The beyondblue National Postnatal Depression Program
Prevention and Early Intervention 2001 – 2005
Final Report
Volume I: National Screening Program
beyondblue National Postnatal Depression Program
VOL I: National Screening Program
This report was prepared by A/Prof Anne Buist and Dr Justin Bilszta
(National Director and National Project Manager)
With the assistance of the State Directors:
Prof Jeannette Milgrom (VIC & TAS)
Prof John Condon (SA)
Dr Craig Speelman (WA)
Prof Barbara Hayes (QLD)
Prof Bryanne Barnett (NSW)
Prof David Ellwood (ACT)
This work would not have been possible without the support to the
National and State Investigators by:
The State Project Managers and Research Teams
The beyondblue Board and its Chair, the Hon. Mr Jeff Kennett
Ms Leonie Young, Dr Nicole Highett and the beyondblue staff
The hospitals involved in the National Screening Program
&
The thousands of women, and their families, who participated in this
initiative and shared their lives with us over the last four years
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“This booklet is fantastic and should be provided to
everyone. Where can I get one to send to my son and
daughter-in-law who are expecting their first baby in
Vancouver." Midwife, VIC.
VOL I: National Screening Program
“In the past (due to experience) we
thought we could 'pick' women who
were depressed, but am astounded
by the numbers we are picking up
with screening.” MCHN, WA.
“It was reassuring to find out from my MACH nurse that I was in fact not depressed after my
son arrived. She helped me to see that my feelings were normal and expected in motherhood.”
Postnatal woman, ACT.
“Having experienced postnatal depression
with my first baby, I felt supported by
knowing that midwives were interested in my
experience.” Antenatal woman, NSW.
“I’m glad that the hospital is concerned
with how we feel” Antenatal women, VIC.
“Its great to be able to provide
women in need with information.”
Health worker, QLD.
“As a mother who is suffering PND after my twins,
the information on your booklet has helped me
realize how common the illness is…” Consumer,
W.A
Clockwise, from top left - mother and baby photo from promotional posters; Janette Brooks, WA project manager, with a stand at PND Awareness
Week 2003; Ms Claudinia Daley from TAIHS, Townsville; Prof John Condon, Prof Ian Hickie and Dr Margaret Tobin at the launch of the SA
initiative; family photo used on the cover of the twins booklet; Party to celebrate six months of screening at Royal North Shore Hospital, NSW; Prof
Jeannette Milgrom, the Hon Mr Michael Wooldridge, A/Prof Anne Buist and Dr Justin Bilszta at the national launch of the PND Program in 2001.
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CONTENTS PAGE
Executive Summary ...........................................................................................................................8
Recommendations ................................................................................................... 10
National Action Plan To Implement Perinatal Depression Screening....................................... 11
What Are the Problems .......................................................................................... 11
Where To From Here.............................................................................................. 11
Reflections From The National Co-Ordinator ............................................................................. 14
Reflections From Victoria And Tasmania.................................................................................... 15
Reflections From South Australia ................................................................................................. 16
Reflections From Western Australia............................................................................................. 17
Reflections From Queensland........................................................................................................ 18
Reflections From New South Wales .............................................................................................. 19
Reflections From The Australian Capital Territory ................................................................... 20
Vale: Professor Sherryl Pope and Rachael McCarthy ................................................................ 21
Aims & Objectives Of The beyondblue National Postnatal Depression Program .................... 22
1. Establishment and Evaluation of the Introduction of Routine Screening for Antenatal and
Postnatal Depression at Major Maternity Hospitals/Health Services in Australia. ................. 23
Overview................................................................................................................... 23
What Have We Learnt? .......................................................................................... 24
Implementation of Perinatal Depression Screening............................................. 25
Evaluation of the Feasibility and Acceptability of Introducing Perinatal
Depression Screening .............................................................................................. 27
2. Development of Materials to Address Community and Health Professional Awareness of
Perinatal Depression and its Treatment ....................................................................................... 29
Overview................................................................................................................... 29
Health Professional Training ................................................................................. 30
Media and Promotion ............................................................................................. 32
Postnatal Depression Information Booklet ................................................. 33
Postnatal Depression Information Pamphlet............................................... 35
Depression Management Guide .................................................................. 37
Guide To Using The Edinburgh Postnatal Depression Scale...................... 39
Promotional Posters .................................................................................... 40
www.beyondblue.org.au/postnataldepression............................................. 42
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3. Evaluation of Changes in Health Professional and General Community’s Knowledge of
Perinatal Mood Disorders .............................................................................................................. 43
Overview................................................................................................................... 43
Aims .......................................................................................................................... 44
Method ..................................................................................................................... 44
Population ................................................................................................... 44
Health Professionals.................................................................................... 44
6-12 Week Postnatal Women...................................................................... 45
Questionnaires............................................................................................. 45
Experience of Perinatal Depression Screening.................... 45
Knowledge Questionnaire ................................................... 45
The Edinburgh Postnatal Depression Scale......................... 45
Results ..................................................................................................................... 45
Response Rates............................................................................................ 45
Summary of Baseline Findings ................................................................... 46
Demographic Profile of Postnatal Mothers................................................. 46
Emotional Health of Mothers...................................................................... 46
Awareness – Perinatal Depression .............................................................. 47
Awareness – Booklet................................................................................... 47
Health Professional Knowledge.................................................................. 48
Recommendations/Preferences for Treatment ............................................ 48
Changes in Help Seeking Behaviour........................................................... 49
Barriers to Treatment .................................................................................. 49
Discussion ................................................................................................................. 50
Increasing Awareness of Perinatal Depression in Health Professionals and
Perinatal Women........................................................................................... 50
Improving Knowledge of Perinatal Depression and its Treatment in Health
Professionals ................................................................................................. 50
Improving Health Professional’s Confidence in Treating Perinatal Depression
..................................................................................................................... 50
Improving Access to Services by Perinatally Depressed Women................. 51
Conclusions .............................................................................................................. 51
4. Provision of a National Database of Young Families in Australia ......................................... 52
Overview................................................................................................................... 52
Demographics Overview......................................................................................... 53
Mood Data................................................................................................................ 57
Risk Factors for Antenatal and Postnatal Depression......................................... 60
Demographic Variables............................................................................... 60
Psychosocial Variables................................................................................ 61
Correlation of EPDS and K10/Sphere................................................................... 63
5. Evidence of Efficacy of Early Intervention Initiatives ............................................................ 64
Overview................................................................................................................... 64
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Staff Members ................................................................................................................................. 65
Hospitals/Area-Health Services Involved ..................................................................................... 67
Acknowledgements And Thanks ................................................................................................... 68
Appendices....................................................................................................................................... 71
Appendix A – Feedback to Services Document .................................................... 72
Appendix B – Detailed List of Organizations to Receive PND Training ........... 74
Appendix C – Health Professional Training Guidelines...................................... 84
Appendix D – Detailed List of Media and Promotional Activities ..................... 86
TV, Radio and Promotional Activities........................................................ 86
Newspaper and Magazine Articles.............................................................. 96
Appendix E – Detailed list of Conference Presentations and Scientific Articles
.................................................................................................................................. 101
Conference Presentations ........................................................................... 101
Scientific Articles.......................................................................................108
Tables and Figures
Figure 1. The Perinatal Depression Screening Protocol...............................................................26
Table 1. Health Professionals Screening Experience....................................................................28
Table 2. Groups Involved in Baseline Evaluation (BE) & End Evaluation (EE)......................45
Table 3. Recognition/Awareness of Postnatal Depression in Health Professionals and
Postnatal Mothers at Baseline (BE) and End Evaluation (EE) .......................................... 46
Table 4. Demographic Profile of Postnatal Mothers at Baseline (BE), End Evaluation (EE) &
National Average 2002............................................................................................................ 47
Table 5. Recommendations/Preferences for Treatment..............................................................49
Table 6. Perceived Barriers to Treatment of Perinatal Depression ............................................50
Table 7. National Demographic Overview.....................................................................................54
Table 8. State Demographic Overview...........................................................................................55
Table 9. Rates of Antenatal and Postnatal Depression by EPDS Scores ................................... 57
Figure 2. Distribution of Antenatal EPDS Score ......................................................................... 58
Figure 3. Distribution of Postnatal EPDS Scores......................................................................... 58
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Table 10. Mean EPDS Score and Prevalence Rates for Each State ............................................59
Table 11. EPDS Prevalence: WA Public Patients vs. WA Private Patients .............................. 59
Table12. Odds Ratios: Demographic Variable ............................................................................ 61
Table 13. Odds Ratios: Psychosocial Variables ........................................................................... 62
Table 14. Postnatal Depression (EPDS > 12) Prediction Model ................................................. 62
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Executive Summary
The beyondblue National Postnatal Depression program is an Australian public health
initiative developed and implemented over four years, with a scope that makes it unique on a
worldwide level.
The Program focused on bringing about change in healthcare for women with perinatal
depression, to improve outcomes for them and their families, in order to reduce the potentially
devastating consequences on current and future generations. Multidisciplinary teams across seven
States and Territories engaged with primary perinatal health care providers, in 43 different health
services/regions. This involved over 40,000 pregnant women being screened directly and over
200,000 being reached by the Program’s publicity, educational and/or resource materials.
The Program operated at a number of levels:
♦ introduction of routine screening for perinatal depression;
♦ provision of information to women and their families;
♦ education of, and support for, primary healthcare professionals;
♦ a specific focus on detection/intervention in each State.
This project collected data on over 40,000 antenatal women and over 12,000 postnatal
women. The key preliminary findings include:
♦ in Australia, rates of depression (as recorded on a validated, perinatal specific
screening tool, the EPDS) are high in the general postnatal population (15.7%),
similar to rates in other Westernised countries;
♦ antenatal rates of depression appear lower than postnatal rates (5.4% - 8.9%
depending on cut-off score used) and, when trimester screened is considered,
similar to other Westernised countries;
♦ for the first time, the importance of psychosocial risk factors is confirmed for the
general Australian perinatal population. In particular, past history of abuse, prior
history of depression, anxiety, lack of support, lower socio-economic status and a
stressful pregnancy are all key factors;
♦ Indigenous Australian women are at heightened risk of depression, and
psychosocial factors are of particular importance in generating this elevated rate.
These high rates of depression and identification of key psychosocial risk factors highlight
the importance of perinatal universal depression screening. Provision of information and the
education of health professionals in depression identification and early intervention strategies
must also take place.
Universal depression screening has been controversial for a number of reasons. This
Program has demonstrated that:
♦ a majority of women found screening acceptable when delivered with as part of
routine care with her health provider;
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that the standard screening tool used (the EPDS) was appropriate and superior to
alternatives;
♦ a standardized, Indigenous version of the EPDS produces similar scores and is
more acceptable to Indigenous Australian women;
♦ when screening was combined with information – in particular an information
booklet given in pregnancy – screening significantly increased awareness of
depression;
♦ help sought by those women who were part of the Program and were either not,
or mildly, depressed, decreased. These women were more satisfied with what
help they did seek and found the depression information received more useful.
This suggests the increased awareness of emotional health issues resulting from
this Program decreased need for extra help, and needs be a core part of routine
screening so as to make best use of community resources.
♦
Depressed women were more likely than non-depressed women to seek help. However, a
significant proportion did not seek help at all, even after screening, indicating substantial barriers.
Some ways of overcoming barriers to seeking help were suggested by the following findings:
♦ linking women to their GP, who had been trained to routinely ask about
depression, appears a critical step in increasing early identification and
intervention;
♦ information about the treatment of depression was helpful in decreasing the
reluctance of women to consider using antidepressant medication during the
postnatal period;
♦ GP training had helped broaden the GPs range of treatment options;
♦ barriers to seeking assistance were identified in the specific State antenatal
interventions and it was found that reluctance to engage was highest among those
at high-risk and male partners.
The PND Program developed a range of promotional, educational and resource materials
which are available on it’s website (www.beyondblue.org.au/postnataldepression). The site includes
information in 19 languages other then English, as well as for Indigenous women and multiple birth
mothers, and depression management and Edinburgh Postnatal Depression Scale guides for health
professionals. Health Professionals were:
♦ empowered to be able to deal with perinatally depressed women when they
encountered them as part of their routine work. Provision of pathways-to-care
protocols allowed these health professionals to deal with issues that previously
they were at a loss to know what to do;
♦ highly supportive of screening and found training helpful;
♦ knowledge levels increased through training, however, midwives remained a
group in need of extra training and support for the implementation of routine
screening to be feasible;
♦ at each locale, a significant degree of commitment is required to adapt a blueprint
for the specific needs and structure of the service, requiring management and
service support. A “one-size-fits-all” approach is not appropriate although a
blue-print for all services is required to ensure best minimal practice;
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teleconferencing to remote and rural areas could also provide education and
training, but this was not without technical difficulties and, as elsewhere, needed
to be ongoing.
The PND Program has become an identified source locally, nationally and internationally for
cutting edge information resources and provision of eduction. This is an enviable situation, which
needs to be promoted in order to continue the work that has been started over the past 4 years.
Recommendations
The PND Program recommends:
1. A national advocacy group of key stakeholders be formed. Their task will be to
promote the introduction of routine psychosocial assessment and referral
pathways and consider relevant training and education needs.
2. Depression screening is a part of routine antenatal and postnatal care.
3. The use EPDS as the best available and most practical screening tool.
4. Use of additional key psychosocial questions to assess risk and planning
perinatal care, in particular, level of support, past history of anxiety and
depression and current stressors.
5. Antenatal screening in the third trimester.
6. Postnatal screening 6-8 weeks after childbirth.
7. All pregnant women are provided with an information and resource booklet on
emotional health in the perinatal period.
8. Specific resources to address the needs particular groups, such as Indigenous,
culturally and linguistically diverse, multiple birth mothers and male partners, be
supported.
9. Screening programs need to be accompanied by ongoing training and support of
all relevant health professionals involved in perinatal care.
10. Each obstetric/area-health service needs to develop a local care-pathway
including appropriate referral and allied-health service links
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National Action Plan To Implement Perinatal Depression Screening
What Are The Current Problems?
It has long been identified that services for perinatal women with a mood disorder are spread across
many areas of the health sector with inadequate coordination. Where policy development in this
area has occurred:
♦ implementation has been poor resulting in many service gaps;
♦ there are significant disparities between States and between private and public
systems;
♦ there has been an overemphasis on physical health to the exclusion of emotional
health.
Research into perinatal depression has shown that:
♦ in primary health care settings, if depression is not routinely asked about, over
50% of cases are missed, highlighting the need for a systematic approach to
perinatal psychosocial assessment;
♦ perinatal (i.e. antenatal and postnatal) mood disorders, such as depression and
anxiety, are common;
♦ depression has high economic, personal and family costs, with significant
potential effects beginning in pregnancy with an impact of maternal depression
and anxiety on the developing foetal brain;
♦ during the perinatal period, suicide is the equal (with haemorrhage) leading cause
of maternal death in Australia.
Where To From Here?
The beyondblue National Postnatal Depression Program has been highly successful in
raising awareness of the importance of emotional health in the perinatal period, both within the
general community and in health settings. The next steps will be to ensure that emotional health
becomes a priority agenda item in health and that research is translated into both policy and
practice. To date we have:
♦ positioned ourselves as an effective national group advocating for the need of
health services to focus an perinatal emotional health;
♦ continued working with at least one “show-case” hospital in each State as an
example of how depression-screening can be incorporated into routine perinatal
care with appropriate staff training and feedback;
♦ forwarded a submission to the Senate inquiry into perinatal mental health
services in Australia;
♦ provided policy advice to Federal & State Governments;
♦ drafted an information document to be sent to all stakeholders involved in the
PND Program and all perinatal services in Australia (see Appendix A);
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met with Victorian Department of Health (on a number of occasions, including
mental health, & early childhood), President and President elect of the College of
Psychiatrists;
formed a Perinatal Interest Group as part of the Royal Australian and New
Zealand College of Psychiatrists, which meets regularly in three States; a broader
group meets in another State;
in Queensland, interviews with the Ministers, or their designated representatives,
and the National Director in the offices of Family Services, of Child Protection
and of Health are in process for September, 2005;
formal interviews and contacts of the Queensland Director with The Australian
College of Midwives Incorporated in Queensland and nationally; with The
Australian and New Zealand College of Mental Health Nurses; and with the
Queensland State Unit for Child Health Nurses in Queensland;
had discussions with hospital/area-health services, looking at strategies for the
implementation of routine screening using the EPDS.
Whilst the beyondblue National PND Program is working diligently to focus attention on
emotional health within routine perinatal health care, there remain many barriers to it becoming part
of care universally. These include:
♦ stretched hospital resources;
♦ differing opinions as to the value of screening and the role of obstetric services;
♦ disparities between the states;
♦ the need for ongoing training and support for health workers;
♦ funding for ongoing resource materials;
♦ reluctance of women to seek help for emotional problems.
Following the submission of this report to the beyondblue board, the PND Program
anticipates the need for:
♦ formation of a National Advisory Group of key stakeholders. This groups will
work with state bodies to ensure that perinatal depression is on the National
Health Agenda at a number of levels;
♦ each State forming a Steering Committee of key stakeholders. This will include
the State research teams but also broaden to key clinicians, researchers and
managers. Their tasks will be to promote the introduction of routine psychosocial
assessment and referral pathways and consider relevant training an education
needs;
♦ develop a consensus document for perinatal care. NSW has developed an
Integrated Perinatal and Infant Care Plan, which the PND Program supports,
but this needs to be further developed with the addition of information package
and education for a number of health professional groups that come into contact
with perinatal women. Importantly, it must be adapted across different setting
and States, with particular reference to implementation issues, referral and crossdisciplinary links;
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provision of support and expertise, through ongoing staff training and education,
to hospitals to facilitate implementation of depression screening programs or to
take over existing programs;
to continue the valuable links between the research involved in the PND Program
and to welcome others to work together on the issue;
further analysis of the vast amount of data collected with publications locally and
internationally;
ongoing training and presentations to public, professionals and stakeholders, both
locally and internationally, of the data and recommendations in this report;
presentation of the findings of the PND Program at the Australasian Marce
Conference in Melbourne in September 2005. Seventeen abstracts, either directly
involving or related to the PND Program have been accepted by the conference
organizers;
ongoing research in perinatal depression, furthering the work of this Program and
progressing our understanding of perinatal depression. This includes two
established projects:
− “EPDS Tool Pilot”. Condon, Alder, Sved-Williams et al. Funded by
SA State Government. This continues from the National PND
Program, specifically aiming to introduce, and evaluate the use of, the
EDPS into child-youth health centres
− “Optimisiming Emotional Health During Pregnancy And Early
Parenthood”. Buist, Milgrom, Bilszta & Ericksen. Victorian Centre of
Excellence Grant. This study aims to further explore the reluctance to
seeking treatment for perinatal depression (as evidenced by the
National PND Program) and piloting of methods to overcomes this.
Applications will also be submitted to other funding bodies, such as NHMRC and
NARSAD, to build upon the projects initiated as part of the PND Program.
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Reflections From The National Co-Ordinator
A/Professor Buist is Associate Professor of Psychiatry at Austin Health and University of
Melbourne, the current Director of the Banksia House Mother Baby Unit, and former
Director of Psychiatry at the Mercy Hospital for Women. Both her research Masters and
MD investigated postnatal disorders and she has written and researched extensively in this
area, including a textbook for GPs. She regularly teaches to a variety of health
professionals on these topics. She has many years clinical and research experience in
Women's Mental Health and involvement in the International and Australasian Marcé
Society (the latter of which she is the President). In 1999 she was awarded the Organon
Travelling Fellowship by the Australian Society of Psychosomatic Medicine and the AMA Women's Health Award.
The beyondblue National Postnatal Depression was an ambitious program involving a large
number of multidisciplinary teams across Australia in both antenatal and postnatal health care
settings. It tackled an enormously important health problem that affects the lives of 13-15% of
women and their families. The Program raised community awareness of perinatal depression,
investigated early identification and intervention strategies and took the lead in training health
professionals in the diagnosis and management of mood disorders during pregnancy and early
parenthood. Understanding the particular needs of male partners, multiple-birth families,
Indigenous women and women from culturally and linguistically diverse backgrounds, was also a
major focus.
The Program began its planning stage in 2001 and became operational in 2002, spreading to
over 43 antenatal hospitals/area-health services and reaching over 200,000 women and health
professionals from a wide range of service providers. Unlike any other project any of us had been
involved in, it was not just a research project but also a public health initiative – and a passion.
The dedication, enthusiasm and long hours beyond the call of duty from all those involved
has been extraordinary. My thanks go to all team members across Australia for bringing together
this unique project that would have been impossible without them. It has been a pleasure to know
and work with them all.
As a result of an enormous amount of hard work, this project has provided a wealth of
information on the mental health of women giving birth in Australia, as well as the feasibility and
acceptability of perinatal depression screening, usefulness of education program and increasing the
awareness of the emotional health needs of women during pregnancy and early parenthood.
The beyondblue PND Program, and this report, aims at making a difference - the findings
can, and we hope will, be used by health professionals, policy planners and politicians throughout
the country to improve the outcomes for all women giving birth, their children and the families that
support them.
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Reflections From Victoria And Tasmania
Professor Milgrom is a Professor of Psychology, University of Melbourne and Director of
Clinical and Health Psychology at Austin Health. She has been involved in clinical practice
and research on mother-infant interaction and postnatal depression since 1978 and has held
a Harkness Fellowship in the USA as well as an O’Rourke Fellowship in Paris for working
with families and infants. Professor Milgrom developed a model centre for families and
infants, the ‘Infant Clinic’ and established the Parent-Infant Research Institute (PIRI) in
2001, which aims to become the pre-eminent body in Australia developing interventions for
parent-infant difficulties. Professor Milgrom has published widely in the area and held a
number of long-term research grants. She is also active professionally and has held positions in the Australian
Association for Infant Mental Health (Victorian Branch) and the College of Health Psychologists of the Australian
Psychological Society.
Being part of the beyondblue National PND Program has provided us with a unique
opportunity to influence the emotional health care of Australian women. We have been privileged
to be part of a significant movement in changing practice to ensure that asking women if they are
depressed, is considered a critical practice by professionals involved with pregnant and postpartum
families.
The scope of the program was immense and the opportunity to sample such a large segment
of the population has provided us with a wealth of information. The success we have had in rolling
it out and witnessing change in attitudes and care within the maternity hospitals and community
settings has been fascinating and gratifying. It makes the many challenges we faced as a Victorian
team worthwhile, including the sad loss of Rachael McCarthy, one of our team. The lessons learned
will stand us in good stead in thinking about future projects and implementing them, and our
commitment to continue working with this population has grown.
In addition, the PND Program called on researchers around Australia to work together in
order to produce a research program and public health initiative that was standardized and of high
quality. These national working relationships will set the scene for future collaboration, which
strengthens the research community in Australia making it an international leader in the field. It has
changed the culture of Australian research in PND with everyone working with a common focus.
There have been many rewards in being associated with the high profile of beyondblue. The
general promotional activities of beyondblue have supported and contributed to our success and we
thank them for their guidance and support. In particular, beyondblue’s approach in budgeting for
publications (pamphlets, flyers, posters and booklets) has changed the attitudes of health workers.
The impact of these has been extensive and their existence helps training and raising of awareness,
which will endure for longer than if, they were not available.
In summary, it has been very fulfilling being part of a national body that is having an impact
on practice and policy regarding screening for perinatal depression, and women’s lives as a
consequence. The “whole is greater that the parts…”- the involvement of multiple sites around
Australia has strengthened the impact of the Program, raised its profile both in Australia and
internationally, and helped many women and their families.
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Reflections From South Australia
Professor Condon is Professor of Psychiatry at Flinders University of South Australia and
Director of Psychiatry at the Repatriation General Hospital in Adelaide. For 15 years he has
operated a specialist clinic at Flinders Medical Centre for women referred with problems in
the area of psychosocial obstetrics and gynaecology. He has received funding from the NH &
MRC for a number of projects, including the determinants of antenatal and postnatal
attachment; the impact of the transition to fatherhood on male mental health; adolescents’
idealized attitudes to pregnancy and parenthood; and adolescent pregnancy prevention
through interventions targeting young males. Between 1993 and 1999, he was chief examiner
of the Royal Australian and New Zealand College of Psychiatrists and is currently a member
of General Council of that College.
