Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort

Abstract

BackgroundCommon mental disorders (CMD) such as anxiety and depression during the maternal period can cause significant morbidity to the mother in addition to disrupting biological, attachment and parenting processes that affect child development. Pharmacological treatment is a first-line option for moderate to severe episodes. Many women prescribed pharmacological treatments cease them during pregnancy but it is unclear to what extent non-pharmacological options are offered as replacement. There are also concerns that treatments offered may not be proportionate to need in minority ethnic groups, but few data exist on treatment disparities in the maternal period. We examined these questions in a multi-ethnic cohort of women with CMD living in Bradford, England before, during and up to one year after pregnancy.MethodsWe searched the primary care records of women enrolled in the Born in Bradford cohort for diagnoses, symptoms, signs (‘identification’), referrals for treatment, non-pharmacological and pharmacological treatment and monitoring (‘treatment’) related to CMD. Records were linked with maternity data to classify women identified with a CMD as treated prior to, and one year after, delivery. We examined rates and types of treatment during pregnancy, and analysed potential ethnic group differences using adjusted Poisson and multinomial logistic regression models.ResultsWe analysed data on 2,234 women with indicators of CMD. Most women were discontinued from pharmacological treatment early in pregnancy, but this was accompanied by recorded access to non-drug treatments in only 15 % at the time of delivery. Fewer minority ethnic women accessed treatments compared to White British women despite minority ethnic women being 55–70 % more likely than White British women to have been identified with anxiety in their medical record.ConclusionsVery few women who discontinued pharmacological treatment early in their pregnancy were offered other non-pharmacological treatments as replacement, and most appeared to complete their pregnancy untreated. Further investigation is warranted to replicate the finding that minority ethnic women are more likely to be identified as being anxious or having anxiety and understand what causes the variation in access to treatments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0805-x) contains supplementary material, which is available to authorized users.

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review

“…24 Three studies reported on data from GP patient records; one examined 411 entries in GP records, 29 and another two papers reported data from GP records of 8991 and 2234 women from the same cohort. 34,35 Where several types of health-care professionals were surveyed, results are reported from GPs and FPs only. Three papers reported on care during pregnancy, 25,33,35 five papers focused on the postpartum period, 28,29,31,32,36 and five studied both pregnancy and the postpartum period.…”

“…34,35 Where several types of health-care professionals were surveyed, results are reported from GPs and FPs only. Three papers reported on care during pregnancy, 25,33,35 five papers focused on the postpartum period, 28,29,31,32,36 and five studied both pregnancy and the postpartum period. 24,26,27,30,35 Ten papers used a questionnaire or survey to gather information from participants, of which four papers also included a vignette.…”

“…37 Two papers reported on GP data from the "Born in Bradford Cohort" which recruited 12,450 women at 26-28 weeks of pregnancy. 34,35 -Insert Table 1 about here -…”

“…35 In pregnancy, 298 (13%) of these women had prescriptions issued for anxiety or depression; 86% of these women had an antidepressant (69% were SSRIs) and 23% of them had an anxiolytic prescribed. 174 women (58%) did not have a prescription issued after the end of the first trimester.…”

“…174 women (58%) did not have a prescription issued after the end of the first trimester. 35 Only 26 of these 174 women (15%) had a subsequent code indicating provision of a non-pharmacological treatment during their pregnancy 35 .…”