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Emphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved. Highlights: To assess whether infant sleep outcomes (i.e., frequency of nocturnal wakes; nocturnal wakefulness and total sleep per day) at 6 and 12 months predict early childhood anxiety disorders at 3–4 years of age.Maternally reported infant sleep outcomes were not associated with the risk of developing early childhood anxiety disorders at 3–4 years.It may be total infant sleep, irrespective of when sleep occurs or night waking and, independently, active physical comforting that requires further investigation. [ABSTRACT FROM AUTHOR]

University participation rates are significantly lower in low socioeconomic status (SES) areas in Australia. Specifically, rates differ between-schools and within-schools, where inequalities in opportunities to access university pathway programs exist. The aim of this study was to test whether academic encouragement supported students' school satisfaction and increased their desire for, expectation of and belief in the possibility of university study and whether differences were evident depending on pathway of study: the ATAR pathway versus a Year 12 access enabling pathway program called TLC110. A sample of 257 high school students (58% female) from 18 high schools, within a low-SES area of outer metropolitan Perth, Western Australia, were surveyed. Teacher encouragement was found to be positively associated with school satisfaction and, in turn, supported university desire, expectation and belief for ATAR students but not for TLC110 students. Qualitative data were collected (n = 9) to contextualise the inclusivity of TLC110 for high school students from low-SES backgrounds to support aspirations for university.

Young people in low socioeconomic (SES) regions, including regional and rural areas of Australia, aspire to attend university after high school at a comparable rate to young people in higher SES regions. However, without concrete opportunities to support and develop their aspirations, students in regional areas are unable to internalize the goals of a university education. Therefore, university participation rates are lower for regional than metropolitan students. This study examines the roles of aspiration and expectation to attend university for regional and metropolitan high school students living in a low-SES region of Western Australia, where a four-year university aspiration project was implemented. Specifically, the directionality of the development of university desire and expectation is tested using data collected over 18 months within a cross-lagged modeling framework. Differences within the region are explored using multiple group analysis, comparing the model of a regional sample with the model of propensity-score matched metropolitan sample. The results demonstrate that for metropolitan students within the region, higher early university desire feeds higher university expectations, which, in turn, crystalise subsequent university desires. For regional students, however, the cross-lagged effects were not demonstrated, suggesting other neighbourhood factors, beyond familiarity with university pathways, remain for when low-SES students live further from a major city. These findings suggest that within the same low-SES region, there is variation in how the culture and neighborhood factors interact to determine the efficacy of university participation widening programs. Addressing logistic factors that restrict access to university may further reduce the participation gap.

Students' university aspirational capacity and expectancies are key factors in predicting future university participation. Aspirations and expectations to attend university are strongly influenced by parent educational socialisation and school culture. This study investigates associations between students' university discussions with parents and their aspirations and expectations for university, and whether this link is particularly salient for students from disadvantaged schools. As well, differences in students' exposure to university are examined. Students (N = 548, 57% female) from Perth's south-west metropolitan region in Western Australia were surveyed. Multilevel analysis revealed that students from low socio-economic status (SES) schools who reported more frequent university discussions with parents had higher aspirations and expectations for university than students from similar SES schools who had fewer university discussions with parents. Furthermore, university discussions with parents predicted higher levels of aspirations for university and this link is stronger for students from lower SES schools. The effect of school-SES for the university expectations model was similar, though of weaker influence. Exposure to university is greater for students in high-SES schools. Therefore, students and parents in low-SES areas may benefit by increasing university exposure to develop knowledge and discussions about university, and support aspirations to grow expectations to attend university.

