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Up to 25 per cent of women will experience depression during their pregnancy. Perinatal mental health problems are a leading cause of maternal morbidity and mortality, however care provided to women is often a low priority. The purpose of this paper is to explore women’s perspective of care from GPs and midwives, when they experience symptoms of depression during pregnancy.

Women, with self-reported symptoms of depression, were invited to post comments in response to a series of on-line questions posted on two discussion forums over a nine month period. The questions were related to the care women received from GPs and midwives. Data were analysed using thematic analysis.

In total, 22 women responded to the on-line questions. A number of themes were identified from the data including women’s disclosure of symptoms to GPs and midwives; lack of knowledge of perinatal mental health among health providers; attitudes of staff and systemic issues as barriers to good care; anti-depressant therapy and care that women found helpful.

Women often face significant emotional and psychological health issues in the transition to motherhood. This small study indicates women often experience difficulties in interacting with their GP and midwife in seeking help. This research has identified some contributing factors, however more rigorous research is needed to explore these complex issues.

This paper highlights service provision in the care of women with depression in pregnancy.

Foetal programming is one of the key mechanisms by which physical and social adversity is biologically embedded during pregnancy. While early interest in such programming focused on the long-term impact of the mother's nutritional state on the child's later physical health, more recent research has identified an increased risk of psychopathology in children of women who have experienced stress, anxiety and depression during pregnancy. The purpose of this paper is to examine the literature addressing the impact of stress in pregnancy and the implications for practice.

An overview of the literature has been provided.

Both anxiety and depression in pregnancy are common, with a prevalence in the region of 20 per cent. Exposure in pregnancy to anxiety, depression and stress from a range of sources (e.g. bereavement, relationship problems, external disasters and war), is associated with a range of physical (e.g. congenital malformations, reduced birthweight and gestational age), neurodevelopmental, cognitive, and emotional and behavioural (e.g. ADHD, conduct disorder) problems. The magnitude is significant, with the attributable risk of childhood behaviour problems due to prenatal stress being between 10 and 15 per cent, and the variance in cognitive development due to prenatal stress being around 17 per cent. A range of methods of intervening are effective in improving both maternal anxiety and depression, and in the longer term should improve outcomes for the infant and child.

This research highlights the importance of intervening to support the psychological wellbeing of pregnant women to improve outcomes for infants and children, and points to the need for further research into innovative ways of working, particularly with high-risk groups of pregnant women.

The paper provides an update of earlier overviews.

Transition to parenthood (TTP) is a major life event that affects all aspects of one’s psychosocial function. Similar to their partners, men experience a lot of psychological changes during the TTP process. As there are a few studies on this subject, so the purpose of this study is to review previous studies on psychological and functional changes in men during TTP.

This is a review study that reports the findings from a review of previous studies on psychological and functional changes in men during TTP. This study searched from the electronic database between articles published in between 2005–20.

This study was carried out in five stages: framing research questions; searching databases with an effective strategy; selecting relevant studies; findings mining; summarizing and classifying findings; and providing results. After the literature review, relevant studies were categorized into three groups. The first, second and third groups included studies on prenatal, labor and delivery and postnatal TTP, respectively. Psychological and functional changes in men during TTP significantly affect child-father relationships, development of children and sexual relationship with a partner. Therefore, further attention should be given to this important process, along with changes, expectations, needs, etc.

This study reviews men’s functional changes along with their psychological changes during the parental transition. This study also reviews effective strategies and interventions for successful parental transition in men.

Work-life challenges experienced by employees navigating pregnancy, maternity, and parenting young children are well documented in the literature. Correspondingly, work-life balance policies and provisions aimed at supporting affected staff are well established in many modern organizations. Within this agenda however, complications within maternity journeys, and specifically the intersection with mental health has been neglected. In this chapter, we consider the work-life issues associated with perinatal (pregnancy and post-birth) mental illness. After introducing perinatal mental illness, and its impact on individuals and families, we consider the two-way relationship between illness and work: how employment factors influence the development of perinatal mental illness and recovery trajectories, with implications for family life; and how such illnesses impact work and employment. We offer key insights from our empirical research on this topic in the context of UK policing, highlighting challenges linked to the nature of police work and organization culture, and issues that are more broadly applicable to how maternity and mental illness are treated in the workplace. The chapter offers recommendations for people management practice aimed at reducing or mitigating occupational factors that exacerbate illness and maximizing those facilitating recovery in the perinatal period and beyond, thus advancing work-life inclusion.

The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender.

