Maximising the Utility of Screening for PND

PIRI published one of the most careful estimates of the predictive value of the main screening instrument for PND (the EPDS) and the first estimates of the prevalence of perinatal mental disorders in Indigenous Australians.

We have a longstanding interest in improving processes for identifying perinatal mental health difficulties and ensuring that improved identification results in treatment. We have developed new digital clinical decision support systems for health professionals to help collate and act on screening results. With our partners in City of Whittlesea Maternal & Child Health Service we are continuing a pilot cluster RCT in this area or work.

Recently, funding for a new, much larger cluster RCT (n = 1650) of our clinical decision support system (PIRIMID: Perinatal Identification, Referral and Integrated Management for Improving Depression) has been granted by NHMRC and this new trial will involve a comprehensive health economic analysis.

PIRI has also had a longstanding collaboration with beyondblue and has received funding from the beyondblue Victorian Centre of Excellence to conduct a number of research studies Since 2000, PIRI has been centrally involved in the development of an integrated, evidence-based national strategy towards perinatal depression screening. Beginning with the beyondblue funded National Postnatal Depression Project (2001-2005), key perinatal depression researchers from around the country and 43 health services collaborated in a feasibility study of antenatal and postnatal screening that involved more than 40,000 women over 5 years. PIRI screened over 10,000 women in Victoria and Tasmania. This culminated in a National Action Plan focused on the detailed mapping of perinatal mental health needs in Australia to which PIRI made a substantial contribution as part of the Perinatal Mental Health Consortium (2008).

Working closely with beyondblue and others PIRI contributed to the development of the beyondblue Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period (2011) and led the content of the accompanying online training module for health professionals for screening and management. Ultimately, this sustained program of work has resulted in today’s National Perinatal Depression Initiative. The NPDP resulted in government commitment of $85M for universal screening of perinatal depression. Grounded in the evidence-based recommendations of the Clinical Practice Guidelines, this ongoing, federally-funded initiative mandates universal psychosocial assessment, including depression screening, for every perinatal woman in Australia at least once in pregnancy and at least once in the first year postpartum. PIRI is also involved in the implementation of the National Perinatal Depression Initiative (NPDI).

Our Director chaired the beyondblue National Workforce Training Committee in 2013 and PIRI is now involved in training health professionals in assessing and managing perinatal depression and developing resources for the NPDI, including a fact sheet for health professionals about the evidence.