Prevalence of mental illness in the perinatal period

Background

It is difficult to know exactly how many parents experience mental illnesses like anxiety and depression during pregnancy and the first 12 months of their baby’s life (the perinatal period). There are a number of factors that make it difficult to estimate, including differences in the way research data is collected and different ways of defining or diagnosing mental illness. Despite this, there is agreement that mental health problems in the perinatal period are common, can impact the health of the entire family, and are very important public health issues¹.

What we know

Some parents experience mental health difficulties for the first time during pregnancy or early parenthood, while others may come to pregnancy and parenting with a history of mental illness. Any mental illness present during pregnancy or the first 12 months after birth is considered a ‘perinatal mental illness’, regardless of whether the person has experienced the illness before.

Anxiety and depression are the most common mental health issues in the perinatal period. Until recently most research on mental health in the perinatal period focused on depression after birth, so much less is known about mental illness in pregnancy, anxiety, and other illnesses. This is however beginning to change, and we are beginning to broaden our understanding of perinatal mental health.

Women’s mental health in the perinatal period

Research undertaken in Australia and other countries usually finds that around 15-22% of women experience depression during pregnancy and/or following the birth of their baby^2–5. While there has been less research about perinatal anxiety, it is understood to be at least as common as depression, if not more so⁶. A number of women will experience both anxiety and depression⁷. Therefore, at least one in every five women will likely experience anxiety, depression, or both during pregnancy and/or following birth.

A number of women will experience what is known as postnatal psychosis. Based on research that reviewed the number of women admitted to an inpatient mental health facility following birth it seems one to two women per 1000 giving birth will experience postnatal psychosis^11–13, however these numbers may be an underestimate as some women may be treated at home⁸.

Women may also experience other less common but still important mental health disorders. This may include Post Traumatic Stress Disorder (PTSD), bipolar disorder, and schizophrenia. The perinatal period is associated with an increased risk of severe mental illnesses such as bipolar disorder and affective psychosis^8,9. Research from the United Kingdom indicates that most women with bipolar and schizophrenia do become parents¹⁰, so it is important that their needs are met even though less women experience these disorders.

Men’s mental health in the perinatal period

There is less research available about the mental health of fathers, however it is thought that 10% (or one in ten) men will experience depression¹⁴. Anxiety is also a common experience for fathers, and is often experienced along with depression¹⁵. A recent review estimates that the prevalence of anxiety in men in the perinatal period is 3.4%-25%¹⁶.

Priority populations

Families from minority communities face additional risks for perinatal anxiety and depression, and barriers to accessing safe, appropriate services. Populations more at risk include LGBTIQ+ parented families, Aboriginal and Torres Strait Islander families, and Culturally and Linguistically Diverse (CALD) families. Experiences of discrimination and isolation, and the fear they create of further discrimination, increase isolation and discourage help-seeking at a time of particular risk for these vulnerable families. The importance of services acknowledging and responding to family diversity will be explored in greater detail in future position statements.

Summary

• Perinatal mental illness is common, and a crucial public health issue.
• Estimates indicate that one in five women and one in ten men will experience anxiety and/or depression in the perinatal period.
• Some families, including LGBTIQ+ parented families, CALD, and Aboriginal and Torres Strait Islander families face additional challenges to their mental health in the perinatal period.

References

1. Austin M-P, Nicole H, Expert Working Group. Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne; 2017.
2. Gavin NI, Gaynes BN, Lohr KN, Meltzer-brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5):1071-1083.
3. Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health. 2010;10(1):771-781. doi:10.1186/1471-2458-10-771
4. Howard LM, Ryan EG, Trevillion K, et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry. 2018;212(01):50-56. doi:10.1192/bjp.2017.9
5. Woolhouse H, Gartland D, Mensah F, Brown S. Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG. May 2014:1-10. doi:10.1111/1471-0528.12837
6. Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016;200:148-155. doi:10.1016/j.jad.2015.12.082
7. Falah-Hassani K, Shiri R, Dennis CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: A meta-analysis. Psychol Med. 2017;47(12):2041-2053. doi:10.1017/S0033291717000617
8. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014;384(9956):1789-1799. doi:10.1016/S0140-6736(14)61278-2
9. Wisner KL, Sit DKY, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013;70(5):490-498. doi:10.1001/jamapsychiatry.2013.87
10. Howard LM, Kumar R, Thornicroft G. Psychosocial characteristics and needs of mothers with psychotic disorders. Br J Psychiatry. 2001;178(MAY):427-432. doi:10.1192/bjp.178.5.427
11. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150(MAY.):662-673. doi:10.1192/bjp.150.5.662
12. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New Parents and Mental Disorders. Jama. 2006;296(21):2582. doi:10.1001/jama.296.21.2582
13. Terp IM, Mortensen PB. Post-partum psychoses: Clinical diagnoses and relative risk of admission after parturition. Br J Psychiatry. 1998;172(JUNE):521-526. doi:10.1192/bjp.172.6.521
14. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. J Am Med Assoc. 2010;303(19):1961-1969.
15. Leach LS, Poyser C, Cooklin AR, Giallo R. Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. J Affect Disord. 2016;190:675-686. doi:10.1016/j.jad.2015.09.063
16. Philpott LF, Savage E, FitzGerald S, Leahy-Warren P. Anxiety in fathers in the perinatal period: A systematic review. Midwifery. 2019;76:54-101. doi:10.1016/j.midw.2019.05.013