Volume 187 - Issue 8
Maternal mortality and psychiatric morbidity in the perinatal period
Author: Marie-Paule Austin
Med J Aust 2007; 187 (8): 474-476. || doi: 10.5694/j.1326-5377.2007.tb01368.x
Published online: 15 October 2007
Published online: 15 October 2007
In reply: Boyce and Barton raise a number of points.
Firstly, with respect to their critique of the 2006 beyondblue postnatal depression report,1 there are, to date, no studies assessing the cost of antenatal screening programs. Furthermore, while false positives are a feature of all screening programs, that, in itself, is not a deterrent to using antenatal screening if the rate of false positives is considered acceptable. While midwives have concerns about undertaking routine psychosocial assessment, uptake of such a program can be done through adequate training and support of staff, as now demonstrated in a number of sites around Australia.2 With respect to the inadequate uptake of services by “high-risk” women, these are generally poor in the psychiatric clinic setting3 and would not be expected to be different perinatally.
Secondly, the authors report that “a number of the suicide cases were already under the care of mental health services, and screening may not have prevented the tragic outcomes”. This overlooks one of the key attributes of routine psychosocial assessment in the primary health care setting — that it encourages communication and monitoring across the primary (eg, midwifery) and mental health sectors. Thus, while some women may be lost to psychiatric follow-up during pregnancy, most will attend antenatal appointments, thus providing their health care network with an opportunity for ongoing psychosocial review.
Thirdly, while we agree with Boyce and Barton that “targeted interviewing” (as described in the UK National Institute for Health and Clinical Excellence guidelines) is important, “psychosocial assessment”, as undertaken in some Australian maternity settings, aims to assess the broad number of psychosocial risk factors that may contribute to the mental health outcomes of a woman and her infant. This point has been identified as a key issue in the 2007 beyondblue national action plan for perinatal mental health briefing document.4
References
- Buist A, Bilszta J, Milgrom J, et al. The beyondblue National Postnatal Depression Program. Prevention and early intervention 2001–2005. Final report. Melbourne: beyondblue, 2006.<eMJA full text>
- Buist A, Condon J, Brooks J, et al. Acceptability of routine screening for perinatal depression. J Affect Disord 2006; 93: 233-237. 0_pgfId-1430602
- Krulee DA, Hales RE. Compliance with psychiatric referrals from a general hospital psychiatry outpatient clinic. Gen Hosp Psychiatry 1988; 10: 339-345. 0_pgfId-1430610
- National beyondblue Perinatal Mental Health Program briefing document. March 2007. http://www.beyondblue.org.au/index.aspx?link_id=6.819 (accessed Sep 2007).