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Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention.
BMC Pregnancy Childbirth. 2019 Jul 02; 19(1):221.BP

Abstract

BACKGROUND

Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness.

MAIN TEXT

The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment.

CONCLUSION

The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care.

Authors+Show Affiliations

Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW, 2132, Australia. sarah.khanlari@health.nsw.gov.au. School of Medicine and Public Health, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia. sarah.khanlari@health.nsw.gov.au. Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW, 2050, Australia. sarah.khanlari@health.nsw.gov.au.Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW, 2050, Australia. School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington Campus, Kensington, NSW, 2052, Australia.Translational Health Research Institute, School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW, 2132, Australia. Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW, 2050, Australia. Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia. School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW, 2052, Australia. Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW, 2006, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31266468

Citation

Khanlari, Sarah, et al. "Re-examination of Perinatal Mental Health Policy Frameworks for Women Signalling Distress On the Edinburgh Postnatal Depression Scale (EPDS) Completed During Their Antenatal Booking-in Consultation: a Call for Population Health Intervention." BMC Pregnancy and Childbirth, vol. 19, no. 1, 2019, p. 221.
Khanlari S, Barnett Am B, Ogbo FA, et al. Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy Childbirth. 2019;19(1):221.
Khanlari, S., Barnett Am, B., Ogbo, F. A., & Eastwood, J. (2019). Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy and Childbirth, 19(1), 221. https://doi.org/10.1186/s12884-019-2378-4
Khanlari S, et al. Re-examination of Perinatal Mental Health Policy Frameworks for Women Signalling Distress On the Edinburgh Postnatal Depression Scale (EPDS) Completed During Their Antenatal Booking-in Consultation: a Call for Population Health Intervention. BMC Pregnancy Childbirth. 2019 Jul 2;19(1):221. PubMed PMID: 31266468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. AU - Khanlari,Sarah, AU - Barnett Am,Bryanne, AU - Ogbo,Felix Akpojene, AU - Eastwood,John, Y1 - 2019/07/02/ PY - 2019/01/31/received PY - 2019/06/24/accepted PY - 2019/7/4/entrez PY - 2019/7/4/pubmed PY - 2020/1/15/medline KW - Depression KW - Distress KW - EPDS KW - Perinatal KW - Policy KW - Pregnancy KW - Prevention KW - Risk-stratification KW - Screening SP - 221 EP - 221 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 19 IS - 1 N2 - BACKGROUND: Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness. MAIN TEXT: The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment. CONCLUSION: The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/31266468/Re_examination_of_perinatal_mental_health_policy_frameworks_for_women_signalling_distress_on_the_Edinburgh_Postnatal_Depression_Scale__EPDS__completed_during_their_antenatal_booking_in_consultation:_a_call_for_population_health_intervention_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2378-4 DB - PRIME DP - Unbound Medicine ER -