Perinatal mental health screening in Australia

Perinatal mental health generally refers to the social and emotional wellbeing of a woman from the time of conception through to the baby turning 12 months old.

Mental health conditions are the leading cause of disease burden in Australian women of child-bearing age (15 to 44 years) (AIHW 2022b), with the perinatal period considered to be a time of increased risk. Perinatal mental health conditions are those that present symptomatically as they would at other times of a woman's life (including depressive and anxiety disorders, schizophrenia, bipolar disorder and borderline personality disorder), in addition to perinatal period-specific disorders such as psychological birth trauma and postpartum psychosis (Highet et al. 2023). Many women experience changes in their mental health during this period – women with a current or previous mental health condition may be at increased risk of worsening symptoms or relapse, while other women may experience symptoms for the first time (Highet et al. 2023).

Effect of poor perinatal mental health on mothers and babies

Poor perinatal mental health has a significant impact on the woman and can also have a long-term impact on her baby. Mental health conditions during pregnancy have been associated with adverse obstetric and pregnancy outcomes, such as premature birth, independent of mental health-related medication use (Adane et al. 2021; Jarde et al. 2016; Mitchell and Goodman 2018). Perinatal mental health conditions are also associated with poorer child and adolescent development, including increased risk of poorer cognitive development, emotional problems and externalising behavioural difficulties (such as attention deficit hyperactivity disorder) (Rogers et al. 2020; Slomain et al. 2019; Stein et al. 2014). The relationship between having a perinatal mental health condition and the long-term outcomes for the baby is complicated, and may be due to a mix of genetic, epigenetic (how environmental influences and experiences affect a person’s genes) and environmental factors, including through effects on parenting practices and mother-infant attachment (Rogers et al. 2020; Slomain et al. 2019; Stein et al. 2014). 

Key risk and protective factors

Key risk factors for developing a perinatal mental health condition include a history of mental illness, history of abuse or intimate partner violence, limited social support and lower socioeconomic status (Bayrampour et al. 2018; Bedaso et al. 2021; Míguez and Vázquez 2021; Yang et al. 2022). Other risk factors may include poor sleep quality (Ladyman et al. 2021) and experiencing psychological childbirth-related trauma (Ayers et al. 2016; Kranenburg et al. 2023; Loxton et al. 2021). Conversely, factors such as personal resilience, positive childhood experiences and social support have a protective effect against perinatal mental health conditions and can mitigate the effects of some risk factors (Atzl et al. 2019; Carlin et al. 2021).

How common are perinatal mental health conditions?

Anxiety disorders are the most common mental health conditions in the perinatal period, with prevalence estimates ranging from around 10% to 20% of mothers (Dennis et al. 2017; Fawcett et al. 2019), and this often co-occurs with depression (Falah-Hassani et al. 2017). It is estimated that perinatal depression affects around 10% of mothers in high-income countries, and that prevalence is considerably higher in low- and middle-income countries (Woody et al. 2017). Research indicates rates of depression and/or anxiety tend to be higher during pregnancy compared with the first year after birth, and that having depression or anxiety during pregnancy is associated with postnatal depression and anxiety (Dennis et al. 2017; Liu et al. 2021; Underwood et al. 2016). It is estimated that childbirth-related post-traumatic stress disorder (PTSD) affects from 3% to 6% of mothers (Heyne et al. 2022).

Mental health conditions such as schizophrenia, postpartum psychosis (which includes symptoms such as hallucinations, delusions, mood swings, confusion and changes in behaviour), and bipolar disorder are less common but can have a significant impact on the health and wellbeing of women and families (Jones et al. 2014; Masters et al. 2022; VanderKruik et al. 2017).

Fathers and other parents

Traditionally, the focus of perinatal mental health research has been on the mother who gave birth. However, there is increasing evidence that fathers, partners and other non-birthing parents or guardians, such as adoptive parents and step-parents, can also be affected by poor mental health during the perinatal period, experiencing perinatal depression and depressive symptoms, anxiety disorders, and suicidal thoughts (Anthony et al. 2019; Cameron et al. 2016; Chhabra et al. 2020; Darwin et al. 2021; Giallo et al. 2023; Leach et al. 2016; Mott et al. 2011). 

Whilst there is less research available on paternal perinatal mental health, it is estimated that around 1 in 10 expecting or new fathers experience perinatal anxiety and/or depression (PANDA 2020; Giallo et al. 2012; Chhabra et al. 2020; Philpott et al. 2019). A recent review of paternal mental health research estimated similar rates of paternal anxiety (11%) and depression (7.3%), observing that many men experience anxiety throughout the perinatal period, starting as early as the first trimester (Leiferman et al. 2021).

The National Perinatal Mental Health Guideline covers important areas of screening and psychosocial assessment not only for women, but also recommends offering mental health screening to non-birthing parents during both the antenatal and postnatal periods (Highet et al. 2023).

For more information, see Key information gaps.