Background: Hypertensive disorders of pregnancy are associated with longer term cardiovascular risk. Understanding if depression or antidepressant use in pregnancy is associated with HDP is important in identifying those potentially vulnerable to poorer health in later life. This study examines if depression and antidepressants are associated with HDP. Methods: In all, 815 pregnant women were recruited within an Australian pregnancy cohort study at less than 20 weeks of pregnancy, all undertook the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and were assigned to four groups for this paper: those with unmedicated depression meeting criteria for current depression (n = 97), those taking selective serotonin reuptake inhibitors in early pregnancy (n = 101), those taking serotonin and noradrenaline reuptake inhibitors in early pregnancy (n = 31), and those without depression or taking antidepressant medication (control; n = 586). Women were then assessed again following birth. Hypertensive disorders of pregnancy were diagnosed according to the Society of Obstetric Medicine in Australia and New Zealand Guidelines. Results: Use of serotonin and noradrenaline reuptake inhibitors (SNRIs) (adjusted risk ratio = 9.10, 95% confidence interval = [3.82, 21.67]) and unmedicated depression (adjusted risk ratio = 3.11, 95% confidence interval = [1.32, 7.35]) were independently associated with significantly higher risk for developing hypertensive disorders of pregnancy compared to controls. Selective serotonin reuptake inhibitors (SSRIs) use did not confer any increased risk. Higher doses of SNRIs, but not selective serotonin reuptake inhibitors, were associated with significantly higher risk for developing HDP (adjusted risk ratio = 4.83, 95% confidence interval = [1.50, 15.58]). Conclusions: Our findings suggest that those with depression in pregnancy and/or on an serotonin and noradrenaline reuptake inhibitor should have closer surveillance for the development of hypertensive disorders of pregnancy. These findings support treatment of depression in pregnancy, however, also the consideration of class of antidepressant. [ABSTRACT FROM AUTHOR]

Objective: Perinatal emotional well‐being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well‐being. This study compares perinatal well‐being between women living in metropolitan and rural regions. Design: Prospective, longitudinal cohort. Participants/setting: Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Main outcome measures: Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2‐MM3 and 43 in rural to remote MM4‐MM7. The Structured Clinical Interview for DSM‐IV (SCID‐IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post‐natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. Results: The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Conclusions: Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality. [ABSTRACT FROM AUTHOR]

Objective: To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women.Method: Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected.Results: Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers.Conclusions: Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings. [ABSTRACT FROM AUTHOR]

Objective: Poorer mother–infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM -5 was used to diagnose major depressive disorder (n = 60) and bipolar disorder (n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant's interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring's emotional availability at 6 months postpartum, particularly in maternal intrusiveness. [ABSTRACT FROM AUTHOR]

Background: There have been conflicting findings for severe mental illnesses and the risk for gestational diabetes mellitus (GDM). Outside of pregnancy, both severe mental illnesses and specific antipsychotic medications have been associated with an elevated risk for metabolic disorders, including type 2 diabetes mellitus. Aim: This study examined the risk of developing GDM in relation to mental disorder, psychotropic treatment and comorbid risk factors. Materials and Methods: A retrospective study of 539 pregnant women with mental disorders was carried out. Measures included GDM diagnosis, mental health diagnosis, psychotropic medication, body mass index, age, smoking, alcohol and illicit substance use. Results: This study found that women with psychotic disorders had a significantly elevated risk for GDM (20.9%) compared with women with non‐psychotic severe mental illnesses during pregnancy (P = 0.023), and nearly threefold the expected population rate (8.3%). Furthermore, women using specific antipsychotic agents – risperidone (P = 0.016), clozapine (P < 0.001) and higher‐dose quetiapine (P = 0.029) – also had a higher risk of developing GDM. After adjusting for maternal age and body mass index, women taking these specific agents continued to have a fourfold risk of having GDM compared with women not taking these agents. Smoking, alcohol consumption and illicit drug use were not associated with elevated GDM rate in women with mental disorders. Conclusions: These findings support the need for early screening and closer surveillance of metabolic risk in pregnancy for women with psychotic disorders and those taking specific atypical antipsychotic agents. [ABSTRACT FROM AUTHOR]

