Antenatal psychosocial screening for prevention of antenatal and postnatal anxiety and depression

Perinatal depression and screening among Aboriginal Australians in the Kimberley

PROBLEM

Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley.

BACKGROUND

Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health.

QUESTION

What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach?

METHODS

A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening.

RESULTS

More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.

Collaboration and integrated services for perinatal mental health: an integrative review

BACKGROUND

  An integrative review was undertaken to synthesise the research related to professionals' perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems.

METHOD

  A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review.

RESULTS

  The overarching theme identified in the review related to the process of 'making it happen'. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways.

CONCLUSION

  Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.

Using the Edinburgh postnatal depression scale to screen for perinatal anxiety

We replicated the factor structure of the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS) in a large convenience sample of Western Australian women who participated in the beyondblue National Postnatal Depression Program. In addition, we determined an appropriate cut-off score for the anxiety subscale. Factor analyses conducted on the EPDS responses yielded depression and anxiety factors as identified in previous research. Two-factor solutions accounted for over 50% of the variance at two time frames: antenatally (N=4,706) and at postnatal follow-up (N=3,853). The anxiety and depression factors had similar factor structures antenatally and postnatally and were consistent with previous published findings. The concurrent validity of the anxiety subscale was demonstrated by its significant relationship to anxiety-related items on a psychosocial risk factors questionnaire. Anxiety dropped significantly from the antenatal to the postnatal time period. These findings confirm the anxiety subscale of the EPDS and point to its utility in screening for anxiety symptoms using a cut-off score ≥4 which captured the top quartile of the antenatal sample.

A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings

Recognition of high rates of mental health morbidity and mortality that affect women during the perinatal period has prompted the development of psychosocial risk assessment programs. Designed to identify women, at risk, during routine health checks and delivered by primary care health service providers, these fit within a primary prevention and early intervention strategic approach to the reduction of perinatal mental illness and reflect an integrated approach to perinatal health services delivery. This paper describes the development and use of the psychosocial risk assessment model (PRAM) at the Royal Hospital for Women in Sydney, Australia. Data is presented on 2,142 women who attended the Antenatal Midwives Clinic between 2002 and 2005. The PRAM guides primary care staff to quickly identify women experiencing emotional distress and/or psychosocial problems during pregnancy or postnatal checks. Measures used in pregnancy are the symptom-based Edinburgh Depression Scale and the psychosocial risk-based Antenatal Risk Questionnaire. In postnatal setting the Postnatal Risk Questionnaire is used. Scores can be used to compute a Psychosocial Risk Index (PRI) to guide individualized care planning, define needs for referral and classify groups for clinical and research purposes. Based on the PRI, among 2,142 women assessed in pregnancy 70.6% were classified as low/no risk (no interventions indicated currently), 24.1% as medium risk (in need of monitoring), and 5.3% as high risk (complex). The PRAM offers a conceptual framework, methods and measures for brief psychosocial assessment with clinical and research applications. Postpartum follow up studies of women assessed during pregnancy have commenced. Randomized controlled trials and cross-cultural studies are now indicated to strengthen the evidence base for the model.