Catherine Chojenta

Quality, rigour and usefulness of free-text comments collected by a large population based longitudinal study - ALSWH.

While it is common practice for health surveys to include an open-ended question asking for additional comments, the responses to these questions are often not analysed or used by researchers as data. The current project employed an automated semantic program to assess the useability and thematic content of the responses to an open-ended free response item included in the Australian Longitudinal Study on Women’s Health (ALSWH) surveys. The study examined the comments of three cohorts of women, born between 1973–78, 1946–51, and 1921–26, from Survey 1 (in 1996) and Survey 5 (in 2007–2009). Findings revealed important differences in the health status of responders compared to non-responders. Across all three cohorts, and at both time points, women who commented tended to have poorer physical health (except for women aged 82–87) and social functioning, experienced more life events, were less likely to be partnered, and (except for women aged 18–23 years) more likely to have higher levels of education, than women who did not comment. Results for mental health were mixed. The analysis revealed differences between cohorts as well as changes over time. The most common themes to emerge for the 1973–78 cohort were health, time, pregnant and work, for the 1946–51 cohort, the most common themes were health, life, time and work, while for the 1921–26 cohort, the most common themes were husband, health and family. The concepts and frequency of concepts changed from the first to the fifth survey. For women in the 1973–78 cohort, pregnant emerged as a prevalent theme, while eating disappeared. Among women in the 1946–51 cohort, cancer, operation and medication emerged as prevalent themes, while for women in the 1921–26 cohort, the concept children disappeared, while family emerged. This analysis suggests that free-text comments are a valuable data source, suitable for content, thematic and narrative analysis, particularly when collected over time.

Agreement between self-reported perinatal outcomes and administrative data in New South Wales, Australia

BackgroundMany epidemiological studies that focus on pregnancy rely on maternal self-report of perinatal outcomes. The aim of this study was to evaluate the agreement between self-reported perinatal outcomes (gestational hypertension with or without proteinuria, gestational diabetes, premature birth and low birth weight) in a longitudinal study and linked to administrative data (medical records).MethodsSelf-reported survey data from the Australian Longitudinal Study on Women’s Health was linked with the New South Wales Perinatal Data Collection. Agreement between the two sources was evaluated using percentage agreement and kappa statistics. Analyses were conducted at two levels by: i) the mother and ii) each individual child.ResultsWomen reliably self-report their perinatal outcomes (≥87 % agreement). Gestational hypertension with or without proteinuria had the lowest level of agreement. Mothers’ reports of perinatal outcomes were more reliable when evaluated by child. Restricting the analysis to complete and consistent reporting further strengthened the reliability of the child-specific data, increasing the agreement from >92 to >95 % for all outcomes.ConclusionsThe present study offers a high degree of confidence in the use of maternal self-reports of the perinatal outcomes gestational hypertension, gestational diabetes, preterm birth and low birth weight in epidemiological research, particularly when reported on a per child basis. Furthermore self-report offers a cost-effective and convenient method for gathering detailed maternal perinatal histories.

Older women in Australia: ageing in urban, rural and remote environments

Objective:  To explore differences in quality of life and health service use for older women living in urban, rural and remote areas of Australia.

History of Pregnancy Loss Increases the Risk of Mental Health Problems in Subsequent Pregnancies but Not in the Postpartum

While grief, emotional distress and other mental health conditions have been associated with pregnancy loss, less is known about the mental health impact of these events during subsequent pregnancies and births. This paper examined the impact of any type of pregnancy loss on mental health in a subsequent pregnancy and postpartum. Data were obtained from a sub-sample (N = 584) of the 1973-78 cohort of the Australian Longitudinal Study on Womens Health, a prospective cohort study that has been collecting data since 1996. Pregnancy loss was defined as miscarriage, termination due to medical reasons, ectopic pregnancy and stillbirth. Mental health outcomes included depression, anxiety, stress or distress, sadness or low mood, excessive worry, lack of enjoyment, and feelings of guilt. Demographic factors and mental health history were controlled for in the analysis. Women with a previous pregnancy loss were more likely to experience sadness or low mood (AOR = 1.75, 95% CI: 1.11 to 2.76, p = 0.0162), and excessive worry (AOR = 2.01, 95% CI: 1.24 to 3.24, p = 0.0043) during a subsequent pregnancy, but not during the postpartum phase following a subsequent birth. These results indicate that while women who have experienced a pregnancy loss are a more vulnerable population during a subsequent pregnancy, these deficits are not evident in the postpartum.

