Guidelines for preventive activities in general practice

Reproductive and women’s health

Perinatal mental health

      1. Perinatal mental health

Reproductive and women’s health | Perinatal mental health

Screening age bar

0–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 ≥80

The perinatal period (the time from conception to 12 months after birth) is a time of significant change for parents. Subsequently, it can be a high-risk time for the onset and relapse of mental health conditions.1 It is estimated that perinatal depression and anxiety affects 1 in 5 mothers and 1 in 10 fathers/partners.1,2

Screening

Recommendation Grade How often References
Assess psychosocial risk factors as early as practical in pregnancy and again after the birth using the Antenatal Risk Questionnaire (ANRQ). Recommended (strong) As early as practical in pregnancy, again after birth. 1
Screening women for a possible depressive or anxiety disorder using the Edinburgh Postnatal Depression Scale (EPDS) is recommended. Recommended (strong) for depression Complete the first postnatal screening 6–12 weeks after birth and repeat screening at least once in the first postnatal year. 1
Practice point for anxiety
Routinely screen for intimate partner violence. Explain to all women that asking about family violence is routine part of postnatal care. Ask about family violence only when alone with the woman, using validated screening tools. Recommended (strong) Consider more than once. 3,4
 
 

Perinatal depression

Common symptoms of perinatal depression:5

  • Loss of interest or pleasure in everyday life
  • Physical symptoms (eg lethargy, numbness)
  • Cognitive symptoms (eg negative thinking)
  • Behavioural symptoms (eg withdrawal)
  • Emotional symptoms (eg tearfulness)

Depression in the perinatal period is identified by the presence of a number of symptoms experienced over a period of time, typically two weeks or more. Moderate to severe perinatal depression can also affect a parent’s ability to care for their baby and/or other children in their care.5 Any discussion of suicide should be taken seriously, with treatment from a mental health professional or other appropriate person immediately sought.6

Perinatal anxiety

Although pregnancy and the arrival of a new baby can be very exciting, most women experience some worries about things like having a healthy pregnancy, delivering the baby, keeping their baby safe and potential impacts on their relationship, career or finances. For some people, those worries can become overwhelming and unmanageable.6

Common symptoms of perinatal anxiety:7

  • Anxiety or fear that interrupts thoughts and interferes with daily tasks
  • Panic attacks: outbursts of extreme fear and panic that are overwhelming and feel difficult to bring under control
  • Anxiety and worries that keep coming into the woman’s mind and are difficult to stop or control
  • Constantly feeling irritable, restless or ‘on edge’
  • Having tense muscles, a ‘tight’ chest and heart palpitations
  • Finding it difficult to relax and/or taking a long time to fall asleep at night
  • Anxiety or fear that stops the woman going out with her baby
  • Anxiety or fear that leads the woman to check on her baby constantly

Information on key considerations before screening and psychosocial assessment is available at the Pregnancy care guidelines.

Be aware that anxiety disorders are very common in the perinatal period and should be considered in the broader clinical assessment.

Non-birthing partners

Information on assessing perinatal mental health in non-birthing partners is available in Part B – Screening and psychosocial assessment of the Centre of Perinatal Excellence’s (COPE) Mental health care in the perinatal period Australian clinical practice guideline.

When screening Aboriginal and/or Torres Strait Islander women, consider language and the cultural appropriateness of the tool.1,4 It is important to note that EPDS scores among Aboriginal and Torres Strait Islander women may be influenced by factors such as understanding of the language used, mistrust of mainstream services or fear of consequences of depression being identified (ie involvement of child protection services).1 If use of the EPDS is considered inappropriate, involvement of an Aboriginal Health Worker may facilitate assessment of symptoms of depressive or anxiety disorders.1

The Kimberley Mum’s Mood Scale (KMMS) has been developed for use in Aboriginal and Torres Strait Islander populations; however, it has only been validated for use in the Kimberley region and may not be applicable for Aboriginal and Torres Strait Islander women in other areas.1

Where possible, seek guidance/support from an Aboriginal and/or Torres Strait Islander worker or professional worker or professional when screening Aboriginal and/or Torres Strait Islander woman for depression and anxiety.1

For further information, refer to the Prevention of depression section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.
 

Perinatal depression and anxiety are more commonly reported among the following population subgroups:1,2

  • people with a prior history of mental illness
  • Aboriginal and Torres Strait Islander peoples
  • migrant women (including refugees, asylum seekers)
  • women living in rural and remote areas
  • women experiencing pregnancy in adolescence
  • women experiencing intimate partner violence
  • LGBTIQA+ parents
  • women who experienced birth trauma.

For screening in women from a culturally and linguistically diverse (CALD) background, use appropriately translated versions of the EPDS with culturally relevant cut-off scores. Consider language and the cultural appropriateness of the tool.1

Further information on the identification and management of abuse and violence:
Abuse and violence – working with our patients in general practice | RACGP
 
Guideline for the early identification of mental health conditions in the perinatal period for women and/or their partners
Mental health care in the perinatal period: Australian clinical practice guideline | COPE
 
Guidelines on all aspects of pregnancy care, including social and emotional screening:
Pregnancy care guidelines | Department of Health and Aged Care
 
A broad collection of resources for GPs to help patients with mental health illness:
Resources for GPs | GPMHSC

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Related documents

  Lifecycle-chart.pdf (PDF 0.12 MB)

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