Prevalence of maternal psychiatric disorder in pregnancy: 1986 and 2016

We note that, in a study by Howard et al, the population prevalence rate for a psychiatric diagnosis for women at their first antenatal appointment is 27%, a disturbing one in four women.¹ In 1986 we used a similar two-stage methodology, the Leeds Anxiety and Depression Scales² and the Clinical Interview Schedule,³ with women booking in at two general practice antenatal clinics in the same inner-city location.⁴ The point prevalence for a psychiatric disorder (ICD-9)⁵ at 20 weeks was 25% and at 36 weeks was 23.5%. The period prevalence was 38%. One in three women had a psychiatric disorder during pregnancy.

The pregnant women recruited into Howard et al’s study have a mean age of 32 years and could well be the offspring of the mothers whom we interviewed in 1986. Why are the point prevalence rates of psychiatric disorder exactly the same as they were 30 years ago? It is likely that one in three pregnant women still have a psychiatric disorder.

We have had two sets of National Institute for Health and Care Excellence guidelines (2007, 2014) for managing perinatal mental health,^{6, 7} but Howard et al’s evidence shows that we have not reduced the number of people with these disorders. We seem to be good at identifying mental ill health but what are we doing to prevent the next generation from experiencing these conditions?

My colleagues and I have interviewed the South London Child Development Study cohort of women and children at eight time points through pregnancy in 1986 and the following 26 years to 2012. We have shown that women's mental health in pregnancy is a risk factor for psychiatric disorder in the offspring through childhood, adolescence and into young adulthood.⁸ The evidence from Howard et al’s paper shows that we have not yet been able to stem the intergenerational transmission of psychiatric disorder. Screening without follow-up intervention does not help prevent later mental ill health or transmission to the next generation. Is it not time that we could and should intervene?