How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women?

INTRODUCTION The purpose of this study was to examine the risk factors for postnatal depression (PND) using longitudinal data in a representative sample of Australian women. METHODS Mailed survey data collected from the youngest cohort of the Australian Longitudinal Study on Womens Health were analyzed. Of the women in this cohort, 2451 had a child in the 4 years preceding survey 4 in 2006, and those who reported being diagnosed or treated for PND at survey 4 (n = 252) were compared to those who had no report of PND at survey 4 (n = 2324) in order to identify risk factors for PND. RESULTS Women with a history of depression (from survey 2 in 2000 and from survey 3 in 2003) were more likely to report postnatal depression (odds ratio [OR] 2.10; 95% confidence interval [CI], 1.39-3.18 and OR 2.15; 95% CI, 1.37-3.35, respectively). Contrary to previous research, demographic factors were not significantly related to PND. Women who rated their affectionate support and positive social interaction as being available some of the time were significantly more likely to experience PND (OR 2.37; 95% CI, 1.24-4.53) than those who rated this type of support as being available all of the time. DISCUSSION While previous mental health problems and a history of stressful life events were found to be significant risk factors for PND, the results of this study show that women with PND are also lacking some aspects of social support around the time of the birth of their children. Implications for treatment and policy are discussed.

Disparities in reported psychosocial assessment across public and private maternity settings: a national survey of women in Australia

BackgroundPsychosocial assessment and depression screening is now recommended for all women who are pregnant or have recently given birth in Australia. Existing studies which have examined the extent of participation by women in such population-based programs have been primarily concerned with depression screening rather than a more comprehensive examination of psychosocial assessment, and have not been sufficiently inclusive of the 30% of women whose maternity care is provided in the private sector. Whether there are disparities in equity of access to perinatal psychosocial assessment is also unknown.MethodsA sub-sample of women (N = 1804) drawn from the Australian Longitudinal Study on Women’s Health participated in the study. Overall rates of assessment across five psychosocial domains (current emotional health; mental health history; current level of support; current drug or alcohol use; experience of domestic violence or abuse), as well as receipt of mental health promotion information, were examined. Log binomial regression was performed to investigate whether there were socio-demographic or health system inequalities among women who are and are not assessed across each domain.ResultsTwo-thirds of women (66.8%) reported being asked about their current emotional health in the antenatal period, increasing to 75.6% of women in the postnatal period. Rates decreased markedly for reported assessment of mental health history (52.9% during pregnancy and 41.2% postnatally). Women were least likely to be asked about their experience of domestic violence or abuse in both the antenatal and postnatal periods (in total, 35.7% and 31.8%, respectively).In terms of equity of access to psychosocial assessment, women who gave birth in the public hospital sector were more likely to report being assessed across all domains of assessment in the antenatal period, compared with women who gave birth in the private sector, after adjusting for other significant covariates. State of residence was associated with reported rates of assessment across all domains in both the antenatal and postnatal periods. Women from non-English speaking backgrounds and women with more than one child were less likely to be assessed across various domains.ConclusionThis study provides an important insight into the reported overall penetration of and access to perinatal psychosocial assessment among a sample of women in Australia. Opportunities to minimise the current shortfall in assessment rates, particularly in the private sector, and for ongoing monitoring of assessment activity at a national level are discussed.

