Shining a light on perinatal depression and anxiety

Amanda Lyons

17/11/2017 9:13:34 AM

The statistics on late maternal mortality in Australia are stark.

Perinatal depression and anxiety is often also linked to issues of family violence.
Perinatal depression and anxiety is often also linked to issues of family violence.

‘The number one cause of maternal mortality in the 12 months post-partum is suicide,’ Dr Wendy Burton, Chair of the RACGP Antenatal/Postnatal Care Specific Interests network, told newsGP.
This week marks Perinatal Depression and Anxiety Awareness Week and, according to Dr Burton, people may be surprised to learn how common these types of issues can be.
‘One in 10 women suffer with a depressive illness in the antenatal period, one in seven in the postnatal period, and anxiety is about one in five women across both antenatal and postnatal period,’ she said.
Suicide is the most severe consequence of perinatal depression and anxiety, but the condition can also have other harmful impacts, such as problems with mother–baby attachment and the fracturing of the family. But social expectations of motherhood can make it difficult for women to recognise, or even admit to themselves, that they need help.
‘Many new mothers believe it’s just a normal part of early motherhood to deal with depressed or anxious thoughts, and so they simply soldier on,’ Prof Marie-Paule Austin, Director of Perinatal Psychiatry at the Royal Hospital for Women in Sydney, said. ‘Thus, many of these women will remain unidentified and untreated.’
Dr Burton believes that GPs, who often have significant levels of contact with women in the perinatal period, are ideally placed to monitor new mothers’ mental health with proactive screening, using tools such as the Edinburgh Postnatal Depression Scale (EPDS). Dr Burton takes an ‘every woman, every time’ approach to screening, as it may not always be immediately evident when a woman is experiencing perinatal depression and anxiety.
‘[I screen] routinely,’ she said. ‘I tell the women, “I’m not asking you these questions because I think there’s anything wrong, but I know these conditions are common in pregnancy”.’
It is also necessary that practitioners remain sensitive to potential indicators of family violence when women do present with perinatal depression and anxiety.
‘Unfortunately, the two are linked. Women who present with antenatal or postnatal depression and/or anxiety are at a higher risk of also experiencing domestic violence,’ Dr Burton said. ‘The antenatal period is one of the times where the incidence of domestic violence is high enough to warrant universal screening.’
Once a family violence situation is identified, it is important for GPs to then be able to provide the patient with appropriate levels of assistance.
‘That may involve engaging them in some form of counselling. It may involve directing patients to online resources, or to psychological services. It may be that we need to consider medication or referral to a psychiatrist,’ Dr Burton said.
‘Or [the patient] may need a support group, or perhaps somebody needs to take time off and be that second pair of hands.
‘There is no one-size-fits-all; it really depends on the individual in front of you.’

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