Publications by authors named "Stephanie J Brown"

62 Publications

Maternal mental health in the first year postpartum in a large Irish population cohort: the MAMMI study.

Arch Womens Ment Health 2022 06 29;25(3):641-653. Epub 2022 Apr 29.

School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, DO2 T283, Ireland.

Purpose: The international perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated.

Methods: MAMMI is a prospective cohort study of 3009 first-time mothers recruited in pregnancy. Depressive, anxiety and stress symptoms measured using the Depression, Anxiety and Stress Scale (DASS 21) in pregnancy and at 3-, 6-, 9- and/or 12-months postpartum.

Results: Prevalence of depressive and stress symptoms was lowest in pregnancy, increasing to 12-months postpartum. Anxiety symptoms remained relatively stable over time. In the first year after having their first baby, one in ten women reported moderate/severe anxiety symptoms (9.5%), 14.2% reported depression symptoms, and one in five stress symptoms (19.2%). Sociodemographic factors associated with increased odds of postpartum depression, anxiety and stress symptoms were younger age and being born in a non-EU country; socioeconomic factors were not living with a partner, not having postgraduate education and being unemployed during pregnancy. Retrospective reporting of poor mental health in the year prior to pregnancy and symptoms during pregnancy were strongly associated with poor postpartum mental health.

Conclusions: The current findings suggest that the current model of 6-week postpartum care in Ireland is insufficient to detect and provide adequate support for women's mental health needs, with long-term implications for women and children.
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http://dx.doi.org/10.1007/s00737-022-01231-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9072451PMC
June 2022

Mental health of children and parents after very preterm birth.

World Psychiatry 2022 Feb;21(1):148-149

Murdoch Children's Research Institute, Parkville, VIC, Australia.

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http://dx.doi.org/10.1002/wps.20936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751583PMC
February 2022

A Systematic Review of Child Health and Developmental Outcomes Associated with Low Birthweight and/or Small for Gestational Age in Indigenous Children from Australia, Canada and New Zealand.

Int J Environ Res Public Health 2021 12 1;18(23). Epub 2021 Dec 1.

Intergenerational Health Department, Murdoch Children's Research Institute, Melbourne 3052, Australia.

While much is known about the health implications of low birthweight for infants and adults, there is limited information about the health implications in childhood, particularly for Indigenous children. The aim of this systematic review was to assess associations between low birthweight (LBW) and/or small for gestational age (SGA) and the developmental, physical or mental health outcomes for Australian, Canadian and New Zealand Indigenous children (5-12 years), including the potential mediating role of cultural connections. The review was guided by an Aboriginal Advisory Group established to guide the Aboriginal Families Study. Four databases were investigated with pre-determined inclusion/exclusion criteria. The search identified 417 articles after independent screening by two authors. Eight studies assessing six child outcomes were included. The review identified limited evidence, although the review suggested possible links between LBW and/or SGA and childhood asthma, lower body mass index (BMI) and poorer academic performance. Links between LBW, SGA and disability, global health and developmental vulnerability were inconclusive. One study identified cultural-based resilience as protective against perinatal adversity. In summary, research on the relationship between adverse birth outcomes and Indigenous children's health and development is limited. Further investigation and collaboration with Indigenous communities is required to drive optimised health and social services responses and equitable system reform.
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http://dx.doi.org/10.3390/ijerph182312669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657270PMC
December 2021

Using Participatory Methods to Engage Diverse Families in Research about Resilience in Middle Childhood.

J Health Care Poor Underserved 2021 ;32(4):1844-1871

Background: Resilience entails drawing on resources to navigate adversity; few measures exist to explore how children cope with adversity in varying cultural contexts.

Purpose: We aimed to develop a socially-inclusive measure of child resilience by (1) co-designing methods to engage diverse families, and (2) identifying resilience factors.

Methods: We used a community-based participatory research (CBPR) approach to recruit Aboriginal families, refugee families, and families from hospital outpatient clinics. To triangulate findings and codesign methods, we held discussion groups with 21 service providers. Codesigned group-based visual methods were employed in discussion groups with 97 parents and 106 children (5-12 years).

Findings: Participants identified culturally-meaningful resilience factors such as loving family, speaking their home language (for families of Non-English speaking backgrounds). We discuss differences and commonalities across participant groups.

