Postnatal depression slipping through the cracks

One in three expectant and new parents are not screened for perinatal mental health problems, a survey finds.

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Many parents say they’re not being screened for perinatal depression and anxiety (PNDA), and their mental health is not prioritised. 

This is despite the high rates in the community, with one in five mothers and one in 10 fathers diagnosed every year.  

While the majority of expectant parents receive routine antenatal care, the physical assessments, blood tests and genetic screening are all prioritised over mental wellbeing, according to Gidget Foundation Australia, a not-for-profit focusing on education, advocacy and services for around perinatal depression and anxiety. 

In May the foundation surveyed 505 people either expecting a child or with a child under the age of three. One-third of the group said their emotional wellbeing was never screened, 23% said they were screened but their physical health was prioritised after the birth, 20% said they were screened but no action was taken. Only 10% of respondents said they were screened and referred to a specialist. 

Dr Erin Seeto, counselling psychologist and Gidget Foundation Australia clinical team leader, said screening for PNDA was difficult in a consultation where so much must be covered, and that physical health often ended up being the priority.  

The diversity in symptoms added to the difficulty, said Dr Seeto.  

“When a dad comes to you as a client, and says, I’ve got a headache, and really lacking motivation, and I’m a bit disinterested in the world – that may actually be the presentation of PNDA, as opposed to the emotional variability which you tend to see women more comfortable talking about.” 

Men will often present with physical symptoms like headaches, fatigue, lack of motivation, difficulties concentrating, increased anger and irritability, Dr Seeto said.  

“Whereas with women, you will get slightly more tearfulness, you will get a sense of hopelessness. And you might find that they are more easily able to label anxiety and worry and ruminative thoughts, whereas men don’t necessarily use that language to explain what’s going on.” 

It can also be difficult to differentiate between the expected effects of transition to parenthood and signs of PNDA. 

“That’s to do with the length of time and the impact on functioning,” she said. “If you’re feeling that more days than not are just really hard and a real slog or really relentless, then that’s where we start to think this is something more than an off day or an off week. So that’s why most of our screeners [ask] ‘over the last two weeks, how often have you felt the symptoms or experiences?’” 

With long waiting lists for stretched mental health care, state-based services could be good referral options for these patients, she said. For instance:  

• NSW has the Perinatal Infant Mental Health Services.  

• Queenslanders have the Queensland Centre for Perinatal and Infant Mental Health.  

• The ACT has the Perinatal and Infant Mental Health Consultation Service.  

• In Victoria, four hospitals have specialist mother and baby units that provide services in the postnatal period, and some mental health services have a perinatal emotional health programs. 

• There is also a Perinatal and Infant Mental Health Service in Tasmania.   

• In Western Australia, the Statewide Perinatal and Infant Mental Health Program has detailed referral pathways.  

• The Perinatal Mental Health Team in the Northern Territory can be accessed via the NT Mental Health Access team. 

Patients with previous mental health issues were more likely to be screened, said Dr Seeto, but PNDA can affect anyone.  

“We would advocate for screening of everyone, particularly because this is a time where you’re going through increased internal changes. You’re also going through a process of quite significant transitions in life. People are going to be more vulnerable in this period, whether you have prior mental health issues or not.” 

It’s worth planting the seed of thinking about mental health at a time when families are more connected with services, even if it’s just handing out fact sheets so they can be aware of symptoms. 

“Even if the client hasn’t been flagged as someone who potentially needs onward referral, that they have the support lines, like the PANDA hotline, or other resources that they can turn to, should they notice a decline.” 

Patients could be asked to fill in standard questionnaires prior to appointments or in the waiting room, to ensure screening is not missed. 

“Patients at the point of entering a GP appointment are often bringing a cluster of different questions,” Dr Seeto said.  

“Then there’s making sure that appointment or referral was made, that you’re booked in for your antenatal appointment in the hospital, making sure that you’re having all the appropriate screeners, that your vaccinations are up to date, managing risk factors. 

“Often, mental health is an afterthought. It is seen as a secondary issue and physical health is the primary issue.” 

While a screening questionnaire is useful, it is not enough in isolation. There are individual and cultural and linguistic considerations too. 

Tools such as the Edinburgh Postnatal Depression Scale are available in several languages online. “But what that doesn’t provide is the contextual information,” Dr Seeto said. “And not all mental health language translates easily in different languages.” 

For Aboriginal and Torres Strait Islander patients, the Kimberley Mums Mood Scale could be the best tool.  

“It’s about being able to adapt your service to accommodate for the needs of the person that sits in front of you and ensuring that all care is person centred and unique. Everyone’s interpretation of an experience of mental health is going to be different.”