Data opportunities in perinatal mental health screening

The majority of available data are about antenatal mental health screening of mothers conducted by state and territory-funded services, which only covers a segment of the perinatal mental health screening occurring across the country. 

Data about mental health and psychosocial screening are collected in antenatal and postnatal settings such as hospitals and GP clinics through the course of providing care to patients. These data are stored within the health setting’s clinical information system, and may be electronic or paper-based. The ease of which this information can be extracted varies, due to the way data are collected and stored, legislative remit, and resource constraints. 

Key information gaps include: 

• postnatal mental health screening, which generally occurs through primary health care or Maternal, Child and Family Health Services
• psychosocial risk factor screening and anxiety screening in the antenatal and postnatal period 
• repeat screening
• perinatal mental health screening of private patients and of mothers in non-hospital settings such as by GPs, other primary health care workers, and obstetricians 
• data for population groups that may be at higher risk, such as First Nations parents, Culturally and Linguistically Diverse (CALD) parents, parents who identify as Lesbian, Gay, Bisexual, Trans and Gender Diverse, Intersex, Queer or other (LGBTIQ+), and parents with disabilities 
• fathers and other non-birthing parents
• protective factors in the perinatal period
• relationship between physical and psychological birth trauma and perinatal mental health.

First Nations communities

First Nations people are an important priority population as they typically have poorer health outcomes including higher rates of adverse pregnancy and birth outcomes (AIHW 2021b), high prevalence of mental illness and suicide (Martin et al. 2023), and higher experiences of intimate partner violence and child abuse and neglect compared to non-Indigenous Australians (AIHW 2022a).  

Current research generally suggests that the standard English version of the EPDS is not culturally appropriate for First Nations mothers, however some health care professionals have expressed mixed perceptions on its suitability (Chan et al. 2021). Alternative screening tools have been or are being developed specifically for First Nations women, such as the Kimberley Mums Mood Scale (KMMS), Baby Coming You Ready? (BCYR) and the Mount Isa Depression Scale (MIDS). Expanding data collections to include these screening tools that have been culturally adapted and validated (such as the KMMS) or specifically developed for First Nations people (such as BCYR), may improve representation of First Nations women in the data and result in higher quality data about the perinatal mental health of First Nations women.

Culturally and Linguistically Diverse (CALD) communities

Migrants, refugees and asylum seekers are a diverse population, and as such estimates of the prevalence of perinatal mental health conditions and other psychosocial risk factors vary widely (Eastwood et al. 2021; Stevenson et al. 2023; Sullivan et al. 2020). People from CALD backgrounds may have different levels of social support in Australia, have different levels of language proficiency, may be recovering from pre-migration trauma, and may have experienced or continue to experience discrimination and other stressors such as employment difficulties and insecure visa status (Sullivan et al. 2020). 

How mental health is expressed, understood and stigmatised differs across cultures. Women’s responses to screening and help-seeking behaviours may be influenced by mistrust of their health care provider or translator, language and translation issues, perception of stigma, and different cultural norms about emotional expression (Firth et al. 2022; Skoog et al. 2022). This has implications for how mental health data are collected and interpreted clinically and for research: for instance, lower EPDS cut-off scores are recommended when screening women from CALD backgrounds to account for this (Highet et al. 2023). 

Providing screening in a woman’s preferred language improves their understanding of questions being asked in the tool (Willey et al. 2020). Research indicates that women feel more able to answer sensitive questions truthfully when they can complete screening by themselves, by using a translated paper or digital screening tool, however the presence of an interpreter is still valuable for clarifying the meaning of questions and providing support when speaking to health professionals (Willey et a. 2020).  

Accurately identifying CALD populations is a challenge for many data collections, including the NPDC which currently collects country of birth (AIHW 2022e). Collecting other variables such as language, English proficiency, and year migrated to Australia, will support understanding of the perinatal mental health of CALD populations, including allowing recommended culturally relevant cut-off scores to be accounted for when analysing data.

LGBTIQ+ childbearing parents

Childbearing parents who identify as LGBTIQ+ may face unique mental health risks during pregnancy and following childbirth, including stigma, discrimination, difficulty accessing inclusive services for fertility, antenatal, birthing and postnatal support, and challenges related to gender identity. Emerging research suggests the prevalence of perinatal mental health conditions in LGBTIQ+ childbearing parents may be higher than cisgender heterosexual mothers (Kirubarajan et al. 2022). It is currently not possible to identify LGBTIQ+ parents in national data collections, however this is a potential area for exploration in the Perinatal Mental Health pilot (see Data opportunities).

Fathers and other non-birthing parents

Fathers and other non-birthing parents can also experience poor mental health and social and emotional wellbeing during the perinatal period. 

It is estimated depression affects between 5% and 10% of fathers during this period (Cameron et al. 2016; Mazza et al. 2022; Paulson and Bazemore 2010), and anxiety affects around 5% to 15% of fathers (Leach et al. 2016). It is estimated that paternal depression co-occurs in around 1% to 3% of mothers and fathers (Mazza et al. 2022; Smythe et al. 2022). Paternal depression during the perinatal period is associated with an increased risk of long term emotional, behavioural and social difficulties in children, independent of maternal perinatal depression (Gentile and Fusco 2017). There are limited data about the prevalence of perinatal mental health conditions in other non-birthing parents and guardians, including adoptive parents, step-parents, and non-birthing LGBTIQ+ parents. 

At present, there are limited data available about perinatal mental health screening and outcomes of fathers in Australia, and even scarcer data available on other non-birthing parents. Addressing and measuring the mental health and wellbeing needs of fathers and other parents requires a tailored approach noting cultural differences in parenting roles, and differences in when and how parents interact with the health system. Signs of mental health conditions can also display differently in men, with symptoms such as irritability, aggression and risk-taking behaviours not captured by the EPDS (Kennedy and Munyan 2021). The EPDS has been used to screen fathers using a lower cut-off score, however evidence for which cut-off score is mixed (Kennedy and Munyan 2021). The ANRQ has recently been adapted for men (Highet et al. 2023), and work is underway to adapt other screening tools for fathers, such as BCYR.