Conclusion: Co-designing research that is both rigorous and inclusive is critical for gleaning culturally-meaningful data from diverse families.
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http://dx.doi.org/10.1353/hpu.2021.0170DOI Listing
December 2021

Evaluation of an Aboriginal and Torres Strait Islander strengths based coaching program: a study protocol.

BMC Public Health 2021 07 23;21(1):1451. Epub 2021 Jul 23.

University of Melbourne, Melbourne, Australia.

Background: Increasingly, strength-based approaches to health and wellbeing interventions with Aboriginal and Torres Strait Islander Australians are being explored. This is a welcome counter to deficit-based initiatives which can represent a non-Indigenous view of outcomes of interest. However, the evidence base is not well developed. This paper presents the protocol for evaluating a strengths-based initiative which provides life coaching services to Aboriginal and Torres Strait Islander community housing tenants. The study aims to evaluate the effect of life coaching on social and emotional wellbeing (SEWB) of tenants in three Victorian regions.

Methods: The More Than a Landlord (MTAL) study is a prospective cohort study of Aboriginal Housing Victoria tenants aged 16 years and over that embeds the evaluation of a life coaching program. All tenant holders in one metropolitan and two regional areas of Victoria are invited to participate in a survey of SEWB, containing items consistent with key categories of SEWB as understood and defined by Aboriginal and Torres Strait Islander peoples, and key demographics, administered by Aboriginal and Torres Strait Islander peer researchers at baseline, 6 and 18 months. Survey participants are then invited to participate in strengths based life coaching, using the GROW model, for a duration of up to 18 months. Indigenous life coaches provide tenants with structured support in identifying and making progress towards their goals and aspirations, rather than needs. The study aims to recruit a minimum of 200 survey participants of which it is anticipated that approximately 73% will agree to life coaching.

Discussion: The MTAL study is a response to Aboriginal and Torres Strait Islander community and organisational requests to build the evidence base for an initiative originally developed and piloted within an Aboriginal controlled organisation. The study design aligns with key principles for research in Indigenous communities in promoting control, decision making and capacity building. The MTAL study will provide essential evidence to evaluate the effectiveness of strengths-based initiatives in promoting SEWB in these communities and provide new evidence about the relationship between strengths, resilience, self-determination and wellbeing outcomes.

Trial Registration: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID: ISRCTN33665735 .
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http://dx.doi.org/10.1186/s12889-021-11503-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301731PMC
July 2021

Group Pregnancy Care for refugee background women: a codesigned, multimethod evaluation protocol applying a community engagement framework and an interrupted time series design.

BMJ Open 2021 07 19;11(7):e048271. Epub 2021 Jul 19.

Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Introduction: Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework.

Methods And Analysis: The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation.

Ethics And Dissemination: Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.
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http://dx.doi.org/10.1136/bmjopen-2020-048271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291298PMC
July 2021

Early postnatal discharge from hospital for healthy mothers and term infants.

Cochrane Database Syst Rev 2021 06 8;6:CD002958. Epub 2021 Jun 8.

Murdoch Children's Research Institute, Parkville, Australia.

Background: Length of postnatal hospital stay has declined dramatically in the past 50 years. There is ongoing controversy about whether staying less time in hospital is harmful or beneficial. This is an update of a Cochrane Review first published in 2002, and previously updated in 2009.

Objectives: To assess the effects of a policy of early postnatal discharge from hospital for healthy mothers and term infants in terms of important maternal, infant and paternal health and related outcomes.

Search Methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (21 May 2021) and the reference lists of retrieved articles.

Selection Criteria: Randomised controlled trials comparing early discharge from hospital of healthy mothers and term infants (at least 37 weeks' gestation and greater than or equal to 2500 g), with the standard care in the respective settings in which trials were conducted. Trials using allocation methods that were not truly random (e.g. based on patient number or day of the week), trials with a cluster-randomisation design and trials published only in abstract form were also eligible for inclusion.

Data Collection And Analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted and checked data for accuracy, and assessed the certainty of evidence using the GRADE approach. We contacted authors of ongoing trials for additional information.