CHC and its treatment options were reviewed examining their relationship with depression and gender.

CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results.

The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.

The antenatal psychosocial intervention to prevent postnatal depression, Preparing for Parenthood, was evaluated in an additional qualitative study of the participants' experience of the classes. This was to complement the findings of the core study with respect to the intervention's immediate impact on their emotional well‐being. All the women interviewed who attended the intervention considered it a positive experience. However, initial indications are that the intervention did not decrease, overall, the likelihood of a woman's developing postnatal depression. The distinction between developing a ‘pleasant’ and an ‘effective’ health promotion intervention requires careful negotiation and longer‐term assessment.

The purpose of this paper is to investigate the validity and accuracy of the Whooley questions for routine screening of maternal distress in Dutch antenatal care.

In this cohort design, the authors evaluated self-reported responses to the Whooley questions against the Edinburgh Depression Scale screening for antenatal depression, State-Trait Anxiety Inventory for general anxiety and the pregnancy-related anxiety questionnaire-revised screening for pregnancy-related anxiety, among Dutch pregnant women during the first and third trimester of pregnancy. The authors used standard diagnostic performance measures for the two case-finding items.

The Whooley items in this study showed a higher specificity than sensitivity. The Whooley results showed good evidence to identify women who are depressed or (trait)anxious in both trimesters of pregnancy, but the results showed weak to moderate evidence to identify pregnancy-related anxiety. The Whooley items had a low to moderate predictive ability for depression, trait-anxiety and pregnancy-related anxiety and a good ability for negative case-finding. The Whooley items proved to be more able to report how effective the case-finding questions are in identifying women without depression, trait-anxiety and pregnancy-related anxiety (ruling out) rather than how effective these are in identifying women with depression, trait-anxiety and pregnancy-related anxiety (ruling in). The Whooley items were accurate in identifying depression and trait-anxiety in both trimesters but were not very accurate to identify pregnancy-related anxiety.

Assessment of pregnancy-related anxiety using a case-finding tool requires further attention.

The two-item Whooley case-finding tool has shown good utility as a screening instrument for maternal distress. The continuous assessment of maternal emotional health during the childbearing period or, at least, revisiting the topic, would both support the woman and the midwife in regarding perinatal emotional wellbeing as an important remit of midwifery care.

A novel aspect of this paper is the proposition of applying the Whooley questions at later stages of pregnancy or presenting the Whooley questions in a written or digital form.

The purpose of this paper is to measure reliability, validity and accuracy of the 12-item General Health Questionnaire (GHQ-12) as a measure of emotional wellbeing in pregnant women; utility and threshold in particular.

The authors measured self-reported emotional wellbeing responses of 164 low-risk pregnant Dutch women with the GHQ-12 and a dichotomous case-finding item (Gold standard). The authors established internal consistency of the 12 GHQ-items (Cronbach’s coefficient α); construct validity: factor analysis using Oblimin rotation; convergent validity (Pearson’s correlation) and discriminatory ability (area under the receiver operating characteristics curve and index of union); and external validity of the dichotomous criterion standard against the GHQ-12 responses (sensitivity, specificity, likelihood ratios and predictive values), applying a cut-off value of ⩾ 12 and ⩾ 17, respectively.

A coefficient of 0.85 showed construct reliability. The GHQ-12 items in the pattern matrix showed a three-dimensional factorial model: factor 1, anxiety and depression; factor 2, coping; and factor 3, significance/effect on life, with a total variance of 59 per cent. The GHQ-12 showed good accuracy (0.84; p=<0.001) and external validity (r=0.57; p=<0.001) when the cut-off value was set at the ⩾ 17 value. Using a cut-off value of ⩾ 17 demonstrated higher sensitivity (72.32 vs 41.07 per cent) but lower specificity (32.69 vs 55.77 per cent) compared to the commonly used cut-off value of ⩾ 12.

Findings generally support the reliability, validity and accuracy of the Dutch version of the GHQ-12. Further evaluation of the measure, at more than one timepoint during pregnancy, is recommended.

The GHQ-12 holds the potential to measure antenatal emotional wellbeing and women’s emotional responses and coping mechanisms with reduced antenatal emotional wellbeing.

Adapting the GHQ-12 cut-off value enables effective identification of reduced emotional wellbeing to provide adequate care and allows potential reduction of anxiety among healthy pregnant women who are incorrectly screened as positive.

A novel aspect is adapting the threshold of the GHQ-12 to ⩾ 17 in antenatal care.

The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period.

A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point.

The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family.

Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running.

This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.