Referral for management of emotional health issues during the perinatal period: Does mental health assessment make a difference?

Routine assessment of current or past mental health issues during pregnancy and the postnatal period has been endorsed in clinical practice guidelines in Australia and a number of other countries. However, there is little evidence as to whether such assessments increase rates of referral for further treatment or management.

The aim of this study was to evaluate the impact of current and past mental health on referral for additional support or treatment during pregnancy and the first postpartum year. A subsample of 1,804 women from the 1973-78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) provided data.

  • The strongest predictor of being given a referral for additional treatment or support during pregnancy was being asked by a health professional about past mental health.
  • Women who were asked about current mental health were also more than twice as likely to receive a referral.
  • The odds of receiving a referral were around 14 times higher for women who were asked about both their current and past mental health than for women who did not receive any form of assessment.
  • Being asked about one’s past or current mental health during the postnatal period also increased the likelihood of referral during the postnatal period.
  • The odds of receiving a referral were around 16 times higher for women who were asked about both their current and past mental health compared with women who received no assessment.
  • Experiencing significant emotional distress also predicted referral during both the prenatal and postnatal periods, suggesting that assessment did not inappropriately inflate referral rates.

The findings indicate that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals, and highlights the importance of a comprehensive approach to mental health assessment.

Citation: Reilly N, Harris S, Loxton D, Chojenta C, Milgrom J, Austin M-P (2013). Referral for management of emotional health issues during the perinatal period: Does mental health assessment make a difference? Birth, 40(4), 297-306.

How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women?

Postnatal depression (PND) is a debilitating condition that affects between 10-20% of Australian mothers. Several factors have been found to be predictive of PND, including a higher rate of obstetric interventions, having a caesarean birth, as well as suffering from depression and anxiety during or immediately prior to pregnancy.

However, while a number of studies have examined the predictors of PND, most have focused on events immediately prior to pregnancy and birth. The aim of this study was to examine both short- and long-term risk factors for PND using data collected before, during, and after pregnancy. The study used data from women born 1973-78, who had completed the first four surveys from the Australian Longitudinal Study on Women’s Health from 1996-2006.

  • The strongest predictor of PND was a history of depression; compared with women who had not reported depression, women who reported depression 3 or 6 years prior to pregnancy were more than twice as likely to experience PND.
  • Stressful life events reported both six years prior to, and at the time of the fourth survey were related to future PND, while women who had less affectionate support/positive social interaction were also at higher risk.
  • Contrary to other studies, demographic factors, including ability to manage on income, area of residence and education level were not associated with PND.

The findings suggest that PND has both short- and long-term risk factors. It is important that healthcare providers are aware of the range of factors that may increase the risk of PND in order to allow for a more targeted detection of women who may develop the condition.

Citation: Chojenta C, Loxton D, Lucke J (2012). How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? Journal of Midwifery and Women’s Health, 57(2), 145-150.

Lack of association between drought and mental health in a cohort of 45-61 year old rural Australian women

Drought has a range of adverse physical, economic, emotional and social consequences. However, while these may be expected to result in higher rates of mental health problems, little research has explored the relationship between drought and mental health.

The aim of this study was to investigate the impact of drought on the mental health of rural Australian women. This included examining the effects on women who may be more vulnerable to adverse effects of drought, including women who are more isolated, poorer and less educated, and women with already have long-term illness or poor mental health

The study involved 6,664 women from the Australian Longitudinal Study on Women’s Health (ALSWH), born between 1946 and 1951, who lived outside of major cities. Women were sent five surveys between 1996 and 2008, which assessed mental health and a range of other health, behavioural and demographic variables. These data were linked to information about drought for their area of residence.

A third of women experienced drought in 1998 and half the women experienced drought in 2007. Drought was less common in 1996, 2001 and 2004 with less than one in ten women experiencing drought at these time points. While experience of drought varied over time, no relationship was found between drought and mental health. This was the case both for the overall findings, as well as among the groups considered to be vulnerable.

The findings suggest that drought does not lead to poorer mental health among mid-aged Australian women. Further research is needed to see if these findings apply to men, as well as to women of other ages.

Citation: Powers JR, Dobson, AJ, Berry, HL, Graves, AM, Hanigan IC, Loxton, D (2015). Lack of association between drought and mental health in a cohort of 45-61 year old rural Australian women. Australian and New Zealand Journal of Public Health. (in early view). doi:10.1111/1753-6405.12369

History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum

Women who experience a pregnancy loss, including medical termination, miscarriage, ectopic pregnancy and stillbirth, commonly experience mental health problems such as depression and anxiety following the loss. However, little is known about mental health outcomes during subsequent pregnancies and following healthy births.

