Why perinatal mental illness matters « PATH

Perinatal mental illness matters because of the following:

MBRRACE-UK reports

Between 10% and 20% of women will develop a mental illness during pregnancy or within the first year after having a baby.

They are also one of the major causes of maternal death (from suicide).

MBRRACE-UK report, 2015 : This report from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity published in 2015, reported that almost a quarter of women who died between six weeks and one year after pregnancy died from mental-health related causes.

MBRRACE-UK Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK

Key messages from the report 2015:

9 women per 100,000 died up to six weeks after giving birth or the end of pregnancy in 2011-13
14 women per 100,000 died between six weeks and a year after their pregnancy in 2011-13
Mental health matters
> Almost a quarter of women who died between six weeks and one year after pregnancy died from mental-health related causes
> 1 in 7 women died by Suicide
Specialist perinatal mental health care matters*
If the women who died by suicide became ill today:

> 40% would not be able to get any specialist perinatal mental health care
> Only 25% would get the highest standard of care
It’s Ok to tell
The mind changes as well as the body during and after pregnancy.

Women who report:
> New thoughts of violent self harm
> Sudden onset or rapidly worsening mental symptoms
> Persistent feelings of estrangement from their baby
Need urgent referral to a specialist perinatal mental health team

*Mapping data from the Maternal Mental Health Alliance http://everyonesbusiness.org.uk

MBRRACE-UK report published in November 2018 shows that maternal suicides continue to be the leading cause of direct deaths occurring between six weeks and one year after the end of pregnancy.

Causes of death amongst women who died between six weeks and one year after the end of pregnancy, UK 2014-16

Causes	Percentage (%)
Coincidental malignancy	20
Suicide	18
Drug and Alcohol / others	13
Cardiac disease	12
Neurology	8
Indirect- malignancy	8
Other indirect deaths	7
Thrombosis and thromboembolism	4
Indirect- sepsis	4
Coincidental- others	2
Homicide	2
Haemorrhage/ early pregnancy death/ pregnancy related sepsis/ eclampsia/ pre-eclampsia	1
Unknown cause	1

Most women will have mild to moderate illness, including depression, anxiety and PTSD, but some will have severe depression, PTSD or pre-existing serious illness like schizophrenia or bipolar disorder or they may develop postpartum psychosis with no previous history. Some women will have drug and alcohol problems.

MMBRACE report 2020 – Infographic

Impact on child and family

Approximately 10% fathers experience PMI but 25-50% of fathers will experience perinatal anxiety or depression when the mother also has a PMI.

The consequences include immense distress for women and their families. The first two years of a baby’s life are the building blocks of their long-term social and emotional development. Please refer to ‘Impact on child development’ for more information.

Cost to society

The huge economic impact of untreated perinatal depression, anxiety and psychosis carries a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, with two-thirds of the cost being linked to short and long term problems for the child

90% of women diagnosed with perinatal mental health illness are cared for in primary care.

Treatment is effective and there are clear guidelines for care. Intervening early reduces the impact of the disorders on the mother, her child and family.