Perinatal mental health problems are increasingly recognised, and specialist services are more widely available for support and treatment. However, little is known about how women use these services. This study examined the use of health and support services associated with perinatal anxiety, and possible inequities.

To determine the health service use and healthcare experiences of women with perinatal anxiety, and to examine regional differences and inequalities.

A prospective longitudinal follow-up of women recruited from 17 hospital trusts. Participants (N = 722) completed anxiety measures 6 weeks postpartum, and health service use and experience measures 6 months postpartum.

Anxiety 6 weeks postpartum was associated with more GP (incidence risk ratio (IRR) 1.02, 95% CI 1.01–1.03) and health visitor (IRR 1.01, 95% CI 1.01–1.02) visits for the mother but not for the infant. Effects were moderated by ethnicity for GP visits (IRR 1.03, 95% CI 1.00–1.06) and by level of education for health visitor visits (IRR 1.02, 95% CI 1.01–1.03). Anxiety was associated with lower satisfaction with GP care for the baby, health visitor care and poorer overall healthcare experiences. Women with anxiety were more likely to attend specialist mental health (odds ratio 1.09, 95% CI 1.06–1.12) or other support services (odds ratio 1.04, 95% CI 1.01–1.06). However, 29.2% of those referred to mental health services and 30.8% referred to other support services did not attend.

Perinatal anxiety increases health service use for mothers but not for infants. Anxiety also negatively impacts satisfaction with healthcare. Findings can inform strategies to improve access and experience of care.

Suicide is one of the leading causes of maternal mortality in high-income countries. Suicide prevention policy calls for maternity care providers to actively explore potential risk factors and self-reported suicidal intent with perinatal women. However, longitudinal research establishing the prevalence of suicidal intent and associated risk factors with representative cohorts of perinatal women in the UK is lacking.

This secondary analysis aimed to determine the prevalence of suicidal intent in pregnancy and postpartum, and examine factors associated with suicidal intent.

A total of 2210 women completed self-report assessments in early, mid- and late pregnancy and early postpartum. Suicidal intent was measured with the item ‘I have made plans to end my life’ (Clinical Outcomes in Routine Evaluation-10). Other variables included anxiety (Generalised Anxiety Disorder-7, Stirling Antenatal Anxiety Scale), depression (Whooley Questions), health status (EuroQoL EQ-5D-5L), mental health history, and sociodemographic and pregnancy variables.

Suicidal intent was indicated by 72 participants (3.26%, 95% CI 2.56–4.09) on at least one occasion. Suicidal intent was significantly associated with having negative feelings about pregnancy (odds ratio 3.63, 95% CI 1.99–6.63), unplanned pregnancy (odds ratio 2.03, 95% CI 1.25–3.30), previous and current mental health problems (odds ratio 3.70 95% CI 2.19–6.25), symptoms causing daily difficulties (odds ratio 5.94 95% CI 3.32–10.66) and being of Asian (odds ratio 2.62, 95% CI 1.44–4.77) or mixed ethnicity (odds ratio 3.43, 95% CI 1.49–7.93). Poor physical health in early pregnancy was also associated with suicidal intent (t = 6.37, d.f. = 2108, p < 0.001).

These findings indicate that daily difficulties associated with mental health, and negative feelings about pregnancy are important and underexplored risk factors for experiencing suicidal intent. The findings also corroborate previous research indicating that previous and existing mental health problems and ethnicity are significant risk factors.

Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.