The position statement aims to articulate the arguments for and against universal psychosocial assessment and depression screening, and provide guidance to assist decision-making by clinicians, ...policy makers and health services. More specifically it: 1. Outlines the general principles and concepts involved in psychosocial assessment and depression screening; 2. Outlines the current debate regarding benefits and risks in this area of practice including the clinical benefits and the ethical, cultural and resource implications of undertaking universal psychosocial assessment in the primary health care setting; 3. Provides a document that will assist with advocacy for the development of perinatal mental health services in the primary care setting. The statement does not set out to make specific recommendations about psychosocial assessment and depression screening (as these will need to be devised locally depending on existing resources and models of care) nor does it attempt to summarise the vast evidence-base relevant to this debate.
Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive ...symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors.
We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors.
1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant.
These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development.
Maternal psychological distress is one of the most common perinatal complications, affecting up to 25% of pregnant and postpartum women. Research exploring the association between prenatal and ...postnatal distress and toddler cognitive development has not been systematically compiled. The objective of this systematic review was to determine the association between prenatal and postnatal psychological distress and toddler cognitive development.
Articles were included if: a) they were observational studies published in English; b) the exposure was prenatal or postnatal psychological distress; c) cognitive development was assessed from 13 to 36 months; d) the sample was recruited in developed countries; and e) exposed and unexposed women were included. A university-based librarian conducted a search of electronic databases (Embase, CINAHL, Eric, PsycInfo, Medline) (January, 1990-March, 2014). We searched gray literature, reference lists, and relevant journals. Two reviewers independently evaluated titles/abstracts for inclusion, and quality using the Scottish Intercollegiate Guideline Network appraisal tool for observational studies. One reviewer extracted data using a standardized form.
Thirteen of 2448 studies were included. There is evidence of an association between prenatal and postnatal distress and cognitive development. While variable effect sizes were reported for postnatal associations, most studies reported medium effect sizes for the association between prenatal psychological distress and cognitive development. Too few studies were available to determine the influence of the timing of prenatal exposure on cognitive outcomes.
Findings support the need for early identification and treatment of perinatal mental health problems as a potential strategy for optimizing toddler cognitive development.
Background
The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between ...PIPA‐determined psychosocial risk and obstetric and neonatal outcomes.
Methods
Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017‐2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At‐risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors.
Results
In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium‐high/high risk. Compared with no/low‐risk women, medium‐high/high‐risk women were more likely to remain in hospital for >72 hours (aOR 1.47 95% CI 1.33‐1.64); to not be breastfeeding at discharge (aOR 1.77 95% CI 1.20‐2.61); to have their infants experience birth complications (aOR 1.24 95% CI 1.03‐1.50); and to be admitted to the NICU (aOR 1.63 95% CI 1.26‐2.11). There was a modest increase in odds of cesarean birth (aOR 1.12 95% CI 1.00‐1.27), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium‐high/high‐risk women referred for support.
Conclusions
The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high‐risk women who were referred for extra support, suggesting that psychosocial review and referral for high‐risk women may reduce the risk of adverse obstetric and neonatal outcomes.
To report rates of Medicare Benefits Schedule (MBS) mental health item use among a sample of women who gave birth in NSW (2009‐2015) and examine if the SAFE START policy increased use of these items ...among perinatal women.
Data was drawn from women participating in the Australian Longitudinal Study on Women's Health 1973‐1978 cohort, linked to data from the NSW Perinatal Data Collection and MBS.
Use of Medicare‐subsidised mental health items increased 2.7‐fold among perinatal women (n=1,453) between 2009 and 2015 (4.1% versus 11.0% respectively), compared to a 1.3‐fold increase among non‐perinatal women (n=1,800, 6.3% versus 8.4% respectively). However, the increased use of MBS mental health items among perinatal women was not observed to be impacted by the SAFE START policy, after accounting for time trends.
There was a substantial increase in the use of MBS mental health items among women in NSW between 2009 and 2015, with a more pronounced increase among women who had given birth compared to those who had not.
This study provides important information about changes in mental health service use during a time of significant investment in perinatal mental health, and demonstrates the value of longitudinal survey data linked with administrative health data to evaluate the impact of health policy.
