The MAP Alliance study
1 in 5 women experience a mental health problem in pregnancy or the first year after birth. Anxiety and associated disorders like depression are the most common mental health problems experienced during the perinatal period – from pregnancy to after birth. These disorders can cause suffering for women and their families, are associated with poorer birth outcomes including premature birth, and can lead to mental health and behavioural problems for children through to adulthood.
If women with perinatal anxiety have access to care that is effective, acceptable, and practical for the NHS to provide, the burden of these disorders on women, their families, and the economy could be reduced. At the moment, we know little about what care is offered to and accessed by women with perinatal anxiety and associated disorders, and what the impact and cost of that care is.
The MAP ALLIANCE study investigated (1) what care is offered to women with and without anxiety and whether they access that care; (2) the costs of that care; and (3) women and health professionals’ experiences and views of that care.
We gathered this information by following up a group of over 700 women who took part in the Pregnancy MAP study. The MAP Alliance study followed these women and their babies until two years after birth in six connected projects described below. Publications based on these projects can be found here.
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For further information on the MAP Alliance study, please visit: MAP Alliance.
Project 1
What healthcare services do postnatal women with and without anxiety use?
We identified which health services women are offered and access, and regional differences. We also looked at whether all women have access to services to support their needs. To do this, we asked women from the Pregnancy MAP study to complete questionnaires about their anxiety, general health, and health service use 6, 12 and 24 months after giving birth. This highlighted women with perinatal anxiety who do not receive care, as well as helped us recommend ways that these women can be better identified and supported in the future.
Project 2
Medical records study of services women use for perinatal mental health
We aimed to examine medical records of around 40 women who had a diagnosis of perinatal anxiety or an associated disorder to assess the relationship between anxiety and health service use. We also aimed to look at whether medical records gave us similar information about health service use compared to women's questionnaire responses in Project 1.
Project 3
Postnatal women's views of care for their mental health
We explored what support and care is offered to women with anxiety or distress at any point during pregnancy and after giving birth, whether they received that care, and women’s views on that care. Women who completed questionnaires as part of Project 1 and had anxiety or distress during pregnancy or after birth were invited to take part in a one-to-one interview. We interviewed 60 women who experienced anxiety or distress to get their views of the care they were offered/received and how acceptable they found it. In the interview, women were asked about their experience of anxiety and distress, their journey of telling their GP, midwife, or health visitor about their symptoms, as well as any treatment they might have had or reasons for not accessing any treatment or support. We also asked women about ways in which treatment and services can be improved.
Project 4
Healthcare professionals' views of identifying and managing perinatal anxiety
We invited healthcare professionals who work with pregnant and/or postnatal women, such as midwives, GPs, health visitors, and psychologists, to take part in an in-depth interview. We interviewed over 60 health professionals and managers and asked them about how services identify and diagnose anxiety, distress, and depression in pregnancy and after birth, the options of care that are available to women, how confident professionals feel in managing women’s anxiety, as well as what changes are needed in order to provide the best care.
Project 5
The cost of services postnatal women with and without anxiety use
We investigated the cost of health service use for women with and without perinatal anxiety. As part of the previous projects, women provided information about the health services they used for themselves and their baby/babies from pregnancy to two years after giving birth. We used this information to calculate and compare the cost of health service use between women with and without anxiety. We also explored wider societal costs, like whether women’s anxiety impacted their plans to return to work or affected their household and family responsibilities. The results provide information on the financial and societal cost of perinatal anxiety, the types of services accessed by women, and can inform health service commissioning and budgets.
Project 6
Which services do postnatal women with and without PTSD use and what do they cost?
We are investigating the cost of health service use for women with and without postpartum post-traumatic stress disorder (PTSD) or birth-related PTSD. Postpartum PTSD can develop due to traumatic events that occurred prior to birth. In contrast, birth-related PTSD arises as a direct result of birth. We will use information women provided in Project 1 about their mental health and health service use for themselves and their baby. We will look at the circumstances of women with and without postpartum PTSD and birth-related PTSD to investigate whether there are differences in who gets referred and accesses services. We will calculate the cost of health service use and compare this for women with and without postpartum PTSD and birth-related PTSD. As in Project 5, we will also explore the wider societal costs, such as whether women’s PTSD affected their plans to return to work or their household and family responsibilities.