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We examined the effect of person‐related factors on capacity to obtain needed healthcare for non‐COVID‐19 health conditions/disabilities under COVID‐19 restrictions. This was an anonymous online survey of Australian residents ≥18 years (3rd April to 2nd May 2020). We determined the ability to obtain care needed for non‐COVID‐19 health conditions/disabilities, experience of COVID‐19, COVID‐19 restrictions and sociodemographic characteristics using study‐specific questions; and clinically significant depressive and anxiety symptoms using Patient Health Questionnaire 9 and Generalised Anxiety Disorder Scale 7 respectively. We calculated the population attributable fraction (PAF) to determine the proportion of worse access to non‐COVID‐19 health/disability care attributable to independent risk factors. 13,829 (91.5%) participants had complete data. 6,712 (46.4%) identified a need for healthcare/disability services (<45 years 42.1%, ≥45 years 50.3%). 31.6% aged <45 years and 24.3% aged ≥45 years reported worse access to health/disability care than experienced prior to the pandemic. In those aged <45 years the PAF was highest for depressive symptoms (21.4%; 95% CI 12.6%–29.3%) and anxiety (PAF 19.9%, 12.3%–26.9%). with a PAF of 49.6% (40.1%–57.6%) if any one of the following was being experienced: doing unpaid work; being a student; depressive symptoms; symptoms of anxiety; experiencing high adverse impact of COVID‐19 restrictions. In those ≥45 years, PAF was highest for having depressive symptoms (PAF 20.9%, 16.6–24.8) with a PAF of 44.1% (36.0%–51.2%) if any one of the following was being experienced: depressive symptoms; symptoms of anxiety; doing unpaid work; living alone; being in lowest socioeconomic quintile; main source of income from government benefits; any personal experience of COVID‐19. The identified risk factors, which include many that characterise those with worse health outcomes generally, explained 44%–50% of worse access to necessary health/disability care. These data have the potential to inform targeted strategies aimed at reducing a post‐pandemic escalation of poor health outcomes, especially in vulnerable populations. [ABSTRACT FROM AUTHOR]

Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner, organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT. Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers' needs and expectations, clinicians' attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers. Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered. The MRC Guidance for developing and evaluating complex interventions is a useful framework for conceptualizing and reporting translational formative evaluation, which is an essential step in the evidence trajectory. The results of the evaluation will inform the protocol for a cluster RCT of WWWT and associated health economic evaluation. [ABSTRACT FROM AUTHOR]

Background: Australia's public access residential early parenting services provide programs to assist parents who selfrefer, to care for their infants and young children. Treatment programs target infant feeding and sleeping difficulties and maternal mental health. There is limited systematic evidence of maternal and infant mental health, psychosocial circumstances or presenting problems, or the effectiveness of the programs. The aim of this study was to contribute to the evidence base about residential early parenting services. Methods: A prospective cohort design was used. A consecutive sample of mothers with infants under one year old recruited during admission to a public access residential early parenting service for a 4 or 5 night stay in Melbourne, Australia was recruited. They completed structured self-report questionnaires, incorporating standardised measures of infant behaviour and maternal mood, during admission and at one and six months after discharge. Changes in infant behaviour and maternal psychological functioning after discharge were observed. Results: 79 women completed the first questionnaire during admission, and 58 provided complete data. Women admitted to the residential program have poor physical and mental health, limited family support, and infants with substantial behaviour difficulties. One month after discharge significant improvements in infant behaviour and maternal psychological functioning were observed (mean (SD) daily crying and fussing during admission = 101.02 (100.8) minutes reduced to 37.7 (55.2) at one month post discharge, p < 0.001; mean (SD) Edinburgh Postnatal Depression Scale at admission = 11.3 (5.7) reduced to 6.78 (4.44), at one month, p < 0.001) which were sustained at six months. Participant satisfaction with the program was high; 58 (88%) found the support of the nurses and 50 (75%) the social support of other mothers very helpful. Conclusions: This psycho-educational approach is an effective and acceptable early intervention for parenting difficulties and maternal mood disturbance, and contributes to a system of comprehensive mental health care for mothers of infants. [ABSTRACT FROM AUTHOR]

