title: Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women's hospitals.
abstract: BACKGROUND
  Australia is a leader in recognising that perinatal mental health problems are prevalent and constitute a significant burden of disease among women. In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) to address this.
  
  
  OBJECTIVE
  To investigate implementation of Australia's NPDI.
  
  
  METHODS
  Data were collected by a structured online survey assessing: screening for depression and depression risk in women receiving antenatal and postnatal care; staff training about perinatal depression; barriers and enablers to implementing the NPDI recommendations. All Australian members of Women's Healthcare Australasia (WHA) were invited to complete the survey in March 2011.
  
  
  RESULTS
  Of 30 Australian WHA members, 14 (46.6%) completed the survey. The sample included a representative distribution of small, medium and large hospitals. All respondents had introduced some NPDI recommendations. Most (80%) reported using the Edinburgh Postnatal Depression Scale (EPDS) to screen for antenatal depression and for risk of developing depression but at varied gestational ages, and with differing cut-off scores for follow-up or referral. Only one assessed depression status postpartum. Responsibility for screening and feedback was predominantly assigned to midwives, most of whom were offered <4 h training. Implementation barriers included insufficient personnel; per-client time requirements; insufficient clarity about screening protocols; difficulties modifying the medical record; few referral options and a lack of training resources.
  
  
  CONCLUSIONS
  Implementation of the NPDI is uneven among Australian maternity hospitals. Little is known about perinatal mental health screening practices in the private sector and hospitals with <1000 births annually.
authors.affiliation: The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. jane.fisher@monash.edu
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chatham
authors.forename: Sally
authors.initials: S
authors.lastname: Haseler
authors.forename: Beth
authors.initials: B
authors.lastname: McGaw
authors.forename: Jane
authors.initials: J
authors.lastname: Thompson
mesh_terms: D001315:Australia; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006782:Hospitals, Special; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education; D008880:Midwifery / Q000193:education; D009774:Obstetrics; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D015397:Program Evaluation