Search

Background: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non‐refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. Methods: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non‐refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Results: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non‐refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Conclusion: Similarly, high proportions of women of refugee and non‐refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is a time of increased risk for developing or re‐experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems‐level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory‐informed, evidence‐based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university‐based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. Methods: In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision‐making by healthcare organizations. Results: Using a behavioural change framework (Capability, Opportunity, Motivation–Behaviour Model), the key barriers, processes and outcomes are described for a real‐world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven‐stage implementation guide is presented for use in a range of healthcare settings. Conclusions: These findings describe an equity‐informed, evidence‐based approach that can be used by healthcare organizations to address common systems and individual‐level barriers to implement perinatal depression and anxiety screening guidelines. Patient or Public Contribution: These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well‐being, the NGO COPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study. [ABSTRACT FROM AUTHOR]

Purpose: The early postnatal period is a time of increased risk for psychiatric admission. However, there is scope to further examine if this increase in risk extends to the entire perinatal period (pregnancy and first postnatal year), and how it compares to admission outside of the perinatal period. Methods: Data were linked across birth and hospital admission registers from July 2000 to December 2009. The study cohort, consisting of all pregnant and childbearing women with a psychiatric history, was divided into two groups: case women (at least one perinatal principal psychiatric admission in the study period) (38%) and comparison women (no perinatal principal psychiatric admissions) (62%). Outcomes were admission rate and length of stay adjusted for diagnosis, socio-demographic factors and timing of admission. Results: Antenatal and postnatal admissions rates were both higher than non-perinatal admission rates for case women for all diagnoses. There was little evidence that women with perinatal admissions were at an increased risk of admissions at other times. Socially disadvantaged women had significantly fewer and shorter admissions than their respective counterparts. Conclusions: The entire perinatal period is a time of increased risk for admission across the range of psychiatric disorders, compared to other times in a woman's childbearing years. Reduced admission rate and length of stay for socially disadvantaged women suggest lack of equity of access highlighting the importance of national perinatal mental health policy initiatives inclusive of disadvantaged groups. [ABSTRACT FROM AUTHOR]

This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70–1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period. [ABSTRACT FROM AUTHOR]

Objective: To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method: A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results: The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion: Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic?: The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add?: This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners?: Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations. [ABSTRACT FROM AUTHOR]

Objective:The objective of this paper was to inform the development of a mobile phone-optimised, SMS-based, informative and interactive telephone-linked support system for new fathers. Methods:The SMS4dads intervention was designed to support fathers with helpful and encouraging text messages, links to relevant web resources, mood monitoring and connection to a crisis telephone support if needed. Forty-six participants were recruited through clinics and social media across Australia. Outcome measures evaluated uptake, user engagement and acceptability. Results:Forty men (87%) remained engaged with the SMS4dads intervention for the full six-week period. Users' feedback indicated that SMS4dads had good acceptability and that the content was helpful. An embedded tool to allow tracking of users' mood was utilised by slightly less than half of the study participants. Concerning levels of psychological distress may have been detected in several participants. Conclusion:The results provide tentative support for the use of mobile phone technology to deliver parenting and mental health information to men in the perinatal period. Participants' engagement and positive responses suggest that this technology could provide a welcome conduit for essential information and support for new fathers, and could potentially be further developed as a feasible medium for collecting information on fathers' levels of psychological distress. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Method: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. Results: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. Conclusion: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies. [ABSTRACT FROM AUTHOR]

In 2008-2009 a national household mailout was undertaken across Australia by beyondblue: the national depression initiative. The aim was to raise awareness of depression and encourage people to seek more information via the beyondblue information line or website. Following the staggered dispatch of information across the country, 2051 telephone surveys were conducted to evaluate recall of the material, and calls to the beyondblue infoline and website hits were monitored. The results indicate that direct mail can be a highly effective strategy to not only promote mental health, but also encourage information and help seeking. The impact of a range of factors on recall and help-seeking behaviour is also explored. Findings reveal the impact of demo- graphic factors whilst also highlighting the potential importance of brand recognition and perceived relevance of information when determining those most likely to recall and respond to mailouts as mental health promotion strategy. [ABSTRACT FROM AUTHOR]