Background: Antenatal psychological well-being is multifactorially determined, including by social circumstances. Evidence suggests that workplace conditions are salient determinants of mental health, but it is not known whether employment conditions influence antenatal psychological well-being. Aims: To investigate the relationship between employment conditions and antenatal psychological well-being in Australian women. Methods: A sociodemographically diverse consecutive cohort of employed nulliparous women was recruited in late pregnancy. Data were collected by a structured interview assessing sociodemographic characteristics, employment arrangements, experience of pregnancy-related discrimination, and access to maternity leave entitlements. Participants completed two standardised psychometric measures of maternal mood: the Edinburgh Depression Scale (EDS) and the Profile of Mood States (PoMS). Comparisons of self-reported mood were made between women by experience of workplace adversity, using a composite measure of workplace events. Results: Of 205 eligible women, 165 agreed to participate. Of these, 114 of 165 (69%) reported at least one form of workplace adversity during pregnancy. More women without private health insurance (78%) reported workplace adversity than those who were privately insured (57%) (χ21 = 6.95, P = 0.008). Women experiencing workplace adversity had significantly worse psychological well-being as indicated by the EDS score (7.7 ± 5.1) than those who were experiencing no workplace adversity (5.5 ± 3.4), mean difference (95% CI) = –2.2 (–3.7 to –0.8), P = 0.003. Similar results were reported for the PoMS. Conclusions: Workplace adversity during pregnancy is associated with poorer maternal psychological well-being. Workplace conditions and entitlements are salient factors for consideration in assessments of antenatal psychosocial well-being. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: Maternal serum screening is routinely offered to pregnant women in public hospitals in Victoria, Australia, regardless of their age. The aim of this study was to determine whether pregnant adolescents are less likely to make informed choices about undertaking this test than adult pregnant women. Design: Controlled, prospective design. Setting: Public hospital antenatal clinics in Victoria, Australia. Participants: Adolescents up to 20 years of age were recruited at young mothers’ clinics before they were offered second trimester maternal screening. They completed self-report questionaires prior to maternal serum screening and again after the screening result was known. Main Outcome Measures: A validated measure of informed choice was used to determine whether adolescents made informed choices about undertaking second trimester maternal serum screening. Results: Complete data were available for 147 adolescents. These data were combined with data from 85 adults which had been collected in an identical way. Ten percent of the adolescents made informed decisions about having the maternal serum screening, compared with 37% of the adult participant group (P < 0.05). Adolescent women were significantly less likely to make an informed choice than adult women, when relevant demographic and reproductive history variables were controlled for (adjusted OR = 0.25; P = 0.004; 95% CI for OR: 0.10, 0.63). Conclusion: Few pregnant adolescents made informed decisions about maternal serum screening. Clinicians face a challenge to improve adolescents’ knowledge about maternal serum screening. [ABSTRACT FROM AUTHOR]

Importance: Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted., Objectives: To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk., Design, Setting, and Participants: This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018., Exposures: One-hour interviews covering mental health, intimate partner violence, and other social measures., Main Outcome and Measures: World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed., Results: Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P < .001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P < .001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%])., Conclusion and Relevance: Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.

Background: Social support is essential for physical and mental health and well-being. Evidence indicates that social and peer support is particularly important and beneficial for the well-being of those who care for children with chronic illness or disability in improving personal well-being and influencing parent-child play opportunities and child behaviour and development positively. MyTime is a government-funded Australia-wide facilitated peer support group program for carers of children with special needs., Aim: The aim was to investigate the barriers and promoters of participation in this peer support group program., Method: A qualitative approach was adopted where semi-structured telephone interviews were conducted with 20 group members, four group facilitators and three play helpers. Interviews were recorded and transcribed. Inductive thematic analysis of the transcripts was conducted., Results: Most group members described gaining significant social support from group participation. Good group facilitation, the availability of play helpers, access to disability-related information and expertise, and the mutual exchange of support between members emerged as the most important promoters of group participation. Barriers included insufficient funding to run the program throughout the year, too much diversity in group members' socio-economic position and severity of their children's disability., Conclusion: The facilitated peer support group program described in this paper appears to confer significant benefits to carers of children with disabilities and may be a model for other nations to consider in their strategies to improve services for carers of children with special needs., (© 2014 Nordic College of Caring Science.)

Breast cancer and its treatment in reproductive-age women can reduce fertility and compromise family formation. To learn about women's experiences of fertility-related cancer care we interviewed 10 women (aged 26-45), at least one year postdiagnosis. Thematic analysis revealed that all women, including one who chose to be child-free, valued fertility and motherhood. They reported experiencing varied fertility-related care, from support for fertility preservation to apparent disregard of their fertility concerns. Women's needs were heterogeneous, but all wanted health care providers to communicate fertility options and avoid assumptions about women's fertility desires while working to extend each woman's life.

