Abstract
IntroductionOptimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing. Few studies, however, have focused on Indigenous women and the specific risk and protective factors that may prompt vulnerability to perinatal mental disorders in this culturally diverse population.ObjectivesTo assess mental health contacts in the period before childbirth among Australian Aboriginal and Torres Strait Islander women, the association with socioeconomic factors and whether it differs by geographic remoteness.MethodsThis is a retrospective cohort study of 19,165 Aboriginal mothers and includes all Aboriginal mothers and their children born in Western Australia from January 1990 to March 2015. It draws on population-level, linked administrative data from hospitals and mental health services, with a primary focus on the mental health contacts of Aboriginal women in the 5 years leading up to childbirth.ResultsThe prevalence of maternal mental health contacts in the five years prior to birth was 27.6% (93.6% having a single mental health disorder), with a greater likelihood of contact in metropolitan areas compared with regional and remote settings. There was a positive relationship between socioeconomic advantage and the likelihood of a mental health contact for women in Metropolitan (β = 0.044, p=0.003) and Inner regional areas (β = 0.033, p=0.018), and a negative association in Outer regional (β = -0.038, p=0.022), Remote (β = -0.019, p=0.241) and Very remote regions (β = -0.053, p<0.001).ConclusionsThe findings from this study provide new insights on the dynamic relationship between SES, geographic location and mental health issues among Aboriginal women in the 5 years leading up to childbirth. The results underscore the need to apply location-specific approaches to addressing the material and psychosocial pathways that lead to mental health problems and the provision of culturally safe, appropriate and accessible services for Aboriginal women
Highlights
Optimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing
The Midwifes Notification System (MNS) records the circumstances of all births of 20 weeks of gestation or more, with information received from attending practitioners since 1980 and was used as the primary data source to establish the cohort
The final study sample included 19,165 mothers and their 39,845 Aboriginal children born between January 1990 and March 2015 and represents the participants with complete information on primary predictors (IRSAD decile score, geographical remoteness) and other covariates (88.1% of all 45,211 in-scope children)
Summary
Optimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing. Few studies have focused on Indigenous women and the specific risk and protective factors that may prompt vulnerability to perinatal mental disorders in this culturally diverse population. The existing literature clearly supports the importance of maternal mental health from pre-conception, through pregnancy and the postpartum for both maternal and infant wellbeing[1,2]. There is very limited research on Indigenous women to understand the specific risk and protective factors that may underlie their vulnerability to perinatal mental disorders. Open Access under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/deed.en)
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