Reducing risk of mental health relapse after childbirth

Mother holds baby

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, and in partnership with the University of Exeter, the London School of Hygiene & Tropical Medicine and the University of Liverpool, 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 The 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.

Professor Helen Sharp, Professor of Perinatal and Child and Adolescent Clinical Psychology, University of Liverpool, a co-author in this study, said: “The findings of this study support the argument for continued CPMHT provision in all areas nationally, which of course includes all areas of the Liverpool city region, ensuring women have access to specialist perinatal mental health care and support. The need for close working relationships between mental and physical health care providers during pregnancy is also highlighted. Our findings suggest CPMHT service provision should be prioritised at a policy and practice level going forward.”

Professor 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.

Professor 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.”

This study was possible thanks to funding from the National Institute for Health and Care Research.

The paper, ‘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’ was published in The Lancet Psychiatry (DOI: 10.1016/S2215-0366(23)00409-1)