Confronted with an imminent bushfire threat, Australian householders can respond by evacuating, waiting to see what the bushfire does before deciding, or remaining to defend property from the fire. This decision-making is central to householders' survival because late evacuation has been associated with fatalities. North Americans who seek alternatives to mandatory evacuation from wildfires are confronted with similar choices. Lindell and Perry's Protective Action Decision Model (PADM) has been extensively used to analyse the behaviour and decision-making of people subject to threat from a wide range of hazards and has acquired the status of a theory of hazard decision-making. It has not been widely used for the study of hazards in Australia. This paper addresses the question of how the PADM can be applied to the analysis of behaviour in Australian bushfires and North American wildfire, and whether the model requires adjusting for effective use in a context where householders choose their protective response rather than having decisions made for them. The paper addresses Australian bushfire policy, which emphasises the dangers of staying to defend during extreme fire weather conditions and promotes leaving early as the safer option but allows householders to decide whether to 'stay or go' during a bushfire. This Australian policy approach impacts key elements of the PADM, most importantly how long-run hazard adjustments, preparatory, mitigating and equipping actions, effect the perception of evacuating or remaining. The paper concludes that the PADM should be modified to reflect the complexity of choice confronting Australian bushfire prone householders and North Americans considering alternatives to mandatory evacuation. [ABSTRACT FROM AUTHOR]

Background: Improving our understanding of the relationship between maternal depression and parenting stress is likely to lie in the range of additional factors that are associated with vulnerability to depression and also to parenting stress. Objectives: To examine the role of trauma and partner support, in understanding the relationship between perinatal depression and parenting stress. Methods: This study utilises data from 246 women in a pregnancy cohort study that followed women from early pregnancy until their infant was 12 months. Included were both women with a diagnosis of depression and those without depression. The measures included Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Edinburgh Postnatal Depression Scale, Childhood Trauma Questionnaire, Social Support Effectiveness Questionnaire and the Parenting Stress Index. Results: We found women with depression were more likely to report a history of childhood trauma. Depressive symptoms were positively associated with parenting stress while partner support was negatively associated with parenting stress. The protective role of partner support for parenting distress was observed in those with no history of childhood abuse and low depressive symptoms, but not in those with a trauma history and high depressive symptoms. Conclusions: These findings highlight the importance of early trauma in understanding the protective role of support on the relationship between parenting and depression. These findings can inform future studies and the refinement of future interventions aimed at both perinatal depression and parenting. [ABSTRACT FROM AUTHOR]

Background: Both perinatal depression and infant sleep problems are common concerns in many communities, with these problems often coinciding. Findings in this area conflict and much of the research relies on poor measures of sleep and/or depression. Adding to this complexity is the rise in antidepressant treatment for perinatal maternal depression and no previous study has examined the relationship between such exposure and infant sleep.Methods: This study draws on four waves of data (early pregnancy and third trimester, and six and 12 months postpartum) from 264 women in the Mercy Pregnancy and Emotional Wellbeing Study, a prospective pregnancy cohort study of women recruited in early pregnancy in Melbourne, Australia. Cross-lagged regression models were used to examine reciprocity of longitudinal effects between depressive symptoms and infant sleep.Results: Maternal antepartum depression and antidepressant use were not significant predictors of infant sleep problems. Likewise, infant sleep problems were not significant predictors of postpartum maternal depression. However, maternal cognitions about infant sleep, characterised by maternal expectations to immediately attend to their crying child, did demonstrate positive reciprocal effects with infant nocturnal waking between six and 12 months postpartum.Limitations: Infant sleep outcomes were reported by the mother and the sample were predominantly Anglophone, restricting generalizability of the models to other cultures.Conclusions: Maternal depression and antidepressant use were not found to be significant factors in infant sleep problems and, likewise, infant sleep problems were not associated with maternal depression. However, postpartum maternal cognitions around six months postpartum regarding limit-setting at night may predict increases in later nocturnal infant signaling. [ABSTRACT FROM AUTHOR]

