What is the Health Professional’s Role in Perinatal Psychosocial Screening Assessment and Referral in the Private Sector?
School of Nursing and Midwifery, College of Health and Science, Sydney University, Australia
*Corresponding Author: Tanya Connell, School of Nursing and Midwifery, College of Health and Science, Sydney University, Australia
Received: 09 September 2019; Accepted: 25 September 2019; Published: 30 September 2019
Tanya Connell. What is the Health Professional’s Role in Perinatal Psychosocial Screening Assessment and Referral in the Private Sector?. Journal of Women’s Health and Development 2 (2019): 107-111.View / Download Pdf Share at Facebook
Background: This paper is a discussion paper exploring the health professionals role in psychosocial assessment in the private sector. This study is part of a larger study.
Aim: The aim of this paper is to explore and discuss the health professionals role in psychosocial screening in the private sector. The aim of a larger study was to pilot universal, routine, psychosocial assessment and depression screening in a private hospital.
This article is highly significant to inform health professionals of their role in psychosocial screening and assessment. Little is known about this area and little is published. This will influence screening practices and identify risk factors for postnatal/antenatal anxiety, depression and other disorders. This will influence the introduction of best practice and consistency in psychosocial assessment in the private and the public sector. It will identify/initiate effective referral pathways for follow-up of women identified as high risk of psychosocial problems and mental illness.
The identification of quality local pathways to care underpinning the implementation of universal psychosocial assessment: to address the care and intervention needs of women identified as being at risk, experiencing mild or moderate difficulties through to women experiencing complex and or severe mental illness. The wide range of services and sectors required involves developing a system of care that is effectively networked, collaborative and responsive to the whole family.
Midwives, Private sector, Psychosocial screening, Role
Publications in Australian and international literature, as well as Australian Government initiatives , leading to the National Perinatal Depression Initiative) provide evidence for the importance of ensuring the mental health of women who are pregnant or caring for young children . Attention to psychological and social aspects of obstetric/maternity and postnatal care including depression screening, is inconsistent across the public sector and virtually non-existent in the private sector . Various studies have investigated psychosocial assessment and [4, 5] depressive symptoms in early pregnancy . Psychosocial assessment is integral in good antenatal care . A national psychosocial approach to mental health is needed in Australia . Various initiatives, e.g. Beyondblue; the national depression initiative, with its National Action Plan  NHMRC-approved Clinical Guidelines and Workforce Training and Development Working Party (2010-2011) have attempted to identify best practice and procedural difficulties and address these. Nevertheless, issues of inconsistency in screening, resources and approach are evident in the public health situation and no programs have been definitively established to date in the private system, where some 30% of births occur .
There is a need for further education and training of healthcare professionals to increase their awareness and treatment of perinatal depression . What is in fact the role of the midwife in regards to psychosocial screening in the private sector? Does the fact that the women are not under the direct care of the midwife, influence their decision/involvement/ choice to discuss with women their psychosocial concerns/ screen women for risk factors? Early detection of maternal depression may facilitate treatment and offer support for women who are vulnerable to recurrent depressive episodes . Screening is dependent upon the setting, the population, the health resources available, system changes that enhance the impact of screening efforts and the quality of the programme’s aims, design and implementation .
Antenatal depression is prevalent and has potentially far-reaching adverse consequences. Reported prevalence rates of depression in the antenatal period are similar to postpartum levels and range from 12% to 20% [10-14]. Depression in pregnancy may compromise a woman’s physical and mental health and the health of her unborn baby through diminishing her capacity for selfcare, including inadequate nutrition, increased drug or alcohol abuse and poor antenatal clinic attendance . Antenatally depressed mothers have been found to experience increased episodes of pre-eclampsia , preterm delivery and placental abruption [16, 17] as well as adverse obstetric outcomes . Antenatal depression is also recognised as a powerful predictor of postnatal depression [19, 12]. Thus, some women may not only spend time in pregnancy depressed, but might also enter parenthood in a depressed state, which in turn has been associated with cognitive and behavioral developmental difficulties in infants . Successful treatment for depression is available [21-23] but early detection and management seems imperative to achieve this outcome.
There is acceptance of the value of routine perinatal psychosocial assessment of some form as long as adequate pathways to care and training are available. Great variation is identified between the antenatal and postnatal settings, and across jurisdictions, with pathways to care not always adequate or well-integrated Research evidence and clinical experience indicate it is critical that psychosocial assessment begin in the antenatal setting to optimise early detection for mental health and wellbeing . All women screened in one study (100%) reported that the screening experience was acceptable and not upsetting [9, 10]. Almost 50% reported that the screening process raised their awareness of perinatal depression. No woman reported feeling stigmatised, labelled or distressed by the screening process. Women reported that gaining immediate feedback from midwives was reassuring.
3. Private Sector Workforce
The Australian Institute of Health and Welfare (AIHW) reports that 31% of women who give birth in hospitals choose to do so in private hospitals, ranging from 19.2% in the Northern Territory to 41.1% in Western Australia . It should be noted that in addition to private hospitals, private sector providers include Medical Practitioners (General Practitioners, Psychiatrists, Obstetricians, Paediatricians), Midwives, Mental Health Nurses, Psychologists, Social Workers, and Occupational Therapists. Like the public sector, as private sector providers work to meet the emerging challenges of addressing perinatal mental health issues there is a significant impact on the capacity of these workforces to undertake universal, routine assessment, access quality training programs, identify relevant pathways to care, and ensure organisational and professional policies exist to support these activities. These activities along with the development and endorsement of national standards for perinatal mental health will need to be incorporated into private sector evaluation and continual improvement processes in fulfilling accreditation requirements.
