Perinatal Depression and Screening among Aboriginal Australians in the Kimberley

By Kotz, Jayne; Munns, Ailsa et al. | Contemporary Nurse : a Journal for the Australian Nursing Profession, February 2016 | Go to article overview

Perinatal Depression and Screening among Aboriginal Australians in the Kimberley


Kotz, Jayne, Munns, Ailsa, Marriott, Rhonda, Marley, Julia, V, Contemporary Nurse : a Journal for the Australian Nursing Profession


1. Introduction

This paper explains the process preceding the development of an alternative to the Edinburgh Postnatal Depression Scale (EPDS) for use among Aboriginal women in the Kimberley region of Western Australia (WA). It includes a literature review containing an examination of concepts of Aboriginality and the differences between Western and Aboriginal health beliefs. Following this an account of the background and context for the project, including an assessment of the perinatal depression screening practices by health agencies for Aboriginal women in the Kimberley will be described. Nursing and midwifery frameworks will then be examined in the lead-up to the project's methodology, findings and recommendations for perinatal mental-health screening in the Kimberley.

2. Terminology

Language is extremely powerful. It reflects prior learning and understanding and may influence perception of meaning. Accurate and non-offensive language is an essential component of Aboriginal cultural respect. This paper will use the adjectives 'Aboriginal' or 'Kimberley Aboriginal' to describe a people, with the intent to highlight their individual and social humanity as the original inhabitants of the Kimberley region of WA.

The term perinatal depression will be used in preference to postnatal depression (PND) and will include the time frame from pregnancy to the first year after the birth, as defined in the Clinical Practice Guidelines for Depression and Related Disorder (Austin & Highet, 2011). This covers the critical period where women are at increased risk of developing common mental-health conditions including depression and anxiety.

3.Review of the literature

An in-depth appraisal of English language international, national, state, multidisciplinary peerreviewed literature from 2000 to 2015, pertaining to perinatal depression and anxiety, was undertaken through ProQuest, Cochrane, CINAHL, OVID, EBSCOhost, PubMed, Informit, ABS Online and Google Scholar. Analysis of current guidelines, practices in screening and cultural issues impacting on practice was undertaken through evaluating grey literature from WA Perinatal Mental-health Unit (WAPMU), King Edward Memorial Hospital (KEMH), Kimberley Aboriginal Medical Services Council (KAMSC), BOABS Health Services and Ord Valley Aboriginal Health Service (OVAHS).

3.1. The cultural divide

Health professionals often experience difficulties when providing care to Aboriginal peoples. Frequent short tenures compounds little previous experience in working with Aboriginal clients, which increases difficulty communicating (McDonald, 2006; Trudgen, 2000). Even if professionals are patient and sympathetic, they may be unlikely to extract the necessary information or elicit trust (Brown, 2001; Cass et al., 2002; Department of Health NSW, 2008; Eckermann et al., 2010; McDonald, 2006).

3.2. Cultural fluidity

Some Aboriginal people have internalised non-Aboriginal definitions of themselves resulting in feelings that they have lost their culture (Eckermann et al., 2010). Generally however, they have been very successful in both adapting and maintaining much of their culture (Dudgeon, 2009) which has been an important feature in their resilience. This is evident too regarding their perception of and approach to health care (Pearn, 2005).

Traditional beliefs of Aboriginal peoples have adapted to the changing circumstances in which they live. Whilst there have been many changes in viewpoints of treatment, there has been less change in beliefs regarding the cause of illness. Their traditional health beliefs are interconnected with important aspects of Aboriginal life such as the land, kinship obligations and religion (Brown, 2001). Aboriginal people place emphasis on social and spiritual dysfunction as the cause of illness (McDonald, 2006), and their relationship with family and link to country connect directly to their experience of health and well-being. …

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