Objective This study examines how differences among young adults' residential arrangements and parental support are related to variation in university students' financial and psychological well-being. Method Six-hundred four students completed an online survey about financial experiences and support, and well-being. Students were split into four groups depending on their living situation and perceptions of adequate parental support. A multi-groups approach tested test path differences among the groups. Results Living at home with parents combined with perceiving lower parental financial support was associated with lower financial strain and higher psychological well-being, compared with reporting higher financial support when living at home, and living out of home regardless of support ( p < .001). For students living outside of the parental home and perceiving inadequate parental financial support, economising was most strongly associated with perceived financial strain ( p < .05), which in turn most strongly predicted lower well-being ( p < .05). Conclusions It is suggested that the non-monetary assistance provided by remaining in the family home nullifies the protective benefits of perceiving adequate parental financial support; however, when living away from the parental home, perceiving adequate parental financial support can buffer negative effects of financial strain on well-being. [ABSTRACT FROM AUTHOR]

University students have reported that they engage increasingly in more financial economizing behaviors to cope with limited resources, often to the detriment of their well-being. The objectives of this study were to investigate the mediating role of perceived financial strain between economizing behaviors and depressed mood and life satisfaction, and to compare this mediator model to the prevailing direct effects model currently reflected in the literature. Using structural equation modelling, latent-variable mediation analysis supported the notion that economizing behaviors significantly, but indirectly, predict greater depressed mood and lower life satisfaction through perceived financial strain. When examined using non-hierarchical model comparison indices, the mediation model was a superior fit to the data, compared to the direct effects model. [ABSTRACT FROM AUTHOR]

The Emotional Availability Scales (EAS) are the most widely reported observational assessment measure of parent–child relationships and has been of particular interest in understanding differences between samples of depressed and nondepressed mothers and their offspring. Despite its widespread use, psychometric validation of the factor structure in normative samples and the measurement of invariance within clinical samples has not been published. We evaluated the internal structure (dimensionality, reliability, convergent, and discriminant validity) of the EAS fourth edition using a nondepressed sample of 157 Australian women and their infants aged 6 months, including testing the measurement invariance of the EAS between the same nondepressed sample (n = 157), and a depressed group (n = 185) of mother–infant dyads, using MPlus. Participants were recruited from tertiary hospitals, and depression status was established using a diagnostic measure. Higher-order confirmatory factor analyses on the EAS' six dimensions supported a unidimensional factor solution in our data. Full measurement invariance was not demonstrated due to metric noninvariance of the maternal nonintrusiveness and child responsiveness dimensions. Full scalar invariance supported mean comparisons, and a medium effect of.78SD lower mean emotional availability for the depressed group was found; Cohen's d =.63, 95% CI [.41,.85]. While arguments exist for the clinical utility of differentiating between multiple dimensions of emotional availability, the current findings do not support a multidimensional factor structure or full multigroup measurement invariance of the EAS. Similar psychometric investigations of the EAS in clinical and nonclinical samples are needed. Public Significance Statement: This study reports new validity evidence relating to the Emotional Availability Scales, the most popular observational measure of parent–child relationships. Results challenged the emotional availability theory, underscoring the importance of empirical validations of assessment measures. [ABSTRACT FROM AUTHOR]

Background: Existing research suggests maternal depression may reduce the quality of early mother-infant interaction and this might increase our understanding of how maternal mental health impacts on child development outcomes. However, most studies recruit from community samples and few include both a diagnostic measure of maternal depression together with an observational measure of the quality of the mother-infant relationship.Methods: Data was drawn from 210 women recruited in early pregnancy until 6 months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Those women who at six months postpartum were video recorded interacting with their infant for at least 40-minutes were included in this study, with the quality of those interactions assessed using the Emotional Availability Scales coding system. Depression was measured using the Structured Clinical Interview for the DSM-IV-TR Clinician Version and the Edinburgh Postnatal Depression Scale, and covariates included maternal age and education.Results: Whilst results showed a small negative association between antenatal depressive symptoms in trimester one of pregnancy and maternal EA, there was no effect of maternal depression diagnosis or of maternal depressive symptoms in later pregnancy or postpartum.Limitations: This study focuses exclusively on mothers and does not account for the role of partners.Conclusions: Maternal depression might have a smaller effect on maternal EA then some existing research implies, with that effect most prevalent in early pregnancy. Clinical intervention might not be necessary for all mother-infant dyads experiencing depressive symptomology, but instead be directed to those with additional risk factors. [ABSTRACT FROM AUTHOR]

