Perinatal anxiety is common in pregnancy and during the postpartum period, however most women don’t receive the help that they need. As a result, the NHS have called for more work to be done to improve the delivery of perinatal mental health services that can improve access to treatment in a cost-effective, acceptable and efficacious manner. The Five Year Forward View called for the transformation of service delivery to meet the needs of women in the perinatal period, and NHS England has begun a significant expansion of their services to achieve this, producing five Perinatal Mental Health Care Pathways. While following these pathways is important in terms of treating PNA, they tend to focus on women experiencing complex or severe symptoms, with clearer care options needed for those experiencing lower, but distressing, levels of anxiety.
Importantly, NICE Guideline 192 recommends that timely psychological support must be available to all expectant and new mothers with mild or moderate mental health issues to promote resilience and prevent symptom escalation. Despite this, pharmacological treatments appear to be offered most frequently for PNA in the UK (Ford et al, 2017), with healthcare professionals (HCPs) reporting limited avenues for non-pharmacological treatment.
So what does the research say?
Face-to-face psychological support
Research on treatments for perinatal anxiety is relatively limited at the moment, however a recent systematic review of the treatment of PNA concluded that cognitive behavioural therapy (CBT) is likely to be the most efficacious, safe and attractive treatment for pregnant and postpartum women (Marchesi et al, 2016). As such, CBT seems like the most sensible place to start when supporting women with PNA. There is also preliminary evidence that mindfulness techniques may also be helpful in relieving symptoms of anxiety in the perinatal period (Goodman et al, 2014).
The same review (Marchesi et al, 2016) also found evidence that selective serotonin reuptake inhibitors (SSRIs) may be effective in treating OCD and panic symptoms during pregnancy and postnatally, with no negative side-effects for the baby. Fluvoxamine was also found to be efficacious in postnatally, while tricyclic antidepressants improved panic symptoms in pregnant women, with health infant outcomes.
eHealth programs can increase and expedite access to mental health support. Indeed, a recent clinical and cost effectiveness review by NICE suggest that non-facilitated eHealth interventions are likely to be beneficial in the treatment of anxiety, and recommend the need for research to support this (NCG113).
Over the last decade, a significant number of eHealth programs have been developed for various mental health conditions. eHealth programs have good acceptance and attitudes towards their use are positive. Additionally, outcome data suggest that these types of programs are cost-effective and clinically efficacious, with effect sizes similar to face-to-face therapy. Many CCBT-based eHealth programs exist to support anxiety, however they are largely general public interventions and their effectiveness has not been tested in perinatal contexts. Indeed, apps are produced at a rate that research cannot keep up with, so many lack data about their effectiveness (for a review, see Sucala et al, 2017)
That said, the following apps and websites may be useful in helping women to manage their symptoms:
- The NHS mental health app library
- Live Life to the Full is commonly used by the NHS, and has a perinatal specific material
- Mood Gym – this app has several research studies supporting it’s effectiveness in adults and adolescents
- Headspace – the app has been shown to be effective in combating stress and anxiety (Economides et al, 2018)