A baby turning one is usually a time for celebration, to look back at the milestones reached and to look forward to the next stage of parenthood. However, for parents experiencing mental health difficulties, the first birthday does not necessarily mark such a neat turning point.
Historically, the perinatal period has often been defined as pregnancy and the first 12 months after birth. This has shaped how services are organised, with women and birthing people moving out of specialist perinatal mental health services when their baby turns one (NICE, 2020). However, there is no clear clinical reason as to why perinatal mental illness should spontaneously resolve at the 12-month mark.
Recognising this, NHS England committed to extending specialist perinatal mental health support to two years after birth (NHS England, 2019). This was a welcome extension, however there was little evidence showing how many individuals may require this longer support. Also, it was unknown whether second-year mental illness was a continuation of existing postpartum difficulties, or whether it was emerging for the first time.
Jones and colleagues therefore used routinely collected primary care data to examine recorded moderate and severe perinatal mental illness during the second postpartum year in England.
Methods
The researchers conducted a retrospective cohort study using the Clinical Practice Research Datalink (CPRD GOLD), a large database containing anonymised GP records.
They identified 2,132,754 pregnancies from 1,361,497 women who had a recorded live birth between 1995 and 2020. The main analysis was restricted to births up to 2018 so that two full years of follow-up were available.
Mental illness was identified through three types of GP record: diagnoses, symptoms and prescriptions for psychotropic medication. To produce a cautious estimate, women needed to have at least two of these three indicators.
The researchers examined:
- How common recorded mental illness was during months 13 to 24 after birth
- How many cases appeared to be new during this period
- Changes between 1995 and 2018
- Factors associated with second-year mental illness
Results
Across the study period, 5.9% of pregnancies were followed by recorded mental illness during the second postpartum year. This represented 123,510 pregnancies.
Recorded mental illness was less common than during the first postpartum year, when prevalence was 7.5%. However, the findings suggest that difficulties in the second year cannot simply be understood as conditions continuing from pregnancy or the first year.
The researchers classified 3.3% of pregnancies as being followed by a new case of mental illness during the second postpartum year. These 69,926 cases represented 56.6% of all recorded second-year cases.
In other words, more than half of the women identified with mental illness during the second year had no qualifying mental illness recorded during the first postpartum year. This does not prove that their difficulties began precisely after the baby’s first birthday, but it does challenge the idea that risk is largely confined to the first 12 months.
Recorded prevalence also increased over time, from:
- 3.1% in 1995 to 7.4% in 2018 for all second-year cases
- 1.9% in 1995 to 3.8% in 2018 for cases classified as new onset
However, this should not automatically be interpreted as evidence that mothers’ mental health has deteriorated over time. Changes in awareness, diagnosis, GP recording and prescribing may have made mental illness more likely to appear in medical records. The authors themselves suggest that improved recognition may explain at least some of the rise.
Depression and anxiety were by far the most commonly recorded forms of mental illness. The strongest associated factor was mental illness during the first postpartum year. Women with a first-year record had around nine times the odds of recorded mental illness during the second year compared to women without one.
Higher odds were also found among women with:
- Mental illness before or during pregnancy
- A greater number of recorded pregnancies
- A preterm or near-term birth
- A recorded history of smoking
- A substance use disorder
In a subgroup analysis, women living in more deprived areas had higher recorded odds of mental illness, and women from minority ethnic groups had lower odds of having mental illness recorded than White women. Importantly, this should not be read as evidence that these women had less need. The authors point to existing evidence of barriers to help-seeking, unequal access and under-recognition within services, meaning that lower recorded prevalence may partly reflect women being missed.
Conclusions
The authors concluded that there is substantial ongoing and newly recorded mental health need during the second postpartum year. They argue that the findings support England’s decision to extend specialist perinatal mental health services from 12 to 24 months after birth.
The study therefore provides an important policy message: maternal mental health risk does not end when a baby turns one. However, the findings speak only to mental illness recorded in primary care, which does not necessarily reflect the true number of women experiencing moderate or severe postpartum illness.
