Skip to main content

Advertisement

SpringerLink
Log in

Policy Impacts of the Australian National Perinatal Depression Initiative: Psychiatric Admission in the First Postnatal Year

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70–1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the Western Australia Data Linkage Branch, Department of Health (WADLB) and the New South Wales Centre for Health Record Linkage (CHeReL) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of WADLB and CHeReL.

Abbreviations

CI:

Confidence interval

NPDI:

National perinatal depression initiative

NSW:

New South Wales

PD:

Psychiatric disorders

SEIFA:

Socio-economic indexes for area

T1:

First treatment group

T2:

Second treatment group

UK:

United Kingdom

WA:

Western Australia

References

  • Allison, S., & Bastiampillai, T. (2015). Mental health services reach the tipping point in Australian acute hospitals. Medical Journal of Australia, 203, 432–434.

    Article  PubMed  Google Scholar 

  • Austin, M.-P., Reilly, N., Milgrom, J., & Barnett, B. (2010). A national approach to perinatal mental health in Australia: Exercising caution in the roll-out of a public health initiative [letter]. Medical Journal of Australia, 192, 111.

    PubMed  Google Scholar 

  • Austin, M.-P., Reilly, N., & Sullivan, E. (2012). The need to evaluate public health reforms: Australian perinatal mental health initiatives. Australian and New Zealand Journal of Public Health, 36, 208–211.

    Article  PubMed  Google Scholar 

  • Bang, H., & Robins, J. (2005). Doubly robust estimation in missing data and causal inference models. Biometrics, 61, 962–973.

    Article  PubMed  Google Scholar 

  • Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., & Adelaja, B. (2014). The costs of perinatal mental health problems. London: London School of Economics and Political Science. Accessed August 21, 2015 from http://www.centreformentalhealth.org.uk/pdfs/Costs_of_perinatal_mh.pdf.

  • Beyond Blue. (2011). Clinical practice guidelines for depression and related disorders—anxiety, bipolar and puerperal psychosis—in the perinatal period. Melbourne: Beyondblue

    Google Scholar 

  • Cantwell, R., Clutton-Brock, T., Cooper, G., et al. (2011). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. British Journal of Obstetrics and Gynaecology, 118(suppl 1), 1–203.

    PubMed  Google Scholar 

  • Chambers, G., Randall, S., Hoang, V., Sullivan, E., Highet, N., Croft, M., Mihalopoulos, C., Morgan, V., Reilly, N., & Austin, M.-P. (2016). The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule. Australian & New Zealand Journal of Psychiatry, 50, 264–274.

    Article  Google Scholar 

  • Cohen, L., Altshuler, L., Harlow, B., Nonacs, R., Newport, J., Viguera, A., et al. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. Journal of the American Medical Association, 295, 499–507.

    Article  CAS  PubMed  Google Scholar 

  • Debelle, G. (2009). Some effects of the global financial crisis on Australian financial markets. Accessed August 21, 2015 from http://www.rba.gov.au/speeches/2009/sp-ag-310309.html.

  • French, J., Wang, S., Warnock, B., & Temkin, N. (2010). Historical control monotherapy design in the treatment of epilepsy. Epilepsia, 51, 1936–1943.

    Article  CAS  PubMed  Google Scholar 

  • Funk, M., Westreich, D., Wiesen, C., Stürmer, T., Brookhart, M., & Davidian, M. (2011). Doubly robust estimation of causal effects. American Journal of Epidemiology, 173, 761–767.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gale, S., & Harlow, B. (2003). Postpartum mood disorders: A review of clinical and epidemiological factors. Journal of Psychosomatic Obstetrics & Gynecology, 24, 257–266.

    Article  CAS  Google Scholar 

  • Gehan, E. (1984). The evaluation of therapies: Historical control studies. Statistics in Medicine, 3, 315–324.

    Article  CAS  PubMed  Google Scholar 

  • Highet, N., & Purtell, C. (2012). The National Perinatal Depression Initiative: A synopsis of progress to date and recommendations for beyond 2013. Melbourne: beyondblue, the national depression and anxiety initiative. Accessed August 21, 2015 from http://cope.org.au/wp-content/uploads/2013/12/Final-Synopsis-Report_PDF.pdf.

  • Hirano, K., & Imbens, G. (2001). Estimation of causal effects using propensity score weighting: An application to data on right heart catheterization. Health Services and Outcomes Research Methodology, 2, 259–278.

    Article  Google Scholar 

  • Howard, L., Piot, P., & Stein, A. (2014). No health without perinatal mental health. Lancet, 384, 1723–1724.

    Article  PubMed  Google Scholar 

  • Jones, I., Chandra, P., Dazzan, P., & Howard, L. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384, 1789–1799.

    Article  PubMed  Google Scholar 

  • Kendell, R., Chalmers, J., & Platz, C. (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150, 662–673.

    Article  CAS  Google Scholar 

  • Munk-Olsen, T., Laursen, T., Pedersen, C., Mors, O., & Mortensen, P. (2006). New parents and mental disorders: A population-based register study. Journal of the American Medical Association, 296, 2582–2589.

    Article  CAS  PubMed  Google Scholar 

  • NICE. (2014). Antenatal and postnatal mental health: Clinical management and service guidance. NICE Clinical Guideline 192. National Collaborating Centre for Mental Health.

  • Patton, G., Romaniuk, H., Spry, E., Coffey, C., Olsson, C., Doyle, L., Oats, J., Hearps, S., Carlin, J., & Brown, S. (2015). Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. Lancet, 386, 875–883.

