What is perinatal mental illness?
Perinatal mental illness (PMI) refers to mental illness occurring during pregnancy and up to one-year post birth, according to the NHS, although illnesses can last longer and may or may not be a continuation or re-occurrence of a previous illness. Perinatal mental illness can affect pregnant women/new mothers as well as partners, and there are a number of different diagnoses and symptoms, which may be experienced to varying degrees of severity. A form of PMI may also be experienced in those adopting children.
Prior to the Covid-19 pandemic, the NHS estimated that one in five women and one in 10 men experienced mental illness during the perinatal period, but the prevalence has increased significantly since 2020.
There are several different perinatal mental health conditions, and more than one condition can be experienced together:
Postnatal depression occurs after birth – sometimes soon, sometimes months later – and can have a significant negative effect on the individual and their family if not treated
Antenatal depression occurs during pregnancy. Although less known, antenatal depression is at least as common as postnatal depression
Antenatal and post-natal anxiety
Postpartum psychosis (PPP) is less common, but an extremely serious condition which can occur in women soon after giving birth and should be treated as a medical emergency. Symptoms can include mood fluctuation, confusion, loss of inhibitions and marked cognitive impairment (bizarre behaviour, hallucinations, delusions)
Perinatal obsessive-compulsive disorder (OCD)
Perinatal eating disorders
Tokophobia – severe fear, or phobia, of childbirth, which for many women also extends to pregnancy
Post-traumatic stress disorder (PTSD) linked to birth experience and/or baby stays in neonatal intensive care units (NICUs)
Many people are not aware of these conditions before they experience them and may be very scared and confused by the symptoms.
My interest as a work and employment researcher
My interest in this topic is both personal and professional. Personally, I experienced severe postnatal depression and anxiety following the birth of my little boy nearly four years ago. I truly believe that the support received from my own employer, and also my husband’s employer, was an important part in my recovery, and our family getting through this difficult time. But I am very aware that our experience was unusual – and very lucky.
From a professional perspective, my interest derives from the fact that perinatal mental illness appears to be largely overlooked in the workplace. Perhaps this is linked to assumptions that it is mainly postnatal depression, and this occurs during maternity leave – so is not the employer’s problem.
There is currently little evidence of bespoke organisational policies and provisions for supporting employees affected by perinatal mental illness, and little academic research to inform said provisions. I am working on changing this. I am currently collating research evidence from the broader disciplines, leading a research study in the context of UK policing, and planning a broader interdisciplinary study.
What we know
Research indicates that certain occupational features can be problematic when it comes to perinatal mental health – exacerbating conditions and/or hindering recovery. These include:
precarious employment and financial insecurity
exposure to trauma at work
bullying and harassment
pregnancy/maternity discrimination, which is unfortunately still a common experience
poor handling of maternity or flexible working requests following maternity/paternity leave
stigma around mental illness.
Research also suggests that certain workplace features may be beneficial when it comes to perinatal mental health and recovery. These include:
social support from managers and colleagues
parental leave and pay
a sense of purpose or achievement from work
respite from being at home/parenting
counselling provided through work
workplace parent networks
We also know that people may be reluctant to disclose their illness, or that of their partner, at work, for a number of reasons, including fear and worry about the consequences, shame and not knowing how the recipient will react. Disclosure at work is more difficult when there is no specific mention of perinatal mental health in HR policies; where employees are unaware of others experiencing the same thing; or where relationships with the line manager are weak.
I have written an HR Toolkit with charity PANDAS Foundation to provide more information for employers on perinatal mental health conditions, symptoms and treatments; the intersection with employment; and recommendations for policy and practice. This is a free resource being launched on 7 May, but PANDAS would appreciate a small donation from any employer that finds the resource useful, as well as any feedback.
Dr Krystal Wilkinson is a senior lecturer in HR at Manchester Metropolitan University