Perinatal depression screening in Australia: A position paper

Abstract

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

Perinatal depression screening: a systematic review of recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD)

“…Despite evidence of screening effectiveness in terms of reduced depression risk and increased service use (O'Connor et al 2016;Reilly et al 2020), the impact of PND screening on improving detection and management of depression is likely to be low if appropriate referral and follow-up pathways are not integrated for diagnosis and treatment (Hazell Raine et al 2020;Siu et al 2016). Among some included publications, screening was often recommended under the assumption that follow-up, care and referral pathways are established and available (BC Reproductive Mental Health Program 2014).…”

“…Furthermore, even in high income countries there is often a lack of mental health services and workforce shortages that render referrals even more difficult. For example, women in approximately half of the UK do not have access to specialist perinatal mental health services (Bauer et al 2014), and there is a "critical shortage" of perinatal mental health service and assessment pathways in Australia (Hazell Raine et al 2020). Decisions to recommend against screening or to refuse/withdraw funding for screening may be due to the lack of established post-screening pathways, but may also be due to a lack of evidence to demonstrate the sustainability of screening outcomes and potential long-term benefits of screening among children (Hazell Raine et al 2020).…”

“…For example, women in approximately half of the UK do not have access to specialist perinatal mental health services (Bauer et al 2014), and there is a "critical shortage" of perinatal mental health service and assessment pathways in Australia (Hazell Raine et al 2020). Decisions to recommend against screening or to refuse/withdraw funding for screening may be due to the lack of established post-screening pathways, but may also be due to a lack of evidence to demonstrate the sustainability of screening outcomes and potential long-term benefits of screening among children (Hazell Raine et al 2020). Hence, there is a need for highquality, well-designed studies exploring the effectiveness of PND screening, by a range of healthcare professionals across healthcare settings, to determine pathways for referral, diagnosis, treatment and recovery as well as the longterm impact and cost-effectiveness of PND screening.…”

“…Nonetheless, there is debate in the literature as to whether PND screening should be provided routinely (AE Buist et al 2002;Hazell Raine et al 2020), due to a lack of evidence demonstrating the effectiveness of screening in improving patient outcomes (Thombs et al 2014). A systematic review published in 2014 reported that the evidence did not demonstrate effectiveness of PND screening and that robust randomized controlled trials (RCTs) exploring effectiveness and cost-effectiveness are necessary (Thombs et al 2014).…”

Challenges of Perinatal Depression Care in Mexico City Health Centers

“…However, despite this policy, there are deficiencies such as the fact that PD is not always identified in a timely manner, because detection instruments are inconsistently used. 25 In this regard, it is important to reflect on the importance of implementing actions designed to raise awareness and train health personnel as part of their functions for the correct identification of possible risk factors that may affect pregnancy and the postpartum period, beyond merely focusing on the regulations that force them to provide care.…”