title: Prenatal psychological distress and access to mental health care in the ELFE cohort.
abstract: BACKGROUND
  Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.
  
  
  METHODS
  We used data from the French cohort Étude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.
  
  
  RESULTS
  Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.
  
  
  CONCLUSIONS
  Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.
  
  
  CONCLUSIONS
  Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
authors.affiliation: Bordeaux University, U657, 33000 Bordeaux, France; INSERM, U657, 33000 Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Bales
authors.affiliation: Bordeaux University, U657, 33000 Bordeaux, France; INSERM, U657, 33000 Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Pambrun
authors.affiliation: INSERM, UMRS 1136 Pierre-Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France; Sorbonne University, UPMC Paris University, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Melchior
authors.affiliation: INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France.
authors.forename: N M-C
authors.initials: NM
authors.lastname: Glangeaud-Freudenthal
authors.affiliation: Ined Inserm joint unit Elfe, Paris, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Charles
authors.affiliation: Bordeaux University, U657, 33000 Bordeaux, France; INSERM, U657, 33000 Bordeaux, France; University Department of Adult Psychiatry, Charles-Perrens Hospital, Bordeaux, France.
authors.forename: H
authors.initials: H
authors.lastname: Verdoux
authors.affiliation: Bordeaux University, U657, 33000 Bordeaux, France; INSERM, U657, 33000 Bordeaux, France; University Department of Adult Psychiatry, Charles-Perrens Hospital, Bordeaux, France. Electronic address: alsutter@ch-perrens.fr.
authors.forename: A-L
authors.initials: AL
authors.lastname: Sutter-Dallay
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000523:psychology; D004522:Educational Status; D005260:Female; D005602:France; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D008605:Mental Health Services; D009035:Mothers / Q000523:psychology; D009819:Office Visits / Q000706:statistics & numerical data*; D011203:Poverty / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D049168:Pregnancy, Unplanned / Q000523:psychology; D011275:Pregnancy, Unwanted / Q000523:psychology; D037841:Pregnant People / Q000523:psychology*; D011619:Psychotropic Drugs / Q000008:administration & dosage; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Access to mental health care; Environmental factors; Mental health; Perinatal psychological distress; Pregnancy