Main Results: We identified 17 trials (involving 9409 women) that met our inclusion criteria. We did not identify any trials from low-income countries. There was substantial variation in the definition of 'early discharge', ranging from six hours to four to five days. The extent of antenatal preparation and midwifery home care offered to women following discharge in intervention and control groups also varied considerably among trials. Nine trials recruited and randomised women in pregnancy, seven trials randomised women following childbirth and one did not report whether randomisation took place before or after childbirth. Risk of bias was generally unclear in most domains due to insufficient reporting of trial methods. The certainty of evidence is moderate to low and the reasons for downgrading were high or unclear risk of bias, imprecision (low numbers of events or wide 95% confidence intervals (CI)), and inconsistency (heterogeneity in direction and size of effect). Infant outcomes Early discharge probably slightly increases the number of infants readmitted within 28 days for neonatal morbidity (including jaundice, dehydration, infections) (risk ratio (RR) 1.59, 95% CI 1.27 to 1.98; 6918 infants; 10 studies; moderate-certainty evidence). In the early discharge group, the risk of infant readmission was 69 per 1000 infants compared to 43 per 1000 infants in the standard care group. It is uncertain whether early discharge has any effect on the risk of infant mortality within 28 days (RR 0.39, 95% CI 0.04 to 3.74; 4882 infants; two studies; low-certainty evidence). Early postnatal discharge probably makes little to no difference in the number of infants having at least one unscheduled medical consultation or contact with health professionals within the first four weeks after birth (RR 0.88, 95% CI 0.67 to 1.16; 639 infants; four studies; moderate-certainty evidence). Maternal outcomes Early discharge probably results in little to no difference in women readmitted within six weeks postpartum for complications related to childbirth (RR 1.12, 95% CI 0.82 to 1.54; 6992 women; 11 studies; moderate-certainty evidence) but the wide 95% CI indicates the possibility that the true effect is either an increase or a reduction in risk. Similarly, early discharge may result in little to no difference in the risk of depression within six months postpartum (RR 0.80, 95% CI 0.46 to 1.42; 4333 women; five studies; low-certainty evidence) but the wide 95% CI suggests the possibility that the true effect is either an increase or a reduction in risk. Early discharge probably results in little to no difference in women breastfeeding at six weeks postpartum (RR 1.04, 95% CI 0.96 to 1.13; 7156 women; 10 studies; moderate-certainty evidence) or in the number of women having at least one unscheduled medical consultation or contact with health professionals (RR 0.72, 95% CI 0.43 to 1.20; 464 women; two studies; moderate-certainty evidence). Maternal mortality within six weeks postpartum was not reported in any of the studies. Costs Early discharge may slightly reduce the costs of hospital care in the period immediately following the birth up to the time of discharge (low-certainty evidence; data not pooled) but it may result in little to no difference in costs of postnatal care following discharge from hospital, in the period up to six weeks after the birth (low-certainty evidence; data not pooled).

Authors' Conclusions: The definition of 'early discharge' varied considerably among trials, which made interpretation of results challenging. Early discharge probably leads to a higher risk of infant readmission within 28 days of birth, but probably makes little to no difference to the risk of maternal readmission within six weeks postpartum. We are uncertain if early discharge has any effect on the risk of infant or maternal mortality. With regard to maternal depression, breastfeeding, the number of contacts with health professionals, and costs of care, there may be little to no difference between early discharge and standard discharge but further trials measuring these outcomes are needed in order to enhance the level of certainty of the evidence. Large well-designed trials of early discharge policies, incorporating process evaluation and using standardized approaches to outcome assessment, are needed to assess the uptake of co-interventions. Since none of the evidence presented here comes from low-income countries, where infant and maternal mortality may be higher, it is important to conduct future trials in low-income settings.
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http://dx.doi.org/10.1002/14651858.CD002958.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185906PMC
June 2021

The maternal health study: Study design update for a prospective cohort of first-time mothers and their firstborn children from birth to age ten.

Paediatr Perinat Epidemiol 2021 09 6;35(5):612-625. Epub 2021 May 6.

Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.

Background: Maternal health is critical to the health and well-being of children and families, but is rarely the primary focus of pregnancy and birth cohort studies. Globally, poor maternal health and the exposure of women and children to family violence contribute to the perpetuation and persistence of intergenerational health inequalities.

Objectives: The Maternal Health Study was designed to investigate the contribution of social and obstetric risk factors to common maternal physical and psychological morbidities. Over time, our focus has expanded to include mother-child pairs and investigation of intergenerational trauma and family violence.

Population: A total of 1507 first-time mothers were recruited in early pregnancy from six public hospitals in Melbourne, Australia, in 2003-2005.

Methods: Women completed questionnaires or telephone interviews in early pregnancy (≤24 weeks); at 32 weeks' gestation; at three, six, nine, 12 and 18 months postpartum; and at four and ten years. At ten years, women and children were invited to participate in face-to-face interviews, which included direct assessment of children's cognitive and language development. A wide range of obstetric, social and contextual factors have been measured, including exposure to intimate partner violence (IPV) (1-year, 4-year and 10-year follow-up).

