Antenatal and postnatal mental health : clinical management and service guidance

GUIDELINE DEVELOPMENT GROUP MEMBERSHIP 6 1. EXECUTIVE SUMMARY 9 1.1 Principles of care for all women with mental disorders during pregnancy and the postnatal period 11 1.2 Prediction, detection and initial management of mental disorders 12 1.3 Prevention of mental disorders 14 1.4 Care of women with a mental disorder during pregnancy and the postnatal period 15 1.5 The organisation of services 26 1.6 Research recommendations 27 2. INTRODUCTION 30 2.1 National guidelines 30 2.2 The national antenatal and postnatal mental health guideline 32 2.3 The structure of this guideline 34 3. METHODS USED TO DEVELOP THIS GUIDELINE 35 3.1 Overview 35 3.2 The scope 35 3.3 The Guideline Development Group 36 3.4 Clinical questions 38 3.5 Systematic clinical literature review 39 3.6 Health economics review strategies 49 3.7 Stakeholder contributions 52 3.8 Testimonies from women with mental disorders in the antenatal and postnatal period 52 3.9 Validation of this guideline 53 4. ANTENATAL AND POSTNATAL MENTAL HEALTH: POPULATION, DISORDERS AND SERVICES 54 4.1 Scope of the guideline 54 4.2 Mental disorders during pregnancy and the postnatal period 55 4.3 Incidence and prevalence of perinatal disorders 57 4.4 Aetiology of antenatal and postnatal mental disorders 68 4.5 Consequences of mental disorder during pregnancy and the postnatal period 69 4.6 Treatment in the NHS 74 Contents 3 4.7 The economic burden of mental disorders in the antenatal and postnatal period 77 4.8 Explaining risk to women: helping patients to make decisions about treatment 78 5. THE PREDICTION AND DETECTION OF MENTAL ILLNESS DURING PREGNANCY AND THE POSTNATAL PERIOD 85 5.1 Introduction 85 5.2 Prediction – risk factors for the onset of mental disorder during pregnancy and the postnatal period 89 5.3 Methods for predicting mental disorder during pregnancy and the postnatal period 108 5.4 Methods for detecting mental disorder during pregnancy and the postnatal period 111 5.5 Referral pathways 118 6. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS 121 6.1 Introduction 121 6.2 Issues in research into psychological treatments 121 6.3 Definitions of psychological and psychosocial interventions 125 6.4 Overview of clinical review 129 6.5 Review of treatments aimed at preventing the development of mental disorders during the antenatal and postnatal periods for women with existing risk factors 131 6.6 Health economics evidence on psychological and psychosocial interventions aimed at preventing the development of depression during the antenatal and postnatal periods in women with identified psychosocial risk factors and/or subthreshold depressive symptoms 144 6.7 Clinical practice and research recommendations 155 6.8 Review of treatments aimed at preventing the development of mental disorders during the antenatal and postnatal periods for women with no identified risk factors 156 6.9 Review of non-pharmacological treatments for depression in the postnatal period 161 6.10 Health economics evidence on psychosocial interventions for treatment of depression in the postnatal period 174 6.11 Focusing on the infant: intervening in the mother-infant interaction or measuring child-related outcomes 185 6.12 Broader psychosocial interventions and other treatments 192 6.13 Treatments for women with disorders other than depression 200 Contents 4 7. THE PHARMACOLOGICAL TREATMENT OF MENTAL DISORDERS IN PREGNANT AND BREASTFEEDING WOMEN 201 7.1 Introduction 201 7.2 Risk associated with specific drugs in pregnancy and the postnatal period 203 7.3 The pharmacological treatment of mental disorder during pregnancy and the postnatal period – review of available studies 215 7.4 Prescribing psychotropic medication to pregnant and breastfeeding women 232 7.5 The pharmacological treatment of specific mental disorders during pregnancy and the postnatal period – adaptation of existing guidelines 235 8. THE ORGANISATION OF PERINATAL MENTAL HEALTH SERVICES 242 8.1 Introduction 242 8.2 The current structure of services 242 8.3 Estimating the need for services 245 8.4 The functions of services for women, their partners and carers in the antenatal and postnatal period 248 8.5 The structure of perinatal mental health services 257 8.6 Implementing the managed network model: service recommendations 264 8.7 Research recommendation 265 9. Appendices 266 10. References 345 11. Abbreviations 367