Maximising the Utility of Screening for Perinatal Depression

PIRI has published one of the most rigorous estimates of the predictive value of the primary screening instrument for postnatal depression, the Edinburgh Postnatal Depression Scale (EPDS), and produced the first estimates of the prevalence of perinatal mental disorders among Indigenous Australian women.

PIRI has a longstanding focus on improving the identification of perinatal mental health difficulties and ensuring that identification leads to timely and appropriate treatment. This work has included the development of digital clinical decision support systems to assist health professionals to interpret screening results and support referral and care pathways. In partnership with the City of Whittlesea Maternal and Child Health Service, PIRI continues to undertake pilot cluster randomised controlled trials evaluating these approaches in real-world settings.

More recently, PIRI has been awarded NHMRC funding for a large cluster randomised controlled trial (n = 1,650) evaluating its clinical decision support system, PIRIMID (Perinatal Identification, Referral and Integrated Management for Improving Depression). This trial includes a comprehensive health economic evaluation to assess effectiveness and scalability.

PIRI has also maintained a long-term collaboration with beyondblue, supported by funding from the beyondblue Victorian Centre of Excellence. Since 2000, PIRI has played a central role in the development of an integrated, evidence-based national approach to perinatal depression screening. This work began with the beyondblue-funded National Postnatal Depression Project (2001–2005), which involved collaboration between leading researchers and 43 health services and included more than 40,000 women over five years. PIRI alone screened over 10,000 women in Victoria and Tasmania. This work culminated in a National Action Plan that mapped perinatal mental health needs across Australia, to which PIRI made a substantial contribution as part of the Perinatal Mental Health Consortium (2008).

Working closely with beyondblue and other partners, PIRI contributed to the development of the beyondblue Clinical Practice Guidelines for depression and related disorders in the perinatal period (2011), covering anxiety, bipolar disorder, and puerperal psychosis. PIRI also led the development of the accompanying online training modules for health professionals focused on screening and management.

Collectively, this sustained body of work underpinned the establishment of the National Perinatal Depression Initiative, resulting in an Australian Government commitment of $85 million to universal perinatal screening. Grounded in the Clinical Practice Guidelines, this ongoing, federally funded initiative mandates universal psychosocial assessment, including depression screening, at least once during pregnancy and once in the first year postpartum for all perinatal women in Australia. PIRI continues to be actively involved in implementation of the National Perinatal Depression Initiative.

PIRI’s Director chaired the beyondblue National Workforce Training Committee in 2013, and PIRI remains involved in training health professionals in the assessment and management of perinatal depression and in developing evidence-based resources for the Initiative, including guidance materials for clinicians.