Results: 1507 eligible women were recruited at a mean gestation of 15 weeks. At one year, four years and ten years postpartum, 90.0%, 73.1% and 63.2% of the original cohort took part in follow-up. One in three women in the study (34.5%) reported exposure to IPV in the first ten years of motherhood: 19% in the first 12 months postpartum, 20% in the year prior to four-year follow-up and 18.3% in the year prior to ten-year follow-up.

Conclusion: The study affords a unique opportunity to examine patterns of maternal and child health and health service use associated with exposure to IPV.
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http://dx.doi.org/10.1111/ppe.12757DOI Listing
September 2021

Preventing postnatal depression: a causal mediation analysis of a 20-year preconception cohort.

Philos Trans R Soc Lond B Biol Sci 2021 06 3;376(1827):20200028. Epub 2021 May 3.

Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia.

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14-29 years, 1992-2006), and again during pregnancy, two months postpartum and one year postpartum (2006-2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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http://dx.doi.org/10.1098/rstb.2020.0028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8090815PMC
June 2021

Intimate partner violence and child outcomes at age 10: a pregnancy cohort.

Arch Dis Child 2021 11 21;106(11):1066-1074. Epub 2021 Apr 21.

Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Objective: Assess the mental health, physical health, cognitive and language development of 10-year old children in families where mothers have reported intimate partner violence (IPV) compared with children with no reported IPV exposure.

Design: Prospective pregnancy cohort. Maternal report of IPV (Composite Abuse Scale) at 1, 4 and 10 years. Maternal and direct assessment of child mental health (probable psychiatric diagnosis, anxiety and emotional/behavioural difficulties), cognition (IQ and executive function), language (general, pragmatic and receptive) and physical health at 10 years.

Setting: A subsample of 615 mother-child dyads drawn from a pregnancy cohort of 1507 nulliparous women recruited from six public hospitals in Melbourne, Australia.

Results: Any IPV exposure from infancy to age 10 was associated with poorer child outcomes at age 10. Specifically, twice the odds of a probable psychiatric diagnosis, emotional/behavioural difficulties, impaired language skills (general and pragmatic), and having consulted a health professional about asthma or sleep problems. IPV exposure at age 10 associated with two to three times higher odds of all mental health outcomes, elevated blood pressure and sleep problems. Early life exposure alone (at 1 and/or 4 years) associated with three times higher odds of a general language problem and asthma at age 10.

Conclusion: The high prevalence of IPV and increased risk of poorer health and development among children exposed highlights the burden of ill health carried by children in families experiencing IPV. Fewer difficulties where exposure was limited to the early years builds the case for better identification, understanding and resourcing of effective early intervention.
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http://dx.doi.org/10.1136/archdischild-2020-320321DOI Listing
November 2021

Trajectories of interparental conflict and children's emotional-behavioural functioning at 10-11 years: an Australian population-based study.

Eur Child Adolesc Psychiatry 2022 Apr 5;31(4):625-635. Epub 2021 Jan 5.

Judith Lumley Centre, La Trobe University, Bundoora, Australia.

Interparental conflict (IPC) has the potential to adversely affect children's social, emotional, and behavioural functioning. The overall objective of this study was to investigate the relationship between both the severity and chronicity of IPC across early and middle childhood and children's emotional-behavioural functioning at 10-11 years. Specifically, we aimed to: (1) identify distinct trajectories of IPC spanning 10-11 years since birth of the study child as reported by mothers, and (2) examine the emotional-behavioural functioning of children exposed to the identified IPC trajectories. Drawing from a nationally representative longitudinal study of Australian families (N = 4875), four distinct trajectories of IPC were identified: (1) consistently low exposure to IPC over time, (2) persistently elevated exposure to IPC, (3) increasing IPC exposure over time, and (4) decreasing IPC exposure over time. Children exposed to trajectories with high IPC at any point during the study period were reported by their mothers to be experiencing more emotional-behavioural difficulties than children exposed to low IPC over time. Based on teacher report, there were no differences in emotional-behavioural functioning of children exposed to the different patterns of IPC. Our findings reinforce that high parental conflict at any point in a child's life is a form of adversity that can have adverse consequences for their mental health, and that early interventions for parents and caregivers experiencing high IPC are critical.
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http://dx.doi.org/10.1007/s00787-020-01700-7DOI Listing
April 2022

Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers.

BMJ Open 2020 12 21;10(12):e040891. Epub 2020 Dec 21.

Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Objective: To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child.

Design: Prospective pregnancy cohort study.

Setting: Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum.

Study Measures: Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status.

Participants: 1507 first-time mothers enrolled at mean of 15 weeks' gestation.

Results: One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV.

Conclusions: Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.
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http://dx.doi.org/10.1136/bmjopen-2020-040891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754634PMC
December 2020

Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: 'Its Important, but These Discussions Are Held Is Critical'.

Front Psychol 2020 15;11:2014. Epub 2020 Sep 15.

Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.

Background And Purpose: Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing 'complex trauma.' Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents.

Setting And Methods: A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored.

Main Findings: The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding 'qualities' (e.g., caring), rather than specific 'attributes' (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion.

Conclusion: Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents.
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http://dx.doi.org/10.3389/fpsyg.2020.02014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522325PMC
September 2020

Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design.

PLoS Med 2020 07 10;17(7):e1003089. Epub 2020 Jul 10.

Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Introduction: Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms.

Methods And Findings: The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting.

Conclusions: Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.
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http://dx.doi.org/10.1371/journal.pmed.1003089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351141PMC
July 2020

Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study.

J Paediatr Child Health 2020 Jul 26;56(7):1114-1120. Epub 2020 Feb 26.

Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Aim: The number of children and young people presenting to emergency departments (EDs) with anxiety and depression is increasing. We aimed to determine parent perspectives on: (i) barriers to accessing non-ED mental health services; and (ii) improving access in the paediatric mental health service system.

Methods: Qualitative study with parents of children and young people aged 0-19 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression.

Exclusion Criteria: child or young person without a parent/guardian, or presented with self-harm or suicide attempt. Eligible participants completed semi-structured phone interviews. Interviews were recorded and transcripts were coded and analysed using content analysis.

Results: A total of 72 parents completed interviews. The average child age was 14 years (standard deviation 2.5) and two thirds identified as female (64%). A total of 57% of children and young people presented with a primary diagnosis of anxiety. Parents reported barriers in accessing care including: service shortages and inaccessibility, underresourced schools, lack of clinician mental health expertise, lack of child-clinician rapport, inconsistent care, financial constraints, lack of mental health awareness among parents, and stigma. Parents want expanded and improved access to services, more respite and support services, supportive schools, and improved mental health education for parents.

Conclusions: Parents of children and young people attending the ED for anxiety and depression are generally dissatisfied with services for child mental health. Solutions that enable parents to better care for their child in the community are needed to improve care.
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http://dx.doi.org/10.1111/jpc.14835DOI Listing
July 2020

Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study.

J Paediatr Child Health 2020 Jul 26;56(7):1114-1120. Epub 2020 Feb 26.

Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Aim: The number of children and young people presenting to emergency departments (EDs) with anxiety and depression is increasing. We aimed to determine parent perspectives on: (i) barriers to accessing non-ED mental health services; and (ii) improving access in the paediatric mental health service system.

Methods: Qualitative study with parents of children and young people aged 0-19 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression.

Exclusion Criteria: child or young person without a parent/guardian, or presented with self-harm or suicide attempt. Eligible participants completed semi-structured phone interviews. Interviews were recorded and transcripts were coded and analysed using content analysis.

Results: A total of 72 parents completed interviews. The average child age was 14 years (standard deviation 2.5) and two thirds identified as female (64%). A total of 57% of children and young people presented with a primary diagnosis of anxiety. Parents reported barriers in accessing care including: service shortages and inaccessibility, underresourced schools, lack of clinician mental health expertise, lack of child-clinician rapport, inconsistent care, financial constraints, lack of mental health awareness among parents, and stigma. Parents want expanded and improved access to services, more respite and support services, supportive schools, and improved mental health education for parents.

Conclusions: Parents of children and young people attending the ED for anxiety and depression are generally dissatisfied with services for child mental health. Solutions that enable parents to better care for their child in the community are needed to improve care.
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http://dx.doi.org/10.1111/jpc.14835DOI Listing
July 2020

Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment.

PLoS One 2019 13;14(12):e0225441. Epub 2019 Dec 13.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Background: Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood.

Methods: A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches.

Findings: The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future.

Conclusions: Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225441PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910698PMC
March 2020

Intimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers.

