Why do black mothers in the UK have an increased risk of perinatal mental illness?
The journalist Tobi Thomas continued her concern about the health profile of ethnic Black women in an article in the Guardian on May 7th 2024.
In my recent Blog posts I have presented her concerns about the increased risk of complications following appendix surgery in Black children in the UK, and also about the increased risk of childbirth complications in Black women. They were published in the Guardian earlier in 2024.
Both concerns were stated or assumed to be the result of sociological factors, including racism. It is my concern that there was no mention of the known biological factor of vitamin D deficiency.
The third article to which I draw your attention concerns a high risk of peri-natal mental illness in Black women in the UK. It was based on a Guardian analysis of NHS data.
There had been 777 admissions to NHS England hospitals on account of puerperal mental illness (within six weeks of childbirth) between 2020 and 2023. 12% were ethnic Black women, despite them having only 5% of the deliveries.
They were twice as likely to be admitted to hospital, suggesting that medical neglect and failure to use services might not have been a problem, despite a psychiatry commentator suggesting that difficulties in accessing services might be important.
Other contributing factors suggested were structural inequality, socio-economic disadvantage, and cultural attitudes to mental illness. Dr Rosena Allin-Khan, Labour MP and medical doctor who trained at Cambridge University made the unhelpful suggestion that the reason might be “14 years of Tory mismanagement of our NHS”.
These factors might be important but correcting them might take many years, and there is no evidence that elusive socio-economic corrections would reverse this “horrifying” problem of excess puerperal mental illness in ethnic Black mothers. Imagine the challenges to constructing a randomised controlled trial.
Several other commentators interviewed by Tobi Thomas repeated the social narrative. There was not a single mention of the biological factor of vitamin D deficiency, known to be very common in this ethnic group.
Why is there so much ignorance?
Most of the published reports and comments on the health disadvantages of ethnic Black African and South Asian people are made by sociologists, such as Tobi Thomas herself, and we might be surprised if they were to have significant knowledge of biomedical science. But some of the comments have been made by health professionals and I would have expected them to have some knowledge of the geography and the ethnicity of vitamin D deficiency. But this has not been apparent. It is possible, perhaps likely that the senior health professionals have knowledge of the importance of vitamin D and themselves take supplements, but if so they are not prepared to say so in public. Why not?
My previous Blog post described some of the large evidence of the importance of maternal vitamin D in brain development of the offspring, with benefits extending into adult life. The benefits of vitamin D acquired in adult lfe have also been investigated.
There is a great deal of evidence that low levels of vitamin D in the blood are associated with brain dysfunction. I first became aware of this with reports of seasonality of presentation with schizophrenia. This incidence was higher during the winter months in the Northern Hemisphere, and then the same in Australia during the winter months of the Southern Hemisphere. In Singapore, which lies on the equator there was no seasonal variation.
A review has shown that more than 250 studies, covering 29 Northern and five Southern Hemisphere countries, have been published on the birth seasonality of individuals who develop schizophrenia and/or bipolar disorder. Despite methodological problems, the studies are remarkably consistent in showing a 5-8% winter-spring excess of births for both schizophrenia and mania/bipolar disorder. This seasonal birth excess is also found in schizoaffective disorder (December-March), major depression (March-May), and autism (March).
With knowledge that blood levels of vitamin D are at their lowest in the early sprong, these studies give an impression that vitamin D deficiency might have a role in brain malfunction and mental illness. In recent years confirmatory research has been undertaken, including the role of vitamin D on gene expression in the brain and the production of neurotransmitters.
For example, a great deal of detail can be found in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210535/
It might be several years before more details become understood, but in the meantime we must remember that it is not only puerperal mental health issues (psychosis) to which ethnic Black women are particularly susceptible. We must take this report in conjuction with my two recent Blog posts, which concerned difficulties and death involving childbirth among ethnic Black women in the UK, problems with neurodevelopment of the offspring, and the susceptibility to post-operative problems among their children.
We must not forget that adults of Black African and South Asian ethnicity were very susceptible to death from Covid-19 during the 2020 pandemic.
There is a great deal of research evidence concerning vitamin D and brain malfunction, including mental illness. While research continues it would be in the best interests of ethnic Black women to be checked for vitamin D deficiency, and if found it should be corrected as soon as possible during pregnancy.
This Blog post is not intended to be a full review of vitamin D deficiency in mental illness. It is intended to draw to attention the fact that many health disadvantages of ethnic Black people in the UK are being neglected because of an assumption of sociological causes, without any consideration of biological causes, of which vitamin D deficiency is the most obvious and most easily reversed.
The ignoring of vitamin D in ethnic Black African and South Asian people in the UK is difficult to understand. There are many doctors of these ethnic groups, but they are silent. This is a very serious problem.