Trends of perinatal mental health referrals and psychiatric admissions in Queensland.

BACKGROUND: Perinatal depression is often underdiagnosed; consequently, many women suffer perinatal depression without follow-up care. Screening for depressive symptoms during the perinatal period has been recommended in Australia to increase detection and follow-up of women suffering from depressive symptoms. Screening rates have gradually increased over the last decades in Australia. OBJECTIVE: To explore trends in referrals of women to community mental health services during the perinatal period, and prenatal and postnatal admissions to psychiatric units, among those who gave birth in Queensland between 2009 and 2015. METHOD: Retrospective analyses of data from three linked state-wide administrative data collections. Trend analyses using adjusted Poisson regression models examined 426,242 births. Outcome variables included referrals to specialised mental health services; women admitted with a mood disorder during the second half of their pregnancy and during the first 3 months of the postnatal period; and women admitted with non-affective psychosis disorders during the second half of their pregnancy and during the first 3 months of the postnatal period. RESULTS: We found an increase in mental health referrals during the perinatal period over time (adjusted incidence rate ratio, 1.07; 95% confidence interval, [1.06, 1.08]) and a decrease in admissions with mood disorders during the first 3 months of the postnatal period (adjusted incidence rate ratio, 0.95; 95% confidence interval, [0.94, 0.98]). We did not find any changes in rates of admission for other outcomes. CONCLUSION: Since the introduction of universal screening in Queensland, referrals for mental health care during the perinatal period have increased, while admissions for mood disorders in the first 3 months after delivery decreased.

Association between screening for antenatal depressive symptoms and delivery outcomes: The Born in Queensland Study.

BACKGROUND: Evidence shows that depressive symptoms during pregnancy increase the risk of an intervention during delivery (induction, the use of forceps or vacuum, and caesarean sections (CS)). Many women with depression during pregnancy are not identified and therefore will not receive appropriate follow up of their symptoms. We hypothesised that routine screening for depressive symptoms during pregnancy could reduce detrimental consequences of depressive symptoms on delivery outcomes. AIM: We explored the association between screening for depressive symptoms during pregnancy and delivery outcomes. MATERIALS AND METHODS: A cross-sectional analysis of state-wide administrative data sets. The population included all women who delivered a singleton in Queensland between the July and December of 2015. Logistic regression analyses were run in 27 501 women (93.1% of the total population) with information in all variables. The following were the main outcomes: onset of labour, CS, instrumental vaginal delivery, and all operative deliveries (including both CS and instrumental vaginal deliveries). RESULTS: Women who completed the screening had increased odds of a spontaneous onset of labour (adjusted odds ratio (aOR) 1.18; 95% CI 1.09-1.27) and decreased odds of an operative delivery (instrumental or CS) (aOR 0.88; 95% CI 0.81-0.96). Among women who had a vaginal delivery, those who completed the screening had decreased odds of having an instrumental delivery (aOR 0.84; 95% CI 0.74-0.97). Sensitivity analyses in women who did not have a formal diagnosis of depression showed similar results. CONCLUSION: Our findings suggest that screening may decrease interventions during delivery in women with depressive symptoms.

The effect of antenatal screening for depression on neonatal birthweight and gestation.

