Thousands of UK women develop undiagnosed post-traumatic stress disorder (PTSD) after childbirth every year, research has found. The frightening and dangerous condition is being missed in at least 15,000 women a year across England, Scotland, Wales and Northern Ireland, and the true toll could be double that or more, according to the authors of research in a leading medical journal. The gap in maternal mental health care is revealed in an evidence review published on Friday by doctors at the University of East Anglia’s medical school who specialise in women’s health.
Many GPs mistake PTSD for postnatal depression, which means women who urgently need specialist help for the former receive treatment that is not appropriate, it found. The NHS’s widespread failure to identify PTSD in women who recently had a child has prompted concern because undiagnosed mental ill health among them has been linked to relationship problems, long-term suffering and a high risk of suicide. The research, published in the British Journal of General Practice, is the first attempt by experts to quantify how many cases of childbirth-related PTSD in the UK are diagnosed or not.
The NHS does not collect such figures, despite the fact up to one in 16 mothers develop the serious mental health condition, often because they had a traumatic experience while giving birth. The leader of the UK’s 50,000 GPs admitted that cases of PTSD were going unrecognised and untreated because of “an important gap” in family doctors’ ability to recognise the symptoms, which include nightmares, flashbacks, anxiety and persistent negative thoughts, including hopelessness. Research has estimated that either 5% or 5.9% of women giving birth suffer PTSD and also that fewer than half of those who get it are diagnosed and receive NHS care.
In some cases it can occur even when the woman has had a medically uncomplicated birth. This figure does not include stillbirths and miscarriages, which are significant risk factors for childbirth-related PTSD,” said Dr Megan Foreman, the lead author of the paper, who is also a GP. Many cases of PTSD are being missed when new mothers go to see their GP for the NHS-wide checkup of their own and their baby’s health six weeks after the birth, the six co-authors say.
That is particularly because, although there is NHS guidance on what should happen in those consultations, there is no approved framework for assessing women’s risk of having PTSD. The fact that six-week checks are meant to cover the health of newborns as well as their mothers, including immunisations the baby needs, means the child’s situation can “dominate the consultation … [which] can make assessing the mother’s mental health challenging, particularly if they attend alone with the child”, the study found. Misdiagnosis can be detrimental to women with PTSD because they are then prescribed antidepressants, which are not as effective for treating it as psychological therapy, and also because the evidence shows that “treating depression alone may not improve coexisting childbirth-related PTSD”, the authors say.
Failure to correctly identify PTSD also matters because it and postnatal depression increase the risk of suicide, which is the commonest cause of death among women in the year after giving birth. Angela McConville, the chief executive of the NCT parenting charity, said the findings were worrying and showed that NHS postnatal care needed to focus more on mothers’ emotional wellbeing. PTSD after birth is a serious and often overlooked condition that can have a profound impact on women and new mothers, as well as those around them.
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