J Affect Disord 2020 02 5;262:247-257. Epub 2019 Nov 5.

Murdoch Children's Research Institute, Australia; University of Melbourne, Australia.

Background: We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up.

Results: One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9).

Limitations: Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure.

Conclusions: The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.
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http://dx.doi.org/10.1016/j.jad.2019.11.015DOI Listing
February 2020

Health care experiences and birth outcomes: Results of an Aboriginal birth cohort.

Women Birth 2019 Oct 13;32(5):404-411. Epub 2019 Jun 13.

Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Objective: The aim of this study was to investigate the relationship between perceived discrimination in perinatal care and birth outcomes of women giving birth to an Aboriginal baby in South Australia using methods designed to respect Aboriginal culture and communities.

Design And Setting: Population-based study of women giving birth to Aboriginal infants in South Australia, July 2011-June 2013. Women completed a structured questionnaire with an Aboriginal researcher. Study measures include: standardised measure of perceived discrimination in perinatal care; maternal smoking, cannabis use and exposure to stressful events and social health issues; infant birthweight and gestation.

Participants: 344 women (mean age 25, range 15-43 years) living in urban, regional and remote areas of South Australia.

Results: Half of women (51%) perceived that they had experienced discrimination or unfair treatment by hospitals or health services providing care during pregnancy and soon after childbirth. Women experiencing three or more stressful events or social health issues were more likely to perceive that care was discriminatory or unfair. Aboriginal women who perceived that they had experienced discrimination in perinatal care were more likely to have a baby with a low birthweight (Adj Odds Ratio 1.9, 95% CI 1.0-3.8) or small for gestational age (Adj Odds Ratio 1.9, 95% CI 1.0-3.5), adjusting for parity, smoking and cannabis use.

Conclusions: The study provides evidence of the 'inverse care law'. Aboriginal women most at risk of poor infant health outcomes were the least likely to perceive that they received care well matched to their needs. Building stronger evidence about what works to create cultural safety in perinatal health care is an urgent priority.
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http://dx.doi.org/10.1016/j.wombi.2019.05.015DOI Listing
October 2019

Ending preventable stillbirths among migrant and refugee populations.

Med J Aust 2019 06 9;210(11):488-489.e1. Epub 2019 Jun 9.

Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, VIC.

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http://dx.doi.org/10.5694/mja2.50199DOI Listing
June 2019

What factors are associated with resilient outcomes in children exposed to social adversity? A systematic review.

BMJ Open 2019 04 11;9(4):e024870. Epub 2019 Apr 11.

Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Objectives: Children exposed to social adversity-hardship as a result of social circumstances such as poverty or intergenerational trauma-are at increased risk of poor outcomes across the life course. Understanding what promotes resilient outcomes is essential for the development of evidence informed intervention strategies. We conducted a systematic review to identify how child resilience is measured and what factors are associated with resilient outcomes.

Design: Systematic search conducted in CINAHL, MEDLINE and PsychInfo from January 2004 to October 2018 using the keywords 'resilien* and child* in the title or abstract. Eligible studies: (1) described children aged 5-12 years; (2) identified exposure to social adversity; (3) identified resilience; and (4) investigated factors associated with resilience.

Outcome Measures: (1) approaches to identifying resilience and (2) factors associated with resilient outcomes.

Results: From 1979 studies retrieved, 30 studies met the inclusion criteria. Most studies were moderate to high quality, with low cultural competency. Social adversity exposures included poverty, parent loss, maltreatment and war. Only two studies used a measure of child resilience; neither was psychometrically validated. Remaining studies classified children as resilient if they showed positive outcomes (eg, mental health or academic achievement) despite adversity. A range of child, family, school and community factors were associated with resilient outcomes, with individual factors most commonly investigated. The best available evidence was for cognitive skills, emotion regulation, relationships with caregivers and academic engagement.

Conclusions: While there is huge variation in the type and severity of adversity that children experience, there is some evidence that specific individual, relational and school factors are associated with resilient outcomes across a range of contexts. Such factors provide an important starting point for effective public health interventions to promote resilience and to prevent or ameliorate the immediate and long-term impacts of social adversity on children.
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http://dx.doi.org/10.1136/bmjopen-2018-024870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500354PMC
April 2019

Common maternal health problems among Australian-born and migrant women: A prospective cohort study.

PLoS One 2019 11;14(2):e0211685. Epub 2019 Feb 11.

Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Background: Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women.

Methods: Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence.

Findings: Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum.