Abstract There is little known about real world psychopharmacological prescribing practices in managing pregnant women with severe mental illness (SMI). This study utilised a sample of 535 women with a SMI across two hospitals in Australia. This included women with psychotic disorders, bipolar disorder and a range of non-psychotic disorders. The majority of women with a SMI in pregnancy were prescribed psychotropic medication as part of their management. Furthermore, more than one class of agent was prescribed for 31% of women with psychotic disorders and 30% of women with bipolar disorder. Differences between sites were identified in prescribing practices across the mental disorders. This included the variation in rates of use of multiple agents and pattern of use across pregnancy. This study also identified that women with a SMI had elevated rates of gestational hypertension, gestational diabetes mellitus, smoking and obesity in pregnancy and neonates admitted following delivery compared with the Australian average. These findings suggest that studies that examine associated risks for severe mental disorders or their treatments on pregnancy and infant outcomes should take into account the prescribing practices including the likelihood of exposure to polypharmacy and a range of potential confounding co-morbidities and exposures. The discrepancies in reported findings for pregnancy and infant outcomes following use of antipsychotic and mood stabiliser agents such as lithium may be at least partially accounted for by the complexity of multiple exposures that includes use of multiple psychopharmacological agents, co-exposures such as smoking and co-morbid conditions such as obesity. [ABSTRACT FROM AUTHOR]

Background: Aripiprazole is a second generation antipsychotic medication that has been a useful addition to the treatment of severe mental illness due to its low metabolic and sedation risk profile. Pregnancy is a time of high risk of metabolic complications such as gestational diabetes and the postpartum period is often a time when sedation can compromise infant care. To date there is limited data in pregnancy on the safety of aripiprazole use. While available data do not suggest an elevated malformation risk in pregnancy, there is less information available on pregnancy and neonatal complications.Methods: This study presents preliminary data on pregnancy and neonatal complications on 26 women who took aripiprazole in pregnancy. These women attended at antenatal clinics for women with severe mental illness at two hospitals in Australia.Results: Overall aripiprazole was not associated with an increased risk of gestational diabetes. However, use of aripiprazole in pregnancy was associated with an increased risk of pregnancy hypertension, lower birth weight, shorter gestation at birth and higher rates of admission of the neonate than the expected population rates.Limitations: These findings need to be replicated in a larger, well-designed study to ensure they do not reflect confounding factors.Conclusions: Findings demonstrate that aripiprazole is unlikely to pose a metabolic risk in pregnancy but other pregnancy complications including hypertension, need to be examined in further studies. [ABSTRACT FROM AUTHOR]

Background: Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression., Methods: The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale., Results: Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression., Limitations: Intergenerational conflicts and quality of grandparenting were not assessed., Conclusions: Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access., Design: A descriptive cross-sectional survey design was used., Methods: A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data., Results: Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information., Conclusion: Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information., Implications for the Profession and Patient Care: Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information., Impact: This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions., Reporting Method: The STROBE reporting method was used in the preparation of the manuscript., Patient or Public Contribution: No patient or public contribution., (© 2023 John Wiley & Sons Ltd.)

