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National Perinatal Mental Health Guideline: 2023 update

Melissa Willoughby, Australian Institute of Family Studies, Australia, April 2024

Related to Infant and perinatal care

Resource Summary

This short resource summarises the most recent version of the National Perinatal Mental Health Guideline, which was updated by the Centre of Perinatal Excellence (COPE) in 2023. It outlines what’s included in the Guideline and what’s new from the previous 2017 version.

WHO IS THIS RESOURCE FOR?

This short article is for practitioners who may work with or encounter families in the perinatal period, including those working in generalist services with no experience providing mental health services.

Introduction

Pregnancy and the first year of a child’s life (i.e. the perinatal period) is both a challenging and joyful time for many families. It is also a time when parents can experience increased fears, worries and concerns. For some, these may develop into mental health challenges.

In Australia, 1 in 5 mothers experiences perinatal depression or anxiety (PwC Consulting Australia, 2019). Additionally, 1 in 10 fathers experience depression in the perinatal period (Paulson & Bazemore, 2010), and 1 in 6 fathers experience anxiety in the prenatal period (i.e. from conception to birth) (Leach, Poyser, Cooklin, & Giallo, 2016). Detecting challenges and supporting the mental health of parents is an important part of caring for and working with families in the perinatal period.

The Centre of Perinatal Excellence (COPE) has released a revised version of the National Perinatal Mental Health Guideline. This is an update of the previous version released in 2017. The Guideline provides evidence-based recommendations for screening for mental health symptoms, assessment of psychosocial risk factors, and prevention and treatment of mental health challenges. The Guideline is targeted at health professionals who care for parents and families during the perinatal period and was developed using evidence from the findings of a systematic review, expert opinion and consensus.

This short resource summarises what’s included in the most recent version of the National Perinatal Mental Health Guideline and what’s new from the previous version.

 

What’s included in the Guideline?

The Guideline is an evidence-based reference for professionals supporting and working with families in the perinatal period. Most of the Guideline relates to women’s1 experiences and mental wellbeing. The Guideline contains:

    • Background information from a literature review on:
      • how women’s individual context can impact their perinatal experiences
      • the prevalence of mental health challenges during the perinatal period; and
      • factors that can impact the best-practice provision of mental health care in the perinatal period.
    • Recommendations for screening (i.e. to detect signs and symptoms of mental health challenges) and psychosocial assessment (i.e. to identify the presence of psychosocial factors associated with mental health challenges) during the perinatal period. These include:
      • discussion of factors to consider before conducting the screening or psychosocial assessment
      • advice on screening for depressive and anxiety disorders, including recommended screening tools
      • advice on assessing psychosocial factors that affect mental health, including recommended tools
      • advice on screening and assessing the mental health of non-birthing parents, such as fathers
      • considerations and processes for assessing mother-infant interaction and safety of the woman and infant
      • advice for implementing routine screening and psychosocial assessment, and post-assessment processes; and
      • copies of the recommended tools used for screening and psychosocial assessment.
    • Recommendations related to prevention and treatment of mental health challenges in the perinatal period, including:
      • general principles to promote emotional wellbeing
      • specific treatment and prevention advice for depressive and anxiety disorders
      • specific treatment and prevention advice for other mental health challenges (i.e. schizophrenia, bipolar disorder and postpartum psychosis); and
      • considerations for providing care for women with borderline personality disorder, psychological birth trauma, or who do not respond to treatment.
    • Areas for future research.

Detecting challenges and supporting the mental health of parents is an important part of caring for and working with families in the perinatal period.

What’s new to the Guideline?

The updated version of the Guideline includes two new sections relevant to 1) non-birthing parents, and 2) psychological birth trauma.

Non-birthing parents

Chapter six of the Guideline discusses how to screen and assess the mental health of non-birthing parents. The Guideline notes that there is limited evidence in this area, making it difficult to provide recommendations on the best screening and assessment tools.

Male non-birthing parents may manifest distress differently to women, which should be taken into consideration when screening. They are more likely to show distress through fatigue, irritability or anger; by withdrawing socially; or by using avoidant/escapist activities. In some circumstances, commonly used screening tools such as the Edinburgh Postnatal Depression Scale, the Kessler Psychological Distress Scale (K10), Antenatal Risk Questionnaire (ANRQ), and Postnatal Risk Questionnaire (PNRQ) may still be appropriate tools for screening non-birthing parents (see Guideline for details).

Psychological birth trauma

Chapter 14 of the Guideline outlines considerations for working with women who have experienced psychological birth trauma. The Guideline notes that little research has been conducted into understanding, preventing and responding to psychological birth trauma.

Many factors can contribute to experiencing a birth as traumatic; for example, previous experience of trauma, unplanned intervention, or giving birth to a preterm or stillborn baby. The Guideline provides preventative measures to reduce the risk of birth trauma, such as providing trauma-informed care, screening for vulnerabilities, maximising the woman’s control in labour, and gaining consent for procedures. Some psychosocial and psychological interventions are available to help improve trauma symptoms related to the birth (see Guideline for details).

 

Summary

COPE has released a revised version of the National Perinatal Mental Health Guideline. The Guideline provides evidence-based recommendations for professionals who work with families to support and assess their mental health during the perinatal period. New sections for this version include advice on screening and assessment for non-birthing parents, and guidance for women who experience psychological birth trauma.

Further resources

The following resources may be useful for practitioners working with families in the perinatal period:

  1. The Guideline uses terms such as ‘woman’ or ‘mother’ and ‘breastfeeding’, but the authors of the Guideline advise that these should be interpreted as also including people who are pregnant or have given birth but do not identify as a woman.

References

Leach, L. S., Poyser, C., Cooklin, A. R., & Giallo, R. (2016). Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. Journal of Affective Disorders, 190, 675-686.

Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Jama, 303(19), 1961-1969.

PwC Consulting Australia. (2019). The cost of perinatal depression and anxiety in Australia [Report]. Australia: Gidget Foundation.

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