2026 ECNP Congress

PS01-1172

Co-occurrence of mental health and substance use problems in the perinatal period: prevalence and associated factors

Rodrigo Carmona Camacho — A. Graña Muñoz, L. Navio Garcia, A. Loewen Goñi, S. Machado Perero, J. Chamorro Delmo, N. Lopez Carpintero · Fundación Jimenez Diaz University Hospital, Psychiatry, Madrid, Spain

2026 ECNP Congress

Introduction

The perinatal period represents a stage of increased psychological vulnerability, including depression (~17% [1]), anxiety (~20% [2]), and suicidal behaviour; maternal suicide is also a leading cause of late maternal death in some European countries [3]. Substance use during pregnancy is associated with significant adverse maternal and foetal outcomes [4]. The co-occurrence of mental disorders and substance use (dual pathology) creates additional clinical complexity, exacerbated by under-detection, stigma and fragmented care [5]. Despite international recommendations for integrated screening, a substantial gap between clinical need and access to specialist treatment persists.

Aims

To estimate the prevalence of psychopathology and dual pathology across the perinatal period (pregnancy and postpartum) and to quantify differences between these two sub-periods.

Methods

A cross-sectional study was conducted using self-reported telematic questionnaires administered as part of the e-health evaluation and intervention program for women in the perinatal period (pregnancy and postpartum) receiving care at the Fundación Jiménez Díaz University Hospital, Madrid (Spain), between March 2023 and January 2026. Psychopathology was assessed using validated screening tools with established cut-off scores: GAD-7 (≥ 10), PHQ-9 (≥ 10), AUDIT (≥ 3, adjusted threshold for pregnant women) and Drug Abuse Screening Test (DAST ≥ 3). Sociodemographic variables including age were described using means and standard deviations. Categorical variables were reported as frequencies and percentages. Between-group differences (pregnant vs. postpartum) were examined using Chi-square tests (χ²), and the magnitude of significant associations was quantified using Odds Ratios (OR) with 95% confidence Intervals (95% CI). Statistical significance was set at p < 0.05. All analyses were performed using Jamovi (version 2.6.44).

Results

Of the 5,439 women assessed (pregnant: n = 3,981; postpartum: n = 1,458), 18.1% presented clinically significant anxiety symptoms, 12.5% depressive symptomatology, 5.3% suicide risk and 3.5% non-suicidal self-injurious behaviours. Problematic alcohol use was identified in 7.3% of the sample, and 3.2% met criteria for dual pathology.

Postpartum women showed significantly higher prevalence rates of anxiety (21.9% vs. 16.7%; OR = 1.40; 95% CI: 1.21–1.63), depression (14.4% vs. 11.8%; OR = 1.25; 95% CI: 1.05–1.49) and suicide risk (6.7% vs. 4.8%; OR = 1.41; 95% CI: 1.10–1.82) compared to pregnant women. No significant differences were found in substance use or dual pathology prevalence between both subgroups.

The presence of dual pathology was associated with a suicide risk almost seven times higher compared to women without comorbidity (24.9% vs. 4.7%; OR = 6.76; 95% CI: 4.67–9.80). Problematic substance use alone was associated with a twofold increase in suicide risk compared to non-users (10.2% vs. 4.7%; OR = 2.30; 95% CI: 1.71–3.09).

Conclusions

Postpartum women exhibited significantly higher rates of anxiety, depression, and suicide risk compared to pregnant women. Dual pathology was associated with an almost sevenfold increase in suicide risk, highlighting the increased effect of co-occurring mental health conditions and substance use disorders. Integrated screening for both psychopathology and substance use should be systematically implemented in perinatal care settings, with particular attention to the postpartum period.

References

  1. Shorey, S., Chee, C.Y.I., Ng, E.D., Chan, Y.H., Tam, W.W., Chong, Y.S., 2018. Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis. J. Psychiatr. Res. 104, 235–248.
  2. Fawcett, E.J., Fairbrother, N., Cox, M.L., White, I.R., Fawcett, J.M., 2019. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J. Clin. Psychiatry 80 (4), 18r12527. http://dx.doi.org/10.4088/JCP.18r12527
  3. MBRRACE-UK, 2026. Maternal mortality 2021–2023: data brief. National Perinatal Epidemiology Unit, University of Oxford.
  4. Popova, S., Lange, S., Probst, C., Gmel, G., Rehm, J., 2017. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob. Health 5 (3), e290–e299. http://dx.doi.org/10.1016/S2214-109X(17)30021-9
  5. Weber, A., Miskle, B., Lynch, A., Arndt, S., Acion, L., 2021. Substance use in pregnancy: identifying stigma and improving care. Subst. Abuse Rehabil. 12, 105–121. http://dx.doi.org/10.2147/SAR.S319180