by Annette Bauer
As part of our LSE Health and Social Care Formal seminar series, Professor Vivette Glover from Imperial College London provided colleagues at LSE with new insights into how perinatal mental health can affect the fetus and development of the child.
Setting out the scale and nature of the problem, Vivette highlighted that:
- anxiety and depression affect about one in ten people and are – together with other mental illnesses – responsible for 40% of all disability (for example Layard et al 2006);
- anxiety and depression can be caused by genetic and environmental factors that start in the womb;
- a mother’s anxiety and depression during pregnancy and after birth can cause cognitive impairments, challenging behaviour, anxiety and depression in offspring;
- the estimated proportion of the whole population burden of anxiety and depression that is attributable to mother’s illness in pregnancy is 10-15%.
For centuries, society had an awareness of the link between mother’s emotional state in pregnancy and the impact on the new born.
Research over the past two decades has now proved the causality as well as come up with an explanation as to why this link exists.
To understand whether the link between mothers’ depression and anxiety during pregnancy and after birth is causal requires the collection of data over many years, starting before the child is born. Several large studies of this kind – including from the UK – exist and researchers have used their data to examine the development of children whose mothers have had anxiety and depression during pregnancy.
For example, using data from a large follow-up study (from children of the 1990s), the Avon Longitudinal Study of Parents and Children (ALSPAC), Vivette and her colleagues found an increased risk for a child to develop mental health problems if the mother had high levels of anxiety or depression during pregnancy. For the top 15% of the most anxious or depressed women in pregnancy, the rate of a probable disorder doubled from about 6 to 12% for 13 years old children. And, to ensure that other factors such as lower income or alcohol problems did not influence these results, researchers carried out extensive statistical analysis.
Why does this link exist?
Both genes and the environment play a role and interact with each other. They can also explain why some children are affected but not others.
The ‘fetal programming hypothesis’ suggests that the environment in the womb alters the development of the fetus. Higher in utero exposure to cortisol – caused by mothers’ stress – has been linked to lower cognitive function in children. And while environmental factors after birth (in form of sensitive early mothering) can reverse these effects, mothers with depression often find it particularly hard to provide this environment.
Additional support for mothers with mental illness during this pregnancy and after birth is highly important to both help mothers themselves and prevent long-term negative impacts for their children.
Unfortunately, the current provision of services is highly patchy and adequate treatment rare. Only 40% of women with perinatal depression are identified, 10% receive adequate treatment and only 3% achieve remission.
A recent cost of illness study I led showed that the economic implications are large. Perinatal mental depression, anxiety and psychosis together carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK. Nearly three-quarters (72%) of this cost relates to the adverse impacts on the child rather than the mother. Over a fifth of total costs (£1.7 billion) are borne by the public sector, with the majority falling on the NHS and social services (£1.2 billion).
What should be done?
Maternity and health visiting professionals are in a good place to identify mothers with mental illness and provide support; however, their current focus is on physical problems and they are under resourced. Substantial investment in these services is urgently needed. Mother-and-baby units are well placed to offer specialist treatment but only a few localities fund these units at the moment.
Providing the formal infrastructure for the identification and treatment of mothers-to-be and new mothers is not enough. There is a need to increase awareness, and change the perception, of maternal mental illness. Supporting mothers and families to help themselves is important.
To this regard, Vivette’s seminar challenged some common perceptions of maternal mental illness. Rather than viewing maternal mental illness a ‘madness’ or societal problem per se, it might be more helpfully seen as a human response to an overload of too many stressors and environmental challenges carried across generations.
About the author
Annette Bauer is Research Officer at the Personal Social Services Research Unit at the LSE.