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Published on: May 19, 2015
Perinatal Identification, Referral, and Integrated Management for Improving Depression: Development, Feasibility and
Charlene Holt1, Sarah Maher1, Alan W Gemmill1
1Parent-Infant Research Institute, Austin Health, Melbourne, VIC 3081, Australia.
Insights
A new system, PIRIMID, shows promise for helping nurses manage postnatal depression by improving referrals. While pilot results suggest feasibility and acceptability, further research is needed to confirm its impact on treatment uptake.
Area of Science:
- Public Health and Epidemiology
- Maternal and Child Health
- Mental Health Interventions
Background:
- Postnatal depression presents a significant public health challenge in Australia, with high costs and low treatment uptake.
- Existing systems struggle to effectively support maternal and child health nurses (MCHNs) in managing maternal mental health.
- There is a critical need for improved tools to facilitate timely and effective interventions for postpartum depression.
Purpose of the Study:
- To develop and pilot test the Postnatal Illness Research and Integrated Management Information Decision support system (PIRIMID).
- To assess the feasibility, acceptability, and implementation ease of PIRIMID for MCHNs and women experiencing postpartum depression.
- To evaluate PIRIMID's impact on referral rates and monitor treatment uptake and depression symptoms.
Main Methods:
- PIRIMID was developed through extensive co-design and consultation with stakeholders.
- A pilot cluster randomized controlled trial (RCT) compared PIRIMID with routine care, including a partial crossover design.
- A statewide survey of MCHNs in Victoria, Australia, gathered perspectives on PIRIMID's perceived benefits and barriers.
Main Results:
- PIRIMID was found to be acceptable and helpful to both MCHNs and women, with easy integration into existing clinical systems reported.
- While trends suggested higher referral rates with PIRIMID, treatment uptake was similar across conditions.
- A statewide survey indicated 84% of MCHNs would use PIRIMID, citing time constraints and technical issues as potential barriers.
Conclusions:
- The PIRIMID system demonstrates potential as a feasible and acceptable tool to aid MCHNs in managing postnatal depression.
- Pilot findings support PIRIMID's utility in facilitating individualized management plans and referral pathways.
- Further research with larger sample sizes is recommended to definitively assess PIRIMID's impact on treatment uptake.
Abstract:
Background/Objectives: Postnatal depression imposes a substantial burden on wellbeing as well as costs estimated to exceed $7 billion for every one-year cohort of births in Australia. Despite this, most cases go untreated, a major barrier being the poor rate of treatment uptake. We developed and pilot tested an integrated screening and clinical decision support system (PIRIMID) to assist maternal and child health nurses (MCHNs) to create individualised management plans, with specific referral pathways, for women depressed postnatally. We assessed the feasibility of PIRIMID by examining acceptability for both nurses and women, ease of implementation, and referral rates, and we monitored treatment uptake and depression. Methods: An extensive co-design and consultation process was used to develop PIRIMID. A pilot cluster randomised controlled trial (RCT) was conducted comparing PIRIMID to Routine care, with partial crossover (PIRIMID followed by crossover to Routine care and Routine care followed by continued Routine care). A state-wide survey of MCHNs in Victoria, Australia, explored perceived benefits and barriers of PIRIMID from a consumer perspective. Results: Twelve MCHNs (PIRIMID: n = 6; Routine care: n = 6) and 229 women (conditions: PIRIMID, n = 52; Crossover Routine care, n = 42; Routine care, n = 57; Continued Routine care, n = 78) were recruited to the RCT. Median scores for depression, anxiety and stress symptoms were low and similar at all timepoints and conditions. PIRIMID was acceptable and helpful to MCHNs and women, and most MCHNs rated integration into their existing clinical systems as easy. There were trends in favour of higher referral rates by PIRIMID MCHNs (18%, 95% CI: 5-40) compared with other conditions (10-15%, 95% CIs: 6-29, 2-27, 6-26), but treatment uptake appeared similar across conditions. The statewide survey (n = 292) revealed that 84% of MCHNs would use PIRIMID, and the main potential barriers to use would be time constraints and technical issues. Conclusions: This pilot work indicates that PIRIMID shows promise as a feasible and acceptable tool to assist MCHNs to develop management plans for women depressed postnatally. Further research with adequate statistical power is needed to explore effects on treatment uptake with larger samples of postnatally depressed women.
