Things to remember about perinatal anxiety
Some things to remember when assessing and managing anxiety in the perinatal period are:
- Although the EPDS was specifically developed to detect symptoms of depression, there is evidence to support its use in the detection of symptoms of anxiety, taking into consideration the woman’s scores on questions 3, 4 and 5, her answer to the psychosocial question on “worrying” and applying clinical judgement.
- While the EPDS is a self-report tool, it may be appropriate for it to be administered verbally in situations where there are difficulties relating to language or literacy, cultural issues or disability.
- Before the EPDS is administered, women need clear explanation of the purpose of the assessment (including that it is part of normal care and will remain confidential) so that they can provide informed consent. If a woman does not consent to assessment, this should be documented and assessment offered at subsequent consultations.
- Decision-making about the need for and type of follow-up mental health care is based on the woman’s preferences and clinical judgement.
- Not all women will want or need further monitoring or mental health assessment. Providing information and encouraging continuing contact with an appropriate health professional can support women to seek further assistance.
- Ideally, a woman’s regular GP will provide continuing mental health care in the perinatal period. However, not all women have access to this type of care or choose it when it is available. Assist women to identify a health professional with the skills, knowledge and cultural competence to provide appropriate ongoing care.
- Continuity of care is an important aspect of effective care. It is important to document all assessments and share relevant information with the next health professional providing care to the woman (eg midwife passes information to maternal and child health nurse).
- To access Medicare counselling items, a GP needs to provide a letter of referral for pregnancy support counselling or develop a mental health treatment plan with the woman for more formalised mental health treatment. The GP then refers to a mental health care professional either through the Better Access or perinatal ATAPS Medicare programs. For further information about avaialble support under medicare click here.