The aim of this study was to examine the impact of pregnancy loss on mental health in subsequent pregnancies and during the postnatal period. Data were obtained from a sub-sample of 584 women from the Australian Longitudinal Study on Women’s Health who had previously experienced a loss.

  • Nearly half of the women (45.5%) indicated that they experienced at least one emotional issue during their most recent pregnancy with anxiety being the most commonly reported issue (26.4%), followed by stress or distress (25%), and sadness or low mood (20.2%).
  • Just over half of the women (51.9%) reported at least one emotional issue during the postnatal period, with sadness and low mood being the most commonly reported issue (30.1%), followed by stress or distress (25.3%) and anxiety (22.3%).
  • Women who had a previous pregnancy loss were more than twice as likely to report excessive worry during a subsequent pregnancy, and were also more likely to report sadness or low mood.
  • However, there was no relationship between prior pregnancy loss and any emotional issue during the postnatal period.

Women who have experienced a pregnancy loss are particularly vulnerable to mental health problems during subsequent pregnancies. It is important to monitor the mental health of these women during this time, and if necessary offer anxiety or stress interventions. Such interventions will potentially benefit the woman, as well as reduce adverse outcomes for offspring.

Citation: Chojenta C, Harris S, Reilly N, Forder P, Austin M-P, Loxton D (2014). History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum. PLOS One, 9(4): e95038. doi: 10.1371/journal.pone.0095038

Mental health service use: Is there a difference between rural and non-rural women in service uptake

bottle-tree-389059_1280Findings suggest that people from rural and remote areas of Australia have less access to mental health services than those living in major cities. This may be particularly difficult for women, who are more likely to experience mental health problems than men.

The Better Access Scheme (BAS), introduced under Medicare in November 2006, allows patients suffering from mental health problems to receive up to 10 mental health services a year, including consultations to psychologists, social workers, and occupational therapists.

The aim of this study was to identify the differences in uptake in BAS services and time taken to access the services according to area of residence, relative to need.

  • 21% of women living in major cities used at least one BAS service, compared to 18% of those in inner-regional areas, 13% in outer regional and just 7% of those in remote/very remote areas.
  • Clinical psychologist services offered under the BAS were used by 6% of women in major cities compared to 3.8% in inner regional areas, 2.8% in outer regional and by no women in remote/very remote areas.
  • Of women that accessed treatment, 78% of women living in inner regional areas, 82% in major cities, 86% in outer regional areas and 90% in remote/very remote areas had received a BAS service within 50 days of the initial GP consultation.
  • Across all areas, 12% of women reported a diagnosis of depression/anxiety without being treated under the BAS, with these figures slightly higher in inner regional and outer regional areas.

The findings suggest that women in urban areas have been better able to take up BAS services compared to women in non-urban areas.

Citation: Dolja-Gore X, Loxton DJ, D’Este CA, Byles JE (2014). Mental health service use: Is there a difference between rural and non-rural women in service uptake. Australian Journal of Rural Health, 22, 92-100.

How does retirement affect mental health?

What you need to know: Retirement was associated with high level of psychological distress in men aged from 45 to 74 and in women aged from 45 to 64. Retiring to care for other people, or due to being ill, or being made redundant was also associated with high level of psychological distress.

What this research is about: This research aims at investigate the relationship between retirement and psychological distress for men and women aged from 45 to 79 years.

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What did the researchers do: We looked at data from over 200,000 men and women living in New South Wales aged from 45 to 79 years, and analysed if there is an association between retirement and psychological distress. We looked at men and women separately depending on their ages. Reasons why participants retired were also investigated to see if this also affects their mental health.

What did the research find: Retirement was associated with high level of psychological distress in men and women aged from 45 to 64 years. This finding was also supported in men aged from 65 to 74 years, but not in women in this age group. Being sick or unemployed was also associated with high level of psychological distress, compared to being in paid work. Among retirees, those who retired because of ill health, being made redundant or to care for other people had high level of psychological distress.

How can you use this research: This research supports a relationship between retirement and psychological distress. This will help to shape policies for retirement transition and help to improve metal health for retirees, especially those who are at younger ages (45 to 64) and those who retire because of ill health or being made redundant.

Keywords: retirement, mental health, reasons for retirement

Contact person: Kha Vo (Kha.Vo@newcastle.edu.au)

Citation: Vo K, Forder PM, Tavener M, Rodgers B, Banks E, Bauman A, Byles JE. (2014) Retirement, age, and mental health: A cross-sectional analysis of 202,584 Australians aged 45 years and older. Aging and Mental Health. 2014.