The end of a baby’s first year does not necessarily mark the end of a parent’s mental health needs. A large study of primary care records in England found that mental illness continued to be recorded during the second year after birth, including among many women with no qualifying record during the first year.
The findings support NHS England’s 2019 commitment to extend specialist perinatal mental health support from 12 to 24 months after birth. They also highlight why the figures should be interpreted carefully: the study measured illness recorded in general practice, not every mental health difficulty experienced by women.
What the study examined
Jones and colleagues conducted a retrospective cohort study using anonymised GP records from the Clinical Practice Research Datalink GOLD. The researchers identified 2,132,754 pregnancies involving 1,361,497 women with a recorded live birth between 1995 and 2020.
The main analysis focused on births up to 2018, allowing two complete years of follow-up. Mental illness was identified through combinations of GP diagnoses, symptoms and prescriptions for psychotropic medication. For the more cautious estimate, women needed at least two of those three indicators.
Mental health needs continued into the second year
Across the study period, 5.9% of pregnancies were followed by recorded mental illness between 13 and 24 months after birth. That represented 123,510 pregnancies. The comparable recorded prevalence during the first postpartum year was 7.5%, making second-year records less common but still substantial.
The researchers classified 3.3% of pregnancies as being followed by a case recorded as new during the second postpartum year. These 69,926 cases made up 56.6% of all recorded second-year cases.
More than half of the women identified during the second year had no qualifying mental illness recorded during the first postpartum year. However, the study cannot show that their difficulties began precisely after the first birthday. An illness may have started earlier but only been recorded later, or may not have been coded consistently.
Depression and anxiety were the most commonly recorded forms of mental illness.
Risk was not evenly distributed
Women with a mental illness record during the first postpartum year had around nine times the odds of a recorded mental illness during the second year compared with women without such a record.
Higher recorded odds were also found among women with mental illness before or during pregnancy, a greater number of recorded pregnancies, a preterm or near-term birth, a recorded history of smoking, or a substance use disorder. In a subgroup analysis, women living in more deprived areas had higher recorded odds.
Women from minority ethnic groups had lower odds of having mental illness recorded than White women. The study authors cautioned that this should not be interpreted as evidence of lower need. Barriers to help-seeking, unequal access and under-recognition may all affect what appears in health records.
Why the trend needs context
Recorded second-year cases increased over time. All recorded cases rose from 3.1% in 1995 to 7.4% in 2018, while cases classified as new onset rose from 1.9% to 3.8%.
Those increases do not automatically mean that mothers’ mental health deteriorated over the period. Greater awareness, changes in diagnosis, GP recording and prescribing could all have contributed to the rise.
There is also no clear clinical reason for mental illness to spontaneously resolve at the 12-month point. The study’s results therefore add support to a service boundary that extends beyond the historical definition of the perinatal period as pregnancy and the first year after birth.
What the findings cannot tell us
This was an observational study based on primary care records. It could not directly establish whether an illness was moderate or severe, whether a woman met the threshold for specialist perinatal care, or whether she was referred to or treated by such a service.
Some women may not have sought help, may have been unable to access care, may have discussed their mental health elsewhere or may have had symptoms overlooked. Prescriptions can also have different uses, and psychological treatment may not be fully captured in GP records.
The study excluded pregnancies ending in stillbirth or termination, so its findings cannot be generalised to women experiencing pregnancy loss. It also does not show how many women were referred, accepted by services or able to access timely treatment.
The wider implication
The authors concluded that there is substantial ongoing and newly recorded mental health need during the second postpartum year. Their findings support England’s decision to extend specialist perinatal mental health services to 24 months after birth, while leaving open the question of which type of support is most appropriate for each individual.
In practical terms, the research argues against treating the first birthday as an automatic endpoint for attention to mental health. It also shows why service planning needs to account for people whose difficulties are not recorded promptly or who face barriers to being recognised and supported.
AI tools were used to assist with the preparation of this article.
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