Non-use of antenatal mental health care among women who self-reported having psychological difficulties during pregnancy: 2010–2021 prevalence trend and associated factors in 2021: A nationwide population-based study

BACKGROUND: Untreated self-reported psychological difficulties during pregnancy may negatively impact mothers' and newborns' mental health. Using data from the repeated French National Perinatal Survey, we estimated the 2010-2021 prevalence trend of antenatal mental health care (AMHC) non-use among women giving birth in France who self-reported antenatal psychological difficulties, and the associated factors in 2021. METHODS: We used national population-based samples of mothers to determine the prevalence trend of AMHC non-use. For the 2021 sample, we estimated the adjusted prevalence ratios (aPR) of AMHC non-use using Poisson regression models with robust variance. RESULTS: AMHC non-use by women self-reporting antenatal psychological difficulties remained stable between 2010 and 2016 and significantly decreased in 2021. Three quarters (73.1%, n = 982) of the 2021 sample did not use AMHC. The associated risks for the latter were: i) being born in Africa (aPR = 1.18, 95%CI[1.08-1.29] North-Africa; 1.11, [1.01-1.23] elsewhere in Africa versus France), ii) having an educational level < 3 years tertiary education (maximum aPR = 1.20 [1.09-1.32] for < secondary school diploma versus ≥ 3 years tertiary education), and iii) pregnancy-related pathologies (diabetes (1.08 [1.01-1.16]), hypertension (1.17 [1.04-1.31]), anaemia (1.11 [1.04-1.19])). Sadness and/or anhedonia for at least two consecutive weeks during pregnancy (0.83 [0.78-0.88]), support from midwives (0.89 [0.82-0.96]), support from social workers (0.76 [0.68--0.85]), and support from antenatal class facilitators (0.83 [0.76-0.90]), were all protective factors against AMHC non-use. CONCLUSIONS: In 2021, almost three quarters of women giving birth in France with self-reported antenatal psychological difficulties did not use AMHC. The risk factors we identified for non-use may guide future prevention policy.