What is Perinatal and Infant Mental Health?

Perinatal mental health (PMH)

Perinatal mental health refers to parents’ mental health and emotional wellbeing from preconception until their child is 2^1,2. A range of mental health conditions can affect parents during the perinatal period, with depression and anxiety disorders being the most common³. There are many similarities between mental health conditions during the perinatal period, and mental health conditions which occur at other times in life. However, there can be significant differences³:

• PMH problems often need more urgent intervention than they would at other times because of their potential effect on the baby and on the woman’s physical health and care, and her ability to function and care for her family
• Onset, rapid deterioration and escalation of symptoms can be very quick in the perinatal period and therefore perinatal mental illness requires a lower threshold for intervention
• Persistent sub-threshold symptoms can have cumulative effects for mothers and their families
• Problems frequently go unrecognised and untreated in pregnancy and the postnatal period.
• Barriers to help seeking include stigma, and fear of child removal.

Infant Mental Health (IMH)

IMH reflects whether children have the secure, responsive relationships that they need to thrive. Early relationships set a template for how babies begin to think about themselves and others. Young children experience their world as an environment of relationships, and these relationships affect virtually all aspects of their development. Parents’ responses shape how babies experience their emotions and how they learn to regulate and express these emotions.

Babies are born socially interactive, and their development is shaped by dynamic interaction between their biological make-up and their experience. Responsive relationships with consistent primary caregivers help to build babies’ neuronal connections in the brain, regulate emotions and behaviour, and form secure attachments. These relationships are the foundation of mental health for babies, toddlers and pre-schoolers as they engage with the wider environment⁴.

The term Perinatal and Infant Mental Health references both the baby’s and the parents’ mental health and the relationship between them⁵.

Why it Matters: Prevalence and Impact

• Around 1 in 4 women & 1 in 10 men experience perinatal mental health problems^6,7.
• Mental illness is the most common serious health problem that a woman can experience in the perinatal period⁸.
• Maternal suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy⁸.
• Disparities in the identification, diagnosis and treatment of maternal mental health conditions are reflected in maternal mortality rates⁹:
  • 1.65 times higher for women from Asian backgrounds compared to White women
  • 2.87 times higher for Black women compared to White women.
  • 2 times higher for women from the most deprived areas of the UK compared to women from the least deprived areas.
• As many as 50% of fathers may experience depression if their partner also has a perinatal mental health condition^6,10.
• There is no equivalent data for same sex couples, but due to the significant impact which PMI has on relationships and the wider family, it is likely that there would similarly be substantial effects.
• Suicide is currently the leading cause of death in men under 50 years of age in the UK¹¹.
• Perinatal mental illness (PMI) costs around £8.1 billion for each one-year cohort of births in the UK. 72% of this cost relates to adverse impacts on the child¹².
• Children of parents with PMI are at increased risk of a range of poorer outcomes, especially in relation to their cognitive, social, and emotional development¹³.
• PMI can affect the parent-infant relationship and impact on the baby’s ability to form a secure attachment which is key for their future emotional wellbeing and development¹⁴.

Health visitors have a clinically and cost-effective role in perinatal mental health care, impacting and can break the intergenerational cycles of mental ill-health through early identification and intervention^15,16. Health visitors do this by effectively identifying families at risk of, or experiencing PMI; providing evidence-based treatments for those with sub-threshold or mild-moderate symptoms; and facilitating timely referrals to specialist teams. It is therefore imperative that all health visitors are trained in perinatal and infant mental health to ensure that families receive high quality PIMH care¹⁷.

References

1. NHS Long Term Plan (NHS England, 2019).
2. Parent Infant Foundation, First 1001 Days Movement Evidence Briefs Series. 2021.
3. NICE Clinical Guideline 192: Antenatal and postnatal mental health: clinical management and service guidance Published: 17 December 2014 Last updated: 11 February 2020.
4. Parent Infant Foundation, Securing Healthy Lives. 2021.
5. Parent Infant Foundation, Evidence Briefing for Commissioners. 2021.
6. Howard LM, Ryan EG, Trevillion K, Anderson F, Bick D, Bye A et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry. 2018 Jan; 212(1): 50–56.
7. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010; 303:1961–1969.
8. Knight M, Bunch K, Kelly T et al, eds, on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. 2022; Oxford: National Perinatal Epidemiology Unit, University of Oxford.
9. Felker A, Patel R, Kotnis R et al, (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020-22. 2024; Oxford: National Perinatal Epidemiology Unit, University of Oxford.
10. Cameron EE., Sedov I.D., Tomfohr-Madsen L.M. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 2016. 206:189–203.
11. Office for National Statistics (ONS) Suicides in the UK: 2018 registrations. Registered deaths in the UK from suicide analysed by sex, age, area of usual residence of the deceased and suicide method. 2019.
12. Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B. The costs of perinatal mental health problems. Centre for Mental Health and London School of Economics. 2014.
13. Goodman JH. Perinatal depression and infant mental health. Arch. Psych. Nurs. 2019; 33: 217–224.
14. Royal Foundation Centre for Early Childhood. Big Change Starts Small. 2021.
15. Bachmann C, Beecham J, O’Connor T, Briskman J, Scott, S. The Journal of Child Psychology and Psychiatry. 2022; 63(1): 78-87.
16. Bauer A, Tinelli M, Knapp M. The economic case for increasing access to treatment for women with common maternal mental health problems. Care Policy and Evaluation Centre London School of economics and Political Science. 2022.
17. Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J et al. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. Health and Social Care Delivery Research. 2024; 12(2).