Heather Rowe

Are pregnant Australian women well informed about prenatal genetic screening? A systematic investigation using the Multidimensional Measure of Informed Choice

Background:  Ethical practice requires that decisions to participate in medical care be well informed. Investigations into prenatal genetic screening for Down syndrome have assessed womens knowledge but have not examined whether being well informed about the potential consequences of screening, such as subsequent diagnostic testing, diagnosis and termination, is associated with psychological distress for women.

Using the Edinburgh postnatal depression scale to screen for anxiety disorders: Conceptual and methodological considerations

BACKGROUND Perinatal anxiety symptoms and disorders are prevalent and disabling but have not to date been a focus for specific clinical and public health attention. The EPDS is widely used to detect probable depression, and many studies have also found that three items from this scale load on an anxiety factor, in both the antenatal and postnatal periods. In addition, studies have found clinically significant correlations between the EPDS and various anxiety-specific measures in the perinatal period. The aim of this paper is to examine studies which address the capacity of the EPDS to detect anxiety disorders, to assess whether the EPDS performs differently in women with depressive or anxiety disorders and to consider the implications for future research and clinical practice. METHODS The English-language perinatal mental health literature was searched. Six studies with data pertaining to the capacity of the EPDS to detect perinatal anxiety disorders in women were identified. These studies provide information on i) comparison of total EPDS score by diagnoses of anxiety and depression and ii) comparison of the anxiety subscale score (EPDS-3A) by diagnoses of anxiety and depression. RESULTS There is evidence from both sets of information that the EPDS is useful for screening for anxiety in women and emerging evidence that Total EPDS and EPDS-3A can distinguish depression from anxiety reliably. LIMITATIONS The findings are based on a small number of studies, conducted in a variety of clinical and community settings in different languages and countries, and with variable sample sizes, some of which lack power to ensure reliable conclusions. CONCLUSIONS The EPDS appears to detect perinatal anxiety disorders, but further research is required to establish the clinical and public health value of the EPDS for this purpose, and whether it has more robust psychometric properties or is more feasible and acceptable than existing anxiety-specific measures.

The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants.

Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.

Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study

SummaryAustralia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five-night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.

Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study

BackgroundUniversal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorised, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women.MethodsA before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat.ResultsIn total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group.ConclusionsA universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12605000567628

Reasons women give for abortion: a review of the literature.

The aim was to identify from empirical research that used quantitative or qualitative methods the reasons women give for having an abortion. A search was conducted of peer-reviewed, English language publications indexed in eight computerized databases with publication date 1996–2008, using keywords ‘abortion’ and ‘reason’ (Medline: ‘induced abortion’ OR ‘termination of pregnancy’ OR ‘elective abortion’ and ‘reason’). Inclusion criteria were empirical research on humans that identified women’s reasons for undergoing an abortion, conducted in ‘high-income’ countries. 19 eligible papers were found. Despite variation in methods of generating, collecting, and analysing reasons, and the inadequacy of methodological detail in some papers, all contributed to a consistent picture of the reasons women give for having an abortion, with three main categories (‘Woman-focused’, ‘Other-focused’, and ‘Material’) identified. Ambivalence was often evident in women’s awareness of reasons for continuing the pregnancy, but abortion was chosen because continuing with the pregnancy was assessed as having adverse effects on the life of the woman and significant others. Women’s reasons were complex and contingent, taking into account their own needs, a sense of responsibility to existing children and the potential child, and the contribution of significant others, including the genetic father.

Common mental disorders in women and men in the first six months after the birth of their first infant: A community study in Victoria, Australia

INTRODUCTION Studies of postpartum mental health have focused predominantly on women and on depression. There is limited evidence regarding mens postpartum mental health and about other common mental disorders, such as anxiety and adjustment disorders, which may also be relevant at this life phase. The main aim of this study was to establish the period prevalence of depression, anxiety, and adjustment disorders in primiparous women and their male partners in the first six months postpartum METHODS English-speaking couples were recruited in five local government areas in Victoria, Australia. Women and men completed separate telephone interviews which included the Edinburgh Postnatal Depression Scale (EPDS) and selected Depression and Anxiety modules of the Composite International Diagnostic Interview. DSM-IV criteria were used to classify adjustment disorders, based on subclinical symptoms not meeting criteria for diagnoses of major or minor depression or generalised anxiety disorder. The main outcome was any common mental disorder (depression, anxiety or adjustment disorder) in the first six months postpartum RESULTS Complete data were available for 172 couples. The 6-month period prevalence of mental health problems was 33% for women and 17% for men. The most common diagnosis in both women and men was adjustment disorder with anxiety symptoms LIMITATIONS Unpartnered women and men, women whose partners were not willing to participate and those who did not have sufficient English fluency to complete the interviews were excluded from the sample. The results of this study cannot be generalised to these populations. CONCLUSION The most common postnatal mental health problem in both women and men in this community sample was anxiety.

Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia.

Aims:  To investigate factors associated with health service use by women and their infants in Victoria, Australia.

Paid parental leave supports breastfeeding and mother-infant relationship: a prospective investigation of maternal postpartum employment

Objective: To investigate the association between the mother‐infant relationship, defined as maternal‐infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth.

Postpartum emotional support: a qualitative study of women's and men's anticipated needs and preferred sources

Australian health policy emphasises prevention, early intervention and improved pathways to treatment for perinatal mental disorders. Primary care is vital to achieving these aims. The aim of this study was to understand the anticipated needs and preferred sources of mental health information and support of men and women expecting their first baby. Nulliparous English-speaking expectant parents attending childbirth education programs in public and private hospitals participated in single sex small group discussions in late pregnancy. Discussions were audio-recorded, transcribed and analysed thematically using the group as the unit of analysis. Eight groups (22 women; 16 men) encompassing diverse socioeconomic circumstances were conducted. Analyses showed idealised fantasies consistently tempered with realistic expectations about adjustment to life with a baby. However, there were diverse and gendered views about whether primary care providers should discuss mental health with parents of infants and willingness to complete written questionnaires or be referred for specialist mental health care. Men regard primary family care as mother not father inclusive. Expectant parents readily anticipate realistic postnatal adjustment and need for emotional support. Increased provision of services that meet mens needs and public understanding and acceptance of Australian integrated models of primary postnatal mental health care are needed.