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Mental health care in the perinatal period: Australian clinical practice guideline
Austin M-P, Highet N, Expert Working Group [Centre for Perinatal Excellence]
practice guideline

Studies in Australia and around the world have found that up to one in ten women experience depression during pregnancy and one in seven women in the year following birth. Anxiety disorders are also prevalent (around one in five women in both the antenatal and postnatal periods) and comorbidity with depression is high. Severe mental illnesses -- schizophrenia, bipolar disorder and borderline personality disorder -- are much less common than depression and anxiety disorders. All of these conditions have the potential to have a negative impact on maternal and infant outcomes. This is more likely to occur when a mental health condition is combined with serious or multiple adverse psychosocial circumstances. The importance of a woman's physical and mental health should be central to every aspect of maternity care. As well as affecting a woman's emotional welfare and happiness, mental health conditions affect her experience of pregnancy and parenting, are associated with a degree of increased risk of obstetric and neonatal complications and can profoundly affect a woman's ability to bond with her baby and the infant's psychological adaptation over the longer term. Fetal exposure to an untreated maternal mental health condition can also have a negative impact on the infant's wellbeing. Mental health conditions in the perinatal period often go undetected and untreated, imposing a great burden on women, their families, the health system and society more broadly. This guideline therefore recommends repeated assessment of psychosocial risk and screening for symptoms of depressive and anxiety disorders for all women in the perinatal period. This approach is critical to providing women with access to early intervention if needed. While referral and care pathways vary with setting (eg, general practice, maternity services) and location (eg, metropolitan, rural and remote), it is important that women are provided with access to timely, appropriate services post-assessment, ongoing psychosocial support and appropriate treatments. While women with pre-existing severe mental illness may already be under the care of a GP and/or psychiatrist, specific consideration must be given to planning their care due to the complexity of these conditions and the substantial challenges for primary care professionals involved in their management. Care planning for a woman with a mental health condition ideally begins before conception; requires close multidisciplinary collaboration; and a particular focus on continuity of care across the different health and other government sectors. Interventions to support women with mental health conditions in the perinatal period range from psychosocial support, through structured and systematic psychological interventions to pharmacological treatment, depending on the severity of a woman's symptoms or condition. Interventions are decided with the woman and her significant other(s) based on risk-benefit analysis, which takes into account the benefit to the woman and the fetus or newborn versus the potential for harm. The way in which different health professionals use this guideline will vary depending on their knowledge, skills and role, as well as the setting in which care is provided. Whatever the setting and circumstances, perinatal mental health care should be culturally responsive and family-centred. It should involve collaborative decision-making with the woman and her significant other(s) if the woman agrees, which includes full discussion of the potential risks and benefits of any treatments offered. Health professionals providing care should have appropriate training and skills and should work together to provide continuity of care for women and their families. This guideline provides a reliable and standard reference for health professionals providing care to women in the perinatal period. By providing a summary of the currently available evidence on effective approaches to mental health care at this time, it aims to improve a woman's experience of pregnancy and early parenthood, her emotional wellbeing, her safety and outcomes for all families.

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