Nicole Highet

Positive relationships between public awareness activity and recognition of the impacts of depression in Australia

OBJECTIVE This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors. METHOD A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory). RESULTS Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiative was also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem. CONCLUSION The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.

The Experience of Living with a Person with an Eating Disorder: The Impact on the Carers

Using a combination of focus groups and individual in-depth interviews, the experience of living with a person with an eating disorder was explored in 24 carers. Attention was given to the progression of the disorder to understand its impact upon the family throughout the stages of the illness. Caring for a person with an eating disorder impacted upon the primary carer and the family throughout the course of the illness. Despite this, the impact on the carers was seldom acknowledged and the needs of these carers and their families were unrecognized and neglected by health professionals.

Qualitative insights into women's personal experiences of perinatal depression and anxiety

BACKGROUND AND AIM Symptoms of perinatal depression and anxiety are usually described and understood from a nosological perspective. This research sought to gain insight into womens lived experience of postnatal depression and anxiety, the factors that contribute to these symptoms and the context in which they develop. METHOD Face to face and telephone interviews were conducted with 28 women from metropolitan and rural areas across Australia, who had experienced postnatal depression and/or anxiety within the last five years. Analysis was conducted from a grounded theory perspective. FINDINGS Particular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience. CONCLUSIONS The findings provide useful insights into womens experiences of mental health symptoms during the perinatal period, how these symptoms present and the factors involved in their development and maintenance. The need to consider womens perspectives to develop resources and health promotions strategies, as well as within the context of relationships with health professionals is highlighted. The study emphasizes the need for greater, more accurate information surrounding perinatal depression and the need to increase the profile and awareness of anxiety disorders.

Depression in the perinatal period: awareness, attitudes and knowledge in the Australian population

Objective: To establish a benchmark of awareness, knowledge and attitudes in Australia in relation to depression and its treatment in the perinatal period, and to identify demographic factors associated with perinatal mental health literacy. Method: A cross-sectional telephone survey (n = 1201) of a randomly selected sample of adults in each State and Territory of Australia, conducted in late 2009. Results: Depression was the most frequently cited general health problem for women after childbirth (43.6% of spontaneous responses), in contrast to previous findings of low awareness of depression generally. A total of 94% of adults believed that postnatal depression requires specialized treatment. Older Australians (55 + years) identified postnatal depression less readily than younger Australians. Although well recognized as a specific mental health issue, as a general health issue antenatal depression had low recognition and was viewed by 52% of respondents as ‘normal’. Community beliefs about perinatal rates of depression appeared realistic. Men and women differed in their knowledge and beliefs about the symptoms and causes of postnatal depression. Difficulty in mother-infant bonding was seen as a common sign of postnatal depression, particularly by women. Most commonly, postnatal depression was perceived as having a biological rather than psychosocial etiology (30% of men, 41% of women). Recognition of anxiety in the postnatal period was relatively low, although higher among those with mental health training. Over 80% of Australians believed that all new mothers should be routinely assessed for depression. Conclusions: Awareness of postnatal depression appeared to be at a high level in the community, but both anxiety and antenatal depression were comparatively under-recognized, suggesting there is considerable scope for awareness-raising. Established risk factors for postnatal depression were not coherently recognized. Ongoing tracking of perinatal mental health literacy in Australia is likely to be valuable in assessing the impact of future public awareness efforts.

An Evaluation of beyondblue, Australia's National Depression Initiative

beyondblue is a five-year Australian initiative which takes a populationhealth approach to combating depression. This papers aim is to describe the findings of an evaluation of beyondblue, conducted four years into its existence.The achievements of beyondblue were examined in the light of its objectives, using synthesised data from 15 secondary sources. Many of beyondblues lower-level objectives have been completely achieved, with a plethora of key initiatives in place that have led to greater availability of information about depression, improvements in consumer networks, better support for mental health care delivery in primary care settings and increases in targeted research. Most of its intermediate-level and high-level objectives have been partly achieved, with headway made in terms of the communitys ‘depression literacy’, acknowledgement of the consumer/carer perspective, the degree to which the health workforce is equipped to deal with depression, the likelihood that individuals will seek help, the range of prevention and early intervention options, the role of primary care practitioners in mental health care, and scientific knowledge about depression. However, in all these areas, ongoing efforts are required. beyondblues vision, or highest-level objective, has not yet been realised. Society does not optimally understand, respond to or work actively to prevent depression. beyondblue has begun to make an impression, but it is unrealistic to expect systemic and cultural change of this magnitude to occur quickly. beyondblue has partly achieved its goals, and careful consideration should be given to what action is necessary to foster sustainable positive change.

Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

BACKGROUND Mood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers. AIM To describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector. METHOD Using NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus. FINDINGS The quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment--including risk to mother and infant, and consideration of the mother-infant interaction--and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting. CONCLUSION The development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families.

Perspectives of young people on depression: awareness, experiences, attitudes and treatment preferences

Aim: Ascertaining current knowledge and attitudes towards depression among young people is vital for developing campaigns promoting community awareness and early intervention.

beyondblue, Australia's National Depression Initiative: An Evaluation for the Period 20052010

beyondblue is Australias national depression initiative and is intended to increase the capacity of the Australian community to prevent depression and anxiety and to respond effectively. This study examines the achievements of beyondblue for the period 20052009 and compares them with the earlier period 20002004. A ‘hierarchy of objectives’ derived from a program logic of beyondblues activities was used, based on beyondblues vision, mission and priority areas. Relevant data sources were identified to assess whether objectives on this hierarchy were achieved. Outputs and outcomes of beyondblue programs improved during the present funding period. The lower and lower intermediate objectives have been fully and largely achieved respectively. The higher intermediate objectives were achieved in two of beyondblues five priority areas, ‘primary care’ and ‘targeted research’. beyondblue compares favourably with depression initiatives in other countries. Its activities should continue, at least at current levels, if its higherlevel objectives are to be achieved.

The National Perinatal Depression Initiative: an evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule

Objective: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Method: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. Results: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. Conclusion: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.

Are mailouts an effective health promotion strategy? If so, for whom?

In 2008-2009 a national household mailout was undertaken across Australia by beyondblue: the national depression initiative. The aim was to raise awareness of depression and encourage people to seek more information via the beyondblue information line or website. Following the staggered dispatch of information across the country, 2051 telephone surveys were conducted to evaluate recall of the material, and calls to the beyondblue infoline and website hits were monitored. The results indicate that direct mail can be a highly effective strategy to not only promote mental health, but also encourage information and help seeking. The impact of a range of factors on recall and help-seeking behaviour is also explored. Findings reveal the impact of demographic factors whilst also highlighting the potential importance of brand recognition and perceived relevance of information when determining those most likely to recall and respond to mailouts as mental health promotion strategy.