Women's mental illness in pregnancy: Exploring contact with secondary mental health services and links with offspring health and education outcomes

妇女妊娠期精神疾病：探索与二级心理健康服务的联系以及与后代健康和教育成果的联系

• 批准号: ES/Z502492/1
• 负责人: Yasmin Ahmadzadeh
• 金额: $ 18.41万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FZ502492%2F1
• 关键词: Women; mental; illness; pregnancy; Exploring

1 in 4 women in the UK are reported to experience mental illness in the perinatal period, constituting a costly public health issue linked to reduced family wellbeing, obstetric complications, and adverse child outcomes. The significant health burden is greater for those facing barriers to accessing mental health support. For example, young women and women with minoritised ethnicities or lower socio-economic status are less likely to seek and receive treatment in British mental health services. Further, women face fears and stigma regarding offspring exposure to their mental illness during pregnancy, despite a lack of robust causal evidence in this area. My previous work shows that uncertainties remain regarding the causal impact of mothers' mental illness in pregnancy on child outcomes.I propose an 18-month fellowship to address these challenges, identifying families who could benefit from further support, directly addressing parents' own concerns. I will use linked administrative data from the 'Education and Child Health Insights from Linked Data' (ECHILD) database, holding English administrative health and education records for 20 million individuals born in England since 1984. I will curate a linked longitudinal national dataset to explore mothers' perinatal mental health and links with offspring developmental outcomes. My work will be guided and enhanced by a parent advisory group and the charity Centre for Mental Health.First, I will explore inequities in women's contact with secondary mental healthcare services during pregnancy, focusing on demographic groups at risk of marginalization (i.e., exploring women's age, ethnicity, number of children, and neighborhood deprivation). I will focus on maternity episodes for women in ECHILD between April 2010 - March 2022. I will describe trends in women's contact with secondary mental health services across this period, while documenting nuances in data quality and availability from Hospital Episode Statistics and the Mental Health Services Datasets. I will interpret trends in the context of temporal administrative database and policy changes, for example following government investment in specialist perinatal mental health services from 2016. I will explore the extent to which inequities in service provision appear maintained over time, informing further policy action.Second, I will connect mothers' pregnancy data with birth and offspring outcome data, linking child records from Hospital Episode Statistics and the National Pupil Database. I will rigorously test and improve the quality of data linkages, to ensure accuracy of mother-child and child sibling pairs in the cohort. I will describe the final sample characteristics, including the number of offspring and data availability. Thus, I will produce a valuable resource for timely new intergenerational research, helping move the UK administrative data infrastructure towards alignment with flagship Scandinavian population-level data resources, linking records across family members at scale.Third, I will quantify associations between mothers' mental illness in pregnancy and offspring outcomes (birthweight, gestational age, foetal and neonatal death, chronic health conditions, and primary school attainment). My results will contribute knowledge on the origins of offspring early health and development. I will interpret correlations in the context of the data quality, informed by my earlier learning. Several quasi-experimental methods, including 'sibling-comparison designs', can then be applied to test causal pathways between mother and child variables, spanning beyond my fellowship end. Thus, this work paves the way to provide families, clinicians, and policymakers with robust, evidence-based information on the possible intergenerational effects of perinatal mental illness.

据报道，英国四分之一的妇女在围产期遭受精神疾病，构成了一个昂贵的公共卫生问题，该问题与减少家庭健康，产科并发症和不良儿童成果有关。对于那些面对获得心理健康支持的障碍的人来说，重大健康负担更大。例如，在英国精神卫生服务中寻求和接受治疗的可能性较小的年轻妇女和少数种族或较低的社会经济地位的妇女。此外，尽管在这一领域缺乏强大的因果证据，妇女在怀孕期间对后代暴露于自己的精神疾病的恐惧和污名。我以前的工作表明，关于母亲在怀孕对儿童结局的因果影响的不确定性仍然存在。我提出了18个月的奖学金来应对这些挑战，确定可以从进一步的支持中受益的家庭，直接解决父母自己的担忧。我将使用“来自链接数据的教育和儿童健康见解”（Echild）数据库中的链接行政数据，对1984年以来在英格兰出生的2000万个人拥有英国行政健康和教育记录。我将策划一个链接的纵向国家数据集，以探索母亲的围产心心理健康，并与后代发展的发展与后代发展。我的工作将受到父母咨询小组和慈善心理健康中心的指导和增强。首先，我将探索妇女在怀孕期间与二级心理保健服务接触的不平等，专注于处于边缘化风险（即探索妇女的年龄，种族，儿童数量和邻里剥夺）的人口统计学群体。我将在2010年4月至2022年3月之间关注Echild女性的孕妇发作。我将在此期间描述妇女与二级心理健康服务接触的趋势，同时记录医院情节统计数据和心理健康服务数据集的数据质量和可用性的细微差别。我将在时间行政数据库和政策变化的背景下解释趋势，例如，在政府对2016年以来对专家围产期心理健康服务的投资之后。我将探讨服务提供的不平等现象随着时间的推移而持续下去，以进一步的政策行动，从而为进一步的政策行动提供了信息。我将严格测试并提高数据链接的质量，以确保共同的母子和儿童兄弟姐妹对的准确性。我将描述最终的样本特征，包括后代和数据可用性的数量。 Thus, I will produce a valuable resource for timely new intergenerational research, helping move the UK administrative data infrastructure towards alignment with flagship Scandinavian population-level data resources, linking records across family members at scale.Third, I will quantify associations between mothers' mental illness in pregnancy and offspring outcomes (birthweight, gestational age, foetal and neonatal death, chronic health conditions, and primary school attainment).我的结果将为后代早期健康和发展的起源提供知识。我将在我的早期学习中解释数据质量的上下文中的相关性。然后，可以将几种准实验方法（包括“兄弟姐妹及其比较设计”）应用于母亲和儿童变量之间的因果途径，超出了我的团契终点。因此，这项工作为为家庭，临床医生和政策制定者提供了有关围产期精神疾病可能产生的代际影响的强大的，基于证据的信息铺平了道路。