Risk and resilience: a mixed methods investigation of Aboriginal Australian women\u2019s perinatal mental health screening assessments

Julia V. Marley,David Atkinson,Katherine Ferrari,Emma Carlin,Kimberley H. Seear,Erica Spry

doi:10.1007/s00127-020-01986-7

Abstract

PurposeTo describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women’s Kimberley Mum’s Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome.MethodsWe used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into ‘risk’ and ‘protective’ factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety.ResultsProtective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11–33% high vs 61–100% no risk) and more commonly had risk factors (22–67% high vs 6–28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety.ConclusionAssessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.

Highlights

Perinatal mental health disorders are a major contributor to the burden of disease and disability worldwide [1,2,3], adversely impacting maternal quality of life and levels of productivity [4, 5]
Results from the Kimberley Mum’s Mood Scale (KMMS) validation study demonstrated that the KMMS is capable of identifying women with moderate or high risk of depression and/or anxiety when assessed against a blinded standardised diagnostic interview conducted by a general practitioner (GP) trained and experienced in mental health assessment [13]
The KMMS validation study and subsequent consultations with other groups of Aboriginal women have identified that the inclusion of protective factors is central to Aboriginal women identifying the KMMS as acceptable and culturally safe [42, 43]

Summary

Introduction

Perinatal mental health disorders are a major contributor to the burden of disease and disability worldwide [1,2,3], adversely impacting maternal quality of life and levels of productivity [4, 5]. Studies suggest 10–65% of perinatal women are affected by perinatal mental health disorders [1]. The large variation in prevalence can, in part, be understood by the non-standardised definitions of perinatal mental health disorders and associated diagnostic criteria [1, 3]. Variance in prevalence is underpinned by the uneven distribution of perinatal mental ill-health across different population groups [1, 3, 7]. Within Australia, Aboriginal women have significantly higher rates of anxiety or depression in the perinatal period [8,9,10] than the non-Aboriginal perinatal population [11]. Perinatal depression and anxiety was identified in 25% of a sample of 91 perinatal Aboriginal Australian women from the Kimberley region [13]

Objectives

Methods

Results

Discussion

Conclusion