If you ask someone today “Have you heard of beyondblue?”, the answer is most likely to be
“Yes, I have”. This affirmation represents the success of the beyondblue PND Program at several
levels. Many women have participated in the program and some have been screened two or three
times during the program’s duration. These women are very positive about their involvement: a
confirmation of their own feelings about their mental health state: whether they are well or
otherwise.
The primary professional health workers: medical practitioners, midwives and maternal and
child health nurses of perinatal women receive objective information which contributes to the
clinical management of participating women. Health care providers have received education and
skills development, particularly in the country areas in South Australia and have been energised to
establish a response to postnatal depression at a regional level. Such processes outline the cross
professional roles and responsibilities aimed at the early recognition and prompt treatment of
women who experience antenatal and/or postnatal depression. This ensures the longevity of the
beyondblue program and thus represents the significance and necessity of such a program in mental
health service provision in Australia.
The funding of this program has provided a wonderful opportunity to do something really
worthwhile in relation to strategic approaches to women’s mental health. This has been too good an
opportunity to sit back and be complacent. It has been an honour to contribute to such exciting
developments in women’s health care.
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Reflections From Western Australia
From 2001 to Dec 2003 Prof Sherryl Pope was the Western Australian Coordinator of the
beyondblue National Postnatal Depression Program.
Dr Speelman is currently Head of the School of Psychology and has been the Western Australia
co-ordinator since Jan 2004. He teaches in both the undergraduate and postgraduate
programmes. His research work is primarily in the field of cognitive psychology, with particular
interests in skill acquisition and memory. His recent publications have examined the effects of
different types of training on skill transfer, and the relationship between skill acquisition and
implicit memory. An additional interest is examining the relationship between implicit expertise
and transfer. He is also involved in marrying his previous life as a rock musician with research
on memory for music. He is currently writing a book about learning.
Since our initial formation, with the employment of the first team member Jocelyn Bristol,
the Western Australian beyondblue PND Program team has worked cohesively and with a strong
sense of purpose – motivated by our individual beliefs in and dedication to the Program’s goals and
by our tireless and enigmatic Coordinator Associate Professor Sherryl Pope. This dedication and
strong sense of camaraderie was only strengthened with the tragic and sudden passing of Sherryl
Pope. With a renewed energy, the WA team has set out to make the WA project ‘the best in
Australia’ and make Sherryl proud. We believe our efforts have been reflected in the quality and
quantity of data obtained for the national database from WA and that we indeed have succeeded in
making Sherryl Pope proud of her team.
Upon reflection, the aspect of the project the team has found the most rewarding is the
strong sense that we are making a real difference to people’s lives. This research project has been
quite unique in that we have all felt that we are also ‘giving back’ to the community with the
provision of resources, education for metropolitan and rural health professionals, and the screening
and referrals offered to participants. When depression is picked up through screening, when
otherwise it might not have been, and women are supported into seeking help, the long term
benefits to these women and their families can be quite profound.
“I have undertaken many follow up EPDS by phone on postnatal women and on numerous
occasions have dealt with depressed women. At times I have provided the only opportunity these
women have had to express their current feelings of, at times, despair. I have linked numerous
women into referral agencies so that there depression could be addressed and many times women
have expressed thanks and relief to me that they are seeking help as a result of my phone contact”
(Jocelyn Bristol, Research Midwife).
Personally, each of us has gained valuable skills, contacts and knowledge that we can take
with us into future endeavours and feel ‘blessed’ to have been involved with this project and to have
had the opportunity to carry on the legacy of Dr Sheryl Pope.
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Reflections From Queensland
Professor Hayes is the foundation Professor of Nursing and foundation Head of School at
James Cook University, appointed in 1989. Barbara Hayes is licensed to practice in general
nursing, midwifery and mental health nursing. She gained her first research degree at the
University of Melbourne and her masters and doctoral degrees at the University of California,
San Francisco as a WK Kellogg Fellow. Barbara Hayes has forged her skills in midwifery and
mental health nursing with her research training to establish a strong basis for her research
into the recognition and management of ante and postnatal anxiety and depression. Working
with ease across disciplinary boundaries and within the professions of nursing and midwifery, Barbara Hayes is
committed to quality, holistic care to childbearing women. One of her particular concerns is to explore, in full
partnership with Indigenous midwives, ways in which culturally sensitive and culturally safe care can be accessible to
Indigenous childbearing women.
The following is a compilation of thoughts and experiences from all members of the
Queensland research team. The following three aspects of context in Queensland provide a unique
dimension to the project: (1) Queensland was the only State with a formal program for Indigenous
women; (2) the team was based in Townsville but was over a thousand kilometres from three of the
sites and over 500 kilometres from others. The experiences can be expressed under the following
headings but, in so doing, will lose a lot of evocative detail: (1) Compassion and Commitment; (2)
Increased Knowledge and Skill Acquisition; and (3) Appreciation of the national and local team
and desire for future involvement.
Compassion and Commitment: Every member of the team shared a passion for Women’s
Perinatal Emotional and Mental Health. The research team shared a complementary skill mix that
enabled members to forge highly effective interpersonal bonds, over long distances, both with the
research midwives and with the various Health Service Districts in which the beyondblue project
was established. This skill mix ensured that the ‘duty-of-care’ inherent in eliciting ‘informed
consent’ was met in highly efficient and effective ways. Members mentioned in their
autobiographical accounts “ (it was a) privilege to be part of something that recognized the needs
of women from my Indigenous people”; “ privilege to be part of a national study that was so
effective in making changes for perinatal women”.
Increased Knowledge and Skill Acquisition: All members of the team expressed greatly
increased knowledge of perinatal emotional and mental health in a wide range of both Indigenous
and non-Indigenous women. Increased skill acquisition in assisting midwives, child health nurses,
rural nurses and GPs in early recognition were widely experienced and the generating of robust
referral pathways was an outstanding achievement.
Appreciation of the national and local team and Desire for future involvement: We
acknowledge Professor Anne Buist’s leadership, Dr Justin Bilszta’s national co-ordination, the
collegiality of the other state teams in addition to the deep and enduring collegiality of the
Queensland team. We deeply regret the ending of the project as the research team developed highly
cohesive bonds, which facilitated the achievement of the goals of the project. We appreciate the
vision of beyondblue in providing the funding at this crucial time in recognition and management of
a major public health problem. We deeply regret the death of two members of the National Team:
Associate Professor Sherryl Pope and Ms Rachael McCarthy.
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Reflections From New South Wales
Professor Barnett is a graduate in medicine of the University of Aberdeen and a Fellow of
the Royal Australian and New Zealand College of Psychiatrists. She has a doctoral degree
from the University of New South Wales, and held a Chair of Perinatal and Infant
Psychiatry at that University. Professor Barnett's key interests are the health and wellbeing
of infants, children, adolescents and their parents. To that end she has established various
services addressing their needs and is involved in an extensive research program on issues
relevant to prevention, early intervention and health promotion. She has been
involved in many College and other professional committees. She has been President of the
Australian Psychosomatic Obstetrics and Gynaecology, the Infant Mental Health and the Australasian Marce Societies
and is President Elect of the International Marce Society. She is Chair of the Board of Directors of the Karitane,
Caring for Families, organization. Professor Barnett’s team is committed to ensuring that the needs of migrant and
indigenous families are appropriately included in policy, planning and implementation.
I’m sure I speak on behalf of all beyondblue staff members and associated when I say they
we feel very fortunate to have been involved with the beyondblue National Postnatal Depression
Program. We are all deeply passionate about improving the mental health of mothers, fathers and
their infants and therefore consider ourselves privileged to have been a part of a service that will
increase the quality of life for families and consequently the community in general.
We are excited about the great work that has been accomplished in this State and hope that
the beyondblue program is only the beginning of National acknowledgement of the importance of
perinatal mental health. We would like to thank the beyondblue Board for their insight in
supporting and funding a perinatal mental health program and allowing us this unique opportunity
to research and raise awareness of a public health issue that we know if invested in now will have
invaluable benefits for generations to come.
I would also like to acknowledge the work of A/Prof Marie-Paule Austin and Dr Nick
Kowalenko for co-ordinating the PND Program at Royal Hospital for Women and Royal North
Shore Hospital, respectively.
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Reflections From The Australian Capital Territory
Professor Ellwood is a practicing obstetrician and certified sub specialist in MaternalFoetal Medicine who is interested in teaching and research in high risk obstetrics.
Currently he is the President of the Perinatal Society of Australia and New Zealand
(PSANZ). He is an Executive Member of Women’s Health Australia (WHA). He is also
a member of the Advisory Faculty of Advanced Life Support in Obstetrics (ALSO). He is
the Past Chair of the Maternal-Foetal Medicine Committee of the Royal Australian &
New Zealand College of Obstetricians & Gynaecologists (RANZCOG), and the current
Chair of the Research Assessment Sub-Committee, which oversees research training for
trainees. He is a Past Chair of the High Risk Obstetric Advisory Group of NSW
Perinatal Services Network (HROAG). He is widely published and sits on the Advisory Board of the publication
Australian Doctor. Professor Ellwood’s expert opinion is sought in a wide range of pregnancy and birth related legal
issues
The ACT set a target of recruiting 1000 mothers to the program. This is approximately 20%
of the annual birthing population. During 2004, 987 mothers were recruited to study and their
response to the program has been very positive. More than 1000 information booklets, posters,
pamphlets and booklets were distributed widely. These have proven to be very popular with an
increase in requests for information booklets to be made available to community services. There
have also been significant steps to improve the pathways to help and support for identified women.
Antenatal staff was involved in the development and trial of new management plans, which were
well received. It was rewarding to witness first hand how midwives want to help women by being
involved in the program.
Whilst it has been difficult to estimate the resources required to conduct a complex mental
health early identification program, different sites have responded differently to the increased
demands on staff time. Some antenatal clinics increased the time available for the booking-in visit
to accommodate the addition paperwork and time to talk with mothers. Management supported staff
to attend training sessions in the new assessment procedures and referral pathways.
Maternal and Child Health Nurses were given extended appointments to accommodate the
increased time to administer and discuss screening results. Over time both antenatal and postnatal
nurses became more efficient and confident with the new procedures. Generally their attitude to the
changed work practices became more positive over time. Midwives and Mach nurses reported that
it was important for that increased opportunity for women to talk about their feelings. During the
program we all developed greater understanding of the processes involved in introducing new
practices and how people work together to overcome the inevitable obstacles. In summary, the
beyondblue PND program has generally been very successful and embraced by both health
professionals and Canberra mothers.
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Vale: Professor Sherryl Pope and Rachael McCarthy
Sherryl Pope BA (Hons) MPsychology (Clinical) PhD, was Associate
Professor of Psychology and Coordinator of the Postgraduate Clinical Program in
the School of Psychology at Edith Cowan University, Western Australia and an
Honorary Research Fellow of the Women & Infants Research Foundation (WIRF).
Sherryl had been involved in Psychology for 25 years working in the areas of
Psychiatry, Drugs and Alcohol, Behavioural Medicine and maintaining a successful
private practice. Prior to studying psychology she was a Registered Nurse and Midwife.
Sherryl was formerly the Chief Clinical Psychologist at King Edward Memorial Hospital for
Women from 1989 to 1998, establishing the first specific Clinical Psychology services in a tertiary
level Australian Obstetrics, Gynaecology and Neonatal Paediatric teaching hospital. She was Chief
Investigator of the Postnatal Depression Prevention Study funded by Healthway for 3 years (19921995) and has been the Chief Investigator of several other large postnatal depression studies in the
past decade. Her PhD research investigated couples’ adjustment to parenting and postnatal
depression following the preterm or full-term birth of an infant.
Sherryl was the Project Consultant for the statewide Childbirth Stress and Depression
Project based at KEMH (1995-1998), funded by the National Mental Health Strategy. She was the
first author of a systematic literature review concerning postnatal depression published by the
NHMRC (2000), that was designed to form the basis for the development of national clinical
practice guidelines, and “Postnatal Depression: more than just the baby blues” a consumer guide for
national distribution. From 2001 to 2003 Sherryl was the Western Australian Coordinator of the
beyondblue National Postnatal Depression Program.
Sherryl was an inspiration to all those lucky enough to have worked with her or taught by
her and is dearly missed.
Rachael McCarthy has been a very dear and valued member of the
Victorian Project team. She has worked in the Clinical and Health Psychology
Department Austin Health for over 10 years, and as part of the VIC component
of the PND Program for three years.
Rachael was a talented therapist who had a flare for her work and a real
understanding of her patient’s struggles. She worked in a variety of service areas, including: Staff
Counselling, Spinal Unit, Banksia House Mother and Baby Unit and our Infant Clinic
Rachael has left behind as a legacy, a number of programs that she has been instrumental in
developing, evaluating and running over the last few years. She also leaves behind a very large
circle of friends, acquaintances and colleagues who are all struggling to come to terms with her
passing and the enormous loss that this represents both personally and professionally.
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Aims & Objectives Of The beyondblue National Postnatal Depression Program
The aims and objectives of the beyondblue National Postnatal Depression Program have
focused around five key priority areas:
1. Establishment and Evaluation of the Feasibility of Routine Screening for Antenatal and
Postnatal Depression at Major Maternity Hospitals/Health Services in Australia.
2. Development of Materials to Address Community and Health Professional Awareness of
Antenatal and Postnatal Depression and its Treatment. This was aimed to assist in
demystifying perinatal depression and to improve its recognition, so to minimise the impact of
depression on women, their partners and families and the wider community. Accessibility was
aimed at the maximum number of women, including those from Indigenous and culturally and
linguistically diverse backgrounds.
3. Evaluation of Change in Health Professionals and Postnatal Women’s Knowledge and
Awareness of Perinatal Mood Disorders as a result of this Program.
4. Provision of a National Database of Young Families in Australia to investigate:
♦ the prevalence of pregnancy-related depression;
♦ importance of different risk factors on the development of depression in an
Australian population and;
♦ when best to screen and who is best to perform the screen.
5. Evidence of Efficacy of Early Intervention Initiatives in the following groups:
1. risk of poor parenting in depressed women;
2. culturally and linguistically diverse;
3. rural;
4. Indigenous;
5. fathers/male partners;
6. multiple-birth families.
The beyondblue National PND Program provides a leading direction in postnatal disorders
for Australia and the world through these priority areas.
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1. Establishment and Evaluation of the Introduction of Routine Screening for
Antenatal and Postnatal Depression at Major Maternity Hospitals/Health
Services in Australia.
Overview
The introduction of antenatal and postnatal depression screening and protocols for the
sharing of patient information, in 43 antenatal hospitals/area heath services across Australia, has
been implemented since 2002.
Overall, screening for depression:
♦ had clear advantages of early identification and intervention;
♦ was acceptable to a vast majority of women (85%) – they found the
questionnaires easy to complete and were comfortable in doing so;
♦ was acceptable and feasible for those health professional (98%) who were
involved .
Acceptability and feasibility of screening was closely associated with education and
training, as well as increasing levels of awareness. This is discussed further in Section 3 (Evaluation
of Changes in Health Professional and General Community’s Knowledge and Awareness of
Perinatal Mood Disorders).
Some hospitals elected not to, or only partially participate, and it is clear from our
experience and results that for routine screening to be implemented the process must:
♦ be supported by all levels of hospital management;
♦ have adequate infrastructure;
♦ develop a site-specific model for identification and management of distressed
women;
♦ have as part of it ongoing education and support for staff.
Each hospital and area health service will have individual needs and as part of the successful
implementation, requires links and supports for the care of depressed women. Such integration
requires directive not just from the bottom up, but to be driven also by policy, which prioritises
mental health screening as an integral part of perinatal health care.
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What Have We Learnt?
The PND Program has been a culmination of an enormous amount of work by each of the
State-based research teams. For all teams this has been unchartered territory and the learning curve
extremely steep. As this Program has been a world-first, the evidence found will guide postnatal
depression screening policy, not just in Australia, but also across the world.
Aside from the vast database of pregnant and early postnatal women and the large number of
depression resources that have been developed, this Program has demonstrated that with the
appropriate support and guidance, implementation of depression-screening protocols within primary
health care settings can be successfully achieved. Other positives include:
♦
♦
♦
♦
♦
♦
the involvement of each state has strengthened the impact of the Program and raised its profile
both in Australia and internationally;
women and their families are actively interested and willing to participate in a screening
process, which assesses mental health and wellbeing. This demonstrates the willingness of
women to focus on mental health issues in their childbearing years;
establishing depression-screening protocols as part of routine clinical practice has demonstrated
that appropriate training for the relevant staff, evaluation systems, referral pathways and
community based support services are essential ingredients. ;
evaluating the introduction of an accurate prediction tool for postnatal depression. The Program
has allowed consultation with key stakeholders about the risk factor tool’s acceptability and
feasibility for routine use;
establishing the Edinburgh Postnatal Depression Scale (EPDS) as the recognised depressionscreening tool. This includes reviewing current guidelines regarding the use of the EPDS
antenatally and postnatally;
establishing clear guidelines for the identification and management of maternal depression.
These guidelines should include information on the following:
− ‘the ideal’ period for antenatal and postnatal screening;
− flexible management plans for mothers identified as depressed based on local
resources;
− recommended interventions based on EPDS results;
− which personnel/ professionals should conduct screening;
− details about coordination of care with general practitioners and other treating
health professionals;
− procedures for mothers with suicide risk or safety issues.
Areas, which in hindsight, needed further work or provided unexpected problems include:
•
•
implementation of screening in most sites took significantly longer than expected due to
factors such as ethics committee requirements or reluctance by staff to implement new
procedures;
whilst a strength of the Program was the vast experience of the research teams, differences
in the views and practices regarding implementation of screening across the states meant
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•
•
•
•
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that compromises needed to be made. Whist this doesn’t detract from the final “product”, it
highlights that a one-size-fits-all model isn’t the way to go;
the original proposal under-estimated the level of work needed in some areas, especially the
postnatal screening follow-ups that required extensive work to achieve a statistically
acceptable response rate. This has hampered, to some degree, the amount of data that could
be collected at this time point;
more time was needed to establish the Program so that it operates independently and
routinely in all midwifery clinics. The most important aspect of the beyondblue Program is
its sustainability in the long term. Changing current midwifery practice so that it evolves and
responds to the need to screen all mothers for signs and symptoms of depression requires
extensive consultation, training and time;
there is an urgent need for longer-term follow-up of screened women to establish what
happens to them after they were screened. This will allow us to determine rates of false
positive and false negative risk classifications using present screening methods, and will
indicate where gaps in service provision may be. Reasons why high-risk women fail to take
up services needs to be better understood. The beyondblue Centre Of Excellence has funded
a project in this area in it’s last round of research grants (Optimisiming Emotional Health
During Pregnancy And Early Parenthood. Buist, Milgrom, Bilszta and Ericksen);
even though screening is able to identify women with symptoms of depression being able to
get these women to accept referral is a whole new challenge that warrants further
investigation and efforts.
Implementation of Perinatal Depression Screening
Implementation of perinatal depression screening was a complex and time-consuming
process. It has involved establishing networks in each areas where women are recruited,
development of perinatal depression information for both women and their treating health
professionals, obtaining ethics approval, liaison with each of the maternity hospitals and setting up
of screening and referral procedures at antenatal clinics. The basic screening protocol is described
in Figure 1.
Hospitals in each State and the ACT were invited to participate. These were predominately
city and suburban public hospitals, whilst a representation of private, rural and remote antenatal
services was also included.
Some hospitals/area-health services did not take up the invitation to be involved in the PND
Program, or did so only partially, for the following reasons: philosophical objection to screening,
other current research projects running within the antenatal service, staffing/practical issues and
perceived inadequate support from PND Program staff.
The implementation procedure has been hard to quantify but is the reason why the PND
Program has been so well accepted. Procedures differed not only between the different States, but
also between hospitals in the same state. Ethics committee requirements, staff and management
attitudes, levels of staff knowledge, availability of appropriate referral pathways and allied-health
services and the individual quirks of each hospital, all impacted heavily on the screening protocol.
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There are multiple changes required within the hospital and community including changes to
clinical practice, administration tasks, data collection, coordination of care and referral patterns.
These require extensive consultation with administration and clinical staff as well as management.
The stakeholders involved in the change process have varying levels of expertise, knowledge,
interest and time available to participate. This issue invariably slows the rate of change as it takes
time to manage these issues
Figure 1. The Perinatal Depression Screening Protocol, as Designed
by the National PND Program
From their experiences, each of the States have highlighted the following key criteria for
successful introduction of screening:
♦
Raising awareness and increasing understanding – Raising awareness with executive and
senior clinicians about the importance of assessment and early intervention for improving longterm outcomes is fundamental to the successful uptake of perinatal psychosocial assessment.
♦
Adequate infrastructure – Fundamental to the successful implementation of psychosocial
assessment is the availability of adequate human resources. For the antenatal component this
means an appropriate establishment of antenatal clinic midwives to undertake the assessment
and a network of staff to follow up, support and case manage clients. The staff network will
ideally compromise a social worker, psychologist and psychiatric staff and may include
community-based nurses and non-government community based personnel. A designated
liaison position for the ongoing oversight of the service linkages and the monitoring of the
client’s engagement with services is highly recommended. A similar infrastructure would be
required for the postnatal component. Crossover between the antenatal and postnatal period will
be vital to ensure continuity of care.
♦
Staff education, training and supervision – Education for staff working within the
maternity/postnatal facilities regarding the benefits of early identification and intervention is
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essential. Basic, advanced and other relevant training needs to be available to staff on an
ongoing basis to account for staff attrition and rotation. Clinical/reflective supervision should
also be provided.
♦
Establishment of a steering committee – Key senior maternity service staff from across the
health service should participate in planning for the implementation of screening. This
committee forum would be used to develop a shared understanding of the concept, ascertain
roles and responsibilities identify issues and develop strategies for successful implementation.
♦
Establishment of a local committee to manage implementation – Each hospital
implementing screening should have their own committee. This committee will meet regularly
discuss local issues and further strengthen the process, assist in the development and
dissemination of policies, protocols and other relevant resources, oversee implementation and
ensure adequate data collection and analysis.
♦
Utilisation of an existing meeting or establishment of a multidisciplinary intake (postassessment) meeting – Some referrals may be addressed immediately but most will be deferred
to a weekly intake meeting for discussion including review of individual psychosocial
assessment, allocation of referrals and feedback. A multidisciplinary approach to intake and the
development of referral pathways is recommended.
♦
Identify service partners and the role that they play in service delivery to women and their
families – Development of a local service and resource directory needs to be undertaken to
identify service partners and the specific service that is offered. The information within this
resource directory will assist staff in gaining an awareness and better understanding of a range
of available resources and services.
♦
Feedback mechanisms established – Feedback mechanisms for clinicians needs to be
established at various levels to ensure that appropriate continuity of care is provided.
Evaluation of the Feasibility and Acceptability of Introducing Perinatal Depression Screening
A random sample of health professionals and postnatal women, involved in education and/or
screening, were surveyed at the completion of the project. This is reported fully in Section 3, but
included in this survey were questions on the “experience of screening”.
In evaluating the impact of screening, 97% of mothers questioned, reported that they had the
reason for EPDS being administered explained. Of note 83% of women found the EPDS easy to
complete (0.7% found it more than a bit difficult) and 85% were completely comfortable (1.9%
were quite or very uncomfortable) in answering the questions. Of those who had a high EPDS score
(and who responded to the question – there was a 71% response rate to this question), 81% agreed
with the “diagnosis” and 19% did not. Overall, 23% were relieved to be told their EPDS score and
what it meant and 31% were at least a little upset.
Of those who disagreed with their EPDS score, 26% were at least a little upset, suggesting
disagreement did not have a significant relationship to their reaction to being told their score (and
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perhaps more likely to be associated with the underlying depression). In using the EPDS we did not
diagnose depression; what we did was to screen women who, because they were pregnant or
postnatal, were 'at risk' for depression; a diagnosis of depression could only be made later after the
woman was assessed using a standardised depression protocol.
Experience of screening for health professionals is reported in Table 1. Of note, there was a
significant increase in the use of the EPDS by GPs since baseline (20% to 54%); 20% of the GPs
had cared for women who been involved in the Program, and received letters and management
guide.