    Article  PubMed  Google Scholar 

  • Pirkis, J., Ftanou, M., Williamson, M., et al. (2011). Australia’s better access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45, 726–739.

    Article  PubMed  Google Scholar 

  • SIGN. (2012). Management of perinatal mood disorders (SIGN Publication no. 127). Edinburgh: Scottish Intercollegiate Guidelines Network.

    Google Scholar 

  • Stuart, E. (2010). Matching methods for causal inference: A review and a look forward. Statistical Science, 25, 1–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Terp, I., & Mortensen, P. (1998). Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition. British Journal of Psychiatry, 172, 521–526.

    Article  CAS  Google Scholar 

  • Vesga-López, O., Blanco, C., Keyes, K., Olfson, M., Grant, B., & Hasin, D. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry, 65, 805–815.

    Article  PubMed  PubMed Central  Google Scholar 

  • Viguera, A., Whitfield, T., Baldessarini, R., Newport, D., Stowe, Z., Reminick, A., et al. (2007). Risk of recurrence in women with bipolar disorder during pregnancy: Prospective study of mood stabilizer discontinuation. American Journal of Psychiatry, 164, 1817–1824.

    Article  PubMed  Google Scholar 

  • Watts, N., Lindsay, R., Li, Z., Kasibhatia, C., & Brown, J. (2003). Use of matched historical controls to evaluate the anti-fracture efficacy of once-a-week risedronate. Osteoporosis International, 14, 437–441.

    Article  CAS  PubMed  Google Scholar 

  • Wisner, K., Sit, D., McShea, M., Rizzo, D., Zoretich, R., Hughes, C., et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70, 490–498.

    Article  PubMed  PubMed Central  Google Scholar 

  • Xu, F., Sullivan, E., Li, Z., Burns, L., Austin, M.-P., & Slade, T. (2014). The increased trend in mothers’ hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia. BMC Women’s Health, 14, 119.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Maxine Croft for her contribution to the design of the study; acquisition, analysis, and interpretation of data for this paper. We also thank Nicole Reilly who contributed substantially to the conception and design of the study and the acquisition of data. Thanks to Natasha Donnelley for her comments on coding of the linked data; Cathie Knox for consumer input; our Associate Investigators Fenglian Xu and Dusan Hadzi-Pavlovic; and research assistants Jolie Hutchinson, Taryn Major, and Sharon Vuckovic. Thanks go to the Western Australia Data Linkage Branch, WA Department of Health; the Centre for Health Record Linkage, NSW Health; and Medicare Australia; Department of Human Services for provision of raw data. We gratefully acknowledge funding from the National Health and Medical Research Council (Partnership Project Grant # 1028554); and funding partner beyondblue: the national depression initiative. St John of God Health Care (Burwood) provided infrastructure support. Cathrine Mihalopoulos was funded on a NHMRC Early Career Fellowship during the conduct of this work (APP1035887).

Funding

The current study was funded by a NHMRC partnership Grant APP1028554: The Australian perinatal mental health reforms: using population data to evaluate their impact on service utilisation and related cost-effectiveness. Beyondblue was the funding partner on this grant. Cathrine Mihalopoulos was funded by a NHMRC Early Career Fellowship Grant (APP1035887) during the conduct of this work. St John of God Health Care gave substantial infrastructure and inkind support.

Author information

Authors and Affiliations

  1. Department of Economics, Deakin University, 221 Burwood Highway, Building LB, Burwood, VIC, 3125, Australia

    Wang-Sheng Lee

  2. Deakin Health Economics, School of Health and Social Development, Deakin University, Burwood, VIC, Australia

    Cathrine Mihalopoulos & Mary Lou Chatterton

  3. National Perinatal Epidemiology and Statistics Unit, University of New South Wales (UNSW), Sydney, NSW, Australia

    Georgina M. Chambers

  4. Centre of Perinatal Excellence (COPE), Melbourne, VIC, Australia

    Nicole Highet

  5. Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia

    Vera A. Morgan

  6. Faculty of Health, University of Technology, Sydney, NSW, Australia

    Elizabeth A. Sullivan

  7. Chair Perinatal & Women’s Mental Health, University of New South Wales & St John of God Health Care, Sydney, NSW, Australia

    Marie-Paule Austin

Authors
  1. Wang-Sheng Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathrine Mihalopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary Lou Chatterton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgina M. Chambers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicole Highet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vera A. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabeth A. Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marie-Paule Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WSL proposed the statistical study design, conducted the analyses and wrote the draft of the paper. CM, MLC, GC, NH, VM, ES and MPA were all involved in the developing the study aims, developing and accessing the main linked dataset and revised the article for content and interpretation. CM and MPA also provided overall study leadership in terms of developing the study context. MLC provided extra assistance with data preparation. All authors have read and approved the final version submitted.

Corresponding author

Correspondence to Wang-Sheng Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required. The study was approved by the Government of Western Australia Department of Health Ethics Committee (ref:2012/36), NSW Population & Health Services Research Ethics Committee (ref: 2012/04/386), University of NSW (ref: HC12518) and Deakin University (ref: 2012/290) Human Research Ethics Committees.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, WS., Mihalopoulos, C., Chatterton, M.L. et al. Policy Impacts of the Australian National Perinatal Depression Initiative: Psychiatric Admission in the First Postnatal Year. Adm Policy Ment Health 46, 277–287 (2019). https://doi.org/10.1007/s10488-018-0911-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-018-0911-9

Keywords

Search

Navigation