Objective: To identify whether a diagnosis of depression combined with rurality, compared with either depression or living in metropolitan areas alone, is associated with experiencing more stressful life events in pregnancy., Design: This study uses data from 402 pregnant women (206 metropolitan and 196 rural), enrolled in the Western Australian arm of the Mercy Pregnancy and Emotional Wellbeing Study. Mercy Pregnancy and Emotional Wellbeing Study is a prospective, longitudinal cohort with women recruited during early pregnancy (<20 weeks) across 3 groups: those with diagnosed depression, those taking antidepressant medication and control., Participants: Women were recruited from 3 metropolitan and 3 rural hospitals in Western Australia from 2017 to 2018 and 2018 to 2020, respectively. This study uses antenatal data collected at recruitment and during third trimester (weeks 32-34)., Main Outcome Measures: The Stressful Life Events Scale was used to measure the number of self-reported stressful events. The degree of perceived stress due to the stressful event was also reported., Results: Compared to pregnant metropolitan women diagnosed with depression, pregnant rural women with depression were more likely to report experiencing at least 1 stressful life event. Despite this, pregnant women with depression in both regions reported similar numbers of stressful life events., Conclusions: This study highlights women in rural Western Australia diagnosed with depression might be more vulnerable to experiencing stressful life events than rural women without depression and their metropolitan counterparts. Due to known adverse effects of antenatal depression and stress on maternal well-being and child outcomes, there is a clear need for targeted, preventative interventions for Australian rural women during this period., (© 2022 National Rural Health Alliance Ltd.)

Introduction: Placental dysfunction and inefficiency, is important in understanding fetal growth restriction and low birth weight. Two recent studies have examined the relationship between antidepressant use in pregnancy and placental weight ratios; one found lower placental weight ratio associated with antidepressant use and the other found a higher ratio., Methods: This study examined 342 women recruited in early pregnancy, including 75 taking antidepressants, 29 with current depression and 238 controls. Antidepressant use was measured through self-report in early and late pregnancy, hospital records at delivery and drug concentrations in umbilical cord and maternal blood obtained at delivery. Maternal depression was measured using the Structured Clinical Interview for the DSM IV (SCID) at recruitment. Placentas were collected at delivery and weighed, and infant birth weight recorded. Placental efficiency was measured using standardised placental weight residuals and included as the outcome in general linear models (ANOVA/ANCOVA) to test hypotheses., Results: While placental weight was higher for those on antidepressants compared to controls (z=.30 c.f. Z=-0.08, p=.012), there were no significant differences between the three groups after adjusting for maternal body mass index at recruitment. When comparing antidepressant groups separately there were small-to-moderate positive associations between (SSRI) concentrations and placental weight (rho's > 0.20, p's > 0.05), which did not reach significance., Conclusion: Antidepressant use in pregnancy was not associated with significant changes in placental efficiency after adjustment for confounding variables. Future research should expand on this to examine other aspects of placental function and include a wide range of potential confounding variables to draw clinically meaningful conclusions., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)

Understanding how a mother's traumatic experiences influence her interactions with her infant may have importance for understanding infant development and mental health. Data for this study were drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Maternal trauma from Childhood, Childbirth Experiences, and Stressful Life Events were examined. At six-months postpartum, 211 predominantly first-time mothers (mean age 31.5 years), and their infants, were video-recorded interacting for 40 minutes. Interactions were assessed with the Emotional Availability (EA) Scales. Using structural equation modelling to test multiple mediation pathways, moderate-to-severe childhood trauma had only a direct effect on reducing maternal EA with the infant (β=-.17, p=.031), as did current stressful life events (β=-.19, p=.019), after controlling for maternal depression, age, and tertiary education. This highlights that proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal EA at six-months postpartum.

Background: Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression., Methods: 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models., Results: There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability., Limitations: Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings., Conclusion: Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability., (Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.)

Objective: To examine the risk of past and current experiences of intimate partner violence (IPV) in women with severe mental illness (SMI) in pregnancy., Methods: We examined past and current experiences of IPV in women with SMI in pregnancy. The data of 304 women with SMI including schizophrenia and related psychotic disorders and Bipolar Disorder meeting International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) criteria were extracted from hospital records at King Edward Memorial Hospital, Western Australia. Comparisons were made between our study data and the Australian population data reported by the Australian Bureau of Statistics, which included data on pregnant women in Western Australia. Additional measures included reported demographics, substance use and pregnancy variables., Results: Around 48% of pregnant women with SMI had experienced IPV and were three times the risk when compared with the general pregnant population in Australia. There was no difference in rates of IPV in those women with psychotic disorders when compared with bipolar disorder. Furthermore, the rates of smoking and illicit substance use were significantly higher in pregnant women with SMI who experienced IPV compared with those who have not experienced IPV., Conclusion: These findings suggest women with SMI in pregnancy are at significantly higher risk of having experienced or experiencing IPV. In addition, IPV in pregnant women with SMI may increase the risk of smoking and illicit substance use. Together this suggests that maternity and mental health services should ensure there are both screening and support pathways for IPV that are developed and evaluated specifically for pregnant women with SMI.

