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Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

  • Marie-Paule V. Austin
    Correspondence
    Corresponding author at: Perinatal and Women's Mental Health Unit, St John of God Hospital, PO Box 261, Burwood, NSW 1805, Australia. Tel.: +61 2 9715 9224; fax: +61 2 9747 6845.
    Affiliations
    Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia

    Black Dog Institute and University of New South Wales, Sydney, NSW 2052, Australia
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  • Philippa Middleton
    Affiliations
    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
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  • Nicole M. Reilly
    Affiliations
    Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia

    Black Dog Institute and University of New South Wales, Sydney, NSW 2052, Australia
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  • Nicole J. Highet
    Affiliations
    Beyondblue: The National Depression Initiative, PO Box 6100, Hawthorn West, VIC 3122, Australia
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Published:January 04, 2012DOI:https://doi.org/10.1016/j.wombi.2011.12.001

      Abstract

      Background

      Mood 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.

      Aim

      To 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.

      Method

      Using 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.

      Findings

      The 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.

      Conclusion

      The 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.

      Keywords

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