Ep 131 – Perinatal mental health: awareness, risks and impacts

Perinatal mental health (PNMH) issues refer to the period from the point of conception to a child’s first birthday. It encompasses several different mental health conditions and components far beyond the traditional understanding of post-natal depression and has an important impact on families and society. In part, the huge burden and associated cost is driven by how common PNMH problems are for both men and women. PNMH issues are more common than any physical health problem in pregnancy, so there is a need for GPs to look for and manage them to ensure the best outcomes for families and children. In this episode, Dr James Waldron welcomes Dr Jenny Barnes (GP, Warwickshire) to discuss PNMH problems and help raise awareness of the risks and impact, as well as simple ideas to support families in clinical practice.

Key take-home points

• PNMH issues affect one in five women and one in 10 men and include conditions beyond depression and psychosis, such as post-traumatic stress disorder, obsessive-compulsive disorder, anxiety and adjustment disorder.
• PNMH problems cost society £8 billion annually, primarily due to long-term consequences for the child.
• Currently, 45% of pregnancies are unplanned, which can increase the risk of PNMH issues, particularly in second or third pregnancies.
• Only about 50% of PNMH issues are identified, and only half of those are treated effectively.
• Only 40% of women report bonding with their baby immediately, despite societal pressure to do so. This is compounded by social media and societal norms.
• Adjustment disorders can present as various symptoms in response to stressors and may persist until the child’s first birthday.
• Greater attention is needed on mental health, as physical health often takes priority.
• When talking to a patient, avoid terms like "normal"; use "common" instead. Reframe questions to reduce pressure, such as asking "How are you finding being a mum?" or "Can you sleep when your baby sleeps?".
• Both positive and negative judgments can add pressure. Be neutral and supportive in conversations.
• Clinicians and patients must work together to reduce stigma, normalise discussion and improve outcomes.

Related references

1. Royal College of Obstetricians & Gynaecologists. https://www.rcog.org.uk/for-the-public/rcog-engagement-listening-to-patients/maternal-mental-health-womens-voices/.
2. NHS. https://www.nhs.uk/start-for-life/baby/your-mental-health/.
3. Public Health England. 2019. https://www.gov.uk/government/publications/better-mental-health-jsna-toolkit/4-perinatal-mental-health.
4. Howard LM, Khalifeh H. World Psychiatry. 2020;19(3):313-327. doi: 10.1002/wps.20769.
5. Vignato J, et al. J Clin Nurs. 2017;26(23-24):3859-3868. doi: 10.1111/jocn.13800.
6. Muskens L, et al. Arch Womens Ment Health. 2022;25(3):611-620. doi: 10.1007/s00737-022-01225-9.
7. Centre for Mental Health. https://www.hsph.harvard.edu/wp-content/uploads/sites/2413/2017/07/falling_through_the_gaps.pdf.
8. NICE. 2014. http://www.nice.org.uk/guidance/cg192.
9. Lancet Reg Health Eur. 2024:40:100930. doi: 10.1016/j.lanepe.2024.100930.
10. Midlands Perinatal Mental Health. https://midlandspnmh.co.uk/.