Skip to main content
×
×
Home

Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: Combined analysis of routine and cohort data

  • Stephanie L. Prady (a1), Kate E. Pickett (a1), Emily S. Petherick (a2), Simon Gilbody (a3), Tim Croudace (a3), Dan Mason (a2), Trevor A. Sheldon (a4) and John Wright (a5)...
Abstract
Background

There are limited data on detection disparities of common mental disorders in minority ethnic women.

Aims

Describe the natural history of common mental disorders in primary care in the maternal period, characterise women with, and explore ethnic disparities in, detected and potentially missed common mental disorders.

Method

Secondary analyses of linked birth cohort and primary care data involving 8991 (39.4% White British) women in Bradford. Common mental disorders were characterised through indications in the electronic medical record. Potentially missed common mental disorders were defined as an elevated General Health Questionnaire (GHQ-28) score during pregnancy with no corresponding common mental disorder markers in the medical record.

Results

Estimated prevalence of pre-birth common mental disorders was 9.5%, rising to 14.0% 3 years postnatally. Up to half of cases were potentially missed. Compared with White British women, minority ethnic women were twice as likely to have potentially missed common mental disorders and half as likely to have a marker of screening for common mental disorders.

Conclusions

Common mental disorder detection disparities exist for minority ethnic women in the maternal period.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: Combined analysis of routine and cohort data
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: Combined analysis of routine and cohort data
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: Combined analysis of routine and cohort data
      Available formats
      ×
Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Corresponding author
Stephanie L. Prady, Research Fellow, Department of Health Sciences, University of York, York YO10 5DD, UK. Email: stephanie.prady@york.ac.uk
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Cepoiu, M, McCusker, J, Cole, MG, Sewitch, M, Belzile, E, Ciampi, A. Recognition of depression by non-psychiatric physicians–a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23: 2536.
2 Cooper, C, Bebbington, P, McManus, S, Meltzer, H, Stewart, R, Farrell, M, et al. The treatment of Common Mental Disorders across age groups: results from the 2007 Adult Psychiatric Morbidity Survey. J Affect Disord 2010; 127: 96101.
3 Bhui, K, Bhugra, D, Goldberg, D, Sauer, J, Tylee, A. Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms. Transcult Psychiatry 2004; 41: 307–22.
4 Monk, C, Fitelson, EM, Werner, E. Mood disorders and their pharmacological treatment during pregnancy: is the future child affected? Pediatr Res 2011; 69 (5 Pt 2): 3R10R.
5 Robertson, E, Grace, S, Wallington, T, Stewart, DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004; 26: 289–95.
6 Gaynes, BN, Gavin, N, Meltzer-Brody, S, Lohr, KN, Swinson, T, Gartlehner, G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 2005; 119: 18.
7 Agnafors, S, Sydsjo, G, Dekeyser, L, Svedin, CG. Symptoms of depression postpartum and 12 years later-associations to child mental health at 12 years of age. Matern Child Health J 2013; 17: 405–14.
8 O'Connor, TG, Heron, J, Glover, V. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002; 41: 1470–7.
9 Martin-Merino, E, Ruigomez, A, Wallander, MA, Johansson, S, Garcia-Rodriguez, LA. Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Fam Pract 2010; 27: 916.
10 Wright, J, Small, N, Raynor, P, Tuffnell, D, Bhopal, R, Cameron, N, et al. Cohort profile: the Born in Bradford multi-ethnic family cohort study. Int J Epidemiol 2013; 42: 978–91.
11 Goldberg, DP, Hillier, VF. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9: 139–45.
12 Prady, SL, Pickett, KE, Croudace, T, Fairley, L, Bloor, K, Gilbody, S, et al. Psychological distress during pregnancy in a multi-ethnic community: findings from the born in Bradford cohort study. PloS One 2013; 8: e60693.
13 Prady, SL, Miles, JNV, Pickett, KE, Fairley, L, Bloor, K, Gilbody, S, et al. The psychometric properties of the subscales of the GHQ-28 in a multi-ethnic maternal sample: results from the Born in Bradford cohort. BMC Psychiatry 2013; 13: 55.
14 Dave, S, Petersen, I. Creating medical and drug code lists to identify cases in primary care databases. Pharmacoepidemiol Drug Saf 2009; 18: 704–7.
15 Goldberg, D, Williams, P. A Users Guide to the General Health Questionnaire. GL Assessment, 2006.
