By Annette Bauer
Perinatal depression affects mothers during pregnancy and up to twelve months after giving birth. It can have a major impact not only on the mother’s health and wellbeing, but also on the child. On-going research at PSSRU explores some of the economic consequences of adverse child development outcomes linked to perinatal depression using data from the South London Child Development Study of mothers and children. As far we are aware, this research is the first to explore the economic consequences of perinatal depression from a child’s perspective.
Perinatal depression has a prevalence of 13% in the general population ¹ ² and is higher than 20% in lower socio-economic groups ³ ⁴. Because it not only has a major impact on mothers’ health and wellbeing but also on their children, it contributes to the intergenerational transmission of socio-economic disadvantage.
Although at a national level, guidance has been developed which sets out how women affected by perinatal depression should be identified and treated, service users, policy advocates and front-line professionals continue to raise concerns that the condition is still undetected or untreated in many women and call for better access to services and support⁵ ⁶ ⁷. Data on perinatal depression are not routinely collected which makes it difficult to size the problem, yet data from other countries suggest that almost half of women are missed in primary care⁸.
Support for mothers before and after childbirth can take on different shapes, including psychological, psycho-social, social or practical support. Interventions include parenting programmes, screening and counselling through health visitors, peer support, screening and pharmacological treatment in primary care, and information and advice. Studies which explored the cost-effectiveness of these supports focussing on benefits to the mother indicate that certain interventions such as health visiting are likely to increase quality of life, making the investment worthwhile ⁹ ¹ᵒ ¹¹.
There is another economic aspect: If a negative impact on children could be prevented or reduced then this could increase their chances for improved wellbeing and earning prospects over the life course. It could also reduce government expenditure through a reduced need of publicly paid support. Our study uses data from the still on-going South London Child Development Study of mothers and their children which started in 1986 and estimates the risk of adverse child outcomes due to perinatal depression at the ages of 11 and 16 years. Based on existing literature, we are attaching economic values to those outcomes. Where possible, we look at outcomes over the life course and include the economic impacts on the public sector, the individual and wider society.
Our work aims to inform future research in this area, in particular knowledge of the economic costs of perinatal depression. Furthermore, policy makers may use it to decide whether more evidence should be generated on the longer-term effectiveness of early interventions to improve child outcomes as it has been recommended by some experts in this field ¹².
For more information please contact Annette Bauer firstname.lastname@example.org.
¹ O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression – a meta-analysis, International Review of Psychiatry, 8, 37–54.
² Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence, Obstetrics & Gynecology, 106, 1071-1083.
³ Hay DF, Pawlby S, Sharp D, Asten P, Mills A, Kumar R (2001) Intellectual problems shown by 11-year-old children whose mothers had postnatal depression, The Journal of Child Psychology and Psychiatry and Allied Disciplines, 42, 871-89.
⁴Kiernan KE, Huerta MC (2008). Economic deprivation, maternal depression, parenting and childrenʼs cognitive and emotional development in early childhood, British Journal of Sociology, 59, 783-806.
⁵ NICE (2007) NICE clinical guideline 45: Antenatal and postnatal mental health – Clinical management and service guidance. April 2007.
⁶ The Patients Association (2011) Postnatal depression services: An Investigation into NHS Provision. March 2011.
⁸ Paulden M, Palmer S, Hewitt C, Gilbody S (2009) Screening for postnatal depression in primary care: cost-effectiveness analysis, British Medical Journal, 339, b5203.
⁹ Morrell CJ, Warner R, Slade P, Dixon S, Walters S, Paley G, Brugha T (2009) Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation: the PoNDER trial, Health Technology Assessment, 13, 1-153.
¹ᵒ Bauer A, Knapp M and McDaid D (2011) Health visiting and reducing post-natal depression. In Mental health promotion and mental illness prevention: The economic case (ed. Knapp M., McDaid D. and Parsonage, M.), pp. 4-5. Department of Health, London.
¹¹ Brugha T, Morrell CJ, Slade P, Walters SJ (2011) Universal prevention of depression postnatally: cluster randomized trial evidence in primary care, Psychological Medicine, 41, 739-748.
¹² Cooper P, Murray L, Halligan S (2010) Treatment of Postpartum Depression, Encyclopedia on early Childhood Development, Winnicott Research Unit, University of Reading. Published online May 18th 2010 http://www.child-encyclopedia.com/en-ca/maternal-depression/according-to-experts.html Last accessed 16th April 2013