BACKGROUND: Antenatal depression has been associated with poor perinatal outcomes such as preterm birth and low birth weight. Universal screening of perinatal depression has been recommended to improve maternal and pregnancy outcomes. HYPOTHESIS AND AIM: We hypothesise that screening for antenatal depressive symptoms may reduce the risk of preterm birth and low birth weight. To assess the hypothesis, we explore the association between antenatal depression screening using the Edinburgh Postnatal Depression Scale and neonatal outcomes. METHODS: A retrospective analysis of state-wide population-based health administrative data. Inclusion criteria were pregnant women who gave birth to a singleton in Queensland in the second half of 2015 (29,543 women). Logistic regression analyses were run in 27,817 women with information in all variables. Main outcomes were preterm birth (<37 weeks of gestation) and low birth weight (<2500 grs). RESULTS: Women who did not complete the screening had increased odds of preterm birth (AOR, 1.56; 95% CI, 1.39-1.74; p < 0.001) and low birth weight (AOR, 1.48; 95% CI, 1.30-1.68; p < 0.001) before and after adjustments for relevant confounders when compared to women who completed the screening. Sensitivity analyses performed in women with spontaneous labour and in women without a diagnosis of depression showed similar results. CONCLUSION(S): We found an association between screening for depressive symptoms during pregnancy and better neonatal outcomes. However, this result does not necessarily infer causality. Any association may represent a previously unknown benefit to screening, which could support the case for universal antenatal depression screening.

Association between antenatal screening for depressive symptoms and postpartum psychiatric admissions.

Antenatal depression is the strongest predictor for postpartum depression including psychiatric admission. Universal screening for depressive symptoms during pregnancy may increase the detection of clinical depression and reduce consequent morbidity. We therefore hypothesised that antenatal screening for depressive symptoms could reduce the risk of postpartum psychiatric admissions. We explored the association between antenatal depression screening and postpartum psychiatric admissions using cross-sectional retrospective analysis of state-wide population-based health services administrative data. The analysis included all pregnant women who gave birth to a singleton in Queensland in the second half of 2015 and had information in variables of interest (28,255 women; 95.6% of 29,543 women who gave birth to a singleton during the study period). Women who did not complete antenatal depression screening had increased odds of being admitted to hospital for psychiatric disorders during the first three months after birth (aOR, 2.57; 95% CI, 1.69-3.92), which extended to six months postpartum (aOR, 1.74; 95% CI, 1.10-2.76). We found similar effects for specific psychiatric disorder groups such as mood disorders; schizophrenia, schizotypal and delusional disorders; and mental disorders associated with the puerperium (aOR, 2.65; 95% CI, 1.55-4.54) and mood disorders and puerperal mental disorders (aOR, 3.00; 95% CI, 1.70-5.30). Completion of antenatal depression screening appears to be associated with a decreased risk of psychiatric admission in the first postnatal months. This finding suggests that screening, and associated follow-up interventions, might decrease the severity of depressive symptoms during the perinatal period.

Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study.

OBJECTIVES: To investigate screening with the Edinburgh Postnatal Depression Scale (EPDS) as part of Queensland prenatal care services, as well as maternal and socio-demographic factors associated with not being screened. DESIGN, SETTING: Cross-sectional retrospective analysis of data from the Queensland population-based Perinatal Data Collection for July 2015 - December 2015. PARTICIPANTS: All women giving birth in Queensland during the second half of 2015. MAIN OUTCOME MEASURES: Screening with the EPDS, with the values "yes" (health professional recorded an EPDS score), "no" (health professional reported it was not performed), and "not stated". RESULTS: Of 30 468 women who gave birth in Queensland, 21 735 (71.3%) completed the EPDS during pregnancy; 18 942 pregnant women were enrolled as public patients (91.0%) and 2762 as private patients (28.8%). After adjusting for other socio-demographic factors, screening was less likely for women who were aged 36 years or more (v 25 years or younger: adjusted odds ratio [OR], 0.69; 95% CI, 0.60-0.79), enrolled as private patients (aOR, 0.05; 95% CI, 0.05-0.06), born overseas (aOR, 0.75; 95% CI, 0.68-0.82), Indigenous Australians (aOR, 0.47; 95% CI, 0.39-0.56), single or separated (aOR, 0.83; 95% CI, 0.73-0.94), or of higher socio-economic status. CONCLUSIONS: Four years after clinical guidelines recommending universal screening with the EPDS were published, screening rates for private and public health care patients differed markedly. Our results may inform future comparisons and analyses of the impact on screening of recent changes to Medicare definitions intended to increase that of women in private health care.