Strengths and limitations
A major strength is the scale of the research. The study included more than two million pregnancies and covered over two decades of primary care records. This provided enough data to examine relatively uncommon diagnoses and produce precise estimates.
The researchers also took a cautious approach to identifying cases. Rather than counting a single symptom, diagnosis or prescription, they required two different indicators. The code lists were reviewed by two perinatal psychiatrists and the analysis accounted for women who contributed more than one pregnancy. This therefore enhances the credibility of the study findings.
However, the study could not directly establish whether a woman’s illness was moderate or severe, whether they met the eligibility threshold for specialist care, or whether they were actually referred to or treated by a perinatal service. Medication may also be prescribed for different reasons, while women receiving psychological treatment may not have had this adequately reflected in their GP record.
The research also only captured difficulties recorded in primary care. Women who didn’t seek help, could not access care, discussed their mental health elsewhere, or had their symptoms overlooked, would not have been identified. This may particularly affect groups already facing barriers to services.
There is also uncertainty around “new-onset” cases. Some women’s difficulties may have started during the first year but only been recorded during the second. Equally, an ongoing illness may have appeared new if it was not consistently coded in the GP record.
Finally, the study excluded pregnancies ending in stillbirth or termination. Its findings therefore cannot be generalised to women experiencing pregnancy loss, despite their substantial mental health needs (Cuenca, 2023).
Implications for practice
This study makes a persuasive case against treating a baby’s first birthday as a perinatal mental health finish line.
For professionals, particularly GPs, health visitors and mental health practitioners, the findings highlight the need to remain alert to difficulties emerging or continuing during the second year. Routine postnatal contacts become less frequent as time passes, meaning that women may have fewer natural opportunities to disclose how they are feeling. At the same time, expectations that they should have “adjusted” to parenthood may make asking for help more difficult.
Women who experienced mental illness during pregnancy or the first year appear particularly likely to need continued support. Discharge from specialist perinatal care should therefore involve an active transition plan rather than an abrupt transfer based solely on the child’s age. Women and professionals also need clear information about what support remains available between 12 and 24 months.
However, extending the eligibility window is only useful if services have the capacity to provide care. This study estimates potential recorded need, but does not show how many women were referred, accepted by services or able to access timely treatment. It also doesn’t tell us whether specialist perinatal care is the most appropriate option for every identified woman. Some may be better supported through primary care, NHS Talking Therapies or general adult mental health services, provided that these services understand the specific context of the postnatal period.
The ethnicity differences deserve particularly careful attention. Lower rates of recorded illness should not be used to justify lower levels of provision. Instead, services should investigate who is being missed, whether screening and referral processes work equally well for all women, and how culturally informed support can be made more accessible.
Future research should link primary care records with referrals, service use and treatment outcomes. A clearer and validated way of identifying illness severity would help determine the level of support women require.
The study cannot tell us that every woman identified needed specialist care. What it does show is that the second postpartum year remains an important period of vulnerability, and that support should be organised around women’s needs, rather than the date of a first birthday.
Statement of interests
Jessica Davies has no conflicts of interest to declare.
Editor
Edited by Laura Hemming.
Links
Primary paper
Ellie Jones, Laura Quinn, Jamie-Rae Tanner, Jelena Jankovic, Giles Berrisford, Christine MacArthur, Beck Taylor(2025) Prevalence and incidence of moderate and severe mental illness in the second postpartum year in England (1995-2020): a national retrospective cohort study using primary care data. The Lancet Regional Health Europe 53 101312. https://doi.org/10.1016/j.lanepe.2025.101312
Other references
Cuenca D (2023) Pregnancy loss: consequences for mental health. Frontiers in global women’s health 3 1032212. https://doi.org/10.3389/fgwh.2022.1032212
NHS England (2019) The NHS Long Term Plan, last accessed 6 Aug 2026.
NICE (2020) Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance, NICE Guideline CG192, 11 Feb 2020.