Table 1. Health Professionals Screening Experience
GP
MCHN
Midwife
Use of
EPDS
(%)
54
89
68.5
Usefulness
of EPDS
(%)
54%
75%
57%
Comfort in
Using EPDS
(%)
80%
83%
61%
Mother’s Comfort in
completing EPDS
(%)
73%
77%
83%
Intent to continue
using EPDS
(%)
98%
99%
97%
For those not screening, the most common reasons given were that they would rather ask
about symptoms (60% GPs cp 37% at baseline), or it was not policy to do so (44% MCHN, 47%
midwives). For about 10% of MCHNs and GPs, lack of confidence in the instrument was cited.
Only two health professionals said they did not believe in routine screening.
The results of this study show strong support for the use of the EPDS by both health
professionals and women. There are high rates of acceptance, level of comfort and ease of
completion with the screening tool. Distress is minimal and appears more related to the underlying
condition than the test itself. Introduction of such a program hinges, however, on adequate training
and support – which needs to be an ongoing process.
From top left - Staff from the family Birthing
Centre at the Angliss Hospital VIC; Workers at
Uniting Care Connections, Starting Out Program,
Ringwood VIC; Photo used on the front page of the
PND Program web-site taken from the latest
beyondblue TV advertising campaign; Health
professionals and a consumer with Jennie Ericksen
at the launch of screening at Hamilton Hospital;
Family at the launch of the first screening hospital
in VIC, the Mercy Hospital Werribee, in August
2002; The Hon Mr Jeff Kennett at the launch of the
National PND Program in Sept 2001; photo
featured in community newspapers in the Werribee
area promoting the PND Program at Werribee
Mercy Hospital.
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2. Development of Materials to Address Community and Health Professional
Awareness of Perinatal Depression and its Treatment
Overview
In keeping with the philosophy of beyondblue, a major aim of the National PND Program
was a public health initiative to increase awareness of perinatal depression amongst the general
community and health professionals. This was achieved by a multifaceted approach:
Perinatal Women and Their Families
♦ Screening as many women as possible, and in doing so providing them with information about
emotional health in pregnancy and early parenthood (205,000 women received an information
booklet about emotional health during pregnancy and early parenthood). This, unlike many
similar initiatives, has included information for those from culturally and linguistically diverse
backgrounds (Arabic and Vietnamese booklets as well as translations on the PND Program
website in 19 languages) and specific information for those having multiple births;
♦ Provision of information postnatally in ALL child health centres in Australia (600,000
pamphlets);
♦ Promotional posters in antenatal clinics, GP clinics and Maternal-Child Health centres;
♦ 244 newspaper/magazine articles;
♦ 215 TV, radio and promotional activities.
Health Professionals
♦ Health professionals from 160 different organizations including maternity/obstetrics, maternalchild health, psychology, psychiatry and community & primary mental health, received training
in the detection and management of perinatal depression;
♦ 33,500 depression management guides and 25,000 guides to the use of the EPDS have been
distributed
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Health Professional Training
The acceptability and feasibility of screening are closely linked to training of health
professionals. The need for this was highlighted in our baseline findings of lower recognition of
antenatal depression, anxiety about medication in pregnancy and misconceptions about postpartum
psychosis. Training was well received and welcomed by a majority of health professionals, with
more requested. See Section 3 Evidence for evaluating changes in health professional and general
community’s knowledge of perinatal mood disorders for further discussion of this evaluation.
A total of 160 groups and organizations received training. A detailed list of these is in
Appendix B. The primary focus of training was on three main stakeholders – GPs, midwives and
MCHNs. However, the PND Program also provided training to psychiatrists, psychologists, medical
students, primary-mental health teams, community-health workers (including Aboriginal healthworkers and women Elders) and health administrators.
At the midwife/maternal-child health nurse (MCHN) level, the training focus was on
detection and management of perinatal mood disorders:
♦ what are the signs, symptoms and causes of perinatal depression?
♦ how do I talk about perinatal depression?
♦ how do I distinguish between real depression and “just a bad day”?
♦ how do I develop a management plan?
♦ when should I get a GP involved?
♦ what do I do if a woman says when wants to harm herself and/or her baby?
♦ how do I get a woman the help she needs?
♦ I’m not a counsellor, what do I do if a woman wants to tell me everything that’s
happened in her life?
Considerable time was also taken to training nursing staff on the use of the Edinburgh
Postnatal Depression Scale (EPDS). There are many misconceptions and misunderstandings about
the use of the EPDS. Training sought to teach the staff how to administer and use the EPDS for
investigating perinatal depression, how to interpret “cut-off scores” and using the EPDS as a
starting point for discussing psychosocial issues.
For General Practitioners (GPs), the training focus was similar (i.e. detection of depression
and development of a management plan) but was extended in the areas of:
♦ the use of antidepressant/psycho-active medication during pregnancy and breastfeeding;
♦ management of postpartum psychosis or postnatal depression in the presence of
other mental-health disorders ;
♦ consultation and liaison with mental-health specialists;
♦ links with other services and resources.
The guidelines developed by the PND Program for the suggested minimum information to
be provided at training sessions are in Appendix C. To also assist in training, there has been
development of a “Guide to Depression Management” and a “Guide to Using the Edinburgh
Postnatal Depression Scale”.
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Whilst health professionals have been provided with training in the areas where the Program
has a presence, there remains the need for both introductory training in those areas new to the PND
Program and ongoing training to consolidate knowledge for those already familiar with the
Program. To date, our education programs have not targeted professional groups such as
obstetricians or paediatricians, thus a continuation of the Program would see a focus on the delivery
of educational programs to these specific medical practitioner groups.
Consumer input to health professional training, to give a face to the lived experience of
perinatal depression, is also required. The PND Program is currently liasing with beyondbabyblues
and the various State-based PND support groups, to develop a single training package, which best
reflects the clinical, research and consumer knowledge that has been gained over the last three
years.
From top left: Family photo used on the promotional posters; GP liaison officers from Division of General Practice Northern Tasmania;
Midwives and allied health staff at PND training, Northern Hospital Nov 2004; photo used on the front cover of the Arabic PND booklet; Ms
Sara Brown, PND sufferer, at the launch of the National PND Program Sept 2001; Launceston General Hospital midwives at the launch of
screening Oct 2003; photo used for the front cover of the Vietnamese PND booklet.
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Media and Promotion
Improving the understanding and awareness of the general community and health
professionals has been a key priority area for the PND Program
To achieve this the Program has taken a number of different approaches:
♦ health professional training – as described in the previous section;
♦ development of information and promotion resources – a postnatal depression
information booklet and pamphlet, a series of posters and a website;
♦ active participation in community forums;
♦ presentations at national and international scientific conferences and;
♦ providing journalists, government departments, health services and the coroner’s
office with commentary on postnatal depression issues.
Over the period that the PND Program has been active, it has participated in:
244 newspaper/magazine articles (see Appendix D, for detailed list)
♦ 215 TV, radio and promotional activities (see Appendix D, for detailed list)
♦ 71,500 web-site visits
♦ 73 scientific conferences (see Appendix E, for detailed list)
♦
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Postnatal Depression Information Booklet
“Emotional Health During Pregnancy and Early Parenthood”
1st reprint
2nd reprint
3rd reprint
The PND information booklet was an important component of the PND Program for two
reasons. Firstly, it provided a resource for nursing staff that helped them feel more comfortable and
able to deal with women with perinatal distress. Feedback regarding the booklet has been hugely
positive and demand for it has far exceeded initial expectations. Secondly, the Program wanted to
evaluate the impact of giving women information about depression during pregnancy and early
parenthood, during the antenatal period. This booklet was made available to all women who
presented during their pregnancy (regardless of whether they participated in the screening program
or not), with the exception of women in WA who received a similar booklet but at delivery.
The booklet has under gone three reprints since 2001 and the last version has involved
beyondbabyblues, incorporating parts of their “When the babyblues won’t go away” booklet. A
total of 205,000 copies of “Emotional Health…” have been printed and distributed, both
nationally and internationally.
Such has been the success of “Emotional Health…”, a
version for families with multiple births (eg twins, triples, etc)
has also been developed. This booklet, whilst similar in
content to the original version, discusses some of the issues
particular to having a multiple birth, such as assisted
reproductive technology, the impact on older siblings and
hospitalisation. This booklet, which was produced as part of
the Western Australia intervention, was developed with the
assistance of the Australia Multiple Birth Association
(AMBA). A total of 13,000 copies of the multiples version
of “Emotional Health…” have been printed and
distributed, both nationally and internationally.
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A key component of the PND Program has been to provide information for women and
families from culturally and linguistically diverse backgrounds. Materials for this group are
minimal, with the Community Practitioners and Health Visitors Association (CPHVA) of the UK
producing a series of 5 booklets (Arabic, Urdu, Somali, Urdu and Bengali). Working Women’s
Health, a Melbourne based organization that provides multilingual health education, advocacy,
training, and research, also has postnatal depression information in a number of different languages
and formats.
1st reprint
2nd reprint
1st reprint
2nd reprint
The PND Program has worked closely with a number of organizations, including Working
Women's Health, NSW Multicultural Health Communication Service, NSW Transcultural Mental
Health Centre, Karitane, Fairfield Health Service and the Office of Women’s Health in Vienna, to
produce postnatal depression information in the following languages: Vietnamese, Arabic,
Assyrian, German, Greek, Bosnian, Chinese, Croatian, Farsi/Persian, Indonesian, Japanese,
Khmer/Cambodian, Korean, Lao, Macedonian, Punjabi, Serbian, Spanish, Thai and Turkish.
All these resources are available in pdf format via the PND Program website. The Arabic
and Vietnamese versions have also been printed in hard-copy format as part of the NSW antenatal
initiative (see NSW Antenatal Intervention Report in Vol II, for further discussion). A total of
57,000 copies of the Arabic and Vietnamese-language versions of “Emotional Health…” have
been printed and distributed, both nationally and internationally.
An evaluation of the usefulness of the booklet in presented in Section 3.
The National Project Manager has also
collaborated closely with the Office of Women’s
Health, Vienna, Austria, in the production of their
postnatal depression information booklet. This
version contains information from “Emotional
Health……” and there is acknowledgement of the
PND Program and beyondblue.
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Postnatal Depression Information Pamphlet
Whilst the PND information booklet has proved immensely popular, its physical format has
not always been appropriate. In particular, a number of organizations have sought PND information
that can be placed on display boards and/or taken home by individuals whilst for example, waiting
to visit a GP or MCHN.
As a result, the PND Information Pamphlet was developed. In essence, the pamphlet is an
abbreviated version of the booklet – covering areas such as the difference between postnatal
depression and the baby-blues, what to do if you have postnatal depression, how partners can help
and where to get help. The benefit of having this additional resource is that it can be placed on
notice boards and display holders, which don’t accommodate the booklets size and shape.
To facilitate distribution of the pamphlet, the Program entered into a 6-month agreement
with INFOMED. INFOMED are a brochure, poster and information distribution service, which
currently delivers resource material to 930 GP clinics across Australia. As part of this service, they
place in each general practice, an information board containing brochures on a wide variety of
health–related topics. The PND Program employed INFOMED to stock their information boards
with copies of the PND pamphlet and also provide each clinic with an information pack containing
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a letter of introduction, copies of the English-language and Arabic versions of the PND information
booklet, the GP management and EPDS guides and information about beyondblue, ybblue and
blueVoices. INFOMED also delivered to each practice copies of the PND promotional posters
ensuring that at least one of the posters was displayed in the waiting room.
By entering into this arrangement, the number of GPs receiving information about PND and
beyondblue significantly increased and, more importantly, exposure of the Program to the general
public was also be increased.
All States have also been active in promoting the pamphlet to MCH services. In both
Victoria and South Australia, every MCH centre received copies of the pamphlet, as well as the
other PND resources. In all States, details of the pamphlet were widely advertised and demand for
copies has been strong.
A total of 600,000 copies of PND information have been printed and distributed, both
nationally and internationally.
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Depression Management Guide
As part of the depression-screening initiative, a key component of the PND Program has
been to liase with GPs regarding changes in their patient’s mood during the perinatal period. This
has brought to the surface a number of difficulties - i) many GPs lack the experience and training in
dealing with people with a mental illness; ii) those GPs with mental health training often don’t have
experience with perinatal mental illness and; iii) a mental illness in pregnancy and the early
postnatal period has specific challenges, in particular the use of medication during this period.
The PND Program recognised these problems and developed a guide to assist GPs with
management of depression during the perinatal period.,
This guide covers the areas of how to make a diagnoses of depression (including DSM-IV
criteria, major risk factors for postnatal depression and other causes of depressives symptoms), how
to develop a management plan (eg when referral to a psychiatrist should be made, when to use
medication, how to mobilise family/partner support and the different types of counselling available)
and the use of medication during the perinatal period.
Importantly, in all states, relevant contact numbers for medication information were
included as well as links to local MCH services and details of specialist mother-baby or general
mental-health services.
Uptake of the guide has been broad. In Victoria, the Australia Capital Territory and
Northern Territory the guide has been endorsed by the peak bodies for divisions of general practice
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(GPDV, ACTDGP and GPPHCNT, respectively), whilst nationally gplearning, an online education
service managed by the Royal Australian College of General Practitioners, has added the guide to a
postnatal depression case-study for GP training.
As well as general practitioners, use of the guide has been picked up by midwifery
staff/students, MCHNs, psychologists/psychotherapists, obstetricians, social workers and perinatal
depression researchers.
A total of 33,500 copies of the depression management guide have been printed and
distributed, both nationally and internationally
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Guide To Using The Edinburgh Postnatal Depression Scale
Another area that the PND Program has recognised as inhibiting successful detection of
perinatal mood disorders is a lack of understanding by health professionals of the use of depressionscreening instruments. In particular, health professionals knowledge of the Edinburgh Postnatal
Depression Scale (EPDS), one of the most widely used perinatal depression screening instruments,
needs significant improvement. Whilst a majority of professionals have heard of the scale, many do
not understand how to use it or how to interpret the results of it.
Because of this, the PND Program developed “The Edinburgh Postnatal Depression Scale –
A Guide to Use” which discusses to the importance of screening for depression during pregnancy
and early parenthood, and guidelines for administering the EPDS. It also includes a sample of the
EPDS, information on how to interpret cut-off scores and tips for further investigation
As with the depression-management guide, uptake of the EPDS guide has been broad – GPs,
midwifery staff/students, MCHNs, psychologists/psychotherapists, obstetricians, social workers and
perinatal depression researchers. Requests from consumers have also been high – evidence that
women are taking a more pro-active approach to their care and seeking out information that they
can share with their treating health professional.
A total of 25,000 copies of the EPDS guide have been printed and distributed, both
nationally and internationally.
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Promotional Posters
To promote the PND Program and beyondblue, a series of promotional three posters were
developed. These have been distributed to numerous organizations including antenatal
clinics/hospitals, GP clinics, MCH centres, community health centres, Universities, Centrelink and
high schools.
Of these, the mother-infant poster has proved the most popular and engaging. One criticism
of the remaining two posters, in particular the family poster, is that women aren’t able to identify
with the image as it presents “the perfect family” which is often vastly different from their own
circumstances.
It is also interesting to note the different approach taken by the PND Program compared to,
for example, the Community Practitioners and Heath Visitors Association (CPHVA) in the UK.
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They have also developed a poster series in English, as well as Arabic, Urdu, Chinese,
Somali and Bengali. The images used in their posters are of women with a neutral expression or, in
the case of the two English posters, women in obvious distress. Unlike the PND Program, the
CPHVA posters also list symptoms of depression.
The effectiveness of the posters has not been evaluated as part of this report. Anecdotal
evidence suggests, however, they are useful and raise the issue of perinatal depression in a nonconfrontational way. It may, however, be of use to modify the posters by making them more
informational (eg by adding a list of the symptoms of depression) and by using images of women
from culturally and linguistically diverse backgrounds.
A total of 15,000 copies of the promotional posters have been printed and distributed,
both nationally and internationally
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www.beyondblue.org.au/postnataldepression
The development of the PND Program website, as a satellite site of the beyondblue website,
has proved has been a vital component of the activities of both organizations. Although, in our
original proposal, there was no facility for a website, the PND Program recognized the importance
for there to be a presence of the web – allowing 24hr access to information and the opportunity for
people from overseas to see the approach Australian researchers are taking to the investigating
perinatal mood disorders.
In the period Jan 2005 – July 2005, there were 71,500 visits to the web-site The five most
popular pages, in order, were – the Homepage (18337 visits), Educational Materials (4390 visits),
About the PND Program (3315 visits), Personal Experiences (2866 visits) and Frequently Asked
Questions (3024 visits).
Requests for information, through the website, have come from Australia, New Zealand,
England, Scotland the USA, Canada, Italy, Germany, Vienna, Finland, Russia, Hong Kong, Israel,
and Pakistan.
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3. Evaluation of Changes in Health Professional and General Community’s
Knowledge of Perinatal Mood Disorders
Overview
Prior to commencement, and at completion of the PND Program, postnatal women and
health professionals involved in perinatal care were surveyed with respect to their knowledge and
attitudes to perinatal depression and its treatment. Women surveyed in the end evaluation had all
been involved in the program receiving at minimum the information booklet and EPDS. Health
professionals had received at minimum the management guide and in most cases, training.
At baseline evaluation the health professionals, particularly MCHN and GP’s over
midwives, had a significantly higher knowledge of and ability to recognize depression than
postnatal women. There were significant differences in treatment preferences, most strongly
between the pharmacological preferences of the GP’s and that of natural therapies by the women.
After involvement in the study, postnatal women:
♦ were better able to recognize and assess their own symptoms and coping;
♦ showed marked improvement in the ability to recognize depression in a hypothetical
situation (though still significantly less than health professionals);
♦ were more accepting of the use of antidepressant medication postnatally;
♦ reluctance remained to consider medication antenatally;
♦ decreased their help seeking behaviour in the non-depressed group and had increased
satisfaction with the help they did receive and;
♦ a significant number of women with high EPD scores did not seek treatment, even if
they agreed with the “diagnosis” of depression.
The booklet appeared to have the strongest impact on those of low to moderate EPDS scores
and when given in pregnancy rather than at delivery.
There was a significant increase in perinatal depression knowledge in MCHN and GPs (the
latter showing the greatest improvement) but with a decrease in that of midwives, highlighting the
importance of more intensive training and support for this group.
GP’s relied less on mental health professionals, with no increase in barriers or a negative
impact of the PND Program’s implementation. The importance of the GP link to screening was
highlighted by a significant number of depressed women not raising depression as an issue, even
when midwives or MCHNs had suggested this to them.
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Aims
1. To assess the effectiveness of the beyondblue National PND program in:
♦ increasing awareness of perinatal depression in treating health professionals and
perinatal women;
♦ improving knowledge of perinatal depression and its treatment in treating health
professionals;
♦ improving health professional’s confidence in treating perinatal depression;
♦ improving access to services by perinatally depressed women.
2. To assess the feasibility and acceptability of routine screening antenatally and postnatally for
depression.
Method
Ethics approval was received from 43 maternity hospitals/area health services. At the
commencement of the project, meetings were held with key stakeholders, including the College of
General Practitioners, State Divisions of General Practice (DGP) and Primary Mental Health Care
coordinators. Articles about the program appeared in a number of divisional newsletters and widely
distributed publications for GPs.
Population
Evaluation was concentrated in the regions in which the PND Program operated, prior to
commencement and at its completion.
A baseline evaluation (BE) of women and health professionals (GPs, Maternal-Child
Health Nurses and Midwives) assessing knowledge, level of depression and services accessed was
conducted (Buist et al x 1 accepted; 1 submitted) prior to the PND Program commencing.
At the end evaluation (EE), a random sample of postnatal women who had participated in
screening, and of health professionals was sent questionnaires evaluating the project, with a
stamped addressed return envelopes. This was conducted one to three years after introduction, by
the PND Program, of routine screening.
Health Professionals
Health Professionals were asked to complete:
1. Information about their own professional experiences including type of professional
training, years of experience, how often they deal with perinatal problems and how they
manage with them, methods of diagnosing pregnancy-related depression, ‘barriers to
successful treatment, and the impact on their practice of seeing perinatal emotional
problems;
2. Experience of perinatal depression screening;
3. Knowledge questionnaire;
4. Vignette of a woman with perinatal distress and options for management.
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6-12 Week Postnatal Women
Women were asked to complete:
1. Survey of Services Used. Basic demographic information, problems during pregnancy
and questions relating to the adequacy of support were asked. Information about any
additional help sought and feelings of ante or postnatal depression and anxiety were
gathered. Questions about treatment sought for depression and the perceived satisfaction
with the treatment received were also asked. This was also recorded at baseline;
2. Experience of being involved in the screening program;
3. Edinburgh Postnatal Depression Scale;
4. Vignette of a woman with perinatal distress and options for management.
Questionnaires
Experience of Perinatal Depression Screening
Participants were asked about their involvement with the program, with questions on a likert
scale of usefulness of the educational material and the degree of comfort in completion and use of
the EPDS (health professionals were asked for their feedback/impressions from their patients as
well as their own comfort in administration). Women were also asked if they had been told they
scored positive and what their reaction/response to this was.
Knowledge Questionnaire
This consisted of ten multichoice questions about definition, frequency and treatment of
postnatal depression developed by Watt & Pope (1997).
The Edinburgh Postnatal Depression Scale
The EPDS was administered as a screening tool for possible current depression. The EPDS,
a widely used 10-item questionnaire developed for screening for PND in the community, has good
reliability and validity, and has also been validated for use in an Australian population. This was
administered at maternal-child health services.
Results
Response Rates
The overall numbers of responses to the baseline and end evaluation surveys are recorded in
Table 2; not all respondents completed all questionnaires. Response rates varied from state to state
and between professional groups, from 20% to 80%.
Table 2. Groups involved in Baseline Evaluation& End Evaluation
Respondent
Postnatal Mothers
MCHN
Midwives
GPs
Baseline Evaluation
525
338
569
246
End Evaluation
627
302
377
237
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Summary of Baseline Findings
Although knowledge level was similar among professional groups, MCHNs had higher
levels of awareness of perinatal depression. Both GPs and MCHNs were more likely than midwives
to recognize the need for providing help to women with emotional distress. Depression was more
likely to be considered postnatally than antenatally in all groups, with GPs most likely to provide
this diagnosis. GPs had a significant propensity to recommend antidepressants, and midwives to
select non-specific medications.
There are significant differences between health professionals and postnatal women in the
recognition of depression associated with childbirth (Table 3), with women having a low awareness
of perinatal depression. In addition, women have a strong preference for natural therapies, in
contrast to GPs pharmacological approach. Though those with higher EPDS scores were more
likely to go for help, this was more likely to be sort for general and baby related issues than for their
own depression
Table 3. Recognition/Awareness of Postnatal Depression in Health Professionals and Postnatal
Mothers at Baseline (BE) and End Evaluation (EE). * p<0.01, women cp health professionals
GP
MCHN
Midwives
Mothers
Recognition
BE
EE
97%
95%
90%
85%
89%
89%
47%*
60%*
Need for Help
BE
EE
93%
90%
90%
90%
83%
85%
67%*
67%*
Demographic Profile of Postnatal Mothers
Demographics of the mothers at baseline and end evaluation were compared and presented
in Table 4. The samples were statistically similar with respect to country of birth and English being
first language (98%). They differed however on parity and marital status, and income though with
respect to the latter only 6.0% left income unanswered at the end evaluation compared to 13.7% at
baseline.
Emotional Health of Mothers
The mean EPDS score of postnatal women was lower at end evaluation (4.9 cp to 5.8,
p < 0.001), but with a similar proportion of women with elevated scores >12 (6.9% at baseline,
7.3% at end evaluation).
With respect to mode of delivery, of note, those who had a normal birth or elective
Caesarean were more likely to be feeling positive about the birth experience (69% & 62%,
respectively) than those who had emergency Caesarean sections (26%) or forceps delivery (36%).
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Of women who had no problems breastfeeding, 84% were continuing to breastfeed; of those
who had difficulties only 22% continued.
For 83% mothers who felt supported by their partner, this was closely related to the ease
with which they reported managing parenting (p < 0.0001).
