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

Abstract

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.

Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study

“…The actual assessment rate of 75% of all women who consented to participate was considered very good given the limitations of having a single part‐time (0.4FTE) research midwife to undertake all required assessments. For some domains of psychosocial health (including enquiry into mental health history and experience of abuse), the actual assessment rate was indeed higher than has been previously reported among national or Western Australian‐based respondents …”

“…The study's collaborating perinatal mental health team provided timely clinical supervision to the assessing midwife and access to mental health referral, as required. While this and similar projects in private maternity settings represent important first steps, ongoing and meaningful engagement with both clinicians and consumers in this important sector is required if the potential challenges of embracing a comprehensive and inclusive approach to the delivery of routine psychosocial assessment in this context are to be met.…”

“…These guidelines are unequivocally inclusive of the private maternity sector and have since been supported by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) . This support has been particularly important given that recent research has shown that women who give birth in private maternity settings in Australia are less likely to participate in psychosocial assessment programs, despite approximately one‐third of all births – representing nearly 85 000 women per year – occurring in private hospitals in this country . Compounding this, women who choose private maternity care have traditionally been disproportionately under‐represented in perinatal mental health research in Australia, resulting in a limited understanding of the prevalence of depressive symptoms and the psychosocial profile of this patient group.…”

Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia

“…Most women under private obstetric care in Australia (one‐third of the population) remain less likely to be routinely screened for psychosocial issues when booking in for pregnancy care (Reilly et al . ). A recent study found that when screened, one‐in‐ten women required referral for further assessment and support (Kohloff et al .…”

Identification and evaluation of models of antenatal care in Australia – A review of the evidence

“…An additional limitation is that only one study included the private sector, which may offer a higher degree of continuity of care than public antenatal services. This is an under‐researched group, despite approximately 30% of Australian women choosing to access private obstetric care . Nevertheless, systematic reviews of this nature are valuable because they guide both research and policy regarding improved antenatal care services in the local context.…”