The challenge
Depression and anxiety can cause huge amounts of distress, disruption and disability to both the sufferers and the family unit. There are some effective treatments, but in order to access treatment, people need to have their distress recognised by the health service. There are some limited estimates of the scale of unrecognised disorder in the general population, but we do not know the scale of the problem in women during pregnancy. For women who are in treatment, we also know little about what happens to treatment when women become pregnant.
What we found
During pregnancy, Pakistani mothers seemed to have more distress than White British mothers. Up to a half of BiB mothers who had significant psychological distress did not have their distress noted by their GP. This did not appear to be related to the amount of times women accessed the health service. For every one White British woman whose distress was apparently undetected, two ethnic minority women went undetected. When we looked at women who did have their distress noted by the health service, most discontinued anti-depressant treatment during pregnancy, but very few seemed to get offered other treatments. Ethnic minority women seemed more likely to have anxiety than White British women, but ethnic minority women accessed fewer treatments both during and after pregnancy.
Things we need to find out
There are many important questions that now need to be answered and actions to be put into place. We don’t know why these disparities exist. What happens in a GP appointment that leads to these disparities? How can we best support women to disclose their distress and negotiate treatment, and do health care professionals need more support in recognising signs of distress and offering treatment? What can be done to ensure that women who don’t want to take antidepressants during pregnancy get offered talking therapies instead?
Link to full research
Prady SL, Pickett KE, Petherick ES, Gilbody S, Croudace T, Mason D, Sheldon TA, Wright J. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. Br J Psychiatry. 2016 May;208(5):453-61. doi: 10.1192/bjp.bp.114.158832.
Prady SL, Pickett KE, Gilbody S, Petherick ES, Mason D, Sheldon TA, Wright J. 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.BMC Psychiatry. 2016 Apr 12;16:99. doi: 10.1186/s12888-016-0805-x.
