Associations of loneliness in mental healthcare utilisation within women in the perinatal period accessing secondary mental health services: A retrospective cohort study using a large mental health database in South London

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Problem considered The perinatal period represents a critical time for maternal and infant health, marked by profound physiological, emotional and social changes. During this time, women may be particularly vulnerable to both physical and mental health conditions. Although loneliness is known to affect health outcomes, its psychological consequences and impact on healthcare utilisation in the perinatal period remain under-investigated. Methods A retrospective cohort study was conducted using clinical case record data from a large mental healthcare service in south London. Women in the perinatal period with recorded loneliness were ascertained at an index date of 30th June 2016. Mental health service outcomes were ascertained from 30 th June 2017 until 31 st December 2023 and were modelled using binary logistic regression and Poisson regression, controlling for covariates. Results Among 710 perinatal women, 130 (18%) had recorded loneliness at the index date. Recorded loneliness was associated with greater service use, including more days in receipt of mental healthcare (IRR= 1.28, 95% CI 1.27-1.29, p<0.001), and more attended face-to-face mental health contacts (IRR= 1.28, 95% CI 1.24-1.32, p<0.001). Loneliness was also associated with greater odds of crisis episodes (OR=1.77 (1.08, 2.91), 0.023), inpatient mental health admissions (OR=2.61 (1.47, 4.65), p<0.001), and nearest relative change (OR=4.05 (1.77, 9.26),p <0.001). Conclusions Recorded experiences of loneliness among women in the perinatal period receiving secondary mental health care, were associated with an increase in routine mental health service use, acute psychiatric risks, and increased changes in family support structures These findings highlight the importance of addressing loneliness in perinatal care to support women's mental health and reduce service burden.