Maternal health factors as risks for postnatal depression: a prospective longitudinal study

Purpose While previous studies have identified a range of potential risk factors for postnatal depression (PND), none have examined a comprehensive set of risk factors at a population-level using data collected prospectively. The aim of this study was to explore the relationship between a range of factors and PND and to construct a model of the predictors of PND. Methods Data came from 5219 women who completed Survey 5 of the Australian Longitudinal Study on Women’s Health in 2009 and reported giving birth to a child. Results Over 15% of women reported experiencing PND with at least one of their children. The strongest positive associations were for postnatal anxiety (OR = 13.79,95%CI = 10.48,18.13) and antenatal depression (OR = 9.23,95%CI = 6.10,13.97). Positive associations were also found for history of depression and PND, low SF-36 Mental Health Index, emotional distress during labour, and breastfeeding for less than six months. Conclusions Results indicate that understanding a woman’s mental health history plays an important role in the detection of those who are most vulnerable to PND. Treatment and management of depression and anxiety earlier in life and during pregnancy may have a positive impact on the incidence of PND.

Validity and reliability of stillbirth data using linked self-reported and administrative datasets.

Background A high rate of stillbirth was previously observed in the Australian Longitudinal Study of Women’s Health (ALSWH). Our primary objective was to test the validity and reliability of self-reported stillbirth data linked to state-based administrative datasets. Methods Self-reported data, collected as part of the ALSWH cohort born in 1973–1978, were linked to three administrative datasets for women in New South Wales, Australia (n = 4374): the Midwives Data Collection; Admitted Patient Data Collection; and Perinatal Death Review Database. Linkages were obtained from the Centre for Health Record Linkage for the period 1996–2009. True cases of stillbirth were defined by being consistently recorded in two or more independent data sources. Sensitivity, specificity, positive predictive value, negative predictive value, percent agreement, and kappa statistics were calculated for each dataset. Results Forty-nine women reported 53 stillbirths. No dataset was 100% accurate. The administrative datasets performed better than self-reported data, with high accuracy and agreement. Self-reported data showed high sensitivity (100%) but low specificity (30%), meaning women who had a stillbirth always reported it, but there was also over-reporting of stillbirths. About half of the misreported cases in the ALSWH were able to be removed by identifying inconsistencies in longitudinal data. Conclusions Data linkage provides great opportunity to assess the validity and reliability of self-reported study data. Conversely, self-reported study data can help to resolve inconsistencies in administrative datasets. Quantifying the strengths and limitations of both self-reported and administrative data can improve epidemiological research, especially by guiding methods and interpretation of findings.

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BACKGROUND Clinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial. AIM The current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum. METHODS A subsample of women drawn from the Australian Longitudinal Study on Womens Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N=398) or in the 12 months following birth (N=380) participated in the study. RESULTS Multivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR=0.09, 95%CI: 0.04-0.24) and the postpartum (adjOR=0.07, 95%CI: 0.02-0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR=0.26, 95%CI: 0.15-0.45; postnatal: adjOR=0.14, 95%CI: 0.07-0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident. CONCLUSION This study demonstrates that enquiry by a health professional about womens past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.

Poor Adherence to National and International Breastfeeding Duration Targets in an Australian Longitudinal Cohort

Objectives To report on the proportion and characteristics of Australian infants who are fed, and mothers who feed, in accordance with the national and international breastfeeding duration targets of six, 12 and 24 months. Furthermore, to examine the longitudinal breastfeeding duration patterns for women with more than one child. Methods Breastfeeding duration data for 9773 children have been self-reported by a national sample of 5091 mothers aged 30–36 years in 2009, participating in the Australian Longitudinal Study on Women’s Health. Results Only 60% of infants received the minimum recommended 6 months of breast milk, irrespective of breastfeeding exclusivity. Less than 30% of infants received any breast milk at 12 months, and less than 3% were breastfed to the international target of 24 months. Young, less educated, unmarried or low-income women were at an increased risk of premature breastfeeding cessation. For women with three or more children, nearly 75% of women who breastfed their first child for at least six months reached this breastfeeding duration target for their next two children. Conclusion While national breastfeeding rates are typically evaluated in relation to the infant, a novel component of our study is that we have assessed maternal adherence to breastfeeding duration targets and the longitudinal feeding practices of women with more than one child. Separate evaluations of maternal and infant breastfeeding rates are important as they differ in their implications for public health policy and practice.