Table 4. Demographic profile of postnatal mothers at Baseline (BE), End Evaluation (EE) &
National Average 2002(♠ABS Census 2001, women > 15 years of age; * Australian Institute of
Health and Welfare, “Australia’s Mothers and Babies 2002” (women who delivered in 2002),
December 2004)
Classification
Born in Australia
Age (average yrs)
First Child
Married
Income up to $20,000
Income $20,001 – $40,000
Income $40,001 – $60,000
Income > $80,001
Mode of Delivery – Vaginal
Mode of delivery – LUSC
BE (%)
81
64
71.6
EE (%)
80
31
55
62.7
13.9
27.2
28.4
12.1
-
18.7
21.1
27.9
16.7
63 (9% assisted)
28 (12% elective, 16% emerg.)
National Ave. 2002 (%)
77.9*
29.4*
41.1*
50.3♠
62.1 (10.8% assisted)*
27*
Awareness – Perinatal Depression
There was no change between baseline and end evaluation in the positive awareness of
depression by health professionals, with no differences between states. GPs were at both
evaluations the least likely to miss the diagnosis (i.e. lowest negative awareness).
Of note postnatal mothers showed a significant increase in identifying the hypothetical
woman as being depressed – from 47% at baseline to 60% at the end evaluation (Table 3) with
no change in whether they thought she needed assistance. This suggests that, at baseline and end
evaluation, women felt the hypothetical woman needed help and the Program had resulted in them
better identifying why she need help i.e. that she may be depressed. This still remained significantly
lower than the health professionals, however. Relevant to this, there was significant decrease
from baseline to end evaluation in the number of women who had a low EPDS and who
thought they were depressed or anxious; from 24% to 15%. This again suggests the Program
impacted on understanding of depression and what are “normal adjustment difficulties”.
Awareness – Booklet
Overall, 81% of mothers remembered receiving the “Emotional Health During Pregnancy
and Early Parenthood” booklet. When this was broken down by State, just over half (54%) of
women who were given the booklet at delivery (WA) recalled getting it. In other States, where the
booklet was given during pregnancy, up to 87% of women recalled receiving it.
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35% of women reported reading the book at least a few times and only 16% reported not
reading it at all. Of those who read the booklet, 54% found the material to be of some help, and
another 24% were unsure. Having a high EPDS was not found to be related to reading the booklet,
but those women with EPDS <13 were more likely to find it helpful.
Health Professional Knowledge
Whilst there were no differences in levels of experience between the two samples (baseline
and end), GPs had had significantly more years of experience than the nurses, and the MCHNs
more years of experience than the midwives.
At baseline evaluation, the mean knowledge scores were similar for the three groups of
health professionals. Over the time of the Program, there was significant improvement in the GPs
knowledge levels (mean result 65% at baseline, increased to 69% at end evaluation, p = 0.019),
bringing them to a similar level as the MCHNs (mean 69% at baseline, 68% at end evaluation).
Knowledge was lowest in the midwives, and this decreased over the Program (64% at baseline, 59%
at end evaluation, p < 0.05). It is likely this occurred because, in this sample, less of the midwives
had received training compared to the other health professionals (see below).
Of GPs, 66% felt that they had appropriate training to manage mood disorders during the
perinatal period - 13% having attended beyondblue workshops, 24.6% “in-house” training, 30% had
attended Sphere training and 33% drug company sponsored training. Only 0.4% of GPs received no
training in PND management.
Of MCHNs, 58% felt they had adequate training - 72% reported “in-house” training, 22%
attended a beyondblue workshop whilst 11.5% had received no training at all.
Of midwives, only 32% felt they had adequate training, with 42.4% receiving no training;
40% had “in-house” training and 16% attending a beyondblue workshop.
Recommendations/Preferences for Treatment
For GPs the most common recommendations for antenatal and postnatal care was
counselling, antidepressants and referral to a mental health specialist. Both at baseline and end
evaluation, postnatal depression was more likely than antenatal depression to be recognized and
treated. At end evaluation, there was less reliance by GPs on referral to a mental health
professional (83% down to 67%); this also decreased for MCHN suggesting training and support
was successful in helping them manage more women with postnatal depression.
A summary of key recommendation for treatment is shown in Table 5. At both time
periods there was a higher preference towards antidepressants in health professionals than
the mothers. At end evaluation, postnatal women, however, were more likely to consider use
of antidepressant postnatally than they had at baseline.
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Table 5. Recommendations/Preferences for Treatment at End Evaluation
(Baseline Evaluation figures in parenthesis)
*p<0.05; ***p<0.001, women compared to health professionals
Treatment
Psychological
Antidepressant
GPs
Antenatal
Postnatal
77%
86%
78%
99%
MH specialist
47%
Social work
Referral to GP
Antipsychotics
-
67%
(*83%)
18%
MCHNs
Postnatal
80%
96%
Midwife
Antenatal
59%
55%
-
91%
21%
59%
-
Mothers
Antenatal
Postnatal
29%***
73%*
(*53%)
-
8%
There were a number of differences noted between groups on recommendations of treatment
that did not change over time; in general these can be summarized by GPs adopting more of a
medical model, and less likely to favour naturopathy, self help, yoga and vitamins and minerals than
the nursing groups. Midwives in turn were more likely to favour naturopathy, St John’s Wort, a
special diet and sleeping tablets than MCHNs, who favoured GP referral more than the midwives.
Changes in Help Seeking Behaviour
At baseline, 64% women had sought help; this had decreased to 43% at end evaluation.
However, 66% of women with a high EPDS score, compared to 42% of women with a low EPDS
score, sought help – so whilst the % of depressed mothers seeking help hadn’t changed from
baseline to end evaluation, there was a significant decrease in those with a low EPDS score
seeking help.
Of those women with a high EPDS score, 30% ignored the advice to seek help, and this was
independent of whether they agreed with the score or not. Satisfaction with supports was
significantly increased, from 46% mothers at least moderately satisfied at baseline, to 77% at end
evaluation. There was a trend towards depressed mothers not being as satisfied with the treatment
received, but this did not reach statistical significance (p=0.06).
Barriers to Treatment
Health professionals identified a number of barriers to treatment, with significant differences
between the three groups. GPs noted that up to 50% of women who had an EPDS score >12 and
who came to see them, did not raise the possibility of depression, emphasising the importance of the
health professionals need to do so and to link-in with the perinatal services providing depression
screening.
GPs heightened awareness of depression most likely explains the increase since baseline of
the their ability to pick-up on the women’s reluctance to raise the issue of depression (see Table 6).
Of particular importance is the finding that there was no apparent increase in barriers and
negative impact on GPs from the PND Program routinely advising women with high EPDS
scores to seek their assistance.
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Table 6. Perceived Barriers to Treatment of Perinatal Depression; Baseline Evaluation (BE) results
in parenthesis.
Reason
Unavailability of resources
Reluctance of mothers to seek help
Reluctance of family
Time pressure
Economic
GP (BE results)
50% (47%)
51% (19%)
24% (23%)
39% (82%)
20% (31%)
MCHN
43%
70%
39%
51%
24%
Midwife
22%
58%
21%
33%
17%
Discussion
Increasing Awareness of Perinatal Depression in Health Professionals and Perinatal Women
The most striking finding of the baseline study was the differences in levels of awareness of
depression between health professionals and postnatal mothers, with a high level of awareness of
postnatal depression in GPs and low level of awareness of depression in women.
The high level of recognition was maintained over time in all the health professionals, but
with no significant improvement in awareness of antenatal depression. However, there was a highly
significant impact on the women’s awareness of depression (47% to 60%) and acceptance of
antidepressant medication postnatally (53% to 73%), suggesting that the combination of posters,
media campaign and antenatal booklet was highly successful in achieving its aim.
Improving Knowledge of Perinatal Depression and its Treatment in Health Professionals
Improving Health Professional’s Confidence in Treating Perinatal Depression
The Program tackled this aim with a variety of training programs and provision of
management guides. This was most successful with GPs, whose knowledge increased significantly.
They were more satisfied that they were able to care for perinatal women, and were doing so more
with less referrals to specialists. There was no apparent negative impact, though lack of resources
remained an issue.
The Program was less successful in improving knowledge and confidence in midwives. GPs
and MCHNs were already identifying women with depression as part of their practice prior to the
introduction of the PND Program; until this Program, antenatal emotional health care was largely
ignored in most of the hospitals. Nearly half (42.2%) of the midwives still had not received training
after the Program, compared to 0.4% GP’s and 11.5% MCHN who had not; this suggests more
training is required. Factors such as rosters and lack of exposure to training for those midwives on
the ward rather than the antenatal clinic may need to be considered in the delivery of such training.
The midwives perceived a great need for training and it is likely that for routine screening to
be successful, training and support needs to be more frequent than this Program offered. Despite
this however, the midwives were very positive about the benefits of the program, and supported its
continuation if ongoing support and training were provided.
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Improving Access to Services by Perinatally Depressed Women
Whilst this program did not provide new services, it was anticipated that through better links
and referral paths that more women with depression/stress would access their GP and other support
services. One concern from a number of stakeholders at the commencement of the program was that
this might create an unsustainable deluge on already existing services.
Our results suggest that with better emotional care and information in pregnancy, those
women who are not depressed are better informed and less likely to access services, but when they
do they are more satisfied; depressed women may have a tendency to be less satisfied. Depressed
women are more likely to access help though still not necessarily for themselves, emphasizing the
importance of linking perinatal screening to GPs. Thirty % of women do not specifically respond to
the advice given to them because of the screening process – possibly because some disagree with
the EPDS score, but other issues (eg stigma) appear to be more relevant.
Conclusions
A key task of the beyondblue National PND Program was to assess the impact of a high
level of increased information and education provision on relevant health professionals and
perinatal women with respect to changes in awareness, knowledge and recommendations or access
to treatment, with an assessment of any adverse impact on services of an increased demand.
This was achieved by carrying out a baseline evaluation prior to the programs
implementation and a repeat of this after implementation.
This evaluation demonstrated:
♦ an increased awareness of depression in postnatal women, with improved self
evaluation;
♦ an increase in GP knowledge;
♦ the importance of training and support in the implementation and ongoing process of
screening;
♦ more training is required for midwives;
♦ further training needs to continue to emphasize antenatal depression, particularly for
midwives;
♦ further work is needed to help depressed women access appropriate services;
♦ there was no significant negative impact of screening on service use, rather it seems that
emotional health was incorporated into appointments that were already occurring, with
greater health professional awareness of the need to raise the issue and not rely on the
woman to do so and more confidence to be able to manage locally.
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4. Provision of a National Database of Young Families in Australia
Overview
Over forty thousand women were screened for depression across Australia, the majority of
which were in public hospitals in major cities. The screened population included samples from rural
& remote populations, as well as private hospital patients. Further analysis over the next months
will reveal more detailed insight. Summaries of the key preliminary findings are presented here.
This study confirms high levels of distress in perinatal women, with rates of postnatal
depression (as per EPDS scores) as similar to other Westernised countries - 15.7% of women scored
>9 postnatally. Antenatal rates, depending on the cut-off score used, were lower than postnatal rates
at 5.4% if >14, the currently favoured cut-off score, was used. This, however, is misleading as
lower rates were recorded in NSW (half the total sample recruited) who screened in 1st trimester,
when rate are lower. When the trimester screened is taken into account, rates of depression are
again, similar to international figures.
Comparison of the EPDS with two other screening instruments (K10 and Sphere) confirmed
the need for a specific tool, such as the EPDS, for perinatal women.
State differences were noted in depression rates, with NSW and WA having lower rates both
antenatally and postnatally than other States. Factors possibly contributing to this include:
♦ different demographics variables in the samples, eg higher socio-economic status &
education levels (both States), higher culturally and linguistically diverse background
population (NSW);
♦ earlier timing of antenatal screening (NSW);
♦ long-standing depression- screening and psychosocial assessment program (both States).
Risk factors for antenatal and postnatal depression were similar, and generally consistent
with previous studies, but with some differing relative importance:
♦ past history of abuse, anxiety and depression were the strongest predictors for
depression;
♦ stress, mood and medical complications through pregnancy were also significant risk
factors;
♦ emotional and/or practical support was important, but appears to be more generic rather
than specifically from partner;
♦ lower socio-economic status was a significant risk factor for depression;
♦ higher education, age and socio-economic status were generally protective ;
♦ young mothers were particularly at risk;
♦ a culturally and linguistically diverse background appeared somewhat protective for
antenatal depression and a slight risk for postnatal depression;
♦ being Indigenous increased the risk of perinatal depression.
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Demographics Overview
Forty thousand, three hundred and thirty three (40,333) pregnant women were recruited to
the depression-screening component of the PND Program, from all States and the ACT, excluding
the NT. The largest number of women was recruited from NSW (21285; 52.8%), reflecting the
procedures, policies and networks already established in this State. The smallest number of women
was recruited from Tasmania (749; 1.9%). The data includes 611 (1.7% of overall sample)
Indigenous women. Postnatal data was collected from 12,535 women.
The average age of the pregnant women was 30 years (range 14 - 54 years), with a mean of
2.5 pregnancies and 1.1 children. An overview of the national demographic data is presented in
Table 7. In summary:
♦ 74% of women were Australian-born similar to the 2002 national average of 77.9%;
♦ the largest ethnic group involved were those from Asia (8%) and New Zealand/Oceania
(5.0%);
♦ 42% of women achieved Year 12 as their highest level of education, with 22.4%
completing a Bachelor degree or higher; 14.3% of women did not complete their
schooling;
♦ the sample recruited was predominantly from the public sector, with 1114 women from
private hospitals and 255 at a birth centre. This represents 3% of the total sample, and is
significantly smaller than the 30% women who delivered privately in Australia in 2002.
This is particularly relevant and needs consideration in the interpretation of the results as
lower socio-economic status (SES) and lower education levels have been indicated as
risk factors for depression;
♦ a small sample of women who delivered in rural regional and remote centres were also
recruited – 2517 women (6.5% of total sample).
Demographic data by State is provided in Table 8. In summary:
♦ the average age of women was similar in each State but with more in the <21 years age
bracket in QLD and TAS & in the >35 years age bracket in WA;
♦ WA and QLD had the highest numbers of Indigenous women participating;
♦ all but two states had similar levels of Australian born women; NSW had a higher
number of other ethnic groups. TAS had the highest Australian-born group;
♦ women were recruited to the PND Program at different times during their antenatal
period. This was necessary as the recruitment protocols were adapted to the practicalities
of the individual hospital/area-health services. The average recruitment time was 26
weeks gestation - ACT/SA/VIC at 28-30 weeks, NSW & TAS at 16-18 weeks, QLD at
20 weeks and WA at 33 weeks;
♦ higher education levels were noted in women from ACT and WA and lower in QLD;
♦ ACT women had a significantly higher joint income; this data was not available on
NSW however;
♦ married/Defacto status was higher in ACT, NSW and VIC and lowest in QLD;
♦ medical complications of pregnancy, particularly varicose veins, excessive vomiting and
diabetes were significantly higher in the QLD than other States.
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Table 7. National Demographic Overview
Demographic Variable
Total Number of Women Recruited to national Screening Program
Average Age (yrs)
Number of living children
Number of previous pregnancies
Estimated weeks pregnant (when recruited)
Aboriginal/Torres Strait Islander
Country of Birth
- Australia
- New Zealand/Oceania
- Europe & America (North & South)
- Africa (All)/Middle East
- Asia
Main Language Spoken at Home
- English
- European
- Asian
- African/Middle Eastern
- Other
Level of Education Completed
- Did not finish school
- High School (Yr 7-12)/Apprenticeship
- Certificate/Diploma Level
- Bachelor Degree/Grad Dip/Grad Certificate Level
- Postgraduate Degree
Joint Income
- Up to $20,000
- $20,001 - $60,000
- $60,001 - Greater than $80,001
- Do not wish to divulge
Occupation
- Managers & Administrators
- Professional OR Semi Professional Medical/Health/Science, Building,
Finance & Other Worker
- Tradesperson & Related Worker
- Secretarial, Administrative or Financial Workers/Specialist Clerical or
Sales Worker/General Clerical or Sales, Security, Personal Service or
Domestic Worker
- Plant, Machinery or Vehicle Operator
- Labourer & Related Worker
- Student, Unemployed or Other
Marital Status
- Married/De Facto
- All other including “No partner”
Medical Problems With Current Pregnancy
- High blood pressure
- Bleeding/threatened miscarriage
- Excessive vomiting
- Varicose veins, haemorrhoids or similar
- Bladder or kidney infection
- Diabetes
- Other
PND Program
40,333
30.3
1.1
2.5
26.2
3.3%
National Ave.
N/A
29.4#
1.7♠
N/A
N/A
3.6%#
74.4%
5.0%
9.3%
3.2%
8.0%
77.9%#
2.5%#
7.1%#
3.3%#
9.3%#
84.6%
1.8%
7.8%
4.5%
1.3%
79.2%@
6.7%@
4.8%@
1.4%@
2.0%@
14.3%
42.5%
20.9%
18.7%
3.7%
N/A
N/A
15.4%@
11.9%@
1.4%@
11.6%
48.3%
27.5%
12.7%
3.6%@
38.8%@
42.4%@
1.7%@
2.7%
30.0%
5.7%@
32.6%@
5.0%
41.4%
3.0%@
47.2%@
1.1%
3.8%
16.3%
2.5%@
7.0%@
14.3%@*
82.3%
22.1%
50.3%@^
49.7%@$
5.6%
9.0%
18.3%
21.2%
4.0%
10.5%
6.9%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A – Data not available or not collected
# - from Australian Institute of Health and Welfare, “Australia’s Mothers and Babies 2002”, December 2004
@ - from Australian Bureau of Statistics, National Census, 2001
* - Student and Unemployed only; ^ - ABS does not have a classification for “De facto”; $ - ABS does not have a
classification for “No partner”
♠ - from the Household, Income and Labour Dynamics in Australia (HILDA) study (www.livinginaustralia.org/index)
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Table 8. State Demographic Overview
Demographic Variable
Total Number of Women Recruited
Average Age (yrs)
Number of living children
Number of previous pregnancies
Estimated weeks pregnant (when recruited)
Aboriginal TS Islander (% state total)
Country of Birth
- Australia
- New Zealand/Oceania
- Europe & America (North & South)
- Africa (All)/Middle East
- Asia
Main Language Spoken at Home
- English
- European
- Asian
- African/Middle Eastern
- Other
Level of Education Completed
- Did not finish school
- High School (Yr 7-12)/Apprenticeship
- Certificate Level/Diploma Level
- Bachelor Degree/Grad Dip Level
- Postgraduate Degree
Joint Income
- Up to $20,000
- $20, 001 - $60, 000
- $60, 001 - Greater than $80, 001
- Do not wish to divulge
Marital Status
- Married/De facto
- All other including “No partner”
ACT
984 (2.4%)
30.7
0.8
2.1
28.5
1.1
NSW
21285 (52.8%)
30.4
1.0
2.7
16.1
N/A
VIC
5079 (12.6%)
30.7
1.3
2.3
28.5
1.2
TAS
749 (1.9%)
28.8
1.7
2.3
18.4
3.6
SA
3355 (8.3%)
30.4
0.9
2.3
29.7
1.5
WA
4840 (12%)
30.9
0.9
2.3
33.2
4.4
QLD
4041 (10%)
28.9
1.5
2.5
19.3
7.2
84.3
2.0
6.4
1.2
6.0
50.3
8.4
13.5
8.0
19.8
83.9
3.7
6.4
1.3
4.7
96.1
1.1
1.6
0.7
0.3
84.3
1.7
9.2
0.8
4.0
74.2
4.0
12.7
3.7
5.6
87.6
6.6
3.7
0.5
1.5
94.7
0.8
2.7
0.2
1.6
73.5
2.8
14.0
8.1
1.6
94.3
1.0
1.7
0.9
2.0
99.6
0.0
0.3
0.0
0.1
95.9
1.3
1.7
0.3
0.9
94.8
1.1
2.2
1.6
0.3
98.6
0.3
0.4
0.1
0.7
4.8
34.2
19.1
31.2
10.6
13.2
37.5
20.9
23.6
4.7
14.3
42.8
22.3
17.7
2.9
9.3
57.8
16.3
14.5
2.2
18.6
44.2
19.8
15.1
2.4
12.7
37.6
21.1
23.3
5.2
16.6
48.2
21.5
11.8
1.8
6.1
30.6
54.6
8.7
N/A
N/A
N/A
N/A
8.9
48.1
31.3
11.8
19.9
52.9
20.5
6.8
11.1
51.5
22.0
15.4
13.2
45.7
26.6
14.4
12.8
52.5
23.4
11.3
91.1
2.2
92.2
7.5
87.1
4.1
79.2
11.6
83.0
6.3
80.0
3.9^
70.6
11.9
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Demographic Variable
Occupation
- Managers & Administrators
- Professional OR Semi Professional
Medical/Health/Science,
Building, Finance & Other Worker
- Tradesperson & Related Worker
- Secretarial, Administrative or Financial
Workers/Specialist Clerical or Sales
Worker/ General Clerical or Sales,
Security, Personal Service or Domestic
Worker
- Plant, Machinery or Vehicle Operator
- Labourer & Related Worker
- Student, Unemployed or Other
Medical Problems With Current Pregnancy
- High blood pressure
- Bleeding/threatened miscarriage
- Excessive vomiting
- Varicose veins, haemorrhoids or similar
- Bladder or kidney infection
- Diabetes
- Other
VOL I: National Screening Program
ACT
NSW
VIC
TAS
SA
WA
QLD
8.9
31.6
3.1
46.2
2.5
26.0
2.1
17.3
1.0
21.1
2.4
37.1
3.5
27.5
6.4
40.3
3.9
17.7
4.1
43.2
3.6
33.8
5.2
45.4
6.6
50.1
4.6
40.2
0.1
0.4
12.2
0.2
0.7
28.3
1.4
3.3
19.4
1.1
2.9
39.1
0.9
9.0
17.4
1.6
2.3
N/A
0.6
6.0
17.5
2.6
11.7
8.5
18.7
4.3
2.4
8.1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
5.1
9.9
10.0
12.3
3.4
2.7
6.5
2.5
13.5
12.2
10.7
6.0
1.3
5.5
3.9
8.0
10.1
16.4
4.0
1.7
4.3
10.6
7.8
13.1
18.1
4.9
5.7
12.0
2.6
8.5
43.6
43.1
3.3
35.5
3.1
N/A – Data not available or not collected
^ - does not include “No partner”
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Mood Data
Internationally, the Edinburgh Postnatal Depression Scale (EPDS) is the most widely
accepted screening instrument used in the perinatal period. The EPDS was developed by Cox,
Holden & Sagovsky (1987), and was designed to allow screening of postnatal depression in the
primary care setting. It excludes some symptoms that are common in the perinatal period (tiredness,
sleep disturbance, irritability) that other depression instruments include, as such symptoms do not
differentiate between depressed and non-depressed postnatal women.
As a screening instrument, the EPDS should only be used to assess a woman’s mood over
the past seven (7) days. High scores do not themselves confirm a depressive illness and, similarly,
some women who score below a set threshold might have depression. Thus, the EPDS does not
provide a clinical diagnosis of depression and it should not be used as a substitute for full
psychiatric assessment or clinical judgement. Importantly the EPDS cannot be used to predict
whether or not a respondent will experience depression in the future - it can only be used to
determine current mood.
The EPDS is a 10-item self-report questionnaire. Women are asked to select one of 4
responses that most closely represent how they have felt over the past seven (7) days. Each response
has a value of between 0 and 3 and the total EPDS score is calculated by adding the values of the
response for each item, resulting in a possible total score range of 0-30. If the woman scores 0-9 the
likelihood of depression is considered low; 10-12 the likelihood of depression is considered
moderate and; 13 or more the likelihood of depression can be considered high
The EPDS was evaluated at several cut-off scores. A score of >12 (i.e. 13 or more) was used
in this study, both antenatally and postnatally, to warrant “notification” of high risk of being
depressed. The purpose of this was to minimize the number of false positive results. Evidence in the
scientific literature has suggested that, where community samples are involved, EPDS cut-off scores
of >9 (i.e. 10 or more) postnatally and >14 (i.e. 15 or more) antenatally, are more appropriate.
Antenatally, the suggestion is that “15” is a preferred cut off score because of the high incidence of
“anxiety” that occurs around this time, falsely elevating the frequency of high scores.
The mean EPDS score was 6.9 (SD 4.4) antenatally and 5.4 (SD 4.4) postnatally, the higher
mean antenatally reflective of the need for higher cut-off score at this time point. Rates of antenatal
and postnatal depression by EPDS score are detailed in Table 9.