16 Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinelli, M, Gureje, O, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997; 27: 191–7.
17 Devine, S, West, S, Andrews, E, Tennis, P, Hammad, TA, Eaton, S, et al. The identification of pregnancies within the general practice research database. Pharmacoepidemiol Drug Saf 2010; 19: 4550.
18 Walters, K, Rait, G, Griffin, M, Buszewicz, M, Nazareth, I. Recent trends in the incidence of anxiety diagnoses and symptoms in primary care. PloS One 2012; 7: e41670.
19 National Institute for Health and Clinical Excellence. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance (NICE Clinical Guideline CG45). NICE, 2007.
20 National Institute for Health and Care Excellence. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance (Update) (Clinical Guideline CG192). NICE, 2014.
21 Austin, MP, Hadzi-Pavlovic, D, Priest, SR, Reilly, N, Wilhelm, K, Saint, K, et al. Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Womens Ment Health 2010; 13: 395401.
22 Mann, R, Adamson, J, Gilbody, SM. Diagnostic accuracy of case-finding questions to identify perinatal depression. CMAJ 2012; 184: E42430.
23 Khan, NF, Harrison, SE, Rose, PW. Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br J Gen Pract 2010; 60: e12836.
24 Martin-Merino, E, Ruigomez, A, Johansson, S, Wallander, MA, Garcia-Rodriguez, LA. Study of a cohort of patients newly diagnosed with depression in general practice: prevalence, incidence, comorbidity, and treatment patterns. Prim Care Companion J Clin Psychiatry 2010; 12: e1e8.
25 Dave, S, Petersen, I, Sherr, L, Nazareth, I. Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Arch Pediatr Adolesc Med 2010; 164: 1038–44.
26 Hearn, G, Iliff, A, Jones, I, Kirby, A, Ormiston, P, Parr, P, et al. Postnatal depression in the community. Br J Gen Pract 1998; 48: 1064–6.
27 Tarricone, I, Stivanello, E, Poggi, F, Castorini, V, Marseglia, MV, Fantini, MP, et al. Ethnic variation in the prevalence of depression and anxiety in primary care: a systematic review and meta-analysis. Psychiatry Res 2012; 195: 91106.
28 Husain, N, Cruickshank, K, Husain, M, Khan, S, Tomenson, B, Rahman, A. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. J Affect Disord 2012; 140: 268–76.
29 Weich, S, Nazroo, J, Sproston, K, McManus, S, Blanchard, M, Erens, B, et al. Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med 2004; 34: 1543–51.
30 Gater, R, Tomenson, B, Percival, C, Chaudhry, N, Waheed, W, Dunn, G, et al. Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 198207.
31 Downe, SM, Butler, E, Hinder, S. Screening tools for depressed mood after childbirth in UK-based South Asian women: a systematic review. J Adv Nurs 2007; 57: 565–83.
32 Gilbody, S, Sheldon, T, House, A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ 2008; 178: 9971003.
33 Naylor, C, Parsonage, M, McDaid, D, Knapp, M, Fossey, M, Galea, A. Long-term Conditions and Mental Health: The Cost of Co-Morbidities. The Kings Fund, 2012.
34 Sashidharan, S, Commander, M. Mental health: disadvantage, discrimination and distress. In Primary Healthcare and South Asian Populations: Meeting the Challenges (eds Shahid, A, Atkin, K): 7188. Radcliffe Publishing, 2004.
35 Nazroo, JY. The Health of Britain's Ethnic Minorities. Policy Studies Institute, 1997.
36 Nazroo, J. Ethnicity and Mental Health. Policy Studies Institute, 1997.
37 Saver, BG, Van-Nguyen, V, Keppel, G, Doescher, MP. A qualitative study of depression in primary care: missed opportunities for diagnosis and education. J Am Board Fam Med 2007; 20: 2835.
38 Chew-Graham, CA, Mullin, S, May, CR, Hedley, S, Cole, H. Managing depression in primary care: another example of the inverse care law? Fam Pract 2002; 19: 632–7.
39 Barley, EA, Murray, J, Walters, P, Tylee, A. Managing depression in primary care: a meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators. BMC Fam Pract 2011; 12: 47.
40 Bhui, K, Bhugra, D, Goldberg, D, Dunn, G, Desai, M. Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner. Psychol Med 2001; 31: 815–25.
41 Kleinman, A. Anthropology and psychiatry. The role of culture in cross-cultural research on illness. Br J Psychiatry 1987; 151: 447–54.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Prady et al. supplementary material
Supplementary Table S1-S8

 PDF (504 KB)
504 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: Combined analysis of routine and cohort data

  • Stephanie L. Prady (a1), Kate E. Pickett (a1), Emily S. Petherick (a2), Simon Gilbody (a3), Tim Croudace (a3), Dan Mason (a2), Trevor A. Sheldon (a4) and John Wright (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *