Policy Impacts of the Australian National Perinatal Depression Initiative: Psychiatric Admission in the First Postnatal Year

  • Wang-Sheng LeeEmail author
  • Cathrine Mihalopoulos
  • Mary Lou Chatterton
  • Georgina M. Chambers
  • Nicole Highet
  • Vera A. Morgan
  • Elizabeth A. Sullivan
  • Marie-Paule Austin
Original Article


This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70–1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period.


Perinatal depression initiative Depression Psychiatric disorders Policy analysis 



Confidence interval


National perinatal depression initiative


New South Wales


Psychiatric disorders


Socio-economic indexes for area


First treatment group


Second treatment group


United Kingdom


Western Australia



We thank Maxine Croft for her contribution to the design of the study; acquisition, analysis, and interpretation of data for this paper. We also thank Nicole Reilly who contributed substantially to the conception and design of the study and the acquisition of data. Thanks to Natasha Donnelley for her comments on coding of the linked data; Cathie Knox for consumer input; our Associate Investigators Fenglian Xu and Dusan Hadzi-Pavlovic; and research assistants Jolie Hutchinson, Taryn Major, and Sharon Vuckovic. Thanks go to the Western Australia Data Linkage Branch, WA Department of Health; the Centre for Health Record Linkage, NSW Health; and Medicare Australia; Department of Human Services for provision of raw data. We gratefully acknowledge funding from the National Health and Medical Research Council (Partnership Project Grant # 1028554); and funding partner beyondblue: the national depression initiative. St John of God Health Care (Burwood) provided infrastructure support. Cathrine Mihalopoulos was funded on a NHMRC Early Career Fellowship during the conduct of this work (APP1035887).

Author Contributions

WSL proposed the statistical study design, conducted the analyses and wrote the draft of the paper. CM, MLC, GC, NH, VM, ES and MPA were all involved in the developing the study aims, developing and accessing the main linked dataset and revised the article for content and interpretation. CM and MPA also provided overall study leadership in terms of developing the study context. MLC provided extra assistance with data preparation. All authors have read and approved the final version submitted.


The current study was funded by a NHMRC partnership Grant APP1028554: The Australian perinatal mental health reforms: using population data to evaluate their impact on service utilisation and related cost-effectiveness. Beyondblue was the funding partner on this grant. Cathrine Mihalopoulos was funded by a NHMRC Early Career Fellowship Grant (APP1035887) during the conduct of this work. St John of God Health Care gave substantial infrastructure and inkind support.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required. The study was approved by the Government of Western Australia Department of Health Ethics Committee (ref:2012/36), NSW Population & Health Services Research Ethics Committee (ref: 2012/04/386), University of NSW (ref: HC12518) and Deakin University (ref: 2012/290) Human Research Ethics Committees.


  1. Allison, S., & Bastiampillai, T. (2015). Mental health services reach the tipping point in Australian acute hospitals. Medical Journal of Australia, 203, 432–434.CrossRefGoogle Scholar
  2. Austin, M.-P., Reilly, N., Milgrom, J., & Barnett, B. (2010). A national approach to perinatal mental health in Australia: Exercising caution in the roll-out of a public health initiative [letter]. Medical Journal of Australia, 192, 111.Google Scholar
  3. Austin, M.-P., Reilly, N., & Sullivan, E. (2012). The need to evaluate public health reforms: Australian perinatal mental health initiatives. Australian and New Zealand Journal of Public Health, 36, 208–211.CrossRefGoogle Scholar
  4. Bang, H., & Robins, J. (2005). Doubly robust estimation in missing data and causal inference models. Biometrics, 61, 962–973.CrossRefGoogle Scholar
  5. Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., & Adelaja, B. (2014). The costs of perinatal mental health problems. London: London School of Economics and Political Science. Accessed August 21, 2015 from
  6. Beyond Blue. (2011). Clinical practice guidelines for depression and related disorders—anxiety, bipolar and puerperal psychosis—in the perinatal period. Melbourne: BeyondblueGoogle Scholar
  7. Cantwell, R., Clutton-Brock, T., Cooper, G., et al. (2011). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. British Journal of Obstetrics and Gynaecology, 118(suppl 1), 1–203.Google Scholar
  8. Chambers, G., Randall, S., Hoang, V., Sullivan, E., Highet, N., Croft, M., Mihalopoulos, C., Morgan, V., Reilly, N., & Austin, M.-P. (2016). The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule. Australian & New Zealand Journal of Psychiatry, 50, 264–274.CrossRefGoogle Scholar
  9. Cohen, L., Altshuler, L., Harlow, B., Nonacs, R., Newport, J., Viguera, A., et al. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. Journal of the American Medical Association, 295, 499–507.CrossRefGoogle Scholar
  10. Debelle, G. (2009). Some effects of the global financial crisis on Australian financial markets. Accessed August 21, 2015 from
  11. French, J., Wang, S., Warnock, B., & Temkin, N. (2010). Historical control monotherapy design in the treatment of epilepsy. Epilepsia, 51, 1936–1943.CrossRefGoogle Scholar
  12. Funk, M., Westreich, D., Wiesen, C., Stürmer, T., Brookhart, M., & Davidian, M. (2011). Doubly robust estimation of causal effects. American Journal of Epidemiology, 173, 761–767.CrossRefGoogle Scholar
  13. Gale, S., & Harlow, B. (2003). Postpartum mood disorders: A review of clinical and epidemiological factors. Journal of Psychosomatic Obstetrics & Gynecology, 24, 257–266.CrossRefGoogle Scholar
  14. Gehan, E. (1984). The evaluation of therapies: Historical control studies. Statistics in Medicine, 3, 315–324.CrossRefGoogle Scholar
  15. Highet, N., & Purtell, C. (2012). The National Perinatal Depression Initiative: A synopsis of progress to date and recommendations for beyond 2013. Melbourne: beyondblue, the national depression and anxiety initiative. Accessed August 21, 2015 from
  16. Hirano, K., & Imbens, G. (2001). Estimation of causal effects using propensity score weighting: An application to data on right heart catheterization. Health Services and Outcomes Research Methodology, 2, 259–278.CrossRefGoogle Scholar
  17. Howard, L., Piot, P., & Stein, A. (2014). No health without perinatal mental health. Lancet, 384, 1723–1724.CrossRefGoogle Scholar
  18. Jones, I., Chandra, P., Dazzan, P., & Howard, L. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384, 1789–1799.CrossRefGoogle Scholar
  19. Kendell, R., Chalmers, J., & Platz, C. (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150, 662–673.CrossRefGoogle Scholar
  20. Munk-Olsen, T., Laursen, T., Pedersen, C., Mors, O., & Mortensen, P. (2006). New parents and mental disorders: A population-based register study. Journal of the American Medical Association, 296, 2582–2589.CrossRefGoogle Scholar
  21. NICE. (2014). Antenatal and postnatal mental health: Clinical management and service guidance. NICE Clinical Guideline 192. National Collaborating Centre for Mental Health.Google Scholar
  22. Patton, G., Romaniuk, H., Spry, E., Coffey, C., Olsson, C., Doyle, L., Oats, J., Hearps, S., Carlin, J., & Brown, S. (2015). Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. Lancet, 386, 875–883.CrossRefGoogle Scholar
  23. Pirkis, J., Ftanou, M., Williamson, M., et al. (2011). Australia’s better access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45, 726–739.CrossRefGoogle Scholar
  24. SIGN. (2012). Management of perinatal mood disorders (SIGN Publication no. 127). Edinburgh: Scottish Intercollegiate Guidelines Network.Google Scholar
  25. Stuart, E. (2010). Matching methods for causal inference: A review and a look forward. Statistical Science, 25, 1–21.CrossRefGoogle Scholar
  26. Terp, I., & Mortensen, P. (1998). Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition. British Journal of Psychiatry, 172, 521–526.CrossRefGoogle Scholar
  27. Vesga-López, O., Blanco, C., Keyes, K., Olfson, M., Grant, B., & Hasin, D. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry, 65, 805–815.CrossRefGoogle Scholar
  28. Viguera, A., Whitfield, T., Baldessarini, R., Newport, D., Stowe, Z., Reminick, A., et al. (2007). Risk of recurrence in women with bipolar disorder during pregnancy: Prospective study of mood stabilizer discontinuation. American Journal of Psychiatry, 164, 1817–1824.CrossRefGoogle Scholar
  29. Watts, N., Lindsay, R., Li, Z., Kasibhatia, C., & Brown, J. (2003). Use of matched historical controls to evaluate the anti-fracture efficacy of once-a-week risedronate. Osteoporosis International, 14, 437–441.CrossRefGoogle Scholar
  30. Wisner, K., Sit, D., McShea, M., Rizzo, D., Zoretich, R., Hughes, C., et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70, 490–498.CrossRefGoogle Scholar
  31. Xu, F., Sullivan, E., Li, Z., Burns, L., Austin, M.-P., & Slade, T. (2014). The increased trend in mothers’ hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia. BMC Women’s Health, 14, 119.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Wang-Sheng Lee
    • 1
    Email author
  • Cathrine Mihalopoulos
    • 2
  • Mary Lou Chatterton
    • 2
  • Georgina M. Chambers
    • 3
  • Nicole Highet
    • 4
  • Vera A. Morgan
    • 5
  • Elizabeth A. Sullivan
    • 6
  • Marie-Paule Austin
    • 7
  1. 1.Department of EconomicsDeakin UniversityBurwoodAustralia
  2. 2.Deakin Health Economics, School of Health and Social DevelopmentDeakin UniversityBurwoodAustralia
  3. 3.National Perinatal Epidemiology and Statistics UnitUniversity of New South Wales (UNSW)SydneyAustralia
  4. 4.Centre of Perinatal Excellence (COPE)MelbourneAustralia
  5. 5.Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical NeurosciencesThe University of Western AustraliaCrawleyAustralia
  6. 6.Faculty of HealthUniversity of TechnologySydneyAustralia
  7. 7.Chair Perinatal & Women’s Mental HealthUniversity of New South Wales & St John of God Health CareSydneyAustralia

Personalised recommendations