Table 9. Rates of Antenatal and Postnatal Depression by EPDS Scores
Time point and Cut-Off
Antenatal EPDS >14
Antenatal EPDS >12
Antenatal EPDS >9
Postnatal EPDS >12
Postnatal EPDS >9
Antenatal & Postnatal EPDS >12
Women with Score (%)
5.4
8.9
19.6
7.6
15.7
2.7
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The distribution of antenatal EPDS scores is shown in Figure 2; postnatal EPDS score are
shown in Figure 3.
Figure 2. Distribution of Antenatal EPDS Scores
Figure 3. Distribution of Postnatal EPDS Scores
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The postnatal rates of depression, are consistent with studies in Westernised populations
using an EPDS > 9, which generally quote 13-14% (O’Hara & Swain 1996). Our rate, 15.7%, is
slightly higher than this and is probably accounted for by a higher number of those at risk, in
particular those from lower SES and education level, given our predominantly public hospital
population.
The mean EPDS score and prevalence rates of the individual states are shown in Table 10.
Table 10. Mean EPDS Score and Prevalence Rates for Each State
(* p < 0.05; ** p < 0.01; *** p < 0.001)
State
ACT
NSW
QLD
SA
TAS
VIC
WA
Antenatal
Mean
(SD)
6.5 (4.9)
7.5 (3.9)
6.4 (4.8)
7.0 (4.6)
7.0 (5.6)
6.3 (4.8)
5.6 (4.3)
Ante
EPDS >9
Ante
EPDS >12
Ante
EPDS>14
22.5%
17.6%*
21.9%
26.6%***
28%***
22.4%
16.9%***
12.8%
6.2%***
11.8%
12.8%***
15.4%***
12.4%
7.5%***
7.9%
3.6%***
6.9%
8.2%***
9.3%***
8.0%
4.2%***
Postnatal
Mean
(SD)
5.9 (4.3)
4.1 (3.9)
5.2 (4.7)
6.2 (4.7)
6.1 (4.5)
5.3 (4.4)
4.9 (4.2)
Post
EPDS >9
Post
EPDS >12
Ante & Post
EDPS >12
16%
15%***
17%
19.6%***
19%*
15.4%
13%***
7.1%
6.3%***
8.3%
10.2%***
9%
7.6%
6.1%***
3.5%
1.6%**
3.2%
3.6%**
3.8%
3.1%
2.0%***
Of note, there were significant differences in the prevalence rates of the different EPDS cutoff scores between States - WA and NSW had the lowest rates, whilst SA and TAS the highest. This
was significant at all cut-off scores for WA & NSW vs. the other States and SA & TAS vs. the other
States, except for postnatal EPDS >12 for TAS.
The differences noted might be explained by the different demographic profile of the States
and will require further analysis. Women in WA were older, better educated, had higher incomes
and were more likely to be professionally employed than women from either SA or TAS. When the
WA scores were broken down into those who delivered in a private hospital vs. a public hospital,
those women who delivered privately were less likely to score a high EPDS than those who
delivered the public system (Table 11).
Table 11. EPDS Prevalence: WA Public Patients vs. WA Private Patients
(* as proportion of each group in WA sample)
System
WA Public*
WA Private*
Ante
EPDS >9
17.6%
10.2%
Ante
EPDS >12
8.1%
2.0%
Ante
EPDS>14
4.5%
1.8%
Post
EPDS >9
13.5%
8.7%
Post
EPDS >12
7.6%
0%
Ante & Post
EDPS >12
2.1%
0.7%
NSW data showed similar rates of professional occupation & higher income to WA.
However, for NSW, the low prevalence of EPDS cut-off scores appears most likely to be due to the
timing of the antenatal screen - 16 weeks or less decreasing the chance of having a high EPDS score
(see Odds Ratios, Table 12). This is consistent with other studies – a meta-analysis by Bennett et al
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2004, concluded the prevalence of depression (EPDS > 12) was 7.4% in the first trimester,
increasing to 12.8% and 12% in the 2nd and 3rd trimesters, respectively. The overall antenatal rate in
this study is somewhat lower than that reported in Bennett et al, but is similar when viewed by State
and trimester screened.
Postnatally, prevalence rates in NSW were similar to the other states and may be influenced
by the higher rates of women from culturally and linguistically (CALD) backgrounds.
Of note, the ACT has higher income levels, higher rates of professional occupation and data
for public and private deliveries (and lower CALD groups than NSW) – and rates of high EPDS are
consistently higher than NSW, WA and NSW, and in both delivery settings.
What NSW and WA also have in common, separating them from other States, is that they
both have been screening for some time prior to this PND Program commencing, suggesting a
positive longer term effect of screening (i.e. for reducing EPDS scores and decreasing the number
who remain high throughout).
Risk Factors for Antenatal and Postnatal Depression
Odds Ratios (95% CI) of key demographic and/or psychosocial variables, considered to be
important risk factors in perinatal depression, were calculated for both antenatal and postnatal
depression. Here we present with the cut offs for both as an EPDS >12, but the pattern is similar for
EPDS >9 and >14 (antenatally).
The key factors were found to be the same in both, and in those who were depressed at both
times. These are presented in Tables 12 and 13.
Demographic Variables
The strongest risk factors to emerge from demographics are Indigenous background, socioeconomic status and absence of a partner. Younger age (<21 years) and medical complications were
also important. As Indigenous women have an increased risk of having all these factors, they are
clearly a group that is at particular risk. Of the Indigenous women in this sample, 19% had antenatal
EPDS > 12 (13%, >14), 12% postnatal EPDS >12, 6.3% EPDS >12 both antenatally and
postnatally.
Conversely, older age, higher education and socio-economic status are all protective.
Of interest, and possibly contributing to the lower antenatal EPDS scores in NSW, is the
potential somewhat protective factor of a CALD background for antenatal depression, particularly if
you are born in Australia but to a CALD family. Whilst 8.9% of the total group of women had an
antenatal EPDS >12, 9.3% of the English spoken at home group did, compared to 5.2% who spoke
European languages, 5.8% who spoke Asian languages and 4.6% who spoke African/Middle
Eastern languages. The implication is that the second generation receives the cultural benefits such
as elevated importance of pregnancy of the country of origin without the trauma of migration and
dislocation. Further analysis of this is required.
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The cultural benefits of a CALD background, however, are not maintained postnatally,
where a CALD (Asian and African/Middle Eastern but NOT European) background is a slight risk
factor for postnatal and for continuing depression (antenatally and postnatally) – possibly the group
who are most traumatised by their immigration / experiences in their country of origin, and/or are
separated from families and communities, or the realities of the culture in which they are living
taking effect.
Rural residence does not in itself appear to be a significant risk factor, but an analysis of the
rural women in Victoria compared to the urban women, suggested higher rates of elevated EPDS
scores in the rural women (8.5% of rural women had postnatal EPDS>12 compared to 6.7% of the
urban group used for comparison), in part related to higher rates of other risk factors in rural women
i.e. they were more likely to be single and from a lower socio-economic background.
Table12. Odds Ratios: Demographic Variables
Risk Factor
Indigenous
Born outside Australia
English not spoken at home
(Asian /middle eastern)
Aged <21 years
Age >35 years
Higher education
High income
(>$60,000 per annum)
Low Income
(<$20,000 per annum)
Rural residence
No partner
Number of children
Number of pregnancies
Stage of pregnancy at 1st screen:
16 weeks vs >16 weeks
Medical complications
Ante Odds Ratio
2.4 (1.7 – 3.4)
0.99 (0.84 – 1.16)
1.3 (1.1 – 1.7)
Post Odds Ratio
1.8 (1.2 – 2.8)
1.0 (0.8 – 1.2)
1.1 (0.8 – 1.5)
Ante & Post Odds Ratio
2.6 (1.5 – 4.4)
1.0 (0.7 – 1.3)
1.4 (0.9 – 2.3)
1.7 (1.2 – 2.4)
0.84 (0.72 – 0.98)
0.64 (0.55 – 0.75)
0.57 (0.47 – 0.69)
1.7 (1.2 – 2.4)
0.84 (0.72 – 0.98)
0.65 (0.54 – 0.77)
0.57 (0.47 – 0.69)
1.7 (1.2 – 2.4)
0.8 (0.7 – 1.0)
0.6 (0.4 – 0.7)
0.57 (0.47 – 0.69)
2.8 (2.4 – 3.4)
2.8 (2.4 – 3.4)
2.8 (2.4 – 3.4)
0.76 (0.60 – 0.95)
2.3 (2.0 – 2.7)
1.2 (1.1 – 1.3)
1.2 (1.1 – 1.3)
0.8 (0.5 – 1.2)
1.2 (1.0 – 1.5)
1.9 (1.6 – 2.2)
1.14 (1.07 – 1.23)
1.15 (1.09 – 1.21)
0.8 (0.5 – 1.2)
0.98 (0.68 – 1.42)
2.4 (1.9 – 3.1)
1.3 (1.2 – 1.4)
1.2 (1.1 – 1.3)
0.8 (0.5 – 1.2)
1.8 (1.6 – 2.0)
1.6 (1.4 – 1.9)
1.6 (1.3 – 2.6)
Psychosocial Variables
Psychosocial variables give the strongest indicators to risk of depression, in keeping with
previous research.
Support and partner relationship are probably the most consistent risk factors that have been
associated with postnatal depression in previous studies. This study confirms the importance of
support postnatally and establishes that it is also a factor antenatally. Of note, the presence or
absence of a partner rather than their emotional support from them appears important, suggesting
physical help rather than emotional is important, as is support from others rather than just partner
such as mother.
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Table13. Odds Ratios: Psychosocial Variables
*
includes depression (major & minor), anxiety, eating disorder and difficulty accepting being pregnant
Risk Factor
Past History of Abuse
No available support
Perfectionist personality
Emotional Problems in current
pregnancy*
(range of disorders)
High daily hassles
Past History of Depression and
anxiety
Past history of Anxiety
Mother emotionally
unsupportive
Partner emotionally
unsupportive
Ante Odds Ratio
3.6 (3.2 – 4.2)
3.2 (2.4 – 4.3)
2.4 (2.1 – 2.8)
12.9 (10.9 – 15.2)
Post Odds Ratio
3.1 (2.7 – 3.7)
2.6 (1.9 – 3.7)
2.2 (1.9 – 2.5)
4.9 (4.2 – 5.8)
Ante & Post Odds Ratio
4.1 (3.2 – 5.2)
4.2 (2.7 – 6.4)
3.5 (2.7 – 4.6)
16.4 (11.7 – 22.8)
3.0 (2.5 – 3.6)
7.8 (6.1 – 6.9)
2.3 (1.8 – 2.8)
6.1 (4.7 – 8.0)
3.3 (2.5 – 4.3)
13.4 (9.4 – 19.1)
3.1 (2.3 – 4.3)
1.0 (0.8 – 1.2)
3.3 (2.4 – 4.6)
1.3 (1.1 – 1.6)
4.5 (2.6 – 7.6)
1.2 (0.9 – 1.7)
0.56 (0.45 – 0.71)
0.4 (0.5 – 0.8)
0.6 (0.4 – 0.8)
An analysis of a subsample of women comparing in detail those who were single to those
who had supportive partners and those who had unsupportive partners revealed that the latter
subgroup had the highest risk i.e. an unsupportive partner was worse than no partner at all, a
supportive partner affording the most protection.
Some studies have also highlighted the importance of family of origin that is supported here,
with mother’s support and a history of abuse being significant risk factors.
The strongest predictor of antenatal and postnatal depression is however a past history of
anxiety or depression and emotional problems in pregnancy. The antenatal EPDS score itself
accounts for approximately 25% of the postnatal variation.
A model to predict postnatal depression (as defined by EPDS > 12) looked at the risk factors
outlined above. The final model for best predication is presented in Table 14.
Table 14. Postnatal Depression (EPDS >12) Prediction Model
Factor
Any emotional problems
Any illness
Life stresses
Perfectionist
Higher income
Lower income
Partner support
OR (95% CI)
2.6 (2.1 – 3.2)
2.1 (1.7 – 2.5)
1.4 (1.2 – 1.5)
1.6 (1.3 – 1.9)
0.8 (0.6 – 0.9)
1.4 (1.0 – 1.8)
0.8 (0.7 – 0.9)
Significance
p < 0.0001
p < 0.0001
p < 0.0001
p < 0.0001
p < 0.05
p < 0.05
p < 0.0001
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If antenatal EPDS score was included in the model, any emotional problem, any illness,
perfectionism and pattern support remained in the model. Life stresses approached significance but
income was no longer significant.
Correlation of EPDS and K10/Sphere
In a subsample of the overall group (n=1083), women completed two alternative screening
tools in addition to the EPDS – the K10 and Sphere. Both these tools had been used and
standardised in Australian community samples, but not on perinatal women. A linear model did not
apply and for both tools the percentage variation was very small, suggesting no relationship
between the EPDS scores and that on K10 or Sphere.
This finding is most likely due to two factors; one, the EPDS rates the previous week,
whereas the other two tools look at the prior month; two (and most importantly), that the EPDS,
though it has been criticized antenatally for picking up excessive “normal” anxiety (hence the move
to use a higher cut off score antenatally), it has less questions focusing on this than either of the
other tools and none on physical symptoms. Hence, the K10 and Sphere are picking up on some of
the “normal” features of pregnancy and appear unreliable at this time.
This finding highlights the importance of the use of a tool in perinatal women that has been
designed specifically for perinatal women.
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5. Evidence of Efficacy of Early Intervention Initiatives
Overview
Each State as part of the overall project, sought to build on current expertise and services to
expand and evaluate an intervention for perinatal depression. As a result of the breadth of expertise of
the State directors and their teams, this section of the project was diverse, but with implications for
women across Australia.
In summary:
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
Queensland, Western Australia and NSW all developed information material for specific
groups of women that had not been available to them before. With the exception of the
Indigenous material (more specific to Palm Islanders/Mt Isa, but has been made available as
a base for other Indigenous groups), these have been made available on the web and in hard
copy to women in all States;
mothers who have a “multiplies” birth are at particular risk and have significant unaddressed
needs;
in Victoria a self-help intervention program for pregnant women and their partners, to cope
with the emotional transition to parenthood, was found highly acceptable. However, general
practitioners and maternal and child health nurses need to be more centrally involved in the
program to increase uptake by women;
Indigenous women score no differently on the language specific EPDS than on the
mainstream EPDS, or on the suicidal ideation question (Q10)
an in depth analysis of the issues related to depression in Indigenous perinatal women
reveals the high importance of psychosocial stressors;
long distance education was successful at increasing awareness and knowledge but like the
other education packages, needs ongoing training, and was not without technical difficulties
that could be improved with flexible formats;
a low-cost, self-help intervention was beneficial and potentially feasible on a large scale;
interventions with at risk women, male partners and Arabic women all showed significant
issues of reluctance to seek assistance, but with benefits for those who did. Understanding
and overcoming these barriers remains the key to increasing early intervention, in
association with routine screening;
a more in depth analysis and pilot intervention into Vietnamese and Arabic women showed
benefits of telephone counselling and psychosocial interventions;
despite some difficulties recruiting at risk women, a low cost minimal intervention can be of
benefit and if tied in with screening could increase those women receiving appropriate
assistance;
male partners were particularly difficult to engage (alternatives such as web-based packages
should be utilised) and suggests a larger cultural change is required before a primary
intervention involving them is likely to be successful.
REPORTS FROM THE DIFFERENT STATE BASED ANTENTAL INTERVENTION
INITIATIVES CAN BE FOUND IN VOLUME II OF THIS REPORT
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Staff Members
National Office
A/Prof Anne Buist, National Co-ordinator (2001 – 2005)
Dr Justin Bilszta, National Project Manager (2001 – 2005)
Victoria and Tasmania
Prof Jeannette Milgrom, State Co-ordinator (2001 – 2005)
Ms Jennie Ericksen, State Project Manager (2001 – 2005)
Dr Alan Gemmill, Senior Research Officer (2001 – 2005)
Ms Melina Ramp, Senior Research Assistant (Dec 2002 – 2005)
Ms Kate Neilson, p/t Research Assistant (2001 – 2004)
Mr Christopher Holt, p/t Research Assistant (2004 – 2005)
Toward Parenthood Intervention Team
Ms Bella Saunders, Clinical Psychologist (2001 – 2005)
Ms Elizabeth Loughlin, Clinical Psychologist (2001 – 2005)
Ms Yolanda Romeo, Clinical Psychologist (2001 – 2005)
Ms Bronwyn Leigh, Health Psychologist (2001 – 2005)
Ms Rachael McCarthy, Clinical Psychologist (2001 – 2005)
Students – Bronwyn Leigh, Ying Zhi Gu, Melissa Tang, Eddie Tan, Jessica Rowe, Clare Heaney,
Brooke Ellis, Michelle Puttick, Penny Koutsouridis & Megan Andrews
South Australia
Prof John Condon, State Co-ordinator (2001 – 2005)
Ms Ann Alder, State Project Manger (2001 – 2005)
Ms Liz Gamble, Senior Research Midwife (2001 – 2005)
Ms Carolyn Corkindale, Associate Researcher (2001 – 2005)
Dr Anne Sved-Williams, Associate Researcher (2001 – 2005)
Western Australia
Prof Sherryl Pope, State Co-ordinator (2001 – Dec 2003)
Dr Craig Speelman, State Co-ordinator (Jan 2004 – 2005)
Ms Janette Brooks, State Project Manager (2002 – 2005)
Ms Colleen Ball, Research Midwife (2001 – Dec 2004)
Ms Jocelyn Bristol, Research Midwife (2001 – 2005)
Ms Sandy McClean, Research Midwife (2002 – 2005)
Ms Monica Howard, Research Assistant (2003 – 2004)
Ms Debbie Lien, Research Assistant (2003 – 2004)
Mr James Humphreys, Data Management (2001 – 2005)
Queensland
Prof Barbara Hayes, Queensland Director (2001 – 2005)
Ms Beryl Buckby, Assistant Qld Project Manager (Nov 2003 – Feb 2004)
Queensland Project Manager (Feb 2004 – 2005)
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Ms Renee McAllister, Queensland Project Manager (2002 – Feb 2004)
Ms Justine Doherty, Assistant Qld Project Manager (August – Dec 2003)
Ms Janese McCulley, Assistant Qld Project Manager (April 2004 – 2005)
Dr Alistair Campbell, IT Consultant (2003 – 2005)
Ms Lynore Geia, Indigenous Consultant/Research Assistant (June 2002 – Dec 2004)
Ms Margaret Egan, Indigenous Consultant/Research Assistant (Feb 2004 – 2005)
Ms AnneMarie Lawrence, Research Midwife (The Townsville Hospital) (Sept 2002 – Dec 2004)
Ms Jackie Bowen, Research Midwife (Cairns Base Hospital)(Nov 2002 – June 2003)
Ms Lesley Williams, Research Midwife (Cairns Base Hospital) (June 2003 – Jan 2005)
Ms Alison Thwaites, Research Midwife (Mackay Base Hospital) (Feb 2004 – Sept 2004)
Ms Justine Collins, Research Midwife (Mackay Base Hospital) (July 2004 – Jan 2005)
Ms Ruth McKitrick, Research Midwife (Ipswich Hospital) (April 2004 – March 2005)
Ms Cheryl Hewlett, Research Midwife (Logan Hospital) (June 2004 – March 2005)
Ms Lynda Steward, Research Assistant/Midwife (Townsville) (Sept 2004 – 2005)
Ms Annette Kelly, Research and Admin Support (June 2003 – Aug 2004)
Ms Maryanne Martin, Research and Admin Support (Sept 2004 – 2005)
Ms Tara MacDonald, Prof Hayes Admin Support (2003 – 2005)
Ms Annette Riley, Research Assistant (Indigenous Initiative, Mt Isa) (April 2004 – Dec 2004)
Ms Claudinia Daley, Research Assistant (Indigenous Initiative, Townsville) (June 2003 – March
2005)
Ms Annie Eaton, Research Midwife, Birthcare-Mackay (Dec 2004 – March 2005)
New South Wales
Prof Bryanne Barnett, State Co-ordinator and Senior Investigator SWSHAS (2001 – 2005)
Dr Stephen Matthey, Research Director (2001 – 2005)
Ms Janan Karatas, Research and Liaison Officer (Sept 2003 – 2005)
Ms Leanne Agius (August 2002 – July 2003)
Ms Robby Taouk, Project Officer Arabic Component (March 2002 – Dec 2004)
Ms Thu Tram Lee (March 2002 – July 2003)
Ms Hanh Tran (February 2004 – Dec 2004)
Ms Jane Phillips, Research Assistant IPC (2002 – 2003)
A/Prof Marie-Paule Austin, Senior Investigator Royal Hospital for Women (2001 – 2005)
Dr Susan Priest, Project Co-ordinator Royal Hospital for Women (2001 – 2005)
Ms Sabine Merz, Research Assistant (2004 – 2005)
Dr Nick Kowlenko, Senior Investigator Royal North Shore (2002 – 2005)
Ms Yvonne McCann, Co-Investigator, Royal North Shore (2002 – 2005)
Ms Karen Saint, Senior Research Assistant (2003 – 2005)
Australian Capital Territory
Prof David Ellwood, State Co-ordinator (2003 – 2005)
Ms Rebecca Reay, State Project Manager (2003 – 2005)
Ms Maureen Scott, Research Officer (March 2004 – 2005)
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Hospitals/Area-Health Services Involved
A total of 43-hospitals/area health services were involved in screening and/or collecting data
for the beyondblue PND Program. They were:
Victoria and Tasmania
♦ Werribee Mercy Hospital
♦ Austin Health
♦ Royal Women’s Hospital
♦ Angliss Hospital
♦ Northern Hospital
♦ Hamilton Base Hospital
♦ Launceston General Hospital
♦ Starting Out Program, Connection, Uniting Care
♦ Banyule Community Health Service
♦ Wodonga Regional Health Service
South Australia
♦ Women’s & Children’s Hospital
♦ Flinders Medical Centre
Western Australia
♦ King Edward Memorial Hospital
♦ Osborne Park Hospital
♦ Mercy Private Hospital
Queensland
♦ Townsville, Cairns, West Moreton (Ipswich), Redcliffe/Caboolture, Logan-Beaudesert and Mt
Isa Health Service Districts; Mater Hospital in Townsville; Birthcare, Mackay.
♦ Royal Brisbane Hospital (distribution of education booklets only)
♦ State Intervention with Indigenous Women: Townsville Aboriginal and Islander Health Service
(Townsville), Palm Island, Yapatjarra and Child Health (Mt Isa)
New South Wales
♦ Royal North Shore Hospital
♦ Ryde, Hornsby & Manly Hospitals
♦ Royal Hospital for Women, Randwick
♦ St George Hospital, Kogarah
♦ Liverpool, Fairfield, Bankstown and Campbelltown Hospitals
Australian Capital Territory
♦ The Canberra Hospital
♦ Child, Youth and Women’s Health Program
♦ Calvary Public and Private Hospitals
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Acknowledgements And Thanks
First and foremost, the beyondblue National Postnatal Depression would like to sincerely
thank the thousands of women, and their families, who participated in this initiative and shared their
lives with us over the last four years. We would also like to acknowledge the hundreds of health
professionals who gave their time and support to the Program.
In particular, we would like to thank the following people and organizations for their
ongoing assistance and support:
National
♦ Dr Denny Meyer, Faculty of Life and Social Sciences, Swinburne University of Technology
♦ Dr Annie Solterbeck, Statistical Revelations
♦ Marie Homer and Optima Press Pty Ltd
♦ All-Villa Printing
♦ Working Women’s Health
♦ Community Practitioners and Health Visitors Association, United Kingdom
♦ Office of Women’s Health, Vienna, Austria
♦ Australasian and International Marce Societies
♦ INFOMED
♦ Dept of Psychiatry, University of Melbourne
♦ Veterans Psychiatry Unit, Austin Health
Victoria
♦ All the management and staff at each of our screening hospitals and community agencies:
Werribee Mercy Hospital, Northern Hospital, Launceston General Hospital, The Angliss
Hospital, Western District Health Service Hamilton Hospital, The Royal Women's Hospital,
Wodonga Regional Health Service Wodonga Hospital, Banyule Community Health Service
and Uniting Care Connections.
♦ The General Practitioners who have involved themselves in the treatment of the many women
identified through this program and to those who have involved themselves in the training provided
to enhance their skills to respond to women with depression in their practices.
