As a recipient of an NIHR Research Professorship award, Professor Louise Howard’s research influenced national policies and increased government funding for perinatal mental health services.
Published: 20 August 2024
1 in 4 new and expectant mums experience mental illness
1 in 4 new and expectant UK mums can be affected by mental illness. Only around one third of women seek medical help for perinatal mental health issues, which include anxiety, depression and post-traumatic stress disorder.
Left untreated, these conditions have long-lasting effects on women and their children. These can take the form of developmental delays and behavioural problems. Lack of treatment comes at a high price to society too, costing the UK around £6.6 billion a year.
In light of this, national policy highlighted how perinatal mental illness must be found and treated early. But the question remained: how should the women in need of help be identified?
With support from a £1.5 million NIHR Research Professorship award, consultant perinatal psychiatrist Professor Louise Howard OBE led research that investigated how common perinatal mental health conditions are in early pregnancy.
As part of the research, which was also funded by a £2 million NIHR Programme Grant for Applied Research, her team at King’s College London studied the use of a widely used depression screening tool (the Whooley tool) to identify mental disorders.
Impact on national policy
Professor Howard’s team worked with the NIHR South London Clinical Research Network to recruit and interview nearly 550 pregnant women in South East London.
The research showed that asking pregnant women 2 questions about low mood (the Whooley tool) did help to identify depression. It also helped to detect other perinatal mental health problems. The results are published in the British Journal of Psychiatry.
They also found that it was as effective as a frequently used and longer tool, the Edinburgh Postnatal Depression Scale, which women complete themselves. Using either tool was cost-effective, costing the NHS less in the long term than not screening for depression (published in BMC Health Services Research).
The research influenced national policies by confirming the NICE guideline’s advice to use the Whooley tool in all routine antenatal and postnatal appointments. This amounts to 800,000 women being screened every year, and more women benefiting from proper treatment.
“This study supports the NICE recommendation that women should be asked, by a non-judgemental and supportive health professional, at all contacts in pregnancy and after birth about their emotional wellbeing and are given the opportunity to respond to these structured questions (the Whooley or the Edinburgh Postnatal Depression Scale).”
Professor Louise Howard
Professor Howard’s work also informed the government’s investment of over £290 million in perinatal mental health services. The funding supported their vision for the Five Year Forward View for Mental Health, with the new services helping over 75,000 women so far.
Her research has supported specialist training for thousands of clinicians. It has also informed pregnancy planning tools for the pregnancy charity, Tommy’s, which reach more than 8,000 women each month.
NIHR award impacts on wider perinatal issues
Professor Howard’s NIHR-funded research has changed the course of perinatal mental health care. Her research has influenced international WHO recommendations on domestic violence as well as UK NICE guidelines, changing both policy and practice.
“My Research Professorship was a fantastic step change for me, my team and my research area. In addition to supporting me, the funding supported capacity building in my research area. Many of my team are now in academic posts including a professor, readership, 2 senior lecturers, 4 NIHR post-doctoral fellows and 3 clinical lecturers.”
Professor Louise Howard
More recently, NIHR funding supported her work on other research projects. These include the role of mother and baby psychiatric units, as well as the relationship between mental health problems and poor obstetric outcomes and the role of specialist community perinatal mental health teams in preventing psychiatric relapse after birth.
Professor Howard has since been appointed an NIHR Senior Investigator and co-developed the NIHR Mental Health Incubator. This project supports mental health researchers to develop their careers, leading to positive changes to people’s health nationally. She was awarded an OBE for services to women's mental health in 2023.
The studies were funded by the NIHR Academy, Programme Grants for Applied Research and Health and Social Care Delivery Research.
More information about the study is available on the NIHR’s Funding & Awards website.