title: The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule.
abstract: OBJECTIVE
  To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness.
  
  
  METHODS
  Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative.
  
  
  RESULTS
  The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities.
  
  
  CONCLUSIONS
  In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, University of New South Wales (UNSW), Sydney, NSW, Australia g.chambers@unsw.edu.au.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Chambers
authors.affiliation: Centre for Population Health Research, Curtin University, Perth, WA, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Randall
authors.affiliation: Drug Policy Modelling Program (DPMP), National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Van Phuong
authors.initials: VP
authors.lastname: Hoang
authors.affiliation: Faculty of Health, University of Technology, Sydney, NSW, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
authors.affiliation: Centre of Perinatal Excellence (COPE), Melbourne, VIC, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Highet
authors.affiliation: Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia.
authors.forename: Maxine
authors.initials: M
authors.lastname: Croft
authors.affiliation: Deakin Health Economics, School of Health and Social Development, Deakin University, Burwood, VIC, Australia.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Mihalopoulos
authors.affiliation: Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia.
authors.forename: Vera A
authors.initials: VA
authors.lastname: Morgan
authors.affiliation: Neuropsychiatric Epidemiology Research Unit, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Reilly
authors.affiliation: Neuropsychiatric Epidemiology Research Unit, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia St John of God Health Care, Sydney, NSW, Australia.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Austin
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D005260:Female; D058005:General Practitioners; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care; D011247:Pregnancy; D011570:Psychiatry; D012189:Retrospective Studies
keywords: Postnatal depression; policy analysis; psychosocial screening