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Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort

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posted on 22.04.2016 by Stephanie L. Prady, Kate E. Pickett, Simon Gilbody, Emily Petherick, Dan Mason, Trevor A. Sheldon, John Wright
Background: Common mental disorders (CMD) such as anxiety and depression during the maternal period can cause significant morbidity to the mother in addition to disrupting biological, attachment and parenting processes that affect child development. Pharmacological treatment is a first-line option for moderate to severe episodes. Many women prescribed pharmacological treatments cease them during pregnancy but it is unclear to what extent non-pharmacological options are offered as replacement. There are also concerns that treatments offered may not be proportionate to need in minority ethnic groups, but few data exist on treatment disparities in the maternal period. We examined these questions in a multi-ethnic cohort of women with CMD living in Bradford, England before, during and up to one year after pregnancy. Methods: We searched the primary care records of women enrolled in the Born in Bradford cohort for diagnoses, symptoms, signs (‘identification’), referrals for treatment, non-pharmacological and pharmacological treatment and monitoring (‘treatment’) related to CMD. Records were linked with maternity data to classify women identified with a CMD as treated prior to, and one year after, delivery. We examined rates and types of treatment during pregnancy, and analysed potential ethnic group differences using adjusted Poisson and multinomial logistic regression models. Results: We analysed data on 2,234 women with indicators of CMD. Most women were discontinued from pharmacological treatment early in pregnancy, but this was accompanied by recorded access to non-drug treatments in only 15 % at the time of delivery. Fewer minority ethnic women accessed treatments compared to White British women despite minority ethnic women being 55–70 % more likely than White British women to have been identified with anxiety in their medical record. Conclusions: Very few women who discontinued pharmacological treatment early in their pregnancy were offered other non-pharmacological treatments as replacement, and most appeared to complete their pregnancy untreated. Further investigation is warranted to replicate the finding that minority ethnic women are more likely to be identified as being anxious or having anxiety and understand what causes the variation in access to treatments.

Funding

This article presents independent research funded by the Medical Research Council, award reference MR/J013501/1, the MRC Health e-Research Centre of the Farr Institute (award reference MR/K006665/1), University of Manchester, and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH).

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  • Sport, Exercise and Health Sciences

Published in

BMC Psychiatry

Volume

16

Citation

PRADY, S.L. ... et al, 2016. Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort. BMC Psychiatry, 16:99, DOI: 10.1186/s12888-016-0805-x

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BioMed Central / © The Authors

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VoR (Version of Record)

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This work is made available according to the conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/ by/4.0/

Acceptance date

05/04/2016

Publication date

2016

Notes

This is an Open Access article and it is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

ISSN

1471-244X

Language

en

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