Pregnancy and having a baby is a life-changing event: the body undergoes major changes. For most women, this is a happy and positive experience, but for some women there may be considerable discomfort or even ill health while pregnant. Recognising depression or anxiety and supporting pregnant women who experience it is important for maternal health and the ultimate health and welfare of the child.
Mental health and inequalities in pregnancy
Estimates suggest that up to 1 in 7 mothers will experience a mental health problem in the antenatal or postnatal period. Engagement with services during pregnancy offers valuable opportunities to promote mental wellbeing and for the prevention of mental health problems.
Quick Links:
- what are health inequalities?
- policy context
- how do inequalities relate to mental health in pregnancy?
- what are the risks from mental health problems in pregnancy?
- identifying those at risk
- protective factors for the mental health wellbeing of expectant mothers
What are health inequalities?
The World Health Organization defines health inequalities as 'differences in health status or in the distribution of health determinants between different population groups'. For a discussion of health inequalities and their relation to pregnancy, please see Inequalities in antenatal care.
Policy context
Activity in this area is consistent with the Scottish Government's action plan for mental health improvement, Mental Health Strategy for Scotland 2012-2015, Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, with Equally Well and with the following (external links):
- The Early Years Framework
- Achieving our Potential
- Getting it Right for Every Child
- Better Health, Better Care: Action Plan
- The Healthcare Quality Strategy for NHSScotland
- A Refreshed Framework for Maternity Care in Scotland
How do inequalities relate to mental health in pregnancy?
Mental health problems can be both a cause and an effect of inequality. Estimates suggest that up to 1 in 7 mothers will experience a mental health problem in the antenatal or postnatal period (NICE - Antenatal and postnatal mental health: implementation advice (external link)).
Women from vulnerable groups, including those experiencing mental health problems, are less likely to access antenatal services and other sources of support - a high risk factor for maternal and infant mortality (Growing Up in Scotland 2011 (external link)).
Women with complex social problems, including mental health problems, report discrimination and judgemental behaviour from healthcare staff and that this impacts on their ongoing engagement with services (Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, pp15)
Overall rates of suicide, schizophrenia, depression and anxiety are all higher among general populations living in the most deprived areas: ISD Scotland - Deprivation and Health (external link).
What are the risks from mental health problems in pregnancy?
Stress and mental illness can have negative impacts on physical health and wellbeing at any time and may limit an individual's ability to access help and support.
The children of mothers who are stressed or anxious during pregnancy (stress being the experience of pressure that exceeds a person's ability to cope) are more likely to be anxious, have symptoms of attention deficit, hyperactivity and other mental developmental problems Fetal and Neonatal Stress Research Group) (external link).
The Confidential Enquiries into Maternal and Child Health (external link) found that suicide is the leading cause of maternal death, and that women at high risk are often not appropriately identified or managed (NICE - Antenatal and postnatal mental health: implementation advice (external link).
Identifying those at risk
The most powerful predictor of mental ill health in pregnancy is a prior history of mental illness NICE Guideline CG192 - Antenatal and postnatal mental health: clinical management and service guidance (external link). It's important for health professionals to ask individuals sensitively how they feel about their mental health and wellbeing. Linking with other professionals who may know more about the individual, their family and their circumstances, e.g. carers, GPs, social workers, and voluntary sector agencies, is also useful.
Though not predictors of mental illness or a means of clinical assessment, the following general risk factors for poor mental health should be taken into account:
- experience of poverty and deprivation
- experience of gender based violence
- experience of stigma or discrimination
- living in isolation
- having been in care
- alcohol and substance misuse
- being a teenage mother
A comprehensive list of socioeconomic and individual determinants of mental ill health is contained in Prevention of Mental Disorders - Effective Interventions and Policy Options: WHO 2004 (external link). For a fuller discussion of risk factors for inequalities, see Inequalities in Antenatal Care.
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.
Protective factors for the mental wellbeing of expectant mothers
Protective factors include:
- positive relationships
- family connectedness
- good social supports
- ability to make choices
Active lifestyles, good nutrition, good sleep habits and awareness of and action on personal stress also promote positive mental health among the general population and are likely to be beneficial in pregnancy. A comprehensive list of protective factors is contained in Prevention of Mental Disorders - Effective Interventions and Policy Options (WHO 2004 - external link).
