Follow @KingsIoPPN on Twitter, Instagram, Facebook and LinkedIn
About the University of Exeter
The University of Exeter is a Russell Group university that combines world-class research with high levels of student satisfaction. Exeter has over 30,000 students and sits within the Top 15 universities in The Guardian University Guide 2023, and in the top 150 globally in both the QS World Rankings 2022 and THE World University Rankings 2023. In the 2021 Research Excellence Framework (REF), more than 99% of our research were rated as being of international quality, and our world-leading research impact has grown by 72% since 2014, more than any other Russell Group university.
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The London School of Hygiene & Tropical Medicine (LSHTM) is one of the world’s leading public health universities. Its 3,500 staff and 4,700 students are working together to help create a more healthy, sustainable and equitable world for everyone. With main sites in London, The Gambia and Uganda, and an annual research income of £190 million, it is uniquely placed to make a tangible impact on people’s lives through highly-rated research, postgraduate education and global networks. LSHTM’s mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.
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As Australia’s first university – founded in 1850 – the University of Sydney has a proud history of global leadership in education and research and inspiring people from all backgrounds to contribute to positive real-world change. We’re a world-renowned teaching and research institution – our research combines the expertise and talents of scholars from many disciplines.
Journal
The Lancet Psychiatry
Method of Research
Observational study
Subject of Research
People
Article Title
Community perinatal mental health teams and associations with perinatal mental health and obstetric and neonatal outcomes in pregnant women with a history of secondary mental health care in England: a national population-based cohort study
Article Publication Date
23-Jan-2024
COI Statement
The authors declare funding from The National Institute for Health and Care Research to deliver this study on the effectiveness of community perinatal mental health services, which was carried out by a consortium led by The University of Exeter, including King’s College London, University of Oxford, London School of Hygiene & Tropical Medicine, University of Sydney, and University of Liverpool (17/49/38). We declare no other competing interests.