In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) in order “to improve the prevention and early detection of antenatal and postnatal depression and to provide better support and treatment for expectant and new mothers experiencing depression.” Its scope is very much like the MOTHERS Act, which became law in the United States in 2010. Both initiatives seek to increase public awareness of perinatal depression, to provide support and treatment for pregnant and postpartum women with depression, to fund research in this area, and to implement training of health care professionals.
The two differ in that the MOTHERS Act does not mandate universal screening, but instead recommends more rigorous study of the benefits of screening for postpartum psychiatric illness. Responding to public concerns that universal screening for postpartum depression was “invasive” and may lead to erroneously identifying women as being depressed, the provision for routine screening was removed from the original bill.
In contrast, the Australian NPDI mandates universal screening for depression for women during the perinatal period (once during pregnancy and again about four to six weeks after the birth). Now that the program has been around for several years, there is some preliminary research indicating how well things are going.
All of the hospitals surveyed had implemented at least some of the NPDI recommendations. Most sites (80%) used the Edinburgh Postnatal Depression Scale (EPDS) to screen during pregnancy; however, there wee variations in the cut-off scores used to initiate follow-up or referral. Only one site assessed for postpartum depression.
Screening and feedback were most commonly assigned to midwives, most of whom were offered less than four hours of training. Barriers to screening included insufficient personnel, inadequate time to complete screening, insufficient clarity about screening protocols, inadequate referral options and a lack of training resources.
Obviously there are significant differences between the Australian and American health care systems, but this preliminary report does seem to suggest that just because it’s a law doesn’t mean that it will happen. Perhaps things will improve over time, but this report makes it fairly clear that in order to successfully implement screening for perinatal depression, the screening process must be better integrated into routine care and there must be a greater emphasis on making sure that health care professionals receive adequate training.
What this study does not tell us is whether or not more women wit perinatal depression are getting treatment. Trying to look on the brighter side of what is a pretty gloomy finding, I hope that more women are being screened for depression now than before and, even if they are not screened (or are screened incorrectly), women are more aware of perinatal depression and may be more able to seek out help if they need it.
Ruta Nonacs, MD PhD
Fisher J, Chatham E, Haseler S, McGaw B, Thompson J. Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women’s hospitals. Aust N Z J Obstet Gynaecol. 2012 Oct 10. [Epub ahead of print]