Jones Ellie, Quinn Laura, Tanner Jamie-Rae, Jankovic Jelena, Berrisford Giles, MacArthur Christine, Taylor Beck
Department of Applied Health Sciences, School of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Warwickshire County Council, Shire Hall, Market Place, Warwick, CV344RL, United Kingdom.
Lancet Reg Health Eur. 2025 May 9;53:101312. doi: 10.1016/j.lanepe.2025.101312. eCollection 2025 Jun.
Perinatal mental illness affects around 20% of women in pregnancy and the first postpartum year with little evidence regarding persistence and incidence in the second year. This study aimed to describe prevalence and incidence of moderate and severe mental illness in the second postpartum year to estimate the proportion of women who could benefit from extension of England's specialist perinatal mental health services to two years.
A retrospective cohort study using United Kingdom primary care Clinical Practice Research Datalink GOLD. All women registered with a General Practitioner with third trimester, delivery code or postpartum medical record 1995-2020 were included. Secondary objectives were to investigate mental illness type and associated factors.
2,132,754 pregnancies from 1,361,497 women were included. Prevalence of mental illness likely to need specialist PMH services in second postpartum year increased significantly from 3.1% (n = 2643/85,756) in 1995 to 7.4% (n = 2473/34,098) in 2018. Incident cases increased from 1.9% (n = 1630/85,756) in 1995 to 3.8% (n = 1285/34,098) in 2018 representing 56.6% (n = 69,926/123,510) of all cases in the second year. Adjusted analysis showed odds of mental illness in second year were higher: for women in most ages vs 30-34 yrs; for each additional pregnancy (OR: 1.16, 95% CI: 1.13, 1.19 two vs one); for preterm births (OR: 1.21, 95% CI: 1.15, 1.27), near term (OR: 1.21, 95% CI: 1.17, 1.25) or post-term (OR: 1.07, 95% CI: 1.04, 1.09) vs term; with history of mental illness (OR: 2.46, 95% CI: 2.41, 2.52), smoking (OR: 1.37, 95% CI: 1.35, 1.39), substance use disorder (OR: 1.54, 95% CI: 1.48, 1.60), and for each year vs 1995. Separate analysis using a subset of data showed odds of mental illness were higher for women in all quintiles vs least deprived and for women of white ethnicity vs all other ethnicities. Although severity could not be accurately measured, most recorded illnesses would require specialist perinatal mental health input.
Extension of specialist perinatal mental health services to two years postpartum is justified.
National Institute for Health and Care Research Applied Research Collaboration West Midlands (NIHR200165).
围产期精神疾病影响约20%的孕期女性以及产后第一年的女性，而关于产后第二年的持续情况和发病率的证据很少。本研究旨在描述产后第二年中重度精神疾病的患病率和发病率，以估计可能从英格兰专科围产期心理健康服务延长至两年中获益的女性比例。
一项使用英国初级保健临床实践研究数据链GOLD的回顾性队列研究。纳入所有在1995年至2020年期间向全科医生登记且有孕晚期、分娩编码或产后病历的女性。次要目标是调查精神疾病类型及相关因素。
纳入了来自1,361,497名女性的2,132,754次妊娠。产后第二年可能需要专科围产期心理健康服务的精神疾病患病率从1995年的3.1%（n = 2643/85,756）显著增至2018年的7.4%（n = 2473/34,098）。新发案例从1995年的1.9%（n = 1630/85,756）增至2018年的3.8%（n = 1285/34,098），占第二年所有案例的56.6%（n = 69,926/123,510）。校正分析显示，产后第二年患精神疾病的几率更高：大多数年龄段的女性与30 - 34岁女性相比；每增加一次妊娠（比值比：1.16，95%置信区间：1.13, 1.19，两次妊娠与一次妊娠相比）；早产（比值比：1.21，95%置信区间：1.15, 1.27）、接近足月（比值比：1.21，95%置信区间：1.17, 1.25）或过期产（比值比：1.07，95%置信区间：1.04, 1.09）与足月产相比；有精神疾病史（比值比：2.46，95%置信区间：2.41, 2.52）、吸烟（比值比：1.37，95%置信区间：1.35, 1.39）、物质使用障碍（比值比：1.54，95%置信区间：1.48, 1.60），以及与1995年相比的每一年。使用部分数据的单独分析显示，所有五分位数的女性与最不贫困女性相比，以及白人种族女性与所有其他种族女性相比，患精神疾病的几率更高。尽管严重程度无法准确测量，但大多数记录的疾病将需要专科围产期心理健康干预。
将专科围产期心理健康服务延长至产后两年是合理的。
国家卫生与保健研究所西米德兰兹应用研究合作中心（NIHR200165）
