Data opportunities in perinatal mental health screening

To date, there is no national data about perinatal mental health screening, service use or outcomes. Data about the mental health of parents in the perinatal period are collected by a range of health services, Australian Government and state and territory government agencies, and non-government organisations, mostly as a by-product of delivering maternity services. The range of settings has implications for the ease with which comparable data can be extracted and collated into a national data collection.

A number of existing data collections currently offer some insight into perinatal mental health, including the:

• National Perinatal Data Collection (NPDC)
• National Maternal Mortality Data Collection (NMMDC)
• Medicare Benefits Schedule (MBS). 

In addition, large-scale longitudinal studies also provide insight, including the Australian Longitudinal Study on Women’s Health survey. 

Data relating to the mental health of mothers are also routinely collected in national hospital, hospital emergency department, and pharmaceutical data collections, however data linkage would be required to identify women in the antenatal and postnatal period. 

National Perinatal Data Collection

The NPDC is Australia’s authoritative source of data about pregnancy and childbirth. Each state and territory health authority maintains its own perinatal data collection about births in its jurisdiction and provides an annual standard extract of the data to the AIHW for national collation. Work to include antenatal mental health data in the NPDC commenced in 2010, and in July 2020, three antenatal mental health data items and one family violence screening data item were introduced as part of the voluntary Perinatal NBEDS:

• Antenatal mental health risk screening status (Yes, Not offered, Declined)
• Indication of possible symptoms of depression at an antenatal care visit (total EPDS score)
• Presence or history of mental health condition indicator (Yes, No)
• Family violence screening status (Yes, Not offered, Declined).

The Perinatal NBEDS is not mandated for national collection but there is a commitment to provide data nationally on a best endeavours basis. State and territory health authorities are at different stages in implementing the data items for a variety of reasons. Four state and territory health authorities supplied at least one of the four data items for both the 2020 and 2021 birth cohorts (Table 1). For further information, see Data opportunities.

National Maternal Mortality Data Collection

The National Maternal Mortality Data Collection (NMMDC) is a national data collection of maternal deaths (up to and including 42 days postpartum, irrespective of the duration or outcome of the pregnancy). The NMMDC includes data on if the death was caused by suicide, if mental health screening was offered, complications in the pregnancy and up to 42 days postpartum (including Mental health illness) and pre-existing conditions (including Mental health illness).

Medicare Benefits Schedule

The MBS data collection contains information on services that qualify for a benefit or subsidy and for which a claim has been processed. It includes two antenatal and three postnatal obstetric items that require the claiming GP or obstetrician to offer a ‘mental health assessment’ to the patient. Between 2018 and 2022, the number of these antenatal services claimed per year decreased, from around 121,000 services in 2018 to around 101,000 services in 2022. Use of the postnatal items has increased steadily per year, from around 37,900 services claimed in 2018 to around 59,900 services in 2022 (Figure 3).

The MBS also includes items for non-directive Pregnancy Support Counselling provided by GPs, other eligible medical practitioners (not including specialists or consultant physicians), psychologists, social workers and mental health nurses to patients who are pregnant or 1 year postpartum. Pregnancy support counselling does not need to relate to a patient’s mental health and can be used to discuss any pregnancy related concerns such as parenting, health, relationship and financial concerns. Use of these services has steadily increased, from around 22,500 services claimed in 2018 to 34,200 services in 2022 (Figure 3). These services were provided to patients out of hospital, and the bulk were provided by GPs (96% of services in 2022). 

Figure 3: Number of Medicare-subsidised perinatal mental health-related services, by service type, 2018 to 2022 

It should be noted that the MBS claims data does not include information about if or how the woman was screened (that is, the tools used) or the outcome of the mental health screening – the selected antenatal and postnatal items only tell us that the woman has been ‘offered’ a mental health assessment. In addition, this is likely to be underestimated, as GPs and obstetricians might provide similar services under different ‘general’ MBS items (for example, item 23), or a mental health-specific item that is not specific to women in the antenatal or postnatal period. 

As such, while the MBS claims data can give an indication of the number of women being offered perinatal mental health screening in out of hospital settings, or to private admitted patients of public and private hospitals, its use for monitoring perinatal mental health is limited without linkage to another data source that identifies women in the antenatal and postnatal period. 

Surveys and longitudinal studies

There are several large scale and ongoing surveys and longitudinal studies in Australia that provide insight into perinatal mental health screening and outcomes (Table 2), including:

Table 2: Overview of Australian surveys and longitudinal studies related to perinatal mental health

Mothers

Fathers