title: Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort.
abstract: BACKGROUND
  Common mental disorders (CMD) such as anxiety and depression during the maternal period can cause significant morbidity to the mother in addition to disrupting biological, attachment and parenting processes that affect child development. Pharmacological treatment is a first-line option for moderate to severe episodes. Many women prescribed pharmacological treatments cease them during pregnancy but it is unclear to what extent non-pharmacological options are offered as replacement. There are also concerns that treatments offered may not be proportionate to need in minority ethnic groups, but few data exist on treatment disparities in the maternal period. We examined these questions in a multi-ethnic cohort of women with CMD living in Bradford, England before, during and up to one year after pregnancy.
  
  
  METHODS
  We searched the primary care records of women enrolled in the Born in Bradford cohort for diagnoses, symptoms, signs ('identification'), referrals for treatment, non-pharmacological and pharmacological treatment and monitoring ('treatment') related to CMD. Records were linked with maternity data to classify women identified with a CMD as treated prior to, and one year after, delivery. We examined rates and types of treatment during pregnancy, and analysed potential ethnic group differences using adjusted Poisson and multinomial logistic regression models.
  
  
  RESULTS
  We analysed data on 2,234 women with indicators of CMD. Most women were discontinued from pharmacological treatment early in pregnancy, but this was accompanied by recorded access to non-drug treatments in only 15 % at the time of delivery. Fewer minority ethnic women accessed treatments compared to White British women despite minority ethnic women being 55-70 % more likely than White British women to have been identified with anxiety in their medical record.
  
  
  CONCLUSIONS
  Very few women who discontinued pharmacological treatment early in their pregnancy were offered other non-pharmacological treatments as replacement, and most appeared to complete their pregnancy untreated. Further investigation is warranted to replicate the finding that minority ethnic women are more likely to be identified as being anxious or having anxiety and understand what causes the variation in access to treatments.
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK. stephanie.prady@york.ac.uk.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Prady
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Pickett
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK.|Hull York Medical School, University of York, York, YO10 5DD, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.|School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Petherick
authors.affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Mason
authors.affiliation: Hull York Medical School, University of York, York, YO10 5DD, UK.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Sheldon
authors.affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
authors.forename: John
authors.initials: J
authors.lastname: Wright
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004739:England; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Anxiety; Depression; Ethnic group; Post-natal; Pregnancy; Treatment inequality