Objective: To investigate the association between the mother-infant relationship, defined as maternal-infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth., Method: Samples of employed, pregnant women, over 18 years of age and with sufficient English literacy were recruited systematically from one public and one private maternity hospital in Victoria. Data were collected by structured interview and self-report questionnaire in the third trimester, and at 3 and 10 months postpartum. Socio-demographic, employment, and breastfeeding information was collected. Participants completed standardised assessments of maternal separation anxiety and mother-to-infant emotional attachment., Results: Of 205 eligible women, 165 (81%) agreed to participate and 129 (78%) provided complete data. A reduced odds of employment participation was independently associated with continuing to breastfeed at 10 months (OR=0.22, p=0.004) and reporting higher maternal separation anxiety (OR=0.23, p=0.01) when maternal age, education, occupational status and use of paid maternity leave and occupational status were adjusted for in analyses., Conclusion: Employment participation in the first 10 months postpartum is associated with lower maternal separation anxiety, and shorter breastfeeding duration., Implications: Paid parental leave has public health implications for mothers and infants. These include permitting sufficient time to protect sustained breastfeeding, and the development of optimal maternal infant attachment, reflected in confidence about separation from her infant., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)

Objective: Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared with those conceiving spontaneously. This study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception., Design: A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires., Setting: Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia., Patient(s): A consecutive cohort of English-speaking women with ultrasound-confirmed ART-conceived pregnancies., Main Outcome Measure(s): Standardized psychometric measures of mood, quality of marital relationship, mother-to-fetus emotional attachment, and personality., Intervention(s): None., Result(s): Of the 288 women with confirmed pregnancies, 239 were contactable, and 183 (77%) were recruited, 95% of whom completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles, and intense affectionate attachment to the fetus. Very few (<5%) had clinically significant mood disturbance in late pregnancy., Conclusion(s): There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealized after ART conception, and preparation for the realities of infant care might then be insufficient.

Background: Ethical practice requires that decisions to participate in medical care be well informed. Investigations into prenatal genetic screening for Down syndrome have assessed women's knowledge but have not examined whether being well informed about the potential consequences of screening, such as subsequent diagnostic testing, diagnosis and termination, is associated with psychological distress for women., Aims: To assess informed choice to participate in second trimester maternal serum screening (2MSS) in pregnant women using a validated measure and to compare anxiety levels in women who were well informed versus poorly informed., Methods: A prospective cohort study where pregnant women completed the Multidimensional Measure of Informed Choice and the Hospital Anxiety and Depression Scale immediately prior to the offer of 2MSS. Follow-up questionnaires assessing psychological symptomatology were completed at 20 and 30 weeks gestation., Results: Only 37% of decisions were informed; those who participated in screening were more likely to have made an informed decision than those who did not (P = 0.01); 31% did not know that miscarriage was a possible consequence of diagnostic testing subsequent to an increased risk screening result and only 62% correctly identified that termination of pregnancy would be offered if Down syndrome were to be diagnosed. Short-term anxiety levels in those who were well informed were not significantly different from those who were poorly informed (P = 0.14)., Conclusions: Health promotion strategies, which are readily applicable in clinical settings and address diverse learning needs and attitudes of pregnant women, are needed. The impact of antenatal screening on other dimensions of pregnancy psychology remains to be investigated.

Background: The health and social circumstances of economically advantaged mothers who are caring for infants with unsettled behaviour or feeding difficulties has been under investigated., Methodology: An observational survey of consecutive admissions to one private hospital's mother baby unit in Melbourne admitted with infant feeding or sleeping problems., Results: Of 146 eligible participants, 109 (75%) completed the questionnaire. All had partners and previous employment in the professional/managerial sector. There were low rates of previous psychiatric illness, family history of psychiatric illness, childhood sexual abuse or current domestic violence, despite which most felt currently unwell. They had experienced high rates of reproductive difficulties, (6.5% IVF conception, 25% invasive prenatal testing, 26% antenatal admission, and 53% operative delivery). Many (52%) perceived their postnatal obstetric care as unsatisfactory. Breastfeeding problems were common (29% had experienced mastitis). Severe sleep deprivation associated with frequent infant night time waking was universal. Partner's working hours greatly exceeded the community average and many women felt under supported and unable to confide in their partners. More than half reported serious, coincidental life events., Conclusion: Some economically advantaged mothers experience such significant postpartum ill health they seek hospital admission.