Women can develop mental health problems during pregnancy or at childbirth and over the following year. These problems range from depression (both minor and major), anxiety disorders, post-traumatic stress disorder to bipolar disorder, schizophrenia and psychosis (puerperal psychosis). Life stresses such as bereavement, separation, unemployment, illness, moving house, migration, lack of social support networks, a past history of psychological or psychiatric disorders, history of physical, emotional or sexual abuse, drug or alcohol abuse, dysfunctional personality or coping styles and parenting behaviours can contribute to their onset. Obstetric factors such as timing and type of delivery and infant temperament can also play a role. Disorders may become chronic and carry over to future pregnancies. The mother’s mood during pregnancy and mental illness can impact on the development of the baby both during pregnancy and after birth. Assessing women for psychosocial risk factors and symptoms of distress during regular pregnancy checks gives the opportunity to link women with appropriate services.
The one study that met the criteria for this review randomised healthcare providers to either psychosocial assessment or routine care and involved a total of 273 women. The providers who assessed psychosocial factors were more likely than those giving routine care to identify psychosocial concerns and to rate the level of concern as high. They were also more likely to detect concerns about family violence. The trial did not look at the development of anxiety or depression in these women. Not all healthcare providers chose to take part in the trial and some dropped out, leaving only 48 of the original 185 approached. This could mean that providers who were less interested in this area of clinical practice did not participate and bias the findings toward better than average detection of psychosocial risk. Two studies are currently in progress looking at the impact of early postnatal psychosocial assessment on the prevalence of antenatal and postnatal anxiety and depression.