Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Antenatal Emotional Wellbeing Screening in Aboriginal and Torres Strait Islander Primary Health Care Services in Australia

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Antenatal Emotional Wellbeing Screening in Aboriginal and Torres Strait Islander Primary Health Care Services in Australia

Article excerpt

Screening for antenatal emotional wellbe- ing (EW) including depression has gained significant attention in Australia (Beyondblue: The National Depression Initiative, 2008; Buist, 2008; Buist et al., 2002) with develop- ment of specific guidelines for perinatal mental health care (Obstetrics and Gynaecology CCU and KEMH Liaison GP, 2010). Data on around 40,000 women screened for antenatal EW has indicated that 10-15% of mothers experience antenatal depression (Austin, 2003; Matthey et al., 2004; Milgrom et al., 2008), but there is a lack of data on antenatal EW among Aboriginal and Torres Strait Islander (hereafter Aboriginal) women in Australia. However, psychosocial risk factors that may trigger maternal depression are all highly prevalent in the Aboriginal popula- tion. These factors include their overall lower socio-economic status (gross household income Aboriginal vs. non-Aboriginal was $460 vs. $740 per week in 2006), high unemployment (43% of Aboriginal people age 15-64 years were not in the labour market in 2006) (Australian Human Rights Commission, 2008), high levels of domes- tic violence, and an increased number of bereave- ment events including the death of close relatives (Hayes, Campbell, Buckby, Geia, & Egan, 2010).

Furthermore, health care service data indicate that in general Aboriginal people are more likely to encounter mental health problems than other Australians. Indeed, proxy indicators such as hos- pitalisations for mental health disorders, emergency department attendance for mental health problems, substance misuse-related conditions, and contact with community health services are two to three times higher in Aboriginal people compared to the that observed in the total Australian population (Jorm, Bourchier, Cvetkovski, & Stewart, 2012; Sveticic, Milner, & De Leo, 2012; Vos, Barker, Stanley, & Lopez, 2007). Recent analysis of national survey data also suggests that Aboriginal adults are three times more likely to be classified as having very high levels of psychological distress than other Australians (Cunningham & Paradies, 2012). These proxy parameters together with pregnancy factors including higher rates of teenage pregnancy (23 vs. 4%) (Leeds et al., 2007), delayed first antenatal visit, fewer antenatal appointments (<4 antenatal visits) (Powell & Dugdale, 1999), and higher rates of smoking and alcohol consumption during preg- nancy (Powell & Dugdale, 1999; Sayers & Boyle, 2010) place Aboriginal women at higher risk for antenatal wellbeing concerns compared to their non-Aboriginal counterparts (Milgrom et al., 2008).

For early identification and management of EW, the National Perinatal Depression Initiative (2008- 2013) programme encourages screening pregnant and postnatal women for depression using the Edinburgh Postnatal Depression Scale (EPDS) (Beyoundblue: The National Depression Initiative, 2008; Australian Government Department of Health, 2009; Milgrom, Ericksen, Negri, & Gemmill, 2005). However, ques- tions have been raised about the suitability of the EPDS scale for the Aboriginal population and data indicates a low or static uptake of the screening ser- vice in rural and remote areas in Australia (Armstrong & Small, 2010; Campbell, Hayes, & Buckby, 2008). Available data on reasons for low uptake indicate that midwives were not administering the EPDS and that some mothers did not have time to com- plete the questionnaire (Armstrong & Small, 2010; McCauley, Elsom, Muir-Cochrane, & Lyneham, 2011). A recent Australian study showed that around 50% of midwives were not aware of the prevalence of antenatal depression among Australian women (Jones, Creedy, & Gamble, 2011). Midwives' knowl- edge of risk factors for wellbeing concerns, treatment options and screening tools such as the EPDS has been found to be limited (Jones et al., 2011). The aim of this study was to examine the extent to which antenatal EW assessments are undertaken in primary health care (PHC) centres serving significant num- bers of Aboriginal and Torres Strait Islander people, and to identify factors associated with EW screening in these PHC centres. …

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