Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines |
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| Authors: | Marie-Paule V Austin Philippa Middleton Nicole M Reilly Nicole J Highet |
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| Institution: | 1. Perinatal and Women''s Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia;2. Black Dog Institute and University of New South Wales, Sydney, NSW 2052, Australia;3. Australian Research Centre for the Health of Women and Babies (ARCH), Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia;4. Beyondblue: The National Depression Initiative, PO Box 6100, Hawthorn West, VIC 3122, Australia;1. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN;2. Department of Research, Olmsted Medical Center, Rochester, MN;1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA;2. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA;3. Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA;4. Department of Psychiatry, Massachusetts General Hospital, Boston, MA;5. Brigham and Women’s Hospital, Boston, MA;1. School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil;2. Department of Obstetrics and Gynecology, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil;3. Department of Mental Health, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil;4. National Institute of Science and Technology–Molecular Medicine (INCT-MM), School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil |
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| Abstract: | BackgroundMood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers.AimTo describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector.MethodUsing NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus.FindingsThe quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment – including risk to mother and infant, and consideration of the mother–infant interaction – and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting.ConclusionThe development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families. |
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