Pregnancy and the early post partum period are widely understood as a critical period for the infant's emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children's social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Objective: Since the potential mental health benefits of exercise during pregnancy remain unclear, this study examined longitudinally the bidirectional relationship between exercise and maternal mental health symptoms during the perinatal period, and included adjustment for both depression and antidepressant treatment., Methods: Data were collected across pregnancy (first and third trimesters) and the postpartum (six and 12 months) for 258 women drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). The women were assessed for depression using the EPDS, anxiety using the STAI and a clinical diagnostic interview (SCID-IV), and self-reported use of antidepressants. Exercise was measured using self-reported weekly frequency of 30-min bouts of moderate to vigorous exercise, and data were analyzed using parallel process growth curve modelling., Results: On average, women's weekly exercise frequency declined during pregnancy, returning to first trimester levels by 12 months postpartum. Women with depression and taking antidepressants reported lower first trimester exercise compared to control women. However, where non-medicated depressed women remained lower and continued to decline to 12 months, women taking antidepressants reported increasing levels of exercise during the perinatal period. Notably, a steeper decline in exercise frequency during the perinatal period was associated with a faster rate of increase in depressive and anxiety symptoms., Conclusions: This study is the first to examine the longitudinal interaction between exercise and mental health symptoms across the perinatal period. These preliminary findings demonstrate potential benefits for depressive and anxious symptoms when maintaining levels of early-pregnancy exercise throughout pregnancy and the postpartum., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Background: Recent evidence suggests that the use of low tidal volume ventilation with the application of positive end-expiratory pressure (PEEP) may benefit patients at risk of respiratory complications during general anaesthesia. However current Australian practice in this area is unknown., Methods: To describe current practice of intraoperative ventilation with regard to tidal volume and application of PEEP, we performed a multicentre audit in patients undergoing general anaesthesia across eight teaching hospitals in Melbourne, Australia., Results: We obtained information including demographic characteristics, type of surgery, tidal volume and the use of PEEP in a consecutive cohort of 272 patients. The median age was 56 (IQR 42-69) years; 150 (55%) were male. Most common diagnostic groups were general surgery (31%), orthopaedic surgery (20%) and neurosurgery (9.6%). Mean FiO2 was 0.6 (IQR 0.5-0.7). Median tidal volume was 500 ml (IQR 450-550). PEEP was used in 54% of patients with a median value of 5.0 cmH2O (IQR 4.0-5.0) and median tidal volume corrected for predicted body weight was 9.5 ml/kg (IQR 8.5-10.4). Median peak inspiratory pressure was 18 cmH2O (IQR 15-22). In a cohort of patients considered at risk for respiratory complications, the median tidal volume was still 9.8 ml/kg (IQR 8.6-10.7) and PEEP was applied in 66% of patients with a median value of 5 cmH20 (IQR 4-5). On multivariate analyses positive predictors of tidal volume size included male sex (p < 0.01), height (p = 0.04) and weight (p < 0.001). Positive predictors of the use of PEEP included surgery in a tertiary hospital (OR = 3.11; 95% CI: 1.05 to 9.23) and expected prolonged duration of surgery (OR = 2.47; 95% CI: 1.04 to 5.84)., Conclusion: In mechanically ventilated patients under general anaesthesia, tidal volume was high and PEEP was applied to the majority of patients, but at modest levels. The findings of our study suggest that the control groups of previous randomized controlled trials do not closely reflect the practice of mechanical ventilation in Australia.