Identification of women at high risk of perinatal anxiety: a mixed methods study.

Problem

Perinatal anxiety (PNA), experienced during pregnancy and up to one year after childbirth, impacts on the mother, infant, family and society. Global prevalence of PNA is 21% compared to perinatal depression (PND) of 11%. There is little research into PNA compared to PND. We aim to identify women at higher risk of PNA using medical record data and explore views on the label ‘high risk’.

Approach

Mixed methods approach. Ethical and regulatory approvals obtained. Patient Advisory Group (PAG) and Clinical Advisory Group (CAG) informed each study.

Quantitative analysis of Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) and national pregnancy registry databases; and IQVIA Medical Research Database (IMRD) to identify diagnoses, symptoms, processes of care and outcomes.

Semi-structured interviews with women who have had PNA, primary, community and specialist healthcare professionals, and community organisation representatives, explored understanding of risk, acceptability of using a risk assessment tool and reflections on the quantitative data analysis. Interviews digitally recorded with consent, transcribed, and anonymised. Data thematically analysed and themes agreed through discussion.

Findings

The PNA cohort exhibited greater socioeconomic deprivation, higher white ethnicity prevalence, more smokers, but lower obesity and comorbidities. Healthcare utilisation was higher in the PNA group.

PNA was more common in younger women, those who lived in more deprived areas, those with a recent history of anxiety or depression, and those whose infants had measures indicating poor health. Infants of mothers with PNA had a higher rate of primary care consultations, were more likely to be vaccinated and were less likely to have a record of an infant check.

Women and healthcare professionals attribute increased risk to factors including poor obstetric history, limited support networks, stigma and prior expectations of pregnancy and parenthood. Childhood trauma and domestic violence were felt to be key risk factors which might not be coded in primary care records.

Consequences

The adjusted data showing higher healthcare utilisation among PNA women underlines the need for tailored healthcare strategies for them. Whilst we were limited by missing data in this study, our analysis suggests that infant health plays a key role in the relationship between PNA and infant healthcare use. Infants of mothers with PNA were more likely to be vaccinated than those with no anxiety.

Whilst women would find early identification of higher risk of PNA acceptable providing that support is available to them; primary care records may not include relevant codes to make such risk prediction possible.

This integrated and mixed methods approach will enable us to gain an understanding of risk, assess the acceptability of using a risk assessment tool during consultations and improve the identification and management of women with PNA across primary and specialist care.