♦ Victorian MCHN and Tasmanian FYCH nurses who have always worked with these women
and have embraced this program.
♦ The women who have given their time at such a busy stage of their life to help increase our
knowledge about perinatal depression by consenting to complete the research questionnaires.
♦ The General Practice Divisions Victoria Mental Health Reference group,
♦ Anne Diamond, Primary Mental Health Care Development and Liaison Officer
♦ The Divisions of General Practice in Victoria
♦ Louise Ryan, South West Health Postnatal Depression Project Worker
♦ Jenny Kelly, Barwon Health Postnatal Depression Project Manager and Catharina Dumaresq,
Project Worker
♦ Beth Gemmill, St John Of God Geelong
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South Australia
♦ Prof. Marc J.N.C. Keirse, Professor and Head of Dept, Department of Obstetrics, Gynaecology
& Reproductive Medicine, Flinders University
♦ Associate Professor Robert Bryce (Clinical Director, Obstetrics & Gynaecology), Flinders
Medical Centre
♦ Ms Margaret Smith (Acting Divisional Director, Flinders Women & Children Division),
Flinders Medical Centre
♦ Ms Sue Coppi (Clinical Midwifery Manager, Ambulatory Women’s Health Services), Flinders
Medical Centre
♦ Ms Julie Pratt (Clinical Midwifery Consultant, Birth Centre), Flinders Medical Centre
♦ Ms Sue Cross (Mental Health Liaison Extended Care Nurse), Flinders Medical Centre
♦ All midwives, Women's Health Clinic, Flinders Medical Centre
♦ All midwives, Birth Centre, Flinders Medical Centre.
New South Wales – Royal Hospital for Women
♦ Helen Jarman, Deputy Director of Nursing Royal Hospital for Women
♦ Wendy-Sue Forder, Nurse Unit Manager, Royal Hospital for Women, Outpatient Midwifery
Clinic
♦ All Midwives that took part in the beyondblue Program at Royal Hospital for Women
New South Wales – SWSAHS
♦ Midwives from the antenatal clinics for collecting the data
♦ Thanks to all sites distributing the booklets
♦ Child and Family Health nurses, general midwives and community women from across Sydney
South West Area Health Service - Western Zone for participating in Knowledge and Attitudes
study
♦ The IPC program for allowing beyondblue to build on their existing systems and procedures
♦ The CALD women who assisted us in the making of the beyondblue Arabic and Vietnamese
resources
♦ The Division of Women and Child Health at Liverpool for acknowledging the importance of
perinatal mental health and embracing programs like IPC and beyondblue National Postnatal
Depression Program
♦ The 'Obstet' consortium for allowing us to share their psychosocial data
New South Wales – Royal North Shore
♦ Catriona Andronicos (OBSTET Database Manager), Northern Sydney Health
♦ Rhonda Bignell (Antenatal Clinic, Nurse Manager) & all midwives working in the Antenatal
Clinic, Hornsby-Kur-ring-gai Hospital (H-K)
♦ Shirley Burgoyne & Carmel O'Colmain (Maternity Discharge Planners), Royal North Shore
Hospital (RNS)
♦ Cathy Boot (Midwifery Educator), RNS
♦ Kirsty Brown (Nurse Manager, Antenatal Clinic) & her staff at RNS
♦ Sue Coats (Midwifery Educator,) Manly Hospital
♦ Jacqueline Evans (Nurse Manager, Antenatal Clinic) & her staff at Manly Hospital
♦ Geraldine Gilroy & Sheena Jackson (Midwifery Educators), H-K
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♦
♦
♦
♦
♦
♦
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Samantha Harrop (Receptionist, Maternity), RNS
Yvonne McCann (Divisional Manager, Women's, Children & Family Health), RNS
Pamela Rawling (Maternity Department - Nurse Unit Manager) Manly Hospital
Janice Sim (Clinical Midwifery Consultant), H-K
Rohini Singh (Administrative Officer, Delivery Suite, Maternity), RNS
Carolyn Smith (Divisional Manager, Maternity and Child & Family Health Service), H-K
Western Australia
♦ Department of Psychological Medicine, King Edward Memorial Hospital
♦ Social Work Services, Osborne Park Hospital
♦ Antenatal Clinic Staff at King Edward Memorial Hospital, Osborne Park
♦ Hospital and Mercy Hospital
♦ Anna Roberts, General Practice Division of WA
♦ Community Midwifery WA
♦ Women and Infants Research Foundation, King Edward Memorial Hospital
♦ School of Psychology, Edith Cowan University
♦ Dr Jann Marshall and Western Australia's Child Health Nurses
♦ The Australian Multiple Birth Association
Queensland
♦ School of Nursing Sciences, James Cook University, Townsville.
♦ Queensland Health and the Townsville, Cairns, Mackay, Logan-Beaudesert, West Moreton
Health Service Districts, their associated Ethics Committees, and Birthcare, Mackay.
♦ Without the active and strategic support of Child Health Centres in Cairns, Townsville, Mackay,
Ipswich and Logan the assessment and care of women at risk of depression would not have been
the seamless process it turned out to be.
♦ Midwives, Child Health Nurses, Social Workers, Psychologists, General Practitioners and other
Allied Health Professionals who assisted the program in numerous ways by participating,
accepting referrals, or smoothing the research process.
♦ Queensland Health, the Palm Island Council, the Boards of Yapatjarra (Mt Isa), and the
Townsville Aboriginal and Islander Health Service, the Elders and others who participated
in reference groups.
Australian Capital Territory
♦ The Canberra Hospital public maternity unit
♦ Community Midwifery Program, TCH
♦ Calvary Hospital private and public maternity units.
♦ Child Youth and Women's Health Program
♦ ACT Division of General Practice
♦ Mental Health ACT
♦ Aboriginal Health Service
♦ Post and Antenatal Depression Support and Information Inc (Pandsi)
♦ Families First at Greater Southern Area Health Service
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Appendices
A. Feedback to Services Document
B. Detailed List of the Organizations to Receive PND Training
C. Health Professional Training Guidelines
D. Detailed List of Media and Promotional Activities
E. Detailed List of Conference Presentations and Scientific Articles
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Appendix A – Feedback to Services Document
DRAFT
EMOTIONAL HEALTH CARE IN PREGNANCY & POSTPARTUM
Key Findings and Recommendations: The beyondblue National PND Program
What was the Program?
This program involved 43 antenatal hospitals/area-health services across Australia over 2001-5
in assessing the feasibility and acceptability of routine perinatal depression screening. Information
was collected from the largest sample of Australian women ever screened for depression to help
better understand the risks and their potential solutions.
Why does perinatal depression matter?
Perinatal (antenatal/postnatal) depression affected 15.7% of the 40,000 Australian mothers who
were involved in the program. There are significant long-term impacts on women’s mental health
and parenting, on their partners and on the developmental prospects of their children. Prevention
does not appear effective so early intervention, with best-practice, evidenced-based treatments,
offers the best outcome.
What did the Program find?
Screening with the Edinburgh Postnatal Depression Scale was highly acceptable to (85%)
women and simple to complete. Staff also found screening feasible but only with appropriate
support and education. High depression scores were stressful for screening staff to deal with,
however, with established care pathways they became comfortable with their ability to help the
women who need it. Distress was related to high screening scores (i.e. the depression) rather than
the screening process itself.
Routine screening gives the best possible opportunity to ensure that over half of the women that
would be otherwise missed will be identified. Identification alone does not ensure treatment will be
sought, this it must be combined with staff education, support and facilitation of pathways to care.
Provision of information in pregnancy enabled women to be better informed about mental
health issues. Given this information, women at risk of depression were better able to assess their
own mental state and reported better satisfaction with their support and networks after the program
than before.
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Key Recommendations
1. Depression screening can and should be a routine part of antenatal and postnatal care;
2. The highest time of risk is in the third trimester and is the ideal time to screen;
3. The EPDS is an ideal screening tool for assessing mood status;
4. Key questions for assessing risk and assistance in planing included level of available
support, past history of anxiety & depression and current life stresses;
5. Care pathways including appropriate local referrals and service links need to be developed;
6. An information and resource booklet on emotional health in the perinatal period should be
provided to all pregnant women in Australia;
7. There is a need for resources specific to certain groups such as CALD women, Indigenous
women and multiparous women;
8. Midwives and doctors offering screening obstetric care are in an ideal position to distribute
depression information and undertake psychosocial assessment as a routine part of their
holistic care of women and their families.
The National & State Directors of the beyondblue National PND Program
Anne Buist & Jeannette Milgrom, University of Melbourne (Psychiatry & Psychology)
Bryanne Barnett & Marie-Paule Austin, University of NSW (Psychiatry)
Nick Kowalenko, University of Sydney (Psychiatry)
John Condon, Flinders University (Psychiatry)
Barbara Hayes, James Cook University (Nursing)
Craig Speelman, Edith Cowan University (Psychology)
David Ellwood, Australian National University (Obstetrics)
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Appendix B – Detailed List of Organizations to Receive PND Training
Title
National Office
Postnatal Depression
Parenting with a Mental Illness
The National Postnatal Depression Project: The implication for divisions
Women, Hormones & Mental Illness
The National Postnatal Depression Program
Postnatal Depression – an evening seminar.
Parents with a Mental Illness – Issues for risk assessment
Postnatal Depression
The National Postnatal Depression Program
Semester 10: Psychiatry
National Postnatal Depression Program
Information seminar of the National Postnatal Depression Program
PND for overseas trained Doctors
Parenting with a Mental Illness
Women’s Mental Health Issues
Children with parents who have a mental illness
Children with parents who have a mental illness
Postnatal Depression and the National PND Program
Page 74 of 108
Source/Event
Date
Southern Region General Practitioners
Barwon Health & Geelong Clinic
Mental Health Network, GPDV
GP Meeting, Bundoora, Victoria
GP Training Seminar – Westgate Division of
General Practice (12 GPs)
Angliss Hospital (20 MW/MCHNs)
Child Protection Practitioners Forum: A
Professional Development Opportunity
Postnatal Depression Twilight. St Vincent’s &
Mercy Private Hospital Education Comm.
Information Seminar on postnatal depression Launceston General Hospital
Faculty of Medicine, Dentistry & Health
Sciences, University of Melbourne
Northern Hospital. Melbourne.
South West Postnatal Depression Forum,
Warrnambool
Jean Hales Foundation.
February 2002
February 2002
May 2002
July 2002
October 2002
Protective Services Victoria
Panel Discussion - The Australian Unity
Wellbeing Index.
Dept of Human Services. Induction Program.
Melbourne
Dept of Human Services. Induction Program.
Melbourne.
Postnatal Depression & Mental Health Issues
March 2003
March 2003
November 2002
November 2002
November 2002
December 2002
Feb 2003
Feb 2003
February 2003
March 2003
March 2003
March 2003
June 2003
beyondblue National PND Program Final Report
VOL I: National Screening Program
RWAV – Overseas Training Doctor Program
The Hidden Enemy – Postnatal Depression
The Hidden Enemy – Post Natal Depression
Parenthood and mental Illness: including postpartum disorders
Depression in Women
The Wide Umbrella of Postnatal Depression
SPHERE Presentation
Women with Postnatal Depression
Women with Postnatal Depression
Efficacy of Clinical Supervision for Postnatal Depression Clinical
Presentations
The Legacy of child abuse: learning’s from the past and changing the future
Postnatal Depression in Australia – the beyondblue PND Program
Introduction to women’s mental health and depression, Postnatal Depression,
Depression and the menopause, Premenstrual dysphoric disorder, Drug and
non-drug treatment options
SPHERE Presentation
PND. Presentation to Obstetricians/Clinicians.
PND. Presentation to Health Professionals.
SPHERE Presentation
PND & Effects on the Child
Page 75 of 108
for the Parturient Woman. Benchmark
Education for Midwives (50 MW)
Echuca, Victoria.
Mercy Learning Centre, Mercy Hlth Service,
Albury.
Wodonga Hospital, Wodonga
2nd Yr PM/Mpsychiatry Adult Psychiatry 1.
Mental Health Research Institute
Darwin Meeting (GPs & Psychiatrists)
The Early Motherhood Service, Integrated
Primary Mental Health NE Victoria (30 Psych
nurses, GPs & MCHNs)
Otway DGP (15 GPs)
Dandenong Midwives Association. Annual
General Meeting (30 MW)
Dandenong Midwives Association. Annual
General Meeting.
Clinical Supervision in Nursing Practice: Giving
voice to action. Ballarat.
Launch of Safe from Harm: Professional
development and eduction resource for Nurse.
Aust Nursing Federation, Victorian Branch.
Depression & Anxiety Consumer Research
Unit, National Instit. of Health & Human
Sciences, Australian National University
Women’s Mental Health and Depression.
Presentation to Knox Division of General
Practice
Bendigo & District DGP (10 GPs)
Geelong Hospital (8 MW)
Geelong Hospital (15) GPs
Geelong Div of General Practice (12 GPs)
Albert Road Clinic, Melbourne (10
July 2003
August 2003
August 2003
September 2003
November 2003
November 2003
November 2003
November 2003
November 2003
November 2003
December 2003
April 2004
May 2004
May 2004
May 2004
May 2004
May 2004
October 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
PND Workshop
Women’s Mental Health
Postnatal Depression
Postnatal Depression
“Breaking the Cycle: Early detection and early intervention.” PND:
Implications for our region.
Victoria
Postnatal Depression
Focus Group with to evaluate the program
Update of program progress
One-day workshop – “Postnatal Depression." Included assessment and
treatment and the National Postnatal Depression Program.
Workshop ‘Treating Postnatal Depression’.
Training Midwives 11/2 hours 10 midwives
Training day “Getting Ahead of Postnatal Depression Program” to
Training session with. EPDS and Postnatal depression. 15 nurses
MCHN training session 15 nurses
Presentation to with feed back from 1st year of screening
Psychiatrists)
Mildura, MCHN (25 MW/MCHNs)
Teleconference, Warrnambool Mental Health
Group
Facilitation of Pfizer Workshop for General
Practitioners. Centonove, Kew (10 GPs)
Obstetricians & Gynaecologists. Northpark
Private Hospital (12 O&G/MCHNs)
Mercy Health Service, Albury (30 MCHNs)
May 2005
Mental Health Forum Leongatha Vic
Mercy Werribee midwives
Werribee Mercy Midwives
Queen Elizabeth Centre, Noble Park
August 2001
October 2002
December 2002
February 2003
Austin Health Nurses and Psychologists
Launceston General Hospital
May 2003
June 2003
Shepparton MCHN and PMHT workers
MCHN at City of Wyndham
Banyule
Midwives and antenatal staff Werribee Mercy
Hospital
Trained midwives, Obstetrician Social Worker, set up NPDP. Visited GP North Launceston General Hospital
Division organized mailout for Baseline
MCHN training session
Whittlesea
Meeting with CEO and Midwifery staff. Training about bb program
Wodonga Health Service
Training 10 midwives
RWH
Training 3 staff
Connections Starting Out
Page 76 of 108
November 2004
March 2005
March 2005
April 2005
June 2003
July 2003
October 2003
October 2003
October 2003
November 2003
January 2004
May 2004
May 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
MCHN training 6 Nurses
NPDP Screening with EPDS
NPDP and work of PIRI
Midwife training 6 nurses re set up Toward Parenthood screening
Training MCHN 5 nurses
NPDP and Toward Parenthood protocols
Postnatal Depression and NPDP preliminary findings at Northern Hospital
NPDP
NPDP
Training session on EPDS 14 staff
Antenatal and Postnatal Depression
Postnatal Depression and NPDP and screening with EPDS
Workshop presentation – Lifecycle Stage Example, Transition to Parenthood
Invited workshop - A Workshop on Interventions following Postnatal
Depression targeting both Maternal Mood and the Mother-Infant Interaction.
Findings of Beyondblue NPDP and Models of Care
NPDP and Screening with the EPDS
The role and relevance of the Edinburgh Postnatal Depression Scale
NPDP and Screening with the EPDS
beyondblue National Postnatal Depression Program- Research Impacting Care
The Role and Relevance of the EPDS
Toward Parenthood project and NPDP
Postnatal Depression
Implementation of a Perinatal Mental Health Screening Program. The
Page 77 of 108
City of Melbourne
City of Melbourne MCHN 6
Austin Health GP Liaison Officer
Northern Hospital
City of Wodonga
Northern Hospital 6 midwives, 1 social worker
Study Day Northern Hospital Midwives and
allied health obstetricians and consumers 50
City of Wodonga MCHN 5
Wodonga Hospital midwives
O’Connell Centre
La Trobe University Psychology Students 10
students
O’Connell Centre MCHN and mothercraft
nurses 14 staff
Alma Family Therapy Centre
APS College of Health Psychologists,
Melbourne
June 2004
June 2004
June 2004
July 2004
July 2004
July 2004
July 2004
City Of Banyule MCHN
City Of Wyndham MCHN
City of Greater Geelong and Barwon Health
Women’s and Children’s Services. Surf Coast
MCHN 2 hours
City of Moonee Valley MCHN
Australian College of Midwives Conference
Dandenong Hospital
Division of General Practice Victoria
Primary Mental Health Forum
Study Day Northern Hospital Midwives and
allied health 40-60 staff
GPs Primary Mental Health Policy Forum
DHS Vic Forum Exploring Different
October 2004
October 2004
October 2004
July 2004
July 2004
August 2004
August 2004
August 2004
August 2004
September 2004
October 2004
November 2004
November 2004
November 2004
December 2004
February 2005
beyondblue National PND Program Final Report
VOL I: National Screening Program
beyondblue National Postnatal Depression Program
Screening for PND in the Community
Risk Factors for Antenatal Depression, Postnatal Depression and Parenting
Stress
NPDP overview. Toward Parenthood
NPDP Toward Parenthood
NPDP and Treatment for Depression
Treatment for Postnatal Depression
Treatment for PND
Poster presentation and display about NPDP
NPDP and screening with EPDS
Western Australia
Depression in the Perinatal Period: Early Intervention & Prevention
Approaches to the Psycho-Social Health and
Wellbeing of Pregnant and Post Partum Women
15 MCHN City of Knox 2 hours
Angliss Hospital midwives
Freemasons Hospital Midwives
MCHN City of Yarra 45 mins
Panda support group leaders conference 2 hours
I day workshop for 10 MCHN at O’Connell
Family Centre
City of Banyule MCHN
Research and Innovation Fair Melbourne
University
RWH Midwives Trained for screening
Osborne Park Hospital, Clinical Update
Workshop, Oral
Depression in the Perinatal Period: Early Intervention & Prevention
Swan Districts Mental Health Service, Oral
Depression in the Perinatal Period: Early Intervention & Prevention
Health Department of WA Child Health Nurse
Clinical Update, Oral
The beyondblue National Postnatal Depression Early Intervention & Prevention Nickol Bay Hospital, Karratha, Oral
Program
Depression in the Perinatal Period: Early Intervention & Prevention Strategies Full day facilitated workshop for local Health
Professionals, Geraldton WA
Depression in the Perinatal Period: Early Intervention & Prevention Strategies Swan/Kalamunda Health Service, Oral
The beyondblue National Postnatal Depression Early Intervention & Prevention Facilitated Rural Mental Health Teleconference,
Program
Oral
The beyondblue National Postnatal Depression Early Intervention & Prevention Lecture for Clinical Master of Psychology
Program – WA Intervention “You, Me & Baby Makes Three”
students, Edith Cowan University
Depression in the Perinatal Period: Early Intervention & Prevention Strategies King Edward Professional Development Week,
Oral
The beyondblue National Postnatal Depression Early Intervention & Prevention Mercy Private Hospital, Staff Development
Program
Workshops x 2
Page 78 of 108
March 2005
March 2005
March 2005
April 2005
May 2005
May 2005
May 2005
May 2005
May 2005
June 2002
June 2002
June 2002
July 2002
October 2002
October 2002
October 2002
October 2002
May 2003
May, June 2003
beyondblue National PND Program Final Report
VOL I: National Screening Program
The beyondblue National Postnatal Depression Early Intervention & Prevention
Program Resources
The beyondblue National Postnatal Depression Early Intervention & Prevention
Program Resources
Depression in the Perinatal Period: Early Intervention & Prevention Strategies
‘Better Outcomes – Better Incomes’ Workshop,
General Practice Division WA
‘Partnerships’ Conference, General Practice
Division WA
King Edward Memorial Hospital Midwife
Refresher Course, Oral
The beyondblue National Postnatal Depression Early Intervention & Prevention Mental Health Training Workshop, General
Program Resources
Practice Division WA
The beyondblue National Postnatal Depression Program
Community Midwifery WA, Training
Workshops x 2
Perinatal Mental Health in Australia: Research & Clinical Practice
Edith Cowan University, 4th year psychology
students, Oral
Screening for PND: The beyondblue National Postnatal Depression Program
Postnatal Depression Professionals Association,
Oral
Emotional health during pregnancy and early parenthood: early intervention
North Metropolitan Health Service (NEST),
and treatment
Inner Metro Child Health Nurses Training
Workshop
Screening for depression during pregnancy and early parenthood
Australian Association for Cognitive Behaviour
Therapy (WA) Inc.
Mental Illness…and Motherhood
King Edward Memorial Hospital Professional
Study Day
Queensland
Emotional health of Childbearing women
Two-day presentation and workshop for
Aboriginal Health Workers, women Elders and
other Indigenous women at Palm Island
Screening for depression: The beyondblue PND program, reliability and
Undergraduate program, School of Psychology,
validity of the EPDS
James Cook University
The beyondblue National Postnatal Depression Program: Equipping Child
Statewide Mail-Out to Queensland Child Health
Health Professionals to manage emotional health of Childbearing Women
Centres
The beyondblue National Postnatal Depression Program: Screening for
Migrant Resource Centre Mental Health
Antenatal and Postnatal Depression; Grief, Loss and Depression in
Awareness and Access Project, Townsville
Childbearing women
West Moreton Health District: Screening for Antenatal and Postnatal
Midwives, neonatal nurses and birth suite
Page 79 of 108
September 2003
October 2003
October 2003
November 2003
March 2004
March 2004
April 2004
May 2004
May 2005
May 2005
July 2004
Aug-Sept 2004
Aug-Sept 2004
Sept 2004
Sept 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
Depression
The beyondblue National Postnatal Depression Program: Antenatal and
Postnatal Depression and the EPDS
Logan Health District: Screening for Antenatal and Postnatal Depression
The beyondblue National Postnatal Depression Program: Screening for
Antenatal and Postnatal Depression
The beyondblue National Postnatal Depression Program: Antenatal and
Postnatal Depression and the EPDS
The beyondblue National Postnatal Depression Program: Antenatal and
Postnatal Depression and the EPDS
Follow-up training re screening for post-natal depression (Indigenous program)
Emotional Health of Childbearing Women: Do we take it for granted?
Follow-up training re screening for post-natal depression (Indigenous program)
Screening for postnatal depression in Childbearing women
Screening for postnatal depression.
Feedback and description of screening
The beyondblue National Postnatal Depression Program: Ending well,
Screening for Antenatal and Postnatal Depression
Screening for postnatal depression in Childbearing women
Page 80 of 108
midwives
Undergraduate program for Nurses in Mental
Health Series, James Cook University
Midwives, neonatal nurses and birth suite
midwives
University and Health Care Administrators:
University College, Alesund, Norway
Undergraduate program for nurses in the mental
health series, University College, Molde,
Norway
Postgraduate program for nurses and social
scientists, University College, Molde, Norway
Palm Island Health Workers
Australian Catholic University, Sydney
Australia. Invited presenter of the 2004 Victor J.
Couch Public Lecture.
