Identification of mental illness in maternity settings and care pathways to mental health services during pregnancy in a diverse urban UK population

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Background: Mental disorders affect 27% of UK women during the perinatal period (pregnancy and the first postpartum year) and are associated with increased risk of adverse maternal and child outcomes. Despite the societal burden, access to mental health services remains inconsistent, particularly for certain ethnic groups. The aim of this study was to characterise pregnant women, from an ethnically and socioeconomically diverse UK antenatal urban population, with identified risk of mental disorders in the perinatal period, and to evaluate the proportion in contact with mental health services We also explore potential inequity and barriers to access, as measured by referral and engagement with care. Methods: This study utilised linked maternity and mental health records from the eLIXIR Born in South London database, comprising 67,308 pregnancies from 2018 to 2023. These records provided information about: antenatal mental health assessments through three areas of enquiry: Whooley (depression screening) questions, 2) self-reported mental health conditions, 3) family history of severe mental illness, as well as referrals to, and engagement with mental health services during pregnancy. Findings: Among those in contact with mental health services, 38.39%, 24.73%, and 6.14% had been identified by one, two, or three areas of antenatal mental health enquiry, respectively. A positive relationship was observed between the number of questions endorsed and referral to and engagement with treatment. However, ethnic disparities were evident: Asian and Asian British women had lower odds of referral to mental health service (OR=0.51, 95% CI [0.42, 0.61]) and engagement (OR = 0.73, 95% CI [.59, .91]), compared to White women, while Black, African, Caribbean, and Black British women had higher odds of referral (OR=1.45, 95% CI [1.32, 1.60]), but lower odds of engagement (OR=0.73, 95% CI [0.59, 0.91]). Women requiring an interpreter had lower odds of referral (OR = 0.69, 95% CI [0.56, 0.82]). Interpretation: The study highlights significant disparities in identification and treatment of mental disorders in the perinatal period, perinatal mental disorders. Improved referral and care pathways, and culturally sensitive assessments are indicated to redress these disparities.

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