Psychosocial assessment in the perinatal period refers to the clinical evaluation of a broad number of risk factors that may contribute to the mental health outcomes of a woman and her infant. It is recommended that all women are assessed as part of routine pregnancy and postnatal care.
However, it is not clear how comprehensive such screening is, with most research focusing solely on the assessment of depression. Furthermore, most studies that have investigated screening have not been sufficiently inclusive of the 30% of women whose maternity care is provided in the private sector.
The aim of this study was to examine rates of assessment across a range of psychosocial domains, as well as the provision of mental health promotion information. A sub-study of 1,804 women from the Australian Longitudinal Study on Women’s Health (ALSWH) provided data.
- Rates of assessment for the prenatal and postnatal periods respectively were: current mental health 66.8%, 75.6%, mental health history 52.9%, 41.2%, level of support 69.9%, 70.1%, drug and alcohol use 67.6%, 35.3%, and domestic violence or abuse 35.7%, 31.8%.
- Mental health promotion information was received by 78.3% of women during pregnancy, and 81.6% of women during the postnatal period.
- During pregnancy, women who gave birth in the public sector were far more likely to report being assessed across all domains of psychosocial assessment than women in the private sector.
- The disparity between public and private settings did not extend to the postnatal period however, with similar figures observed for most measures.
- Differences were observed between state/territory of residence for each of the measures. For example, assessment of mental health history during pregnancy ranged from 43.3% in Victoria to 63.8% in New South Wales, while domestic violence/abuse assessment ranged from 20.2% in Western Australia to 52.8% in New South Wales.
- During the postnatal period, 89.1% of women from Western Australia had their current mental health assessed, compared to 58.7% of Queensland women.
The results indicate that there has been significant penetration in some areas of assessment, both during pregnancy and in the postnatal period. However, the low rates of screening for mental health history and domestic violence/abuse are concerning. It is important to minimise the current shortfall in assessment rates in private maternity settings, particularly during pregnancy.
Citation: Reilly N, Harris S, Loxton D, Chojenta C, Forder P, Milgrom J, Austin M-P (2013). Disparities in reported psychosocial assessment across public and private maternity settings: A national survey of women in Australia. BMC Public Health, 13:362.