Conclusion: Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211685PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370277PMC
November 2019

Pre-conception self-harm, maternal mental health and mother-infant bonding problems: a 20-year prospective cohort study.

Psychol Med 2019 12 18;49(16):2727-2735. Epub 2018 Dec 18.

Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.

Background: Self-harm in young people is associated with later problems in social and emotional development. However, it is unknown whether self-harm in young women continues to be a marker of vulnerability on becoming a parent. This study prospectively describes the associations between pre-conception self-harm, maternal depressive symptoms and mother-infant bonding problems.

Methods: The Victorian Intergenerational Health Cohort Study (VIHCS) is a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3-9. VIHCS enrolment began in 2006 (when participants were aged 28-29 years), by contacting VAHCS women every 6 months to identify pregnancies over a 7-year period. Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale during the third trimester, and 2 and 12 months postpartum. Mother-infant bonding problems were assessed with the Postpartum Bonding Questionnaire at 2 and 12 months postpartum.

Results: Five hundred sixty-four pregnancies from 384 women were included. One in 10 women (9.7%) reported pre-conception self-harm. Women who reported self-harming in young adulthood (ages 20-29) reported higher levels of perinatal depressive symptoms and mother-infant bonding problems at all perinatal time points [perinatal depressive symptoms adjusted β = 5.40, 95% confidence interval (CI) 3.42-7.39; mother-infant bonding problems adjusted β = 7.51, 95% CI 3.09-11.92]. There was no evidence that self-harm in adolescence (ages 15-17) was associated with either perinatal outcome.

Conclusions: Self-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother-infant bonding problems.
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http://dx.doi.org/10.1017/S0033291718003689DOI Listing
December 2019

Resumption of sex after a second birth: An Australian prospective cohort.

Birth 2019 03 15;46(1):173-181. Epub 2018 Jun 15.

Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia.

Background: Few longitudinal studies have examined women's experiences of sex after childbirth. Much of the advice given to couples about what to expect in relation to sex after childbirth is based on cross-sectional studies.

Objective: To investigate timing of resumption of sex after a second birth and assess associations with obstetric factors (method of birth and perineal trauma) and time interval between first and second births.

Method: Prospective cohort of 1507 nulliparous women recruited before 25 weeks' gestation in Melbourne, Australia followed up at 3, 6, 9, and 12 months after first births, and 6 and 12 months after second births. Measures include: obstetric factors and resumption of vaginal sex after first and second births.

Results: By 8 weeks after their second birth, 56% of women had resumed vaginal sex, compared with 65% after their first birth. Women were more likely to resume sex later than 8 weeks postpartum if they had a spontaneous vaginal birth with episiotomy or sutured perineal tear (aOR: 2.21, 95% CI: 1.5-3.2), operative vaginal birth (aOR: 2.60, 95% CI: 1.3-5.3) or cesarean delivery (aOR: 2.15, 95% CI: 1.4-3.3) compared with a vaginal birth with minimal or no perineal trauma. There was no association between timing of resumption of sex and the time interval between births.

Conclusion: For almost half of the cohort, sex was not resumed until at least 8 weeks after the second birth. Timing of resumption of sex was influenced by obstetric factors, but not the time interval between births.
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http://dx.doi.org/10.1111/birt.12363DOI Listing
March 2019

Sexual pleasure and emotional satisfaction in the first 18 months after childbirth.

Midwifery 2017 Dec 8;55:60-66. Epub 2017 Sep 8.

Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. Electronic address:

Objective: to investigate the experiences of first time mothers with regard to emotional and sexual intimacy in the period from birth to 18 months postpartum.

Design: prospective pregnancy cohort, with follow-up at 3, 6, 12 and 18 months postpartum.

Setting And Participants: first-time mothers were recruited in early pregnancy at 6 public maternity hospitals in Melbourne, Australia.

Findings: 1239 women who completed the baseline questionnaire and all follow up questionnaires were included in the sample for analysis: 78% resumed vaginal sex by 3 months postpartum, 94% by 6 months and 98% by 12 months postpartum. Emotional satisfaction with intimate partner relationships declined over time, from 67.3% reporting high satisfaction at 3 months to 53.9% at 18 months postpartum. In contrast, sex was described as extremely or very pleasurable by 40.1% of women at 3 months postpartum, compared with 49.1% at 18 months postpartum. There was a strong association between emotional satisfaction and the degree to which women experienced physical pleasure in their sexual relationship. Women who were happy with their partner's contribution to household tasks were markedly more likely to report high emotional satisfaction (OR 10.31, 95% CI6.7-15.9) and somewhat more likely to report greater physical pleasure in their sexual relationship (OR 2.32, 95% CI 1.5-3.5).

