Barriers to diagnosis and support
Barriers to the diagnosis and support of perinatal anxiety (PNA) exist at individual, organisational, structural, and sociocultural levels, limiting timely identification and effective care in the UK.
PNA is frequently under-recognised because anxiety symptoms are not always well understood by families or healthcare professionals (HCPs). Symptoms may be dismissed as a normal part of pregnancy or early parenthood, meaning difficulties go unrecognised. Diagnosis is also affected by the tools currently used in routine practice, which are largely designed to detect postnatal depression (PND). For example, the Edinburgh Postnatal Depression Scale (EPDS) has limited sensitivity for identifying anxiety symptoms.
Individual factors can further limit disclosure. Feelings of stigma, guilt, and shame remain common in the perinatal period. Many people worry about being judged as a “bad parent” or fear negative consequences of disclosure, such as social services involvement, loss of their child, or repercussions within the family (including domestic abuse). These concerns are often intensified by societal pressure to meet idealised expectations of the “perfect mother,” which can increase distress when reality does not align with these ideals.
Sociocultural factors also play an important role. Language barriers, limited access to culturally sensitive services, and differences in perinatal beliefs and practices can reduce identification and access to support for families from minority ethnic backgrounds.
At an organisational level, over-stretched services and limited availability of psychological therapies mean that even when PNA is identified, access to support can be challenging. Many parents report feeling unsupported after birth and describe “slipping through the net,” often due to PND-focused assessments and limited awareness of PNA.
System-level barriers further contribute to these difficulties. Fragmented care pathways, poor continuity of care, limited interdisciplinary communication, and unclear referral routes between maternity, primary care, health visiting, and mental health services can delay or prevent access to appropriate support.
Despite these challenges, there are clear opportunities to improve identification and support for perinatal anxiety. Click to find out more.
