National Perintal Mental Health Project Report: Perinatal Mental Health of Black and Minority Ethnic Women: A Review of Current Provision in England, Scotland and Wales

Mental ill health during pregnancy and early motherhood, or ‘perinatalmental illness’, is a serious public health issue with potentially deleteriousconsequences for women’s life-long mental health and the health andwellbeing of their children and families. For example, postnatal depression(also known as postpartum depression, particularly in North America) is themost common of the potentially serious perinatal mental illnesses and canprecipitate relapse or recurrence of previous mental illness. It can also heraldthe onset of long-term mental health problems and is associated with increasedrisk of maternal suicide1-2.Postnatal depression has also been linked with depression in fathers and withhigh rates of family breakdown3. In addition, depression in mothers appearsto increase the risk of poor birth and child outcomes. These include higherrates of spontaneous abortion, low birth weight babies, developmental delay,retarded physical growth, and physical illnesses such as chronic diarrhoealillness4-7. There is also evidence that children born to depressed mothersdo less well educationally, experience higher levels of behavioural problemsand are more likely to develop psychological problems in later life8-10.The relationship between ethnicity/culture and mental illness is highlycontested and falls outside the scope of this report. In terms of perinatalmental illness among black and minority ethnic (BME) women, evidence onaetiology, course of illness and effective interventions is lacking and/or poorlyunderstood. This may be because research into mental illness and ethnicminorities in the UK has mostly focused on black men11-12 and evidence aboutperinatal mental illness is based largely on research among white Westernwomen13. Although there is emerging research about perinatal mental illness inBME women14-16, this area of psychiatry remains relatively under-explored.What is known is that there is a strong correlation between social and materialdeprivation and onset of perinatal mental illness – particularly depression17-18.Limited clinical and research evidence indicates that, despite high rates ofcommunity-level morbidity19 and disproportionate exposure to psychosocial riskfactors, fewer than expected BME women receive diagnosis and treatment. Thismay be for a number of reasons. BME communities’ fear and mistrust of mentalhealth services might reduce the likelihood of women from minority groupseither self-referring or being referred to services by their families20. Additionally,BME women are more likely to live in the most deprived communities in theUK21-22. Such communities tend to have poorer access to health care.The confluence of structural factors, such as unavailability of BME therapistsand lack of ‘culturally-sensitive’ care pathways, with personal and culturalfactors, such as attitudes and beliefs about mental health and illness23-26might represent significant (sometimes insurmountable) barriers to accessingcare for BME women27. Further research is needed to understand thecomplex relationships between these issues and to devise effective strategiesfor reducing the inequalities in access, care and treatment experienced bysome communities.