Abstract Background This prospective study used both self-report (STAI) and clinical diagnostic interview (MINI-Plus) to examine the course of maternal anxiety across the transition to parenthood. ...The study also assessed i) the validity of the STAI for antenatal use in an Australian sample and ii) the relative utility of the MINI-Plus and STAI scales as antenatal measures of risk for postnatal anxiety and mood disorders. Methods Participants were 100 women recruited during routine antenatal assessment at a major obstetric hospital in Sydney. An antenatal screening instrument (ANRQ) identified half the sample as being at “high risk” for developing postnatal anxiety and/or depression. Participants completed the STAI during the third trimester of pregnancy and the MINI-Plus was administered during pregnancy and during the seventh postnatal month to assess anxiety and depression meeting DSM-IV criteria. Results The data indicated considerable stability in anxiety and depression from pregnancy through the postnatal period, as assessed by both diagnostic interview and maternal self-report. Antenatal anxiety meeting diagnostic criteria and antenatal trait anxiety exceeding a cut-off score of 40 on the STAI were both found to be significant predictors of postnatal anxiety and mood disorders ( p -values < .05). Further analyses revealed that the measures were equivalent in their predictive utility. Finally, the STAI state and trait anxiety scales demonstrated a reasonable estimation of antenatal clinical state when tested against the MINI-Plus diagnostic interview during pregnancy. Conclusions The findings from this study suggest that antenatal anxiety as assessed by either clinical interview or maternal self-report is an important predictor of postnatal anxiety and mood disorders. The validity of the STAI scales for use during pregnancy was also demonstrated for the first time in an Australian sample.
Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims ...to increase women's awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers.
The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined.
Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later.
A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help.
Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.
Background
Studies continue to show that women who give birth in the private maternity sector are less likely to receive depression screening and psychosocial assessment as a routine component of ...maternity care. However, examples of successfully implemented routine psychosocial assessment programs are beginning to emerge, and there is great value in better understanding the factors that can contribute to the successful delivery of emotional health care in this context.
Aim
The aim of this study was to identify factors that facilitated successful implementation of antenatal psychosocial assessment in a private hospital setting.
Methods
This study employed a qualitative research design. Semi‐structured interviews were used to explore the views and experiences of health professionals involved in implementation of the program at the participating site.
Results
Nine health professionals participated in the study (three midwives, three obstetricians, two managers and one mental health worker). Factors that facilitated successful implementation of the program were reflected in five key themes: (i) multidisciplinary support for the program; (ii) training and clinical supervision; (iii) allocation of sufficient resources; (iv) availability of local referral pathways; and (v) normalisation of the process.
Conclusion
This study shows that barriers to implementation of perinatal depression screening and psychosocial assessment are surmountable and will provide confidence to other services, that routine ‘mental health assessment’ as required under updated Medical Benefits Scheme items for obstetric services, can be successfully implemented and sustained in private hospital settings.
While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician.
To assess the impact of psychosocial risk, ...current symptoms and mode of assessment on women’s honesty of disclosure at psychosocial assessment.
Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were ‘always honest’ and ‘not always honest’. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk.
10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18–2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16–2.62, p<0.05; aOR=2.08, 95%CI: 1.11–3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest.
A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback.
Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.
Abstract Background Antenatal anxiety has received increased attention with regards to both its impact on infant outcomes and as a risk factor for postnatal depression. The measurement of anxiety in ...the perinatal setting, however, has proven to be challenging. The aims of the present study are to: determine whether antenatal anxiety as measured by the Brief Measure of Worry Severity (BMWS) is a significant predictor of postnatal depression (PND); examine the psychometric properties of a new measure of anxiety – the BMWS – in an antenatal sample; and examine the comparative capacity of the BMWS to the Speilberger State Trait Anxiety Inventory (STAI) in predicting PND. Method A sample of 748 women completed the BMWS and STAI during the third trimester of pregnancy and returned the Edinburgh Postnatal Depression Scale (EPDS) at 8 weeks postpartum. Results Women with high antenatal anxiety on the BMWS were 2.6 times more likely to have probable PND than those with low scores, even after controlling for confounding factors, including level of antenatal depression on the EPDS. In contrast, the STAI was no longer a significant predictor of PND after controlling for these variables. The BMWS has good construct validity, with scores on this scale correlating strongly with scores on other measures of anxiety, depression and perinatal risk. Limitations When compared to those who participated in the follow-up at 8 weeks postnatally, those who did not participate appeared to be at greater risk of developing PND, raising the possibility of attrition bias within this sample. Conclusions The findings from this study suggest that the BMWS has utility in measuring antenatal anxiety in both clinical and research settings and that antenatal anxiety is an important precursor of PND.
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