When are women screened?
National guidelines recommend all women are routinely screened for depression and psychosocial risk factors at least twice during pregnancy and twice during the first year after birth (Highet et al. 2023).
In practice, women may not be routinely screened, or may be screened multiple times across a range antenatal and postnatal mental health settings (Figure 1). While there are national guidelines, there are differences across state and territories and health settings in how, when and if women are screened for perinatal mental health and psychosocial risk factors.
Although perinatal mental health screening has increased over time, research indicates that some groups have historically been under-represented including First Nations women, women born overseas, single or separated women, private patients and older mothers (Moss et al. 2020; San Martin Porter et al. 2019).
Figure 1: Services where women may be offered perinatal mental health screening, noting potential data sources and funding sources
See extended description
Notes:
- Hospital admission includes admissions related to pregnancy and childbirth, as well as specialised mental health inpatient services. Local referral pathways may exist to ensure the mother receives appropriate care including screening at the right time. Screening for mental health risk factors, for example with the Edinburgh Postnatal Depression Scale (EPDS), may not be needed in these circumstances due to other processes being in place to assess the patient’s mental health.
- In 2021–22, 11% of all outpatient (non-admitted) service events in public hospitals were covered by the MBS.
Perinatal mental health screening settings
Perinatal mental health screening settings include:
- public hospital admitted patient(a)
- public hospital outpatient services, including antenatal clinics and maternity, child and family health services
- private hospital admitted patient(a)
- out-of-hospital care by allied health workers, including psychologists and other allied mental health workers
- out-of-hospital care by medical practitioners, including general practitioners, obstetricians, and other specialists. Includes some maternity and family practices, Aboriginal Health Services and endorsed midwives and nurses working in private practices in a collaborative arrangement with a medical practitioner.
Funding
- State funding covers public admitted patient and outpatient services.
- Medicare subsidised services include out-of-hospital care by medical practitioners, and some public outpatient services, private hospital services and out-of-hospital care provided by allied health workers(b).
- Private health insurance funds some private hospital care, and out-of-hospital care provided by allied health workers.
- Some private hospital care, and out-of-hospital care provided by allied health workers is funded by the patient.
Data sources
Potential data sources include:
- the NPDC for public hospital settings
- State and territory perinatal data holdings for state funded services
- The Medicare Benefits Schedule (MBS) for MBS subsidised services
- Private health insurance data for services funded by private health insurance
- And local hospital network/hospital/practice level health information management systems (HIMS).
Highet NJ, the Expert Working Group and Expert Subcommittees (2023) Effective Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline, Centre of Perinatal Excellence (COPE), accessed 26 September 2023.
Moss K, Reilly N, Dobson A, Loxton D, Tooth L and Mishra G (2020) ‘How rates of perinatal mental health screening in Australia have changed over time and which women are missing out’, Australian and New Zealand Journal of Public Health, 44(4):301–306, doi:10.1111/1753-6405.12999.
San Martin Porter MA, Betts K, Kisely S, Pecoraro G and Alati R (2019) ‘Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study’,The Medical Journal of Australia, 210:32–37, doi:10.5694/mja2.12030.