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).
Mother-Baby Unit (Banksia House) at the Repatriation General Hospital, Austin Health;
Primary perinatal health care providers in 43 different health services/regions.
Project completion year
This program focused on initiating much needed improvements in healthcare for women delivering babies in Australia. The aim was to address and improve outcomes for women and their families who were experiencing antenatal or postnatal depression and anxiety and introduce a prevention and early intervention approach.
Multidisciplinary teams across eight states and territories engaged with primary perinatal health care providers in 43 different health services/regions. Over 40,000 pregnant women were approached directly by their health-care workers and screened for mood disorders using a widely-recognised screening tool, the Edinburgh Postnatal Depression Scale (EPDS). The majority of women were in the public health sector with only 3 percent recruited from the private health sector. All were given an information and resource booklet ‘Emotional Health During Pregnancy and Early Parenthood’.
Women screened as ‘probably depressed’ were linked to their primary health care professionals, most commonly general practitioners (GPs), maternal and child health nurses, midwives and community agencies. The program’s publicity, education and/or resource materials reached a further 200,000 pregnant Australian women..
The program achieved success in the following areas:
- The introduction of routine screening for perinatal depression as part of primary care was established and evaluated at major maternity hospitals and health services throughout Australia. Feedback from key stakeholders (women, GPs, MCHN) identified barriers to screening, high levels of acceptability and recommendations for universal screening.
- The development of information materials to raise awareness of perinatal depression and its treatment including provision of information to women and their families about emotional health and depression in the perinatal period. Promotional posters, pamphlets, television, newspaper and magazine articles and a website are now widely available.
- Guidelines (‘EPDS: A Health Professional’s Guide’) were developed to assist with education and training for health professionals.
- An evaluation of change in community awareness and professional knowledge about perinatal depression was conducted. Surveys confirmed the importance of education and ongoing support for a range of primary health care professionals (GPs, midwives, MCHN, obstetricians, social workers, psychiatrists, psychologists and their administrative support networks). \
- An Australian research database of perinatal women was developed to research the extent of the problem and associated risk factors.
- The development of a range of early intervention resource material targeting:
- Antenatal preparation for parenting in vulnerable women
- Culturally and linguistically diverse women
- Rural women
- indigenous women
- Fathers/male partners
- Multiple-birth families.
Implications for Policy and Practice
The program recommended:
- A national action group of key stakeholders be formed. Their task would be to promote the introduction of routine psychosocial assessment and referral pathways and consider relevant training and educational needs.
- Depression screening to become a part of routine ante and postnatal health care. In the third trimester of pregnancy and six to eight weeks after childbirth, depression screening has been proven to be useful in this study.
- The use of the EPDS as the best available and most practical screening tool.
- The use of additional key psychosocial questions to assess risk and plan perinatal health care and support. Of particular importance is level of support, past history of anxiety and depression and current stressors.
- Screening programs need to be accompanied by ongoing training and support for all relevant health professionals involved in perinatal health care.
- Each primary health service needs to develop a local pathway of care for women identified as needing support including appropriate referral and allied health service links.
- Information and resources about emotional health during pregnancy and early parenthood be provided to all childbearing women.
- Specific resources are developed to address particular groups’ i.e. Indigenous women, culturally and linguistically diverse women and mothers delivering multiple babies. Male partners require different strategies to enlist their support for their partner such as specific web-based information and resources.
- EPDS screening of perinatal women be included as part of full assessment and interview.
- Health professionals need to ensure a woman’s privacy and give practical support with the baby if necessary. Allow the opportunity and time for a full discussion (allow 10 minutes minimum).
- Literacy, cultural and language issues are crucial considerations. Provide materials in other languages and consider the use of an interpreter. Discuss each item on the EPDS and look for mismatch with the woman’s presentation.
- The interview should explore the symptoms of depression if present and any physical, emotional or social causes as well as appropriate interventions.
- Timing of screening should be when women access routine primary health care.
These recommendations have been taken up and feature in the National Plan for the beyondblue antenatal and postnatal depression program www.beyondblue.org.au (2006).
Following the successful completion of the National Postnatal Depression Research Program, beyondblue commissioned the Perinatal Mental Health Group to develop a National Action Plan. Research indicated that the prevalence of perinatal depression in Australia warranted a national approach to improved screening, assessment and co-ordinated care to address depression and related difficulties in women during pregnancy and in early parenthood. The Perinatal Depression Initiative is now a national program supported by the Australian Government and each State and Territory.