None listed
Conditions
Brief summary
Mental health during and after pregnancy is important for the well-being of mother and infant. Perinatal depression and anxiety are common problems, particularly for Aboriginal and Torres Strait Islander women, and can have significant short and long-term impacts on both mother and child. Aboriginal and Torres Strait Islander women in remote areas are at particular risk and the available screening instrument, the Edinburgh Postnatal Depression Scale is not seen as appropriate for this population. The locally developed, validated, culturally appropriate and user friendly KMMS was developed to accurately assess risk of anxiety and depression, improve screening rates and help provide better care for Aboriginal women during the perinatal period. The KMMS has been piloted on 91 women in the Kimberley. It was found to be an effective screening instrument for anxiety and depression in Aboriginal perinatal women, improved relationships between health care providers and their patients, and was a useful tool for providing psycho social support and, where necessary developing pathways for specialised mental health/social and emotional wellbeing follow up. The KMMS is accepted for use across the Kimberley and is included in regional guidelines. The KMMS has not been fully evaluated in a real world setting and has not been trialed in other remote settings. In partnership with health services and Aboriginal communities in northern Western Australia and Far North Queensland, this study aims to: * adapt the KMMS and develop locally appropriate versions for participating partners as required; * evaluate the real-world performance of the KMMS in the Kimberley and other remote regions in northern Australia; and * evaluate the process of implementation.
Interventions
In the Pilbara/Far North Queensland, the intervention is administration of the Kimberley Mum's Mood Scale (KMMS). Trained perinatal health care providers will administer the KMMS (up to 60 minutes to complete part 1 and part 2), face-to-face, in a culturally safe space. The KMMS will be used instead of the EPDS; current EPDS guidelines are twice in the antenatal (early in pregnancy and 28 or 36 weeks) and three times in the postnatal (8 weeks, 4 and 12 months) period or any other time where ther
In the Pilbara/Far North Queensland, the intervention is administration of the Kimberley Mum's Mood Scale (KMMS). Trained perinatal health care providers will administer the KMMS (up to 60 minutes to complete part 1 and part 2), face-to-face, in a culturally safe space. The KMMS will be used instead of the EPDS; current EPDS guidelines are twice in the antenatal (early in pregnancy and 28 or 36 weeks) and three times in the postnatal (8 weeks, 4 and 12 months) period or any other time where there is parental or professional concern. All women with moderate or high risk and up to half of women with low risk of anxiety or depression on the KMMS will be referred for a reference standard assessment using the KMMS diagnosis and management tool. This will be done face-to-face by appropriate clinical experts (e.g. GP, clinical psychologist) and take 15-30 minutes. Diagnosis will be according to DSM IV criteria for anxiety and depressive disorders, and severity (low, moderate, high) based on the GP Mental State Examination. In the Kimberley it is routine practice for all Aboriginal women to be screened with the KMMS and for those who score 'moderate' or 'high' to be referred for further clinical assessment using the KMMS diagnosis and management tool. The intervention part of the study in the Kimberley is for up to half of women who scored 'low 'on the KMMS to be referred for a reference standard assessment using the KMMS diagnosis and management tool. As this is a real world implementation study women at low KMMS risk will be referred for further assessment when resources are available. This will be done face-to-face by clinical experts (e.g. GP, clinical psychologist) and take 15-30 minutes. Diagnosis will be according to DSM IV criteria for anxiety and depressive disorders, and severity (low, moderate, high) based on the GP Mental State Examination. Completed KMMS assessment and diagnosis forms as well as extracted primary health care data will be used to monitor adherence. Based upon feedback provided from users (including both women and clinicians) elements of the KMMS and KMMS diagnosis and management tools and training manuals may be adapted, including the terminology, language used, and elements discussed.
Sponsors
The University of Western Australia
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Women who identify as Aboriginal and/or Torres Strait Islander, able to provide informed consent and either more than 7 days post-partum or more than 6 weeks pregnant who are not known to be currently acutely mentally unwell are eligible to be enrolled in the study.
Exclusion criteria
No exclusion criteria
Outcome results
None listed