Research projects

Models of Care: Evaluating a Best Practice Model for Treating Postnatal Depression

Principal Researchers

Professor Jeannette Milgrom

Jennifer Ericksen

A/Professor Anne Buist

Professor Carol Morse

Marita van Gemert

Institution

Clinical & Health Psychology (Austin Health)

Parent Infant Research Institute (PIRI)

Funding

$50,000

Award Type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

Despite the high prevalence of postnatal depression (10%) women rarely seek help. Moreover the interface between primary care, general medical and specialist mental health systems for women is poor. Facilitating women’s screening assessment and treatment pathway is a major public health issue as untreated postnatal depression has long-term consequences, not only for women, but also for infants and partners. Controversy over whether screening for mental health problems should be universal revolves around the lack of evidence concerning outcomes following referral to existing services. The overall aim of this project is to implement and evaluate best-practice care pathways for postnatal depression and to improve service relationships between primary and secondary mental health settings. This project is a randomized trial, in which we aimed to allocate a total of 105 participants, between 3 quality care pathways (35 in each) while their treatment remains under the overall supervision of their own general practitioner (GP). This project evaluates General Practitioner (GP) management alone and in combination with 2 adjunctive treatments consisting of a counselling package delivered by either a Psychologist or a Maternal and Child Health Nurse (MCHN). All 3 of these treatment combinations last for 6 weeks. To identify mothers at risk of depression the EPDS (Edinburgh Postnatal Depression Scale) is administered by a Maternal and Child Health Nurse (MCHN) or GP. The Beck Depression Inventory (BDI) is used to provide a clinical assessment of depression severity and is the main post-treatment outcome measure. Other domains assessed include anxiety, partner relationships and program evaluation. Professionals complete a vignette-based mental health literacy survey before and after training to allow an evaluation of training effectiveness, as well as a program evaluation allowing professionals’ feedback to us. Project funding for a second year was obtained in order to increase numbers by overcoming difficulties found in the first year of the project.

Key findings

  • Screening procedures established in Banyule requiring relocation of current randomized CBT/Sertraline drug trial to Moonee Valley and Melbourne. This was necessary, to facilitate access to local MCHN and to local GPs who can be offered in-house training and to reduce travel for mothers randomized to a psychology adjunctive treatment. Over the project period of 18 months 1124 mothers were screened in selected catchment areas. This yielded 117 mothers who scored > 12 on the Edinburgh Postnatal Depression Scale and were eligible for study. Whilst the potential participants into the study exceeded our target of 105, only 44 of these mothers were referred to the program with 17 mothers accepting participation into the study. Qualitative data capturing reasons as to why mothers declined treatment indicates that a large proportion of mothers say that they are not depressed or are able to manage on their own perhaps due to fear of stigma.
  • A number of GP’s have received the highly innovative single training session on postnatal depression management. Nurses in the Banyule area have also received this postnatal depression management training session in a group setting.
  • Post-treatment qualitative data indicates that all women who have completed either of the six -week programs agree that the treatment was sufficient in managing the problems they were facing at the time, and that their condition improved during the six week program.
  • Responses recorded from the GP’s who have completed the training session indicated that the training provided information that they will be able to use in their clinical practice and that the manual was a helpful training tool
  • One third of women who are screened as at risk of depression accept referral from their MCHN to this program  which uses existing pathways to care (GP, MCHN, Psychologist). Of those that do accept a referral less than half go into the program.
  • In order to understand reasons we need detailed systems of recording women’s preferences and reasons for declining care.
  • Whilst the responses of women to offers of care recorded in this study provide some insight into how women are engaged into care networks, further research is needed. This information will be obtained through new research funding from the beyondblue Centre of Excellence entitled: ‘Optimising Emotional Health During Pregnancy and Early Parenthood: Improving access to help for women with postnatal depression’.
  • One clear direction that has already emerged from this project is the need for ongoing training of MCHN & GPs when screening and this has occurred to facilitate referrals needed for Year 2 of this project. Part of the training involves the ‘normalization’ of PND as it appears some women may be reluctant to acknowledge depression due to stigma.
  • The GP training manual has been very well accepted. Our innovative model of training within GP practices was suggested by the focus group, piloted and found to be successful. Professional development points were found to be motivating.
  • The development of the Overcoming Depression manual and training workshop for MCHN has been extremely successful with those involved and there have been requests from other municipalities for similar training and access to the manuals. Time constraints are the main reason holding MCHNs back from providing such support to their mothers who are in need. This is an area whereby policy could provide a guideline allowing provision of time-limited support to women in need through the existing MCHN network.
  • This project has had an impact on the existing partnerships in the Banyule area as it has formalised the referral process between 3 key stakeholders and clearly identified pathways to care for these women. Involving GP & MCHN providers in the provision of the program has improved communication and understanding.
  • The barriers to engagement have been largely from the consumers themselves having issues with engagement. The service partnerships established have been very active in their participation and have been very interested and willing to work together and receive more training, particularly with an important focus of improving access and uptake of treatment by women (see section below).

Implications for policy and research

Access to Help for Depressed Women

  • One third of women who are screened as at risk of depression accept referral from their MCHN to this program  which uses existing pathways to care (GP, MCHN, Psychologist). Of those that do accept a referral less than half go into the program.
  • In order to understand reasons we need detailed systems of recording women’s preferences and reasons for declining care.
  • Whilst the responses of women to offers of care recorded in this study provide some insight into how women are engaged into care networks, further research is needed. This information will be obtained through new research funding from the beyondblue Centre of Excellence entitled: ‘Optimising Emotional Health During Pregnancy and Early Parenthood: Improving access to help for women with postnatal depression’.
  • One clear direction that has already emerged from this project is the need for ongoing training of MCHN & GPs when screening and this has occurred to facilitate referrals needed for Year 2 of this project. Part of the training involves the ‘normalization’ of PND as it appears some women may be reluctant to acknowledge depression due to stigma.

Training of GPs and MCHNs

  • The GP training manual has been very well accepted. Our innovative model of training within GP practices was suggested by the focus group, piloted and found to be successful. Professional development points were found to be motivating.
  • The development of the Overcoming Depression manual and training workshop for MCHN has been extremely successful with those involved and there have been requests from other municipalities for similar training and access to the manuals. Time constraints are the main reason holding MCHNs back from providing such support to their mothers who are in need. This is an area whereby policy could provide a guideline allowing provision of time-limited support to women in need through the existing MCHN network.
  • This project has had an impact on the existing partnerships in the Banyule area as it has formalised the referral process between 3 key stakeholders and clearly identified pathways to care for these women. Involving GP & MCHN providers in the provision of the program has improved communication and understanding.
  • The barriers to engagement have been largely from the consumers themselves having issues with engagement. The service partnerships established have been very active in their participation and have been very interested and willing to work together and receive more training, particularly with an important focus of improving access and uptake of treatment by women (see section below).

Stay in touch with us

Sign up below for regular emails filled with information, advice and support for you or your loved ones.


All done! You should’ve received a confirmation email, so please check when you’re finished here and click the link in the email. If you can’t see it, we might be in your junk mail.

Subscribe failed. Please try later or contact us.