Title: OptiMising cAre for Perinatal Anxiety: evaLuation of heaLth servIce utilisAtioN, outComEs and costs (MAP ALLIANCE)
Funder: Department of Health and Social Care

Abstract: One in five women experience a mental health problem in pregnancy or the first year after birth (also called the perinatal period). Perinatal anxiety and associated disorders such as depression are most common, and cause suffering for women and their families. They are associated with poor birth outcomes including premature birth and can lead to mental health and behavioural problems for children through to adulthood. This is a significant public health problem which costs £8.1 billion for every year of births in the UK with most of this caused by the long-term impact on children. If women with perinatal anxiety have access to care that is effective, acceptable, and practical for the NHS to provide, this burden 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. _x000D_ _x000D_ We aim to produce high quality evidence about the accessibility, acceptability and costs of support, care and treatments for perinatal anxiety. To do this we need to know: what care is offered to women with and without anxiety and whether they access that care; the costs of that care; and women and health professionals’ experiences and views of that care. We will gather this information by following up a group of 1600 women who we are already working with. The Methods of Assessing Perinatal Anxiety (MAP) study began in 2020 and is following women through their pregnancy to find the best way of identifying women with anxiety. This new study (MAP ALLIANCE) will continue following these women and their babies until two years after birth in five connected projects. _x000D_ _x000D_ In project 1 we will identify which health services women are offered, which services they access, and regional differences. We will also find out whether all women have access to services to support their needs. We will ask all 1600 women to complete questionnaires about their anxiety, general health, and health service use 6, 12 and 24 months after birth. This will highlight women with perinatal anxiety who do not receive care and help us recommend ways these women can be better identified and supported._x000D_ _x000D_ In project 2 we will examine medical records of 100 women who have a diagnosis of perinatal anxiety or an associated disorder, to assess the relationship between when anxiety started and health service use. We will also check whether questionnaires give similar information about health service use compared to medical records._x000D_ _x000D_ In project 3 we will interview 60 women to get their views of the care they were offered/received and how acceptable they found it. In project 4 we will interview 60 health professionals and managers about their role in managing perinatal anxiety, and factors that help or hinder this. In project 5 the costs of health service use for women with and without anxiety will be calculated._x000D_ _x000D_ We developed this research with women who have experience of perinatal mental illness, midwives and mental health professionals, who will continue to work with us throughout this project. One woman said “[if] a clear pathway can be defined to treat this effectively and quickly then this will be hugely beneficial to thousands of women and their families”. This research will enable us to make recommendations about what is working and what can be improved to support women with perinatal anxiety which will therefore benefit women, their families, and our healthcare system.

Lay abstract: Background: Perinatal mental health (PMH) problems affect one in five women and cost the UK £8.1 billion for every year of births, with 72% of this cost due to the long-term impact on the child. Currently only 30-50% of women with PMH problems are identified and 7% referred to specialist care. The majority of women with PMH problems therefore do not access care and this may be particularly the case for women with mild to moderate PMH problems or those with less commonly recognised problems, such as anxiety, obsessive compulsive disorder or post-traumatic stress disorder. Despite this, there is no quantitative research with nationally representative samples looking at care and health service use for perinatal anxiety and associated disorders. Health service use can be affected by many factors, such as whether anxiety is identified, what services are available and whether they are accessible, and whether they are acceptable to women. To improve access to care the NHS continues to invest in PMH services but there is little UK-wide research on how these services are being used by women._x000D_ _x000D_ Aims: To examine what care is offered to and accessed by women experiencing perinatal anxiety and associated disorders; the impact and cost of that care; as well as inequalities and regional variation from the perspectives of women and healthcare personnel._x000D_ _x000D_ Methods: This will be achieved through five connected work packages (WP). WP1 will determine the health service utilisation, self-report experiences and outcome measures, and health inequalities of women with and without perinatal anxiety and associated disorders. We will follow up an existing cohort of 1600 women who are currently being followed through pregnancy by the MAP study (HS&DR 17/105/16) at 6, 12 and 24 months after birth. In WP2 we will examine mental health history and health service utilisation in more detail, and examine concordance with self-report measures, by extracting data from primary care records for a subsample of 100 women diagnosed with anxiety or associated disorders during pregnancy or after birth. WP3 will explore women’s preferences for, perceptions of and acceptability of care they were offered/received, and regional variation through in-depth qualitative interviews with a purposive subsample of 60 women. WP4 will explore views on and barriers to management of perinatal anxiety and associated disorders and how to develop pathways for optimal care through in-depth qualitative interviews with a purposive sample of 60 health professionals working with perinatal women (e.g. maternity, primary care, health visiting and mental health services) or commissioning services. In WP5 we will determine the costs of health service use for women with and without perinatal anxiety and associated disorders through embedded health economic measures in WP1, WP2 and WP3._x000D_ _x000D_ Anticipated impact: This study will lead to recommendations for accessible, integrated care that is acceptable to women. It will assist NHS commissioners and providers in the design and transformation of services for perinatal women. This will increase the chances for women to receive better care to improve maternal and child outcomes.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH