Maternal anxiety and health service use after birth: cohort study

Background
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.

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

Method
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.

Results
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.

Conclusions
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.