Ulster University

Academic Institute

Economic and Social Research Council

Yes

E097

Perinatal mental health conditions, commonly defined as depression, anxiety disorders, and postpartum psychosis/bi-polar disorder, occur during pregnancy or in the first year following the birth of a child, and can affect up to 27% of new and expectant mums. They are one of the leading causes of maternal death in pregnancy and in the first year after giving birth. Despite the UK government’s commitment to improving perinatal mental health services, as documented in the NHS Long Term Plan (2019), maternal mortality in the UK, unrelated to covid, has increased in recent years. This study will explore the impact of multiple adversity (defined here as social inequalities, socio-demographic factors, maternal interactions with social services in childhood, and domestic abuse) on maternal mortality and morbidity outcomes for women with perinatal mental health conditions in Northern Ireland (NI). Maternal morbidity outcomes include mental health medication use and hospital admissions. The second phase of the study will assess the effect of perinatal mental health conditions on child outcomes. This study has policy implications due to concerns about rising maternal mortality, and the significant and long-lasting effects of mental health conditions on the woman, the child, and the wider family. Previous studies have shown that NI has higher rates of maternal anti-depressant use compared to other Western European countries, and that women living in the most deprived areas in NI have double the rate of antidepressant prescriptions compared to women living in the least deprived areas. However, there has been little research on the effects of perinatal mental health conditions and multiple adversity, and how these impact on maternal mortality and maternal morbidity outcomes. This study will address this gap in the literature so that early effective support and interventions can be implemented to reduce maternal mortality and morbidity outcomes.

While infant mortality is decreasing in the UK, maternal mortality is increasing. Perinatal mental health conditions occur during pregnancy or in the first year following the birth of a child and can affect over a quarter of new and expectant mothers. They are one of the leading causes of maternal death in pregnancy and in the first year after giving birth. To date, there has been little research on the effects of multiple adversity on maternal mortality and maternal morbidity outcomes (assessed by mental health medication use and hospital admissions) in women with perinatal mental health conditions. In particular, the impact of domestic abuse and maternal interactions with social services in childhood has not been assessed in this population. This study will address this gap in the literature so that early effective support and interventions can be implemented to minimise adverse outcomes in this vulnerable population. This study will benefit the public due to the volume of women affected and the significant and long-lasting effects of perinatal mental health conditions on the woman, the child, and the wider family. For instance, in the study period of interest, there was an average of 25,000 births per year in NI which equates to over 6,000 affected women per year, based on current perinatal mental health estimates. In addition, NI has higher maternal antidepressant use compared to other European counties, hence the number of affected women in NI is likely to be higher. Furthermore, our analysis of maternal mental health status as an indicator of future mental health status will enable earlier identification of “at risk” women so that they can be targeted with support and appropriate interventions. This has clear benefit to all the relevant stakeholders, i.e. the affected women, their health care providers, and policy-makers. We have requested the NIMATS data to identify all pregnant women in NI, to obtain information on demographics, risk factors, domestic abuse, and information on maternal self-reported mental illness. NIMATS data are the “core” data and will be used to address all the study objectives (1-7). We request the EPD data to identify all prescriptions for mental health conditions during the perinatal period (Will be used to address objectives 1, 2, 4, 5, 6 and 7). We request PAS data to get information on Hospital Episodes; admissions/discharges; and the Symphony and NIRAES data for information on A&E visits. We ask for the MHLD data up to 2016 for information on mental health inpatient stays. We hope to use the A&E data to validate information on domestic abuse as these women would be expected to have a number of A&E visits if they seek treatment for their injuries. (Will be used to address all objectives 1-7). We request information on the number of deaths due to Intentional self-harm, Injury/poisoning of undetermined intent, and sequelae of intentional self-harm/event of undetermined intent from the Registrar General vital events. (Will be used to address objectives 2, 4, 5, 6 and 7). We recognise the sensitivity of these tragic events and the high risk of disclosure; hence we will do the analysis by grouped years, or all years combined (depending on counts). SOSCARE data will provide information on mothers’ interactions with social services in childhood and the reason for their involvement as these may be important indicators of mortality and morbidity outcomes. (Will be used to address objectives 5, 6 and 7). Finally, we request data from LPS to determine individual level socioeconomic status. (Will be used to address objectives 2, 3, 6 and 7). Based on our previous research, we do not expect to have potential disclosure risks relating to maternal depression or maternal anxiety. However, we expect fewer women with the more severe mental health conditions such as bipolar disorders and postpartum psychosis. If counts in any of the severe perinatal mental condition categories are <10, we have two options for analysing these: 1) Do the analysis for all years combined, rather than by single year or grouped years. 2) Combine bipolar disorders and postpartum psychosis into a single mental health group for analysis i.e. we will not analyse bi-polar disorder etc separately.

29/05/2024

TRE