beyondblue is Australia's national depression initiative were achieved. Outputs and outcomes of beyondblue and is intended to increase the capacity of the Australian programs improved during the present funding period. community to prevent depression and anxiety and to The lower and lower intermediate objectives have respond effectively. This study examines the achievements been fully and largely achieved respectively. The higher of beyondblue for the period 2005-2009 and compares intermediate objectives were achieved in two of them with the earlier period 2000-2004. A 'hierarchy of beyondblue's five priority areas, 'primary care' and objectives' derived from a program logic of beyondblue's 'targeted research', beyondblue compares favourably activities was used, based on beyondblue's vision, with depression initiatives in other countries. Its activities mission and priority areas. Relevant data sources were should continue, at least at current levels, if its higher-identified to assess whether objectives on this hierarchy level objectives are to be achieved. [ABSTRACT FROM AUTHOR]

Objective: To establish a benchmark of awareness, knowledge and attitudes in Australia in relation to depression and its treatment in the perinatal period, and to identify demographic factors associated with perinatal mental health literacy. Method: A cross-sectional telephone survey (n == 1201) of a randomly selected sample of adults in each State and Territory of Australia, conducted in late 2009. Results: Depression was the most frequently cited general health problem for women after childbirth (43.6% of spontaneous responses), in contrast to previous findings of low awareness of depression generally. A total of 94% of adults believed that postnatal depression requires specialized treatment. Older Australians (55 ++ years) identified postnatal depression less readily than younger Australians. Although well recognized as a specific mental health issue, as a general health issue antenatal depression had low recognition and was viewed by 52% of respondents as ''normal''. Community beliefs about perinatal rates of depression appeared realistic. Men and women differed in their knowledge and beliefs about the symptoms and causes of postnatal depression. Difficulty in mother-infant bonding was seen as a common sign of postnatal depression, particularly by women. Most commonly, postnatal depression was perceived as having a biological rather than psychosocial etiology (30% of men, 41% of women). Recognition of anxiety in the postnatal period was relatively low, although higher among those with mental health training. Over 80% of Australians believed that all new mothers should be routinely assessed for depression. Conclusions: Awareness of postnatal depression appeared to be at a high level in the community, but both anxiety and antenatal depression were comparatively under-recognized, suggesting there is considerable scope for awareness-raising. Established risk factors for postnatal depression were not coherently recognized. Ongoing tracking of perinatal mental health literacy in Australia is likely to be valuable in assessing the impact of future public awareness efforts. [ABSTRACT FROM AUTHOR]

Aim: Ascertaining current knowledge and attitudes towards depression among young people is vital for developing campaigns promoting community awareness and early intervention. Methods: Cross-sectional computer-assisted telephone interviews of persons aged 18–90 years were conducted by beyondblue in Australia in 2002 and 2004/05. Items assessed consideration of depression as a major general health or mental health problem, knowledge about prevalence of depression, usual age of onset for depression or anxiety and treatment preferences. Results: The surveys included 2003 and 3200 persons, respectively, with 285 and 400 aged between 18 and 25 years. Depression was not recognized by young persons as a major general health problem (1–2% of responses), but was the most frequently named mental health problem (37–42%). Younger persons were more likely than older persons to see depression as the major mental health problem, placing less emphasis on alcohol and other drug problems. They preferred first to seek help from family or friends (61–65%) and try non-pharmacological treatments. Although understanding of the helpfulness of several evidence-based treatments was good, many younger respondents still considered non-evidence-based treatments to be helpful. A quarter of subjects believed antidepressant medications were harmful and that alcohol use may be helpful. Conclusions: Although knowledge about depression was good, young people do not recognize depression as a major general health problem and remain reluctant to use professional services. These attitudes represent significant barriers to seeking treatment early in the course of common mental health problems. [ABSTRACT FROM AUTHOR]

Objective: This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors. Method: A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory). Results: Sixty-five point four per cent (n = 2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n = 391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n = 2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiative was also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem. Conclusion: The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas. [ABSTRACT FROM AUTHOR]