4. Strategies for Change
Health professionals providing maternity care need the skills to identify and manage challenging psychosocial problems such as depression, domestic violence, child and substance abuse, homelessness, intellectual disability, social isolation, lack of capacity to care for a baby, lack of social and interpersonal support, mental illness. Yet traditional midwifery and medical training has not equipped them well for this role. A common response to this is the development of a psychosocial risk assessment checklist and the implementation of antenatal screening (26). Maternity units involved in antenatal screening need training for referral and support systems. A policy or guideline is also important for the management of women with depression, including referral pathways.
It is recognised that many families choosing the private sector for birthing and other services will, at times, also require the resources of the public sector to support their care. To achieve this, the formation and maintenance of collaborative partnerships between public, private and Non-Government Organisation service providers will be necessary to assist the delivery of appropriate care and support to ensure that privately insured women or those who birth in the private sector receive equally high quality mental health care and can move easily between services and sectors.
Infrastructure and programs within AGPN that can support quality routine perinatal mental health care in the primary health care sector include: delivery of perinatal mental health education and training; clinical support and enhancement of perinatal mental health knowledge and skills for General Practitioners, Psychologists, Allied Health professionals and nurse practice staff; health promotion through the Pregnancy Lifescripts tool kit  support for uptake of related MBS Mental Health items and numbers; development and promotion of linkages; and systematic referral pathways.
The main author conducted the study and analysed and interpreted the data. The main author wrote the article with suggestions from the co-author. All authors read and approved the final manuscript.
Ethical approval and consent to participate
The University of Sydney ethics committee has approved the study as part of the authors PhD. Informed consent was not applicable as there were no human participants.
Consent for publication
The article is the author(s) original work. The article has not received prior publication and is not under consideration for publication elsewhere. All authors have seen and approved the manuscript being submitted. The author(s) abide by the copyright terms and conditions of Elsevier.
Availability of data and materials
All data generated or analysed during this study are included in this published article.
The authors declare that there are no competing interests.
No funding was provided or available for the research.
There are no Grants, financial support and technical or other assistance.
- National Action Plan on Mental Health (2006).
- Priest SR, Barnett B. Perinatal anxiety and depression. Issues, outcomes and Interventions.: Sved-Williams A and Cowling V. Queensland, Australian Academic Press (2008).
- Fisher J, Chatham E, Haseler S, et al. Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women's hospitals. Aust N Z J Obstet Gynaecol 52 (2012): 559-564.
- Austin MP, Hadzi-Pavlovic D, Saint K, et al. Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire. Acta Psychiatr Scand 112 (2005): 310-317.
- Rubertsson C, Wickberg B, Gustavsson P, et al. Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Archives of Women's Mental Health 8 (2005): 97-104.
- Austin MP. Psychosocial assessment and management of depression and anxiety in pregnancy. Key aspects of antenatal care for general practice. Aust Fam Physician 32 (2003): 119-126.
- Yelland JSSGA, Wiebe JL, Brown SJ. A national approach to perinatal mental health in Australia: exercising caution in the roll-out of a public health initiative. Medical Journal of Australia 191 (2009): 276-279.
- Pawlby S, Hay DF, Sharp D, et al. Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. Journal of Affective Disorders 113 (2009): 236-243.
- Gemmill AW. The long gestation of screening programmes for perinatal depressive disorders. Journal of Psychosomatic Research 77 (2014): 242-243.
- Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women’s Health 12 (2003): 373-380.
- Evans J, Heron J, Francomb H, et al. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323 (2001): 257-260.
- Josefsson A, Berg G, Nordin C, et al. Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstetricia et Gynecologica Scandinavica 80 (2001): 251-255.
- Buist A. Managing depression in pregnancy. Australian Family Physician 29 (2000): 663-667.
- Areias ME, Kumar R, Barros H, et al. Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers. British Journal of Psychiatry 169 (1996): 30-35.
- Kurki T, Hiilesmaa V, Raitasalo R, et al. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics and Gynecology 95 (2000): 487-490.
- Séguin L, Potvin L, St-Denis M, et al. Chronic stressors, social support, and depression during pregnancy. Obstetrics and Gynecology 85 (1995): 583-589.
- Zuckerman B, Amaro H, Bauchner H, et al. Depressive symptoms during pregnancy: relationship to poor health behaviors. American Journal of Obstetrics and Gynecology 160 (1989): 1107-1111.
- Chung TK, Lau TK, Yip AS, et al. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine 63 (2001): 830-834.
- Buist A, Barnett BEW, Milgrom J, et al. To screen or not to screen-that is the question in perinatal depression. Medical Journal of Australia 177 (2002): 101-105.
- Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: A large prospective study. Journal of Affective Disorders 108 (2008): 147-157.
- Caron Zlotnick, Jill Matti, Mark Zimmerman. Clinical features of survivors of sexual abuse with major depression?. Child Abuse and Neglect 25 (2001): 357-367.
- Milgrom J, Martin PR, Negri L. Treating postnatal depression: A psychological approach for health care practitioners, 1995-2012. Chichester, UK: John Wiley and Sons (1999).
- Elliott SA. Psychological strategies in the prevention and treatment of postnatal depression. Baillière's Clinical Obstetrics and Gynaecology 3 (1989): 879-903.
- Austin MP. Antenatal screening and early intervention for "perinatal" distress, depression and anxiety: where to from here? Archives of Women's Mental Health 7 (2004): 1-6.
- Mental health national action plan (2008).
- Gunn J, Hegarty K, Nagle C, et al. Putting woman-centered care into practice: A new (ANEW) approach to psychosocial risk assessment during pregnancy. Birth 33 (2006): 46-55.
- Pregnancy Lifescripts (2011).