Background

Women with a pre-existing severe mental disorder have an increased risk of relapse after giving birth. We aimed to evaluate associations of the gradual regional implementation of community perinatal mental health teams in England from April, 2016, with access to mental health care and with mental health, obstetric, and neonatal outcomes.

Methods

For this cohort study, we used the national dataset of secondary mental health care provided by National Health Service England, including mental health-care episodes from April 1, 2006, to March 31, 2019, linked at patient level to the Hospital Episode Statistics, and birth notifications from the Personal Demographic Service. We included women (aged ≥18 years) with an onset of pregnancy from April 1, 2016, who had given birth to a singleton baby up to March 31, 2018, and who had a pre-existing mental disorder, defined as contacts with secondary mental health care in the 10 years immediately before pregnancy. The primary outcome was acute relapse, defined as psychiatric hospital admission or crisis resolution team contact in the postnatal period (first year after birth). Secondary outcomes included any secondary mental health care in the perinatal period (pregnancy and postnatal period) and obstetric and neonatal outcomes. Outcomes were compared according to whether a community perinatal mental health team was available before pregnancy, with odds ratios (ORs) adjusted for time trends and maternal characteristics (adjORs).

Findings

Of 807 798 maternity episodes in England, we identified 780 026 eligible women with a singleton birth, of whom 70 323 (9·0%) had a pre-existing mental disorder. A postnatal acute relapse was found in 1117 (3·6%) of 31 276 women where a community perinatal mental health team was available and in 1745 (4·5%) of 39 047 women where one was unavailable (adjOR 0·77, 95% CI 0·64–0·92; p=0·0038). Perinatal access to any secondary mental health care was found in 9888 (31·6%) of 31 276 women where a community perinatal mental health team was available and 10 033 (25·7%) of 39 047 women where one was not (adjOR 1·35, 95% CI 1·23–1·49; p<0·0001). Risk of stillbirth and neonatal death was higher where a community perinatal mental health team was available (165 [0·5%] of 30 980 women) than where it was not (151 [0·4%] of 38 693 women; adjOR 1·34, 95% CI 1·09–1·66; p=0·0063), as was the risk of a baby small for gestational age (2227 [7·2%] of 31 030 women vs 2542 [6·6%] of 38 762 women; adjOR 1·10, 1·02–1·20; p=0·016), whereas preterm birth risk was lower (3167 [10·1%] of 31 206 women vs 4341 [11·1%] of 38 961; adjOR 0·86, 0·74–0·99; p=0·032).

Interpretation

The regional availability of community perinatal mental health teams reduced the postnatal risk of acute relapse and increased the overall use of secondary mental health care. Community perinatal mental health teams should have close links with maternity services to avoid intensive psychiatric support overshadowing obstetric and neonatal risks.

Funding

The National Institute for Health and Care Research.

中文翻译：

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英格兰有二级心理保健史的孕妇的社区围产期心理健康团队以及与围产期心理健康和产科和新生儿结局的关联：一项基于全国人口的队列研究

背景

本来就患有严重精神障碍的女性在产后复发的风险会增加。我们的目的是评估从 2016 年 4 月起在英格兰逐步实施区域性社区围产期心理健康团队与获得心理健康护理以及心理健康、产科和新生儿结局之间的关系。

方法

在这项队列研究中，我们使用了英格兰国家卫生服务中心提供的国家二级心理健康护理数据集，包括2006年4月1日至2019年3月31日的心理健康护理事件，在患者层面与医院事件统计数据相关联，以及来自个人人口统计服务的出生通知。我们纳入了从 2016 年 4 月 1 日开始怀孕、截至 2018 年 3 月 31 日生下单胎婴儿、且患有既往精神障碍（定义为与继发性精神病有接触）的女性（年龄≥18 岁）。怀孕前 10 年的心理保健。主要结局是急性复发，定义为产后（出生后第一年）入院或与危机解决团队联系。次要结局包括围产期（怀孕和产后）的任何次要心理保健以及产科和新生儿结局。根据怀孕前是否有社区围产期心理健康团队来比较结果，并根据时间趋势和母亲特征 (adjORs) 调整优势比 (OR)。

发现

在英格兰的 807 798 例产科事件中，我们确定了 780 026 名符合条件的单胎女性，其中 70 323 名 (9·0%) 患有先前存在的精神障碍。在有社区围产期心理健康团队的 31 276 名妇女中，有 1 117 名 (3·6%) 发现产后急性复发；在没有社区围产期心理健康团队的 39 047 名妇女中，有 1 745 名 (4·5%) 发现产后急性复发 (adjOR 0·77, 95% CI 0·64–0·92；p=0·0038）。在有社区围产期心理健康团队的 31 276 名妇女中，有 9 888 名 (31·6%) 获得了任何二级心理健康护理；在没有社区围产期心理健康团队的 39 047 名妇女中，有 10 033 名 (25·7%) 获得了任何二级心理健康护理（调整后） 1·35，95% CI 1·23–1·49；p<0·0001）。在有社区围产期心理健康团队的地方（30 980 名妇女中的 165 [0·5%]），死产和新生儿死亡的风险高于没有社区围产期心理健康团队的地方（38 693 名妇女中的 151 [0·4%]；调整 1 ·34, 95% CI 1·09–1·66；p=0·0063），婴儿小于胎龄的风险也是如此（31 030 名女性中有 2227 名 [7·2%] 与2542名女性[6·6] %]（38 762 名女性中；调整 1·10、1·02–1·20；p=0·016），而早产风险较低（31 206 名女性中的 3167 [10·1%]与4341 [11·1%] 1%] 38 961；调整 0·86、0·74–0·99；p=0·032）。

解释

社区围产期心理卫生团队的区域可用性降低了产后急性复发的风险，并增加了二级心理卫生保健的总体使用。社区围产期心理健康团队应与产科服务机构保持密切联系，以避免密集的精神科支持掩盖产科和新生儿风险。

资金

国家健康与护理研究所。