Using a combination of focus groups and individual in-depth interviews, the experience of living with a person with an eating disorder was explored in 24 carers. Attention was given to the progression of the disorder to understand its impact upon the family throughout the stages of the illness. Caring for a person with an eating disorder impacted upon the primary carer and the family throughout the course of the illness. Despite this, the impact on the carers was seldom acknowledged and the needs of these carers and their families were unrecognized and neglected by health professionals. [ABSTRACT FROM AUTHOR]

beyondblue is a five-year Australian initiative which takes a population health approach to combating depression. This paper's aim is to describe the findings of an evaluation of beyondblue, conducted four years into its existence. The achievements of beyondblue were examined in the light of its objectives, using synthesised data from 15 secondary sources. Many of beyondblue's lower-level objectives have been completely achieved, with a plethora of key initiatives in place that have led to greater availability of information about depression, improvements in consumer networks, better support for mental health care delivery in primary care settings and increases in targeted research. Most of its intermediate-level and high-level objectives have been partly achieved, with headway made in terms of the community's 'depression literacy', acknowledgement of the consumer/carer perspective, the degree to which the health workforce is equipped to deal with depression, the likelihood that individuals will seek help, the range of prevention and early intervention options, the role of primary care practitioners in mental health care, and scientific knowledge about depression. However, in all these areas, ongoing efforts are required, beyondblue's vision, or highest-level objective, has not yet been realised. Society does not optimally understand, respond to or work actively to prevent depression. beyondblue has begun to make an impression, but it is unrealistic to expect systemic and culture/change of this magnitude to occur quickly. beyondblue has partly achieved its goals, and careful consideration should be given to what action is necessary to foster sustainable positive change. [ABSTRACT FROM AUTHOR]

To compare existing community treatments for post-partum depression (PPD), treatment efficacy was evaluated for 146 women seeking treatment for PPD in the local community. Self-report questionnaires were designed to assess clinical depression and anxiety (psychological and physiological), risk factors, treatment satisfaction and the impact of social supports. Comparison of treated subjects with those on a wait-list demonstrated that depression and the psychological component of anxiety decreased significantly after treatment. Psychological and pharmacological interventions produced similar clinical benefit in the treatment of psychological symptoms, and receiving both treatments in combination was of no added clinical benefit in the immediate or longer term. Individual treatment was associated with more rapid treatment gains initially than group treatment. However, the benefits of group treatment emerged during the 6 months following treatment, leading both interventions to be equally effective in the longer term. Cognitive behavioural therapy was not superior to the combination of non-specific counselling or behavioural strategies, either immediately following treatment or 6 months later. Clinical efficacy together with other clinical and financial benefits strongly advocate the application of psychological treatment for PPD. Clear parallels between PPD and general depression support the application of knowledge about general depression to extend understanding of PPD and refine clinical management practices. [ABSTRACT FROM AUTHOR]

Two audit surveys were carried out, one in 1992 and the other in 1993, to examine the security needs of South West Thames Region (SWTR) Special Hospital patients. Special Hospital responsible medical officers (RMOs) were surveyed regarding need for security, appropriate placement and reasons for transfer delay for South West Thames patients. Results from both audits were strikingly similar and were also consistent with previous studies based on RMO surveys. They suggest that there are large numbers of Special Hospital patients who do not require maximum security. Assessed need for medium- and long-stay (greater than 2 years) medium secure care in the region highlighted current deficiencies in medium secure provision within South West Thames, which falls short of both Department of Health and Home Office specifications. The most frequently cited reason for postponement of transfer was Home Office delays. The consistent findings of this and previous studies emphasize the ongoing problem of overcontainment in Special Hospitals, which is contrary to government policy and accepted psychiatric practice. The serious implications of this for the rehabilitation and civil liberties of Special Hospital patients cannot be ignored. It is suggested that assessing the needs of Special Hospital patients by using RMO surveys may be the most cost-effective method for regional health authorities to employ, given the expense and time-scales involved in more complex, research-based assessments of need. [ABSTRACT FROM PUBLISHER]

The article relates the author's perspectives on the state of the research on mental health literacy in Australia and New Zealand. The term mental health literacy was first introduced in Australia in 1997 and was defined as knowledge and beliefs about mental disorders which aid their recognition, management and prevention and since then became widespread use in Australia. The initial Australian survey of mental health literacy showed that many people cannot give the correct psychiatric label to a disorder portrayed in a depression or schizophrenia vignette. There is a consensus among mental health professionals about the appropriate treatments for depression and schizophrenia [

The article examines mental health reform for perinatal care in Australia. It highlights several approaches to improve mental health outcomes for mothers, children and families. It details the National Postnatal Depression Research Program which studied the feasibility of widespread screening for depression in the perinatal period. It also reports on the establishment of the National Perinatal Depression Initiative by the Australian Department of Health and Ageing.