CLASP PNA
Research type
Research Study
Full title
Classification, outcomes and interventions for women with perinatal anxiety: a qualitative study.
IRAS ID
318194
Contact name
Carolyn Chew-Graham
Contact email
Duration of Study in the UK
0 years, 5 months, 29 days
Research summary
Research Summary:
Background: The term “perinatal anxiety” refers to anxiety (excessive worrying, restlessness, nervousness) that occurs during pregnancy and/or up to 12 months after birth. During this period, women are at greater risk of experiencing common mental health disorders such as depression and anxiety. Our research will help raise awareness about this and support healthcare decisions, which is of further importance given that the COVID-19 pandemic has resulted in a higher number of pregnant women experiencing mental health problems.\nPrevious research has focused on depression during the perinatal period, but we know far less about anxiety. What we do know is that anxiety may lead to depression and poor quality of life and may impact child development. It has been found in previous research that the knowledge among health care professionals is often limited about perinatal anxiety. This is likely to have negative effects on care received by women. \nThe current research employs qualitative approaches and is planned for two complementary studies: \na)\tSPCR-funded study: ‘Classification and outcomes of perinatal anxiety: implications for practice’ (CLASP). This study has two components: a Clinical Practice Research Datalink (CPRD) study which will identify risk factors for PNA; a qualitative study that will explore the perspectives of women and health care professionals on the usefulness and acceptability of determining the risk of PNA. \nb)\tDoctoral research study (Defining Optimal Interventions for Perinatal Anxiety) which aims to define a framework for intervention for PNA.\nAim: The overall aim is to improve the identification, management, and quality of care for women with perinatal anxiety (PNA). The qualitative component of the study aims to explore the perspectives of women with PNA and healthcare professionals on being labeled as “high risk” and identify clinical training needs. \nMethods:\nThe qualitative component of the study will use semi-structured interviews to explore the study participants’ perspectives. This method will allow the research team to explore, in detail, participants’ views around PNA and provide participants with opportunities to raise issues that are important to them, which have not been predicted by the research team. Four groups of participants will be invited to take part in this study: 1. Women who have personal experience of PNA (either currently or in the past two years) 2. Health Care Professionals (HCPs) 3. Mental health service commissioners and 4. Third sector perinatal mental health organisation representatives (referred to as ‘Third sector representatives’ throughout this protocol). \nImplications: The study outputs will benefit women and their partners, clinicians, academics, commissioners, third sector representatives, lay community groups and policymakers. A stakeholder workshop will be held with women and their partners, clinicians, commissioners and members of our PAG and CAG. The outputs from this workshop will include recommendations for policy and practice, information for women and families about PNA delivered and co-produced using innovative methods (and this will be carried forward by PAG and CAG), advice on other dissemination activities and ideas for future research.\nPatient and Public Involvement and stakeholder involvement: \nA separate patient advisory group (PAG) and a clinical advisory group (CAG) have been formed for the SPCR CLASP study. Members of each group will contribute towards study development, topic guide development, and data analysis and will advise and support the dissemination of findings.\nIt is for this second, qualitative component we are seeking HRA ethical approval. The CPRD study (ISAC protocol) already received ethical approval. \nSummary of Results:
Background: Perinatal anxiety (PNA) is defined as anxiety occurring in the period between becoming pregnant
and up to 12 months after birth. Women may find it difficult to seek help for symptoms of anxiety or find that the
help available does not meet their needs. PNA affects the mother experiencing it and can also affect their child
and family. Diagnosing PNA early might reduce these negative consequences.
Methods: A Patient and Public
Advisory Group (PAG) and Clinical Advisory Group (CAG) contributed to each aspect of the study. We
interviewed women who have experienced PNA and a range of healthcare professionals (HCPs). These
interviews explored whether labelling women as ‘at risk’ of PNA was acceptable, identified what support should
be available and what training HCPs might be needed to improve identification of PNA. We used anonymised
patient records from general practices to assess: - the role of pregnancy and anxiety in healthcare use; - whether
the children of women with PNA have higher healthcare use; - whether women with PNA can be grouped
according to background factors (age, deprivation), pregnancy details (gender of the baby, delivery method and
outcome), lifestyle choices, and other medical conditions.
Findings: Women and HCPs thought it would be
acceptable to identify women at risk of PNA if there were services available to support them. They said that
many factors could contribute to the development and experience of PNA, including a history of childhood
trauma, concerns about body image, lack of support networks, financial worries. These risk factors are not coded
in primary care patient records (though may exist as free text in a patient's notes). Women may not have any
contact with general practice until the postnatal check, and there is little sharing of records between primary care
and maternity care. Analysis of the patient records suggested obesity and other physical health problems placed
women at risk of PNA, and women with PNA had more visits to their GP, referrals and prescriptions, particularly
in the period immediately after delivery. Experiencing PNA can lead to increased use of primary care services for
both mother and baby. Children of mothers with PNA were more likely to be vaccinated.
Conclusions: Women
with PNA use healthcare more, particularly soon after delivery, highlighting the need for early identification and
ongoing support. Primary care records may not include the information needed to predict increased risk of PNA.
A clinician’s assessment may be a better way to identify risk.REC name
London - Surrey Research Ethics Committee
REC reference
23/PR/1095
Date of REC Opinion
16 Nov 2023
REC opinion
Further Information Favourable Opinion