Mental health awareness week provides an opportunity to raise awareness of perinatal mental health and to collaborate to ensure that parents in need know that they are not alone.
We know certain groups of parents are more vulnerable to mental health problems than others. The Policy Research Unit has recently produced a systematic review of evidence which will contribute to improving the support available to these parents.
The review, on the prevalence of anxiety and post-traumatic stress (PTS) among the parents (both mothers and fathers) of babies admitted to neonatal units, was conducted by Reem Malouf, Sian Harrison, Hollie Burton, Chris Gale, Alan Stein, Linda Franck and Fiona Alderdice.
Reem highlighted why this review was needed: “This is an important review for policy makers as we currently don't have an estimate of the prevalence of anxiety and post-traumatic stress symptoms in parents of babies admitted to a neonatal unit.
“As this is a traumatic and often unexpected event, parents are vulnerable to mental health problems, but we don't know how many parents will have mental health problems which makes it very difficult to plan services or to provide adequate support for parents.
“Some reviews have been conducted on depression in parents of babies admitted to neonatal units, but not anxiety and post-traumatic stress. So the main aim of this review was to get some indication of the numbers of parents of babies admitted to a neonatal unit who were identified as having anxiety or post-traumatic stress symptoms.”
Fifty-six international studies involving over 6,000 parents were included in the review. The team pooled the results from all the studies and found the estimated prevalence of anxiety and post-traumatic stress in these parents were much higher than the general perinatal population.
For example, prevalence of post-traumatic stress in the perinatal population after birth has been estimated to be approximately 4-10%, whereas we found that it was around 40% for the neonatal unit parents in the month after birth and around 25% between one month and one year after birth. We also found it stayed around 25% beyond one year after birth, although the data on this finding wasn't as strong. Prevalence of anxiety in the general perinatal population for anxiety is estimated to be between 15-20% however, as with PTS, anxiety prevalence was around 40% up to one month and down to around 25% from one month to one year but the data after one year were too limited to interpret.
Overall, the review findings highlight the significant psychological needs in this group of parents over an extended period of time.
Sian Harrison noted: “As care is understandably focused on the baby rather than the parent, there are challenges around identifying parents who need support, for example, who should assess parent mental health (neonatal staff or midwifery staff or mental health professionals) and how do you identify anxiety or PTS.
“Good and early assessment is key – we need to ensure that whatever way we choose to identify anxiety or PTS minimises the risk of missing parents who need additional support, while not overloading the mental health referral system with parents who do not need additional mental health support.”
In addition to identifying the higher rates of anxiety and PTS in parents whose babies are admitted to a neonatal unit, the review also highlighted a need for very large population-based studies to investigate prevalence of mental health conditions in these parents.
Many groups of parents were underrepresented in existing studies, for example, parents of babies with congenital anomalies, parents whose babies had died, parents with pre-existing mental health conditions, parents from black and minority ethnic backgrounds, fathers and other carers.
There is so much more we need to know about these parents' experiences of neonatal care and early parenthood and Fiona Alderdice highlighted that research into parents' mental health has the potential to have an impact at many levels, not only in terms of supporting parents' mental health, but also through enhancing their transition to parenthood, improving the parent-infant relationship, and supporting longer-term child development.