Palm Island Health Workers
Education, training and support for Aboriginal
health Workers at Yaptajarra (Community
Controlled Health Centre) and at the child
Health Centre, Mt Isa
One day education and training for perinatal and
family Aboriginal Health Workers (Mixed
Gender) at Palm Island
The Steering Committee of the Mums and
Babies Unit, Townsville Aboriginal and
Islander Health Service
Health Administrators, Midwives, Child Health,
other Health Professionals: Mackay Health
Service District
Education, training and support for Aboriginal
health Workers at Yaptajarra (Community
Controlled Health Centre) and at the child
Health Centre, Mt Isa
Sept 2004
Oct 2004
Sept 2004
Sept 2004
Sept 2004
Sept 2004
Oct 2004
Oct 2004
Dec 2004
Dec 2004
Feb 2005
Feb 2005
Feb 2005
March 2005
beyondblue National PND Program Final Report
VOL I: National Screening Program
The beyondblue National Postnatal Depression Program: Ending well,
Screening for Antenatal and Postnatal Depression: A Health District
Perspective
Screening for postnatal depression
The beyondblue National Postnatal Depression Program: Ending well,
Screening for Antenatal and Postnatal Depression: A Health District
Perspective
The beyondblue National Postnatal Depression Program: Ending well,
Screening for Antenatal and Postnatal Depression: A Health District
Perspective
The beyondblue National Postnatal Depression Program: Equipping General
Practitioners to manage emotional health of Childbearing Women
The beyondblue National Postnatal Depression Program: Equipping Rural
Nurses to manage emotional health of Childbearing Women
New South Wales
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & PND assessment & management
Tresillian Home Visiting Family Intervention Program: Work in Progress
Building Better Beginnings
'beyondblue' the National PND Program
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & in NSH
Page 81 of 108
Health Administrators: Cairns Health Service
District
April 2005
One day education and training for perinatal and April 2005
family Aboriginal Health Workers (Mixed
gender) at Palm Island
Health Administrators: West Moreton Health
April 2005
Service District
Health Administrators: Logan Health Service
District
April 2005
Townsville Division of General Practitioners
Mail-Out
Australian Association for Rural Nurses MailOut
May 2005
Obstetrics & Gynaecological Meeting RNS
Maternity Department RNS
Student Doctors, RNS
Maternity staff RNS
LNS PND Interest Group
Maternity staff RNS & Ryde Hospitals
Hornsby-Kur-ring-ai Perinatal Mental Health
Interest Group
C&FHS Queenscliff HC
Ryde Perinatal Health Promotion Committee
Mona Vale Hospital Maternity staff
Northern Beaches PND Interest Group
Mater Hosp Maternity staff
LNS Div of GPs
Manly Hospital Maternity staff
February 2003
February 2003
February 2003
March 2003
April 2003
July 2003
August 2003
May 2005
August 2003
September 2003
October 2003
November 2003
November 2003
February 2004
February 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
'beyondblue' the National PND Program & in NSH
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
Postnatal Depression Management and 'beyondblue' the National PND
Program
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
Perinatal Mental Health
'beyondblue' the National PND Program & PND assessment & management
'Breaking the Cycle - Early detection & early intervention'
South Australia
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
Page 82 of 108
Hornsby Hospital Maternity staff
Manly Hosp Maternity staff
Hornsby Hosp Maternity staff
Student MWs at University of Technology, Syd
Lower North Shore Division of General Practice
February 2004
March 2004
April 2004
August 2004
August 2004
Student Doctors, RNS
Maternity staff, North Shore Private hospital
St. John of God, Burwood
Bowral DGP
H-K-H Perinatal Mental Health Interest Group
Mercy Learning Centres, Albury
November 2004
February 2005
February 2005
March 2005
April 2005
May 2005
Women’s and Children’s Hospital Obstetrics
Division
Women’s and Children’s Hospital Maternity
Division
Flinders Medical Centre Obstetrics Division
Flinders Medical Centre Maternity Division
Women’s and Children’s Hospital Grand Ward
Round
Women’s and Children’s Hospital Maternity
staff
Modbury Hospital Maternity staff
Flinders Private Hospital Maternity staff
Ashford Private Hospital Maternity staff
Calvary Private Hospital Maternity staff
Southern Division of General Practitioners
Women’s and Children’s Hospital Maternity
staff update
Southern Division of General Practitioners
Central Division of General Practitioners
Upper Eyre Health Service, Streaky Bay
August 2001
September 2001
October 2001
October 2001
November 2001
November &
December 2001
April 2002
May 2002
June 2002
July 2002
July 2002
November &
December 2002
August 2003
September 2003
May 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
'beyondblue' the National PND Program & PND assessment & management
Page 83 of 108
Lower Eyre Health Service, Port Lincoln,
Kangaroo Island Health Service, Kingscote,
Alice Springs Health Service, Alice Springs, NT
Darwin Mental Health, NT Health Department
Flinders University of SA Bachelor of
Midwifery
Central Division of General Practitioners
South East Health Area, Mt Gambier Health
Service
South East Division of General Practitioners
Leigh Creek Hospital, Leigh Creek
Child and Youth Health Modbury
Child and Youth Health Salisbury
Child and Youth Health Norwood
Child and Youth Health Marion
Port Pirie Hospital Maternity Staff
Flinders University of SA Bachelor of
Midwifery
May 2004
June 2004
August 2004
August 2004
November 2004
September 2004
March 2005
March 2005
May 2005
June 2005
June 2005
June 2005
June 2005
June 2005
June 2005
beyondblue National PND Program Final Report
VOL I: National Screening Program
Appendix C – Health Professional Training Guidelines
Training in Perinatal Mental Health Issues
Suggested Minimum Information
1. Antenatal
1.1
Current depression and/or anxiety
♦ Symptoms – what is normal and what is not
♦ Identification/diagnosis by screening questionnaires
♦ Management overview, including issues of level of severity and chronicity, and comorbidity eg personality disorders
♦ Use of psychotropic medication in pregnancy
♦ When to refer to a specialist (see also 2.8)
1.2
Groups at risk antenatally of developing PND or PNA (anxiety)
1. Identification by history or screening
2. Use of the EPDS
3. Management
2. Postnatal
2.1
Types of mood changes/adjustment disorders postnatally
♦ Normal mood changes
♦ Adjustment disorders/anxiety
♦ Blues
♦ Puerperal psychosis including brief outline
♦ PND
♦ Related disorders (eg GAD, phobias, PTSD)
2.2
Assessing postnatal mood
♦ Symptoms and findings including physical conditions i.e. differential diagnosis
♦ Overview of management including issues of level of severity and chronicity, and
co-morbidity (eg personality disorders)
♦ When to consult/refer to specialist mental health services (see also 2.8)
♦ Use the Management Guide to help develop an individual management plan with
patient & partner input (if applicable)
2.3
Men and PND
♦ Men and their perinatal mood changes
♦ Impact on male partner and responses to depressed mother
♦ Effects on relationships esp. libido
♦ What men can do to help with PND
Page 84 of 108
beyondblue National PND Program Final Report
VOL I: National Screening Program
2.4
Infant development & PND
♦ Effects and ways of managing
2.5
Extended family and PND
♦ What grandparents etc can do to help
2.6
Medication
♦ Psychotropic medication in pregnancy and breastfeeding
2.7
Community supports
♦ Self-help groups, child and youth health etc
2.8
Referral
♦ When to consider referral and what options are available
2.9
Counselling skills
♦ This will depend on the time available
♦ May include either the BATHE technique (from Anne Sved-Williams), CBT (which
is also covered by the Sphere program) or any other counselling technique favoured
Page 85 of 108
beyondblue National PND Program Final Report
VOL I: National Screening Program
Appendix D – Detailed List of Media and Promotional Activities
TV, Radio and Promotional Activities
Headline/Title/Event
National Office
Postnatal Depression
Parenting with a Mental Illness
beyondblue Postnatal Depression Project
beyondblue Postnatal Depression Project
The National Postnatal Depression Program: Implementation issues and
proposed outcomes
Update on the beyondblue National PND Program & progress in Tasmania
Mother-Baby
Postnatal Depression and the National PND Program
Life Cycle Depression in Women
Pregnancy and lactation. Special topics in pharmacotherapy
Psychosocial Assessment of Mothers and Infants
Postnatal Depression in Australia – the beyondblue PND Program
Psychosocial Assessment of Mothers and Infants.
Pregnancy, Breastfeeding and Psychotropic Medications
Page 86 of 108
Source/Event
Promoting Women’s Mental Health, Banksia House
Mother Baby Unit, Austin Health
Annual Meeting, Family Care Sisters & Mercy
Health & Aged Care Board of Governance
Royal Australian College of General Practitioners –
Victoria.
Maternal & Child Health Sub-Committee, Royal
Australian College of General Practitioners
Hunter Valley, N.S.W
Postnatal Depression Professional Forum.
Launceston
Orygen Youth Health
Postnatal Depression & Mental Health Issues for
the Parturient Woman. Benchmark Education for
Midwives.
Medical Meetings. Park Hyatt, Melbourne
4th year MPM. Austin Health,
Management Strategies for Child & Family
Services Conference. Melbourne
Depression & Anxiety Consumer Research Unit,
National Instit. of Health & Human Sciences,
Australian National University. Canberra.
Management Strategies for Child & Family
Services Conference. Melbourne
2nd Yr PM/Mpsychiatry Adult Psychiatry 1.
Date
October 2001
October 2001
November 2001
November 2001
August 2002
May 2003
May 2003
June 2203
July 2003
August 2003
May 2004
May 2004
May 2004
August 2004
beyondblue National PND Program Final Report
Postnatal Depression - the latest from beyondblue
Responding to Maternal Depressive Illness
National PND Program
Implementation of a National Perinatal Mental Health Screening Program:
The beyondblue
National Postnatal Depression Program
Implementation of a National Perinatal Mental Health Screening Program:
The beyondblue National Postnatal Depression Program
Implementation of a National Perinatal Mental Health Screening Program:
The beyondblue National Postnatal Depression Program
Implementation of a National Perinatal Mental Health Screening Program:
The beyondblue National Postnatal Depression Program
The Development of a National Perinatal Depression Screening Program in
an Australian Population
The Development of a National Perinatal Depression Screening Program in
an Australian Population
Queensland
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood –
combined presentation
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood –
Page 87 of 108
VOL I: National Screening Program
Mental Health Research Institute
Helping Mothers in the 1st Year, Nurse Education
Unit. Peninsula Health.
Mental Health in the Young: A Challenge to the
Community Workshop. Royal Children's Hospital,
Melbourne
Perinatal Psych Group
Francis Perry House, Carlton, Victoria
St Vincent’s and Mercy Private Hospital,
Melbourne, Victoria
Postnatal Depression Study Day, St John of God
Hospital
The Benefit of Knowing, Bass Coast Regional
Shire, Wonthaggi
Wiener Frauengsundheitsprogramm Friedrich
Schimdt-Platz, Rathaus, Vienna
October 2004
October 2004
March 2005
October 2004
November 2004
November 2004
October 2004
October 2003
Community Practitioners and Health Visitors
Association, London, England
November 2003
Australian Psychological Society – Townsville
August 2001
James Cook University, incoming midwifery
students (Practice 1 & 3)
Townsville District Health Service
May 2002
May 2002
Mental Health Services – Townsville District
June 2002
Institute of Women’s & Children’s Health
June 2002
beyondblue National PND Program Final Report
telepsychiatry links
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood –
(networking)
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood (Professor
Anne Buist)
VOL I: National Screening Program
Townsville Hospital, Midwives & Social Work
Department
June 2002
Townsville Hospital floor midwives education
July 2002
Steering committee for postnatal issues:
Townsville District Health Service
QHealth-Family Care (early intervention program)
Program
Townsville Aboriginal & Islander Health Service
July 2002
TAIHS- Medical and nursing staff
October 2002
TAIHS-Indigenous focused
October 2002
Faculty of Medicine, Health and Molecular
Sciences, JCU Research Day
Infant Management & Parenting Scheme
October 2002
October 2002
Child & Youth Mental Health Service
November 2002
Sphere
November 2002
July 2002
October 2002
The Townsville Hospital: Consultant psychiatrists, December 2002
Obstetricians, Senior General Medical Practitioner,
Senior Midwives, Child Health Nurses, Allied
Health Professionals, Floor Midwives
The beyondblue National Postnatal Depression Program – information and
Consultant psychiatrists, Obstetricians, Senior
March 2003
education regarding Depression in pregnancy & early parenthood (sponsored General Medical Practitioners, Senior Midwives
by Pfizer)
and Child Health Nurses, Allied Health
Professionals, Clinic/Unit Midwives
The beyondblue National Postnatal Depression Program – information and
Cairns Base Hospital - Institute for Women’s &
March 2003
Page 88 of 108
beyondblue National PND Program Final Report
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
education regarding Depression in pregnancy & early parenthood
The beyondblue National Postnatal Depression Program – information and
Page 89 of 108
VOL I: National Screening Program
Children’s Health Clinicians & Consumers
Townsville Division of General Practice;
April 2003
2 x Townsville Community Health Centres
April 2003
Cairns Base Hospital – Mental Health Services
June 2003
Mount Isa Centre for Rural & Remote Health
June 2003
Mt Isa District Health’s Service Grand Rounds –
GPs, Psychologists, Medical Students & Other
Health Professionals
Mackay – Mental Health Services
June/July 2003
June 2003
Mt Isa – Integrated Mental Health Services
June 2003
Mt Isa & Mackay – Child Health Services
June 2003
Mt Isa Base Hospital – Indigenous Liaison
June 2003
Mt Isa, Community Health Centre Indigenous
Team
North West Queensland Primary Health Care
Team
Mt Isa Integrated Mental Health – Indigenous
focus
Yapatjarra Health Centre – Indigenous health team
June 2003
Palm Island Council – Indigenous initiatives –
Council and lay members
Q Health Northern Zone Manager (Mackay to
Cape York)
Palm Island – Director of Nursing, Chief Medical
July 2003
July 2003
August 2003
September 2003
September 2003
September 2004
beyondblue National PND Program Final Report
education regarding Depression in pregnancy & early parenthood
NQ Post-Natal Distress Support Group: Information Booklet
Western Australia
Launch of the beyondblue National Postnatal Depression Early Intervention
& Prevention Program
The beyondblue National Postnatal Depression Early Intervention &
Prevention Program
Launch of the beyondblue National Postnatal Depression Early Intervention
& Prevention Program
The beyondblue National Postnatal Depression Early Intervention &
Prevention Program
The beyondblue National Postnatal Depression Early Intervention &
Prevention Program
Depression in the Perinatal Period: Early Intervention & Prevention
The beyondblue National Postnatal Depression Early Intervention &
Prevention Program – Associated Postgraduate Research Projects
The beyondblue National Postnatal Depression Early Intervention &
Prevention Program: A Preliminary Analyses
The beyondblue National Postnatal Depression Program: Early Intervention
& Prevention Strategies
It’s Postnatal Depression Awareness Week
Raising Awareness of PND
N/A
New light shed on depression
beyondblue the National Depression Initiative
Page 90 of 108
VOL I: National Screening Program
Officer, Integrated Mental Health team, Antenatal
& Postnatal Clinic staff
NQ Post-Natal Distress Support Group: For
October 2004
Families, By Families, With Families. Information
Booklet Launch
Channel 31 ‘Face the Facts’ 2 x Interviews
December 2001
Women’s Health Care House, Perth, Oral
January 2002
Official WA Launch of the Program at Edith
Cowan University
Edith Cowan University, Oral
February 2002
Health Department of WA Mental Health
Symposium, Oral
King Edward Memorial Hospital Midwives, Oral
Women & Infants Research Foundation,
Workshop
King Edward Memorial Hospital Lunchtime
Lecture Series, Oral
General Practice Divisions WA, Mental Health
Officers, Oral
7 x Promotional Displays: King Edward Memorial
Hospital, King Edward Family Birth Centre,
Osborne Park Hospital, Mercy Private Hospital,
Edith Cowan University School of Psychology,
ECU Psychological Services Centre
Radio Fremantle, On-air Interview
Radio National, On-air Interview
Wanneroo Times, Newspaper Article
Women & Infants Research Foundation, Teenage
Parents Festival
March 2002
March 2002
July 2002
December 2002
February 2003
April 2003
November 2003
December 2003
January 2004
January 2004
September 2004
beyondblue National PND Program Final Report
Raising Awareness of PND
Raising Awareness of PND
Results of the beyondblue National Postnatal Depression Project for
Families with Multiple Birth Children
Australian Capital Territory
Postpartum Depression in Australia: The beyondblue Postnatal Depression
Program: A/Prof Anne Buist.
The lived experience of postnatal depression: radio interview with ACT
Consumer and Rebecca Reay
Postnatal Depression Seminar: The National Postnatal Depression Program:
The ACT experience of the National Postnatal Depression Program
Victoria
Identification, Assessment and Management of Maternal Depression.
Is it enough to use Depression Improvement as an Outcome Measure with
Postnatal Depression Treatment? The Parent-Infant Interaction
Day long planning seminar on health promotion and PND on needs,
identification of women, provision of services
Maternal and Child Health Nurse Information session
Maternal and Child Health Nurse Information session
Information session
Maternal and Child Health Nurse Information session
Maternal and Child Health Nurse Information session
Maternal and Child Health Nurse Information session
Maternal and Child Health Nurse Information session
Maternal and Child Health Nurse Information session
Grand Round, Austin Health
Page 91 of 108
VOL I: National Screening Program
Radio West, On-air interview
Twin Cities Radio, On-air interview
Australian Multiple Birth Association, State (WA)
Committee AGM
November 2004
December 2004
May 2005
National Institute of Human and Health Sciences:
Australian National University
ABC Radio Canberra
April 2004
ACT Division of General Practice Rydes Hotel,
Maunka, ACT
2XX Radio Canberra
August 2004
April 2004
June 2005
Centre for Community Child Health Seminar New
Directions in Assessment and Management of
Infant Distress. Royal Children’s Hospital
Research Week Austin Health
August 2001
November 2001
Moreland City Council
January 2002
City of Wyndham
City of Whitehorse
Northern Birthing Support Service
City of Whittlesea
City of Whitehorse
City of Darebin
City of Nillumbik
City of Moreland
Antenatal Depression- Enhancing the parent-infant
relationship. (Victorian component of the
beyondblue NPDP)
February 2002
February 2002
February 2002
May 2002
May 2002
May 2002
June 2002
June 2002
July 2002
beyondblue National PND Program Final Report
Maternal and Child Health Nurse Information session
Health professionals Information session
Midwife Information session
Midwife Information session
Midwives and interested health professionals info session
Primary Mental Health Team presentation on Depression Management and
NPNP
PND Information evening - various health professionals including GPs,
MCHNs, midwives, social workers, etc.
Maternal and Child Health Nurse Information session
Invited speaker - Postnatal Depression.
Information session for Antenatal Educators
Information session for Family Birth Centre midwives
Meeting with PR dept to publicize NPDP in local paper and to extend
screening to further clinics
Presentation about the NPDP
½ day workshop on NPNP and PND to health professionals
Information session on NPDP
Information session with midwives
Regional meeting with MCHN Coordinators
Information session on NPDP
“Australia talks back” - guest presenter
“Behind Closed Doors” - presenting the research, profiling best practice.
Mental Health Reference group meeting
Invited speaker - Postnatal Depression
Postnatal Depression and General Practice
What is the effect of maternal depression on the infant? What Helps?
Page 92 of 108
VOL I: National Screening Program
City of Manningham
Whittlesea PND Interest Group
Werribee Mercy Hospital
Angliss Hospital
Northern Hospital
Western, Westgate and South-West Divisions of
General Practice
August 2002
September 2002
September 2002
October 2002
October 2002
October 2002
Angliss Hospital
November 2002
City of Whitehorse
Rotary Club of Whittlesea, Whittlesea
Angliss Hospital
Angliss Hospital
Angliss Hospital
December 2002
December 2002
December 2002
December 2002
February 2003
Obstetric Audit at the Northern Hospital
Warrnambool PND forum
Wyndham MCHN
Angliss Hospital
Boroondara MCHN
Eastern Regional Meeting of MCHN co-ordinators
Radio National
Greater Shepparton Postnatal and Antenatal
Depression Forum
GPDV
Rotary Club of Ivanhoe, Ivanhoe
Division of General Practice Victoria Primary
Mental Health Forum
Australian Association of Infant Mental Health.
February 2003
February 2003
March 2003
March 2003
March 2003
March 2003
April 2003
May 2003
June 2003
June 2003
June 2003
September 2003
beyondblue National PND Program Final Report
Research and clinical findings.
PND and beyondbabyblues launch
Beyondblue National Postnatal Depression Program
Information session on NPDP to new mothers group
Presentation to clinic about NPNDP
Invited speaker - Postnatal Depression
Information session on NPDP
Information session on NPDP
Display and posters about NPDP
VOL I: National Screening Program
Victorian Branch Meeting
Bowen Centre, Hawthorn
South West Health Program Launch Hamilton
City of Kingston
University Psychology Clinic
East Hawthorn Playgroup
Barwon South West Regional Midwives Forum
MCHN 24 hour crisis telephone service
Melbourne University Research and Innovation
Fair
Austin Health GP liaison Officer meeting
Northern Hospital
GPDV Mental Health Reference Group
La Trobe University
Rotary Club Glen Eira, Glen Eira
Royal Children’s Hospital
November 2003
November 2003
February 2004
February 2004
March 2004
March 2004
March 2004
May 2004
Information session on NPDP
Study Day presentation to health professionals and consumers
Information session on NPDP
Invited speaker - Postnatal Depression
Invited speaker - Postnatal Depression
Seminar for Graduate Diploma in Mental Health Sciences,– Attachment
Theory and Research
Invited speaker - Antenatal Support following Depression – Enhancing the
Grand Round, Austin & Repatriation Medical
parent-infant relationship. (Victorian component of the beyondblue National Centre, Heidelberg
Project The National Postnatal Depression Program – prevention and early
intervention)
Antenatal Support Following Depression. The National Postnatal Depression Research Week Austin Health
Program in Victoria and Tasmania
June 2004
July 2004
July 2004
August 2004
August 2004
August 2004
Screening for postnatal depression in routine primary care: Properties of the
Edinburgh Postnatal Depression Scale
Models of Care: Evaluating a best practice model for treating postnatal
depression
Research Week Austin Health
October 2004
Research Week Austin Health
October 2004
Page 93 of 108
August 2004
October 2004
beyondblue National PND Program Final Report
South Australia
beyondblue National PND Program
beyondblue National PND Program
New South Wales
PND and beyondblue
Interview for Body & Soul
Information on beyondblue activities at RHW
PND and beyondblue
PND and beyondblue
PND and beyondblue
PND and beyondblue
PND and beyondblue -linking NESB women to mental health Services
Perinatal Depression and BB PND Program
PND and beyondblue
PND and beyondblue
PND and beyondblue
Parents with Mental Illness - Breaking the Cycle
beyondblue - National Postnatal Depression Program
Antenatal screening, what are the benefit and risks?
beyondblue beyondblue beyondblue beyondblue beyondblue beyondblue Page 94 of 108
National Postnatal Depression Program
National Postnatal Depression Program
National Postnatal Depression Program
National Postnatal Depression Program
National Postnatal Depression Program
National Postnatal Depression Program
VOL I: National Screening Program
Grand Round, Flinders Medical Centre, Adelaide.
Grand Round, Women’s and Children’s Hospital,
Adelaide.
August 2001
September 2001
Malcolm Elliot 2UE Radio
Channel 9
GP Forum
Interviewed on Radio National “Life Matters”
Donna Maria
RHW Perinatal Mental Health Review
Regional Obstetric Social Workers meeting held at
RHW
Multicultural Womens Group
September 2002
September 2002
November 2002
November 2002
November 2002
November 2002
February 2003
Statewide GP day at UNSW on Women’s Health
Train the Trainer workshop.
SESAHS GP Day
Breaking the Cycle: Early Intervention in Infancy:
Transforming the Next Generation (Launch of
Area Health Policy)
You, Me and attachment conference.
Early Agendas – Issues in Infant and Maternal
Mental Health (Royal Australian and New Zealand
College of Psychiatrists) (I Hickie, Keynote
Speaker)
Karitane Open day
Perinatal and Infant services networking forum
beyondblue partnership lunch
Arabic Radio
Western Community Radio – Arabic (2M FM)
2000 FM (Assyrian Radio)
February 2003
February 2004
February 2004
April 2004
April 2004
August 2004
August 2004
June 2004
June 2004
August 2004
May 2003
June 2003
July 2003
beyondblue National PND Program Final Report
beyondblue - National Postnatal Depression Program
beyondblue - National Postnatal Depression Program
beyondblue - National Postnatal Depression Program
beyondblue - National Postnatal Depression Program
Page 95 of 108
VOL I: National Screening Program
SBS Vietnamese Radio
Obstetric and Gynaecological health Professionals,
RNS
Midwifery Parent Educators, Lower North Shore
Area
Lower North Shore Clinical Research Support and
PND Interest Group
March 2003
March 2003
February 2003
March 2003
beyondblue National PND Program Final Report
VOL I: National Screening Program
Newspaper and Magazine Articles
Headline/Title
National Office
WA Uni aims to prevent postnatal depression
Screening for new mothers
National focus on birth depression
Plans to erase mothers’ fear
New plan to fight post-natal blues
New study to focus on postnatal depression
beyondblue program launched
The National Postnatal Depression Program
beyondblue Postnatal Depression Program launched
Test tackles birth blues
Sad Lullabies
Postnatal blues Program soon to bear fruit
GP s offered PND courses
When motherhood brings you down
New aid for postnatally depressed
Postnatal Depression in the Far North
Largest study into baby blues begins
Quizzing mothers-to-be helping to fight the baby blues
Dads, Dummies and Demons
Postnatal depression test okay before birth
Help for depressed mums
Beating the baby blues
Page 96 of 108
Source
ABC News Online
The Age
The Heidelberger
Herald Sun
Progress Press
Peoplefocus
Obstetrics & Gynaecology
Forward Together. Quarterly Bulletin of the
National Secretariat of National Council of
Women of Australia
Women’s Health in Focus
Sunday Herald-Sun
Who Magazine
Medical Observer
Medical Observer
Colesbaby magazine
Sunday Age
Dona Maria Pre & Postnatal Support Network –
Network News
ninemsn website
The Age
Sunday Life
Medical Observer
Letters to the Editor, Herald-Sun Newspaper
Herald-Sun Newspaper
Date
September 2001
September 2001
September 2001
September 2001
October 2001
October 2001
3(4): December
2001
December 2001
December 2001
December 2001
April 2002
May 2002
May 2002
Autumn Edition
2002
July 2002
Winter 2002
August 2002
August 2002
August 2002
November 2002
December 2002
March 2003
beyondblue National PND Program Final Report
Consider SSRI does before giving birth, expert says
Wife suicidal before killings
National Postnatal Depression Program by 'beyondblue'
Maternal depression – does it matter to the kids
Down but not out
Baby blues
Fall from Grace
Swimmer dives into the blues of birth, death and postnatal despair
Fatal does of the blues
The sharp edge of postnatal depression
Program to help mothers
New mums on the edge
Beyond a mother’s control
The birth of the blues
Depression test urged
Screen for antenatal depression: expert
Queensland
Pregnancy help
Raising the profile of baby blues
Beyond the baby blues
Mum study to uncover baby blues
Book for post-natal depression screening
NQ Post-Natal Distress Support Group: Information Booklet
Emotional health during pregnancy
Emotional health during pregnancy
Page 97 of 108
VOL I: National Screening Program
Medical Observer Weekly
The Age
Synergy the newsletter of Multicultural Mental
Health Australia
Every Child
Coles baby magazine
Sydney Morning Herald on-line
New Idea
The Age
Herald Sun
Vicdoc
Heidelberg leader
New Idea
The Age
Good Weekend
Herald Sun
Medical Observer Weekly
Townsville Bulletin
Outlook – JCU Bulletin
Rural Nurse
Cairns Post
The North West Star
NQ Post-Natal Distress Support Group: For
Families, By Families, With Families. Information
Booklet Launch
The Australian Psychological Society Ltd:
Queensland State Newsletter
Queensland state newsletter
February 2004
February 2004
No 2, 2004
10(4): Spring
2004
Spring 2004
March 2004
August 2004
September 2004
September 2004
October 2004
October 2004
November 2004
December 2004
February 2005
March 2005
March 2005
October 2001
November 2001
November 2001
August 2002
July 2004
September 2004
October 2004
November 2004
beyondblue National PND Program Final Report
Western Australia
Postnatal depression studied
Helping mums beat the blues
Raising Awareness of PND
Abuse link to baby blues
Abuse linked to baby blues
Childhood abuse a factor in motherhood depression
Postnatal study
New light shed on depression
The beyondblue National Postnatal Depression Project for Families with
Multiple Birth Children
The beyondblue National Postnatal Depression Project for Families with
Multiple Birth Children
Progress of the beyondblue National Postnatal Depression Program
Depression During Pregnancy & Early Parenthood
The beyondblue National Postnatal Depression Project for Families with
Multiple Birth Children
Depression During Pregnancy & Early Parenthood
beyondblue the National Depression Initiative
Stress
Stress
Information Booklet Advertisement
Ante and Postnatal Depression: Risk Factors, Symptoms and What Can I
Do?
Depression During Pregnancy and Early Parenthood
Page 98 of 108
VOL I: National Screening Program
The West Australian, Newspaper Article
Sunday Times Newspaper, Feature Article
Radio Fremantle, On-air Interview
The West Australian, Newspaper Article
Herald Sun, Newspaper Article
Avon Valley Advocate, Newspaper Article
Guardian Express, Newspaper Article
Wanneroo Times, Newspaper Article
Australian Multiple Birth Association National
Journal/Magazine, Article
Australian Multiple Birth Association Local Club
Newsletters – Nationally, Article x 68
Postnatal Depression Professionals Association
Newsletter
Australian Multiple Birth Association National
Journal/Magazine, Article
Perth & Districts Multiple Birth Association
Newsletter, Article
Australian Multiple Birth Association Local Club
Newsletters – Nationally, Article x 68
Women & Infants Research Foundation, Teenage
Parents Festival
Australian Multiple Birth Association National
Journal/Magazine, Article
Australian Multiple Birth Association Local Club
Newsletters – Nationally, Article x 68
Premiepress: The Psychology of Infancy,
Advertisement for Information Booklets
Twin Talk – Northern Territory Multiple Birth
Club Newsletter
Twin Talk – Northern Territory Multiple Birth
Club Newsletter
August 2002
October 2002
December 2003
December 2003
December 2003
December 2003
December 2003
January 2004
Issue 31, Vol 9
May 2004
June 2004
July 2004
Issue 32, Vol 10
July 2004
July 2004
August 2004
September 2004
September 2004
October 2004
Vol 5(4),
December 2004
March 2005
April 2005
beyondblue National PND Program Final Report
Results of the beyondblue National Postnatal Depression Project for
Families with Multiple Birth Children
Australian Capital Territory
Postnatal Depression to go under national spotlight
Launch of ACT component of National beyondblue Postnatal Depression
Program
beyondblue Postnatal Depression Launch
Victoria
Study of birth and the blues
Baby blues plan a first
Quizzing mothers to be helping to fight the babyblues
Survey to life the spirits of mums
Postnatal Depression Research
The beyondblue National Postnatal Depression Program
Depression after giving birth strikes 1 in 10
Trust in yourself
South Australia
Launch of South Australian postnatal depression initiative
South Australian postnatal depression program launched in Adelaide
Partners enlisted in the fight against postnatal depression
Tracking the signs of postnatal depression
One in five new mums who can’t beat depression.
Fathers help beat the blues
Baby blues can hit before birth
Pregnancy depression ignored and untreated
Beyondblue Opening our eyes to depression in Murray Bridge
Page 99 of 108
VOL I: National Screening Program
Australian Multiple Birth Association, State (WA)
Committee AGM
May 2005
The Canberra Times
The Canberra Chronicle
April 2004
April 2004
Division Action: Monthly Newsletter for the ACT
Division of General Practice
April 2004
The Werribee Times
The Werribee Banner
The Age
Northern Hospital Newsletter
Mercy Health News
Division of GPs newsletter – Northern, North East
Valley, North West Melbourne, Westgate, Western
Knox, Eastern Ranges and Whitehorse
The Age
Mother & Baby
August 2002
August 2002
August 2002
October 2002
November 2002
March/April 2003
The Advertiser
The Advertiser
Flinders Journal, Flinders University, V12:18
The Advertiser
The Advertiser
The Advertiser
The Advertiser
The Advertiser
Public Forum, The Age
September 2001
October 2001
November 2001
February 2001
June 2003
August 2004
September 2004
February 2005
February 2005
January 2004
June/July 2004
beyondblue National PND Program Final Report
New South Wales
Child & Adolescent Psychiatry, RNSH
'beyondblue' at Royal North Shore Hospital
Depression drive is banishing the blues
'beyondblue' the National PND Program
Beating the baby blues, step by step
'beyondblue' at Royal North Shore
Support is the key to beating baby blues
beyondblue National Postnatal Depression Program
Beyond the baby blues: program offers new hope
Depressed new mothers reluctant to seek help
Screening program raises awareness
Baby blues
beyondblue National Postnatal Depression Program
beyondblue National Postnatal Depression Program
'beyond the baby blues for RNSH and Ryde mums'
Marie-Paule Austin and beyondblue
The Birth of the baby blues
'beyondblue' at Northern Sydney Health
Page 100 of 108
VOL I: National Screening Program
Northern Sydney CAMHS news
Northern Sydney Child & Adolescent Mental
Health Service News
Liverpool Champion (Community Newspaper)
Northern Sydney Div of General Practitioners
Newsletter
Sydney Morning Herald
RNS News
Sydney Morning Herald
SWSAHS Division of GPs newsletter
Sydney Morning Herald
Sydney Morning Herald
Sydney Morning Herald
Sydney Morning Herald
The Future Arabic Newspaper
El Telegraph Arabic Newspaper
Royal North Shore & Ryde News
Sunday Telegraph
Sydney Morning Herald
HKR Div of General Practice Newsletter
December 2002
February 2003
March 2003
March 2003
May 2003
May 2003
August 2003
October 2003
December 2003
December 2003
March 2004
March 2004
March 2004
March 2004
July 2004
November 2004
February 2005
August 2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
Appendix E – Detailed list of Conference Presentations and Scientific Articles
Conference Presentations
Conference
National Office
The Australia Society for Psychiatric
Research Annual Scientific Meeting
10th Annual National Conference, Royal
College of Nursing, Australia. Darling
Harbour, Sydney.
Marce Society International Biennial
Scientific Meeting, Sydney, NSW
Marce Society International Biennial
Scientific Meeting, Sydney, NSW
The 27th Congress of the World
Federation for Mental Health.
Melbourne
3rd General Practice Divisions of Vic
Conference. Melbourne Vic.
Presentation Title
Authors
Format
Date
The National Postnatal Depression
Program
The National Postnatal Depression
Program – Reaching out to women
in pregnancy and postpartum
period
The National Postnatal Depression
Program
To Screen or Not to Screen for
Perinatal Depression? – That is the
Question…
Screening for Postnatal
Depression
Buist, A.E & Bilszta, J.L.C.
Poster
Buist, A.E (Keynote Speaker)
Oral
December
2001
February
2002
Buist, A.E & Bilszta, J.L.C.
Poster
Buist, A.E., Milgrom, J., Condon, J.,
Boyce, P., Austin, M-P., Ellwood, D.,
Hayes, B., and Pope, S.
Buist, A.E
Oral
Oral
February
2003
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
April 2003
Buist, A.E., Milgrom, J., Barnett, J.,
Hayes, B., and Pope, S.
Oral
July 2003
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
July 2003
Buist, A.E.,
Oral
October
2003
The National Postnatal Depression
Program – Enhancing the Quality
of GP & Perinatal Service
Partnerships
Joint AAIMH/Marce Society
The National Postnatal Depression
Conference. Building Better Beginnings. Program: National Baseline
Adelaide
Survey
Joint Australian Association for Infant
The National Postnatal Depression
Mental Health/Marce Society
Program – Enhancing the Quality
Conference
of GP & Perinatal Service
Partnerships
Harplands Hospital, Stoke-On-Trent,
The Australian National Postnatal
England.
Depression Program: results of the
Page 101 of 108
September
2002
September
2002
beyondblue National PND Program Final Report
World Association of Infant Mental
Health 9th World Conference.
World Association of Infant Mental
Health 9th World Conference.
2nd International Women’s Mental
Health. Washington. USA
Postpartle Depression: Muttergluck gluckliche Mutter Vienna, Austria
Marce Society International Biennial
Scientific Meeting, Oxford, UK
Marce Society International Biennial
Scientific Meeting, Oxford, UK
RANZCP 40th Annual Congress.
Sydney.
Postpartum International.
San Jose, California, USA
VOL I: National Screening Program
baseline survey of public and
professional knowledge of
postnatal depression.
The National Postnatal Depression
Program - Enhancing the quality
of GP & perinatal service
partnerships
The National Postnatal Depression
Program
The Australian National Postnatal
Depression Program
Implementation of a National
Perinatal Mental Health Screening
Program: The beyondblue
National Postnatal Depression
Program
The Australian National Postnatal
Depression Program
Screening for perinatal depression
using the Edinburgh Postnatal
Depression Scale – Experiences of
the beyondblue National Postnatal
Depression Program
The Mental Health of Women
Giving Birth in Australia 2002-4.
The beyondblue National
Postnatal Depression Program
The Mental Health of Australians
– Results of the beyondblue
Australian PND Program
Barriers to prevention – the
findings of the beyondblue
Page 102 of 108
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, B., Condon, J.,
Hayes, B., & Pope, S
Poster
January
2004
Buist, A.E., & Bilszta, J.L.C
Poster
Buist, A.E.,
Oral
January
2004
March
2004
Bilszta, J.L.C
Oral
May 2004
Buist, A.E., Milgrom, J., Barnett, J.,
Hayes, B., and Pope, S.
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Oral
September
2004
September
2004
Buist, A.E., Barnett, B., Condon, J.,
Austin, M-P., Kowalenko, N., Milgrom,
J., Hayes, B., and Brooks, J.
Oral
May 2005
Buist, A.E. (Keynote Speaker)
Oral
June 2005
Buist, A.E., Barnett, B., Condon, J.,
Austin, M-P., Kowalenko, N., Milgrom,
Oral
June 2005
Oral
beyondblue National PND Program Final Report
VOL I: National Screening Program
Australian PND Program
Australian Capital Territory
Therapies that work Conference. 28th
June 2004 Burgmann College ANU
Counselling Centre, Canberra
The 2004 twilight seminar
Western Australia
Perinatal Society of Australia & New
Zealand, Hobart
Australian Multiple Birth Association
WA Annual State Conference, Bunbury
Joint Australian Association for Infant
Mental Health/Marce Society
Conference, Adelaide
Telethon Institute for Child Health
Research Australian Twin Registry
Conference, Perth
International Marce Society Conference,
Oxford
King Edward Memorial Hospital Stars
Symposium/Conference, Perth
Australian Multiple Birth Association
National Conference, Brisbane
Page 103 of 108
J., Hayes, B., and Brooks, J
The National Postnatal Depression Reay Rebecca
Program: What works for
Postnatal Depression?
‘Beyondblue Tales’- the
Reay, Rebecca
experience of women in the
beyondblue program
Oral
June 2004
Oral
November
2004
‘This Isn’t What we Expected’:
the Impact of Reality in the
Transition to Parenthood
The beyondblue National
Postnatal Depression Project for
Families of Multiple Birth
Children
A Preliminary Analysis of the
First 500 Women in the West
Australian beyondblue Cohort
The beyondblue National
Postnatal Depression Project for
Families of Multiple Birth
Children
The beyondblue National
Postnatal Depression Project for
Families of Multiple Birth
Children
Depressive Symptoms during the
Perinatal Period in Women who
Deliver at King Edward Memorial
Hospital: Preliminary Results of
the National beyondblue Program
The beyondblue National
Postnatal Depression Project for
Pope, S.
Oral
March
2004
Brooks, J.
Oral
May 2004
Pope, S., & Brooks, J.
Poster
July 2004
Brooks, J.
Oral
August
2004
Brooks, J.
Poster
September
2004
Brooks, J.
Oral
September
2004
Brooks, J.
Oral
October
2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
Families of Multiple Birth
Children
Scheduled…
14th Biennial Australasian Human
Development Conference, Perth
14th Biennial Australasian Human
Development Conference, Perth
Australian Multiple Birth Association
National Conference, Hobart
Queensland
Australian College of Midwives
Australian College of Midwives, Inc.
Invited keynote address – Annual State
Conference
Townsville Health District: Women’s
Health Exposition.
Australasian Marce Conference
Australasian Marce Conference
Page 104 of 108
Results of the Western Australian
Cohort of the beyondblue
National Postnatal Depression
Program
Emotional Health for Families
with Multiple Birth Children
Results of the beyondblue
National Postnatal Depression
Project for Families of Multiple
Birth Children
Brooks, J., Doherty, D., & Speelman, C.
Poster
July 2005
Brooks, J., Doherty, D., & Speelman, C.
Poster
July 2005
Brooks, J.
Oral
October
2005
Keynote address: The beyondblue
National Postnatal Depression
Program
Birthing in the tropics: Women
and midwives seeking wisdom in
childbearing
Women’s Health Exposition: A
celebration of womanhood.
Hayes, B.A.
Oral
July 2004
Hayes, B.A. (Keynote speaker)
Oral
July 2004
Hayes, B.A.
Queensland: Regional and Rural
Dimensions Impacting on the
Emotional Health of Childbearing
Women
Queensland: Postal Antenatal and
Postnatal Screening of Regional
and Rural Women in the
beyondblue National Postnatal
Depression Project – A
Buckby, B., Hayes, B.A., McCulley, J.
Invited
March
introductory 2005
& summary
speaker &
chair
Poster
Sept 2005
Hayes, B.A., McCulley, J., Buckby, B.
Poster
Sept 2005
beyondblue National PND Program Final Report
Australasian Marce Conference
New South Wales
Rural Mental Health Conference
beyondblue - National Postnatal
Depression Program
Early Agendas – Issues in Infant and
Maternal Mental Health (Royal
Australian and New Zealand College of
Psychiatrists)
RANZCP 40th Annual Congress.
Sydney.
South Australia
Australasian Midwifery
Expo 2004: Voices Coming Together
Australasian Midwifery
Expo 2004: Voices Coming Together
Victoria
Gippsland Psychology Conference,
Morwell
Jocelyn Wale Seminar, James Cook
University, Townsville, Qld.
1st National Conference for “Meeting the
Challenges for Children & Families
where Parents have a Mental Illness”
Page 105 of 108
VOL I: National Screening Program
demonstration of Ethical and
Clinical Competence
beyondblue: Working in
partnership with Aboriginal
Women and Health Care Workers
towards culturally sensitive
outcomes for childbearing
Indigenous Women at three sites
in Queensland
Hayes, B.A., Geia, L., Egan, M.
Oral
Sept 2005
A Lifespan Approach: Setting the
Foundation for Early Intervention
in Infancy
You, Me and Attachment
Conference
Assessment and early intervention
in the antenatal and postnatal
period.
Kowalenko, N. (keynote speaker)
Oral
March
2004
SWSAHS staff
Poster
June 2004
Barnett, B.E.W
Oral
August
2004
Invited Symposium: Perinatal &
Infant Mental Health Symposium
Kowalenko, N., Buist AE., Powrie, R.
Symposium
May 2005
Beyondblue National Postnatal
Depression Program
Fathers Wellbeing after childbirth
Condon, J.
Paper
Gamble, E.
Paper
August
2004
August
2004
Milgrom, J.
Invited
speaker
Keynote
Mothers, Babies and Postnatal
Depression
Treating Postnatal DepressionMothers, Infants, and Fathers.
“Is it enough to use Depression
Improvement as an Outcome
Measure with Postnatal
Milgrom, J.
Milgrom, J., Ericksen, J., DePaola, C.,
McCarthy, R., & Loughlin, E.
Paper
October
2001
November
2001
May 2002
beyondblue National PND Program Final Report
Melbourne
Marce Society Conference International
Biennial Scientific Meeting. Sydney
Marce Society Conference International
Biennial Scientific Meeting Sydney
International Congress Of Applied
Psychology Symposia XXV
3rd General Practice Divisions Victoria
Conference, The Thing about Quality:
How and Why?
VOL I: National Screening Program
Depression Treatment? The
Parent-Infant Interaction”
A Workshop on intervention
following postnatal depression
targeting both maternal mood and
the mother-infant interaction.
Postnatal Depression and Child
Development-is the early motherinfant interaction a mediating
factor?
Treating Postnatal Depression
The National Postnatal Depression
Program – Enhancing
the Quality of GP & Perinatal
Service Partnerships
Australian Rotary Research Fund
Asking Different Questions: A
Symposium Canberra.
Clinician’s Perspective
Joint Australian Association for Infant
The National Postnatal Depression
Mental Health/Marce Society
Program – Enhancing the Quality
Conference. Building Better Beginnings. of GP & Perinatal Service
Partnerships
Annual Women’s Health East
The National Postnatal Depression
Conference, Moving in from the
Program – Enhancing the Quality
margins, hope and strategies for
of GP & Perinatal Service
improving women’s emotional health
Partnerships
Joint Australian Association for Infant
The National Postnatal Depression
Mental Health/Marce Society
Program: National Baseline
Conference
Survey
Joint Marce Society and Australian
Dysfunctional Parent-Infant
Association for Infant Mental Health.
Relationships following
Building Better Beginnings.
Depression: An intervention Study
th
17 World Congress on Psychosomatic
A Randomised Trial of
Medicine.
Psychological Treatments For
Page 106 of 108
Milgrom, J. Ericksen, J., Loughlin, E.,
Martin, P.R., Negri, L.M., & McCarthy,
R.M.
Workshop
September
2002
Milgrom, J., Ericksen, J., & Westley, D.T.
Plenary
Session
September
2002
Milgrom, J.M.
Symposia
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
November
2002
April 2003
Milgrom, J.
Keynote
May 2003
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
July 2003
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
July 2003
Buist, A.E., Milgrom, J., Barnett, J.,
Hayes, B., and Pope, S.
Oral
July 2003
Milgrom, J., Neilson, K., Loughlin, E.E,
McCarthy, R., & Ericksen, J.
Oral
July 2003
Milgrom, J., Martin, P.R., & Negri, L.M.
Oral
September
2003
beyondblue National PND Program Final Report
World Association Of Infant Mental
Health Melbourne
World Association of Infant Mental
Health 9th World Conference. “The
Baby’s Place in the World”
Annual Scientific Meeting of the
Fertility Society of Australia. Adelaide
Page 107 of 108
VOL I: National Screening Program
Postnatal Depression In Australia
The National Postnatal Depression
Program – Enhancing the Quality
of GP & Perinatal Service
Partnerships
Toward Parenthood an Antenatal
Preparation For Parenthood
Program
Changing Behaviour to Promote
Health and Well-being
Ericksen, J., Bilszta, J.L.C., Buist, A.E.,
Milgrom, J., Barnett, J., Hayes, B., and
Pope, S.
Poster
January
2004
Milgrom,J., McCarthy,R., Saunders,B.,
Ericksen,J., Romeo,Y., Loughlin,E.,
Newnham,C.
Milgrom, J. (Keynote speaker)
Paper
January
2004
Oral
November
2004
beyondblue National PND Program Final Report
VOL I: National Screening Program
Scientific Articles
Article Title
To screen or not to screen – that is the
question in perinatal depression
Can we prevent chronic mental illness?
Authors
Buist A, Barnett B, Milgrom J, Pope
S, Condon J, Ellwood D, Boyce PM,
Austin M-P and Hayes B
Druitt, S
Postnatal Depression: A guide for GPs
Ross J& Baynes A
The National Postnatal Depression
Program - Enhancing the quality of GP &
perinatal service partnerships
Recognition and Management of Perinatal
Depression in General Practice: Results of
an Australian National Survey
Ericksen J, Bilszta JLC, Buist AE,
Milgrom J, Barnett B, Condon J,
Hayes B, & Pope S.
Buist A, Bilszta J, Barnett B,
Milgrom J, Ericksen J, Condon J,
Hayes B, Brooks, J.
Health Professional’s Knowledge and
Awareness of Perinatal Depression:
Results of a National Survey
Buist A, Bilszta J, Milgrom J,
Barnett B, Hayes B, Austin MP.
Page 108 of 108
Journal
The Medical Journal of Australia
Year
2002
Reference
177 7 Oct., No7:
S101-S105
Healthlink: The Health Promotion
Journal of the ACT Region.
Division Action: Monthly Newsletter
for the ACT Division of General
Practice
Infant Mental Health Journal
2004
Winter 2004 16-17.
2004
Vol 102. April
2004 6-7.
2004
24 (Suppl 6A):
357.
Australian Family Physician
2005
Accepted
Journal of Psychosomatic Obstetrics & 2005
Gynaecology
Submitted