Key Conclusions: women experience profound changes in their sexual and intimate relationships in the first 18 months postpartum. While sex appears to improve over time, emotional satisfaction appears to decline. Partner involvement in household tasks is associated with greater emotional satisfaction.

Implications For Practice: pregnant women and their partners may benefit from information and discussion about the likelihood of changes to their emotional and sexual relationships after childbirth.
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http://dx.doi.org/10.1016/j.midw.2017.09.002DOI Listing
December 2017

Authors' reply.

BJOG 2016 10;123(11):1874

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic, Australia.

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http://dx.doi.org/10.1111/1471-0528.14254DOI Listing
October 2016

Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia.

Women Birth 2016 Aug 19;29(4):381-7. Epub 2016 Jul 19.

Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.

Background: The World Health Organisation recommends exclusive breastfeeding to six months postpartum, but most women in developed countries do not breastfeed this long. Prior studies exploring the relationship between breastfeeding duration and maternal depression show ambiguous findings.

Aim: To explore associations between maternal depressive symptoms at three months postpartum, and breastfeeding status over the first six months postpartum.

Methods: Prospective pregnancy cohort study of nulliparous women. 1507 women were recruited from six public hospitals in early pregnancy, completing baseline data in early pregnancy (mean gestation 15 weeks). Follow-up questionnaires were completed at three and six months postpartum. Women reported how many months they breastfed for (breastfeeding refers to 'any' breastfeeding, including expressed breastmilk). Depressive symptoms were measured at three months postpartum with the Edinburgh Postnatal Depression Scale (scores ≥13 indicated probable major depression).

Findings: Of the almost 95% of women who initiated breastfeeding, 76% were still breastfeeding at three months postpartum, and by six months postpartum this dropped to 61%. Women who reported depressive symptoms at three months had significantly lower rates of breastfeeding at six months postpartum compared to women without depressive symptoms (49% vs. 61%; adjusted OR=0.55, 95% CI 0.34-0.90). Maternal social characteristics associated with not breastfeeding at six months postpartum were: young maternal age; lower education; and smoking in pregnancy.

Conclusions: Women's decisions around infant-feeding are influenced by a range of psycho-social factors, and early postnatal depressive symptoms appear to be a significant part of this picture, as either a cause or consequence of decisions to cease breastfeeding.
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http://dx.doi.org/10.1016/j.wombi.2016.05.008DOI Listing
August 2016

Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care.

BMC Pregnancy Childbirth 2016 Apr 26;16:88. Epub 2016 Apr 26.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC, 3052, Australia.

Background: Around 6% of births in Australia are to Aboriginal and Torres Strait Islander families. Aboriginal and Torres Strait Islander women are 2-3 times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia.

Methods: Population-based study of mothers of Aboriginal babies born in South Australia, July 2011 to June 2013. Mothers completed a structured questionnaire at a mean of 7 months postpartum. The questionnaire included measures of stressful events and social health issues during pregnancy and maternal psychological distress assessed using the Kessler-5 scale.

Results: Three hundred forty-four women took part in the study, with a mean age of 25 years (range 15-43). Over half (56.1%) experienced three or more social health issues during pregnancy; one in four (27%) experienced 5-12 issues. The six most commonly reported issues were: being upset by family arguments (55%), housing problems (43%), family member/friend passing away (41%), being scared by others people's behavior (31%), being pestered for money (31%) and having to leave home because of family arguments (27%). More than a third of women reporting three or more social health issues in pregnancy experienced high/very high postpartum psychological distress (35.6% versus 11.1% of women reporting no issues in pregnancy, Adjusted Odds Ratio = 5.4, 95% confidence interval 1.9-14.9).

Conclusions: The findings highlight unacceptably high rates of social health issues affecting Aboriginal women and families during pregnancy and high levels of associated postpartum psychological distress. In order to improve Aboriginal maternal and child health outcomes, there is an urgent need to combine high quality clinical care with a public health approach that gives priority to addressing modifiable social risk factors for poor health outcomes.
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http://dx.doi.org/10.1186/s12884-016-0867-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845352PMC
April 2016

Frequency, severity and persistence of postnatal dyspareunia to 18 months post partum: A cohort study.

Midwifