The impact of implementing universal screening for antenatal mental health conditions in Southern Tasmania, Australia: A retrospective observational study

Abstract

Problem

The impact of universal screening for perinatal depression on referrals is unknown.

Background

The Australian National Perinatal Depression Initiative (NPDI) implemented in 2008 recommended universal screening of perinatal depression and provision of follow-up support and care when indicated.

Aim

To assess the impact of the implementation of the NPDI in public antenatal care in Southern Tasmania on screening levels and referrals provided to support services for mental health and/or psychosocial concerns.

Methods

Data were derived from a clinical audit of digital records for women who attended public antenatal services and gave birth from July-December 2011 (pre-implementation, n = 911) and 2014 (post-implementation, n = 896). Data included patient demographics and obstetric factors, Edinburgh Postnatal Depression Scale (EPDS) scores, and referrals given.

Findings

Pre-implementation, 1.32 % of women were screened with the EPDS and 95.98 % post-implementation, with 31.17 % and 26.00 % of women referred to support services respectively. Of those referred, referrals were provided at 1.25 visits on average pre-implementation, 1.57 visits post-implementation. Women younger than 20 years and women living in the most disadvantaged locations were more likely to have an EPDS score ≥10. Communication between antenatal care and primary care providers increased.

Discussion

Improved communication between care providers indicates a strengthened continuum of care. The impact of the concurrent introduction of an integrated care model on findings is unclear.

Conclusion

The introduction of the NPDI in Southern Tasmania led to higher screening rates but fewer women referred for support services. The findings support the need for embedded evaluations to ensure timely and informed decision-making.