About
Values
National and State Initiatives
State Initiatives
Research Staff and Program Partners
Screening Program
PND Program Outcomes
National Action Plan
beyondblue Resources

Overview

The National Post Natal Depression (PND) Research Program looked at the use of a simple mental-health screening tool, the Edinburgh Postnatal Depression Scale (EPDS), in an Australian population, to identify women who may be at risk of antenatal and postnatal depression. This Research Program now gives us an opportunity to put in place best practice across Australia, with data collection and analysis that is proving to be of enormous benefit to mental health policy direction and planning.

Postnatal depression affects about 14% of women who give birth, and recent evidence suggests that many women may in fact be depressed during their pregnancy. Research has linked depression at this time to chronic depression, marital difficulties and behavioural and cognitive delays in children. Despite the prevalence and consequences of depression occurring antenatally and postnatally, most women commonly remain unidentified and untreated.

beyondblue funded the Research Program for a four year period, 2001-2005. In this time it provided information and resources about Postnatal depression to over 200,000 women. The Program ran in Victoria, South Australia, Western Australia, Queensland, New South Wales, Tasmania and the Australian Capital Territory.

About PND 

Postnatal depression affects one in seven women giving birth in Australia. As well as being a devastating experience for the new mother, it also has dramatic effects on the infant and mother's personal relationships with other family members.

Left untreated, the impact on the mother and her children can be profound. Children of depressed mothers have a higher risk of cognitive and behavioural difficulties, as well as impairments in later mental health. When left untreated, PND can impact on family relationships and some studies have also indicated that the partners of women with PND may also be at greater risk of depression.

If women at risk of postnatal depression are identified during pregnancy and effective psychological and social interventions are provided, then it is possible that postnatal depression may be reduced in severity or prevented altogether. To work towards this goal, beyondblue is sponsoring a large four-year national PND program across six states.

Values 

• Establish a national approach to prevention, early intervention and management of postnatal depression.
• Provide a leading direction in postnatal disorders for Australia and the world.
• Establish procedures for routine screening of antenatal and postnatal depression at major maternity hospitals in each state which would become the basis of ongoing routine care after completion of the project.
• Involve current services in different states.
• Prevent and minimise the impact of depression.
• Seek to de-stigmatise antenatal and postnatal depression.
• Focus on increased consumer and carer awareness of antenatal and postnatal depression
• Use current evidence-based medicine in the development of early identification and prevention strategies.
• Focus on women who are at a higher risk of developing postnatal depression and to ensure there are more support and services available for these women, their partners and their families.
• Determine the current level of services available for women and highlight where there is a lack of, or increased need for, these services.
• Evaluate the different types of support services available and their effectiveness.
• Create resources, which are accessible to the maximum number of women, including those from non-English speaking backgrounds.
• Determine how the development of depression in mothers affects the infant and different family members.
• Reduce the chance that depression will carry through to future generations.

National and State Initiatives 

The beyondblue National PND Research Program presented a unique opportunity to increase our knowledge about the prevention and management of antenatal and postnatal mood disorders. In addition, it enabled a variety of health professionals and self-help organisations to provide information to the public and media about these and other relevant issues.

The program was formed with the collaboration of world-renowned investigators experienced in the areas of perinatal (five months before and one month after birth) and maternal mental health research. The multidisciplinary research team included researchers from the areas of psychiatry, clinical psychology, nursing, midwifery and community mental health.

The program was headed by Associate Professor Anne Buist, Head of Adult Psychiatry and the Mother-Baby Unit (Banksia House) at the Repatriation General Hospital, Austin Health, Heidelberg, (VIC). Associate Professor Buist, in association with the Management Group and beyondblue, worked closely with each State coordinator to determine the scientific direction of the Program. Dr Justin Bilszta was the National Program Manager.

The State coordinators included: Professor John Condon (SA); Doctor Craig Speelman (WA); Professor Barbara Hayes (QLD); Professor Bryanne Barnett (NSW); Professor Jeannette Milgrom (VIC & TAS) and Professor David Ellwood (ACT). These State coordinators worked with their research teams to ensure successful implementation of the screening protocol, assist hospitals in the day-to-day running of the Program and promoted the activities of the beyondblue National PND Program and beyondblue.

State initiatives  

In addition to the education booklet and referral to GPs, five states developed different treatment programs, looking at using current resources and those that were the most practical to implement. Only one treatment program occured in each state and results were compared at the end of the study.

Victoria

Antenatal support following depression: enhancing the parent-infant relationship.

Senior investigator - Associate Professor Jeannette Milgrom, Austin and Repatriation Medical Centre; and, University of Melbourne.

A randomly selected sub-sample of women identified as at-risk of depression were offered a specific treatment program, in addition to the GP referral. Two programs were offered antenatally - Preparation for Parenting with or without a Psychological Therapy for Depression package. These treatments were compared to routine care and outcome measures included infant, maternal and partner functioning.

New South Wales

Antenatal support for women from non-English speaking backgrounds.

Senior investigator: Professor Bryanne Barnett, University of New South Wales.

The focus was on the specific needs of women with postnatal depression from non-English speaking backgrounds. In particular women from Arabic and Vietnamese backgrounds were targeted with culturally sensitive material and a "social networking" service.

Western Australia 

The beyondblue National PND Education & Awareness Project for Families with Multiples.

Senior investigator: Professor Sherryl Pope, King Edward Memorial Hospital; and, Edith Cowan University (July 2001 - Dec 2003). Dr Craig Speelman, School of Psychology, Edith Cowan University (from Jan 2004)

This project incorporated three main components: 1) education and awareness raising initiatives for those that provide support, information and services to families with multiples; 2) education and awareness raising initiatives for pregnant and new multiple birth families; 3) research, including investigation into the incidence of and risk factors for antenatal and postnatal depression in mothers of multiples, and the experiences and needs of new multiple birth families.

South Australia

Focus on fathers: developing their role as supporters of the depressed mother.

Senior investigator: Professor John Condon, Flinders University.

Fathers were the major focus of attention, enhancing their skills at identifying depression in their partners; accessing appropriate resources; and, supporting them through the transition to parenthood. The major aims were to: increase awareness among male partners of the nature of postnatal depression and its effect upon women and their lifestyle; to teach men to recognise problems and develop specific strategies to support their partners; and, ameliorate their distress and provide opportunities for the men to share their experiences and provide each other with support.

Queensland

Education for midwives, maternal child health nurses, rural nurses and focus groups for Indigenous women.

Senior investigator: Professor Barbara Hayes, James Cook University.

The Queensland intervention had two distinct arms. The first was a structured education program for midwives, child health nurses and rural nurses with a pre- and post-test of knowledge levels. The second was conducting culturally sensitive, and safe, focus groups with Indigenous women

Research Staff & Program Partners 

• Link to the research staff involved in the program in each state
• Link to the list of partner organisations involved in the project

Screening Program 

Antenatal Screen

In each state, women were screened antenatally (26-32 weeks) for being at risk of depression, using a simple mental health-screening tool, the Edinburgh Postnatal Depression Scale (EPDS). In addition, women were asked to complete a demographic/psychosocial questionnaire. A small group of women were also asked to complete two additional mental health-screening tools, the K10 (Kessler Psychological Distress scale: a ten-item questionnaire which can be used to identify depressive or anxiety disorders) and the SPHERE (Somatic and Psychological Health Report: a twelve-item questionnaire which can be used to identify common mental disorders including depression, anxiety and somatic distress).

Women screened as part of this program were approached through the antenatal clinics at major maternity hospitals and all women received an educational booklet, 'Emotional Health During Pregnancy and Early Parenthood', which provided resources and contact numbers should they require further help.

All screened women showing signs of being at risk of depression were sent a letter suggesting that if they were concerned about their mood or how they were feeling emotionally, they should approach their general practitioner (GP) to discuss their concerns. A note was also made in their hospital records and their GP was informed by letter. In addition, GPs were also forwarded a flyer entitled 'Antenatal and Postnatal Depression: a Guide to Management' to aid them in assisting patients who presented with a mood disorder, as well as contact numbers for further information or assistance. GPs, maternal child health nurses (MCHNs), midwives and any other interested heath professionals were offered education about pregnancy-related depression at regular seminars.

Postnatal Screen

All women screened antenatally were asked to complete the EPDS again, six to eight weeks after they had their baby. GPs were invited to participate and have women complete the EPDS at their six-week check-up. A copy of the EPDS was sent out with hospital discharge summaries or sent directly to GPs, with an explanation on how to score the questionnaire. If the screening was conducted by the MCHN, the GP was notified of any women screened as being at risk of depression.

Baseline and Post-Study Evaluation

In order to assess the effectiveness of widespread depression screening and educational measures, baseline and post-study evaluation was performed on a selected sub-sample of women and health professionals. Professional and community attitudes and knowledge of pregnancy-related depression were assessed as well as referral patterns, usage of services and management of depression.

PND Program Outcomes  

There has been a lack of national focus and insufficient attention on improving women's mental health before they give birth. The beyondblue PND Research Program established the necessary national collaboration to determine whether postnatal depression could be prevented. The program aimed to determine the value of antenatal screening, information packages and psychological and social interventions.

The final report on the research program is available here in two volumes to dowload:

Volume I: National Screening Program
Volume II: State Based Antenatal Intervention Initiatives

The research has yielded some important findings with respect to knowledge and attitudes about PND and its treatment:

• Women's beliefs about postnatal depression varied significantly from those of health professionals, and most new mothers disagree with way GPs treat this condition.
• Postnatal mothers preferred starting a 'special diet' to help them cope with depression. This finding is likely to relate to the high level of body changes and weight consciousness during and after pregnancy.
• Postnatal mothers also preferred using the herb St John's Wort to treat their depression rather than traditional antidepressant medication. Interestingly, GPs were much more likely to believe that antidepressant medication was useful and most felt there was no evidence to support the use of St John's Wort. This finding highlights the vast difference in opinion between women and GPs over the most useful pharmacological treatment for depression.
• Maternal and Child Health Nurses tended to favour admission to a psychiatric ward or to seeing a psychologist, options that mothers did not favour. Further analysis of the data is needed to determine if this is due to a genuine reluctance by mothers to use psychological therapies or a lack of awareness of this treatment option.
• Most Midwives, whilst able to detect postnatal depression, were unlikely to be aware of antenatal depression. Midwives also advocated counselling, yoga/meditation or self-help groups to treat postnatal depression, rather than pharmacological treatments.
• Most mothers were unlikely to identify their own depression and were also unlikely to see treatment if they did feel depressed.

These initial findings highlight important gaps in knowledge about pregnancy-related depression, particularly in the areas of detection of antenatal depression and the different type of treatment options available. The National PND Research Program was ideally suited, through the design of its research program and development of resource material for health professionals, to alter public and health professional knowledge in these areas.

beyondblue is currently developing a national, integrated, coordinated approach to translate the outcomes of this research into evidence-based policy and practice.

During April/May 2006, beyondblue invited tenders to develop a national action plan for the following components of the program:

• Development of a national plan for routine antenatal and postnatal depression screening and assessment
• Development of pathways to care, diagnosis and treatment to support the screening program
• Training of health professionals
• Convening of a National Steering Committee
• Promotion activities (beyondblue to conduct)

The National Perinatal Depression Initiative 2008-2013
Click here to read an update on the progress of the implementation of the National Perinatal Depression Initiative (October 2009)

National Action Plan 

beyondblue has joined with leading experts and organisations in the field and developed a National Action Plan for screening and management of women with depression during pregnancy and the postnatal period.  The Consortium developed a framework to implement national antenatal and postnatal depression screening and develop pathways to care. 

beyondblue would like to recognise the commitment of both the Federal and State Governments to the National Action Plan for Perinatal Mental Health, with the announcement of $85 million in funding allocated to the program in the 2008-2009 Federal Budget and confirmed contributions from a number States and Territories to date.

 The final National Action Plan (NAP) for Perinatal Mental Health (developed in 2007) is now available for download.

National Perinatal Mental Health Program Brief 
National Perinatal Mental Health Summary

beyondblue Resources 

 
 
Emotional Health during Pregnancy and Early Parenthood is a recently produced beyondblue information resource.  The guide aims to raise awareness of the impact of postnatal depression, provide information about the illness, its symptoms and effective strategies to deal with it. 

The guide includes a specific information card outlining local services for perinatal depression and support services in each State and Territory in Australia.  A version of this resource has also been translated into 19 other languages for parents from Culturally and Linguistically Diverse backgrounds and is available to download from our website.

Emotional Health during Pregnancy and Early Parenthood booklet and State/Territory information and helpline numbers cards can be downloaded here or ordered from the Resources page.