Improving maternal perinatal mental health: integrated care for all women versus screening for depression.

OBJECTIVE: The objective of this article is to highlight the debate about universal routine screening and psychosocial assessment in the perinatal period, and suggest an alternative/additional approach to improving maternal perinatal mental illness. CONCLUSIONS: Universal routine screening and psychosocial assessment in the perinatal period has been introduced in Australia despite a lack of evidence that this affects perinatal maternal morbidity. Furthermore, this approach is not designed to detect maternal illnesses such as schizophrenia, bipolar disorder, borderline personality disorder, although it is these women and their infants who have the highest rates of morbidity and mortality. We propose that any approach to improving maternal perinatal mental health should be tailored to particular situations and populations, with mental health care (inclusive of all mental illness, not just depression) integrated into, and thus a routine aspect of, maternity care provided to all women throughout the perinatal period.

What are we screening for? Development of a psychiatric referral tool for use with adolescent pregnant women.

OBJECTIVE: Psychiatric disorders commonly occur during pregnancy and in the postpartum period, posing substantial risks to both mother and unborn child. Consequently, screening for maternal psychiatric disorder during pregnancy and in the postnatal period has been advocated. In this paper, we describe the development and evaluation of a screening tool for use with a 'high risk' demographic group--adolescent women seeking maternity care. CONCLUSIONS: The tool was developed to identify women with, or at risk of, psychiatric disorders requiring specialist assessment and/or treatment, rather than only those with psychosocial concerns and/or distress, or with depressive symptoms alone. The tool was administered by midwives and used during discussion at the maternity team multidisciplinary meeting to facilitate referral or seek advice through secondary consultation. The tool was well accepted by the women attending the clinic. All women in the group who received psychiatric care later--either during confinement or during the 6-week postnatal period of follow-up--had already been identified by the tool in the antenatal period. Arguably, the tool enabled early intervention, treatment planning and effective care. We suggest that rather than adopting a 'one size fits all' approach, any screening should be tailored to the population of interest.

Consultation-liaison psychiatry in a maternity hospital.

OBJECTIVE: The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. METHOD: Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. RESULTS: Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. CONCLUSIONS: Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.