Enduring questions in perinatal psychology

The National Perinatal Epidemiology Unit (NPEU) had its 40th Anniversary Symposium this October and it was a privilege to speak on ‘Enduring questions in perinatal psychology’. It was great to celebrate the world-leading work of the NPEU and, in particular, research conducted by a number of social scientists, including our own Maggie Redshaw (previous Editor-in-Chief and current Co-Editor).

It was also a very motivating experience to take time to reflect on enduring questions in our field. My first reflection was on the relatively recent introduction of perinatal mental health screening, in particular for perinatal depression, which is increasing worldwide. While this may be a step in the right direction, screening does not yet fully address the enduring question ‘How do we know a woman has mental health problems in the perinatal period?’ Prevalence rates of depression are highly variable internationally. Our epidemiological data are relatively poor despite over 40 years of research and we have often failed to explore, in any depth, the cultural variations in the expression of emotion or the full range of psychological morbidity. While screening raises the awareness of women’s mental health, poor sensitivity and specificity of tools can lead to missing women with mental health problems or overloading an already heavily burdened referral system with false positive screens. It is important to build on our current approaches, to reflect on how we can refine our tools and, above all, to listen to what women are telling us about their psychological well-being.

To understand illness we need to understand a ‘healthy’ response to what is a major life transition, but this has been neglected in research and practice. Maternity care has invested much time on supporting a good physical transition and very little on supporting a good psychological transition. We need to understand the whole spectrum of perinatal well-being to answer this enduring question. Nationally and internationally we need good population-based data, alongside in-depth qualitative data, to explore variations in the expression of psychological symptoms (including persistence of symptoms).

Reflecting on the importance of maternity care and its focus on physical health brings me to my second enduring question, ‘How does maternity care impact on psychological well-being?’ In 1977 George Engel, a psychiatrist, presented the argument for a biopsychosocial model for medicine (Engel, 1977). Increasingly, it is being recognised that it is no longer sufficient for health care professionals to state that an intervention is successful in terms of its effect on a specific physical condition; it is now also necessary to know whether the intervention gives significant improvement in the way in which a woman lives. As the biospychosocial model has also recently celebrated 40 years it has been good to see the debate around the importance of the model in other journals (Gask, 2018; Jull, 2016). However, it is also very clear that we have a long way to go to truly embrace a biopsychosocial approach in research and practice that explores psychological and social outcomes in addition to physical outcomes. The Society’ for Reproductive and Infant Psychology’s aims state:

We believe in the key importance of psychological, socio-cultural and political aspects of reproduction, birth and infancy. These non-biological aspects of reproduction are often neglected or widely dispersed in the research literature so there is a genuine need for a multidisciplinary society (https://srip.org/about/).

The Journal of Reproductive and Infant Psychology remains committed to exploring the biopsychosocial model around the time of birth and in relation to reproduction. This journal issue, like every issue, deals with diverse psychosocial issues across the perinatal time period. However, we need more research that explores the impact of maternity care on the psychological well-being of a woman and her family. We need to explore the whole range of interventions, whether physical interventions around the time of birth or how care is organised and delivered. Recent reflections and celebrations are a reminder, and a motivation, not to lose focus on the enduring questions in perinatal psychology that impact on so many women and their families and still demand our attention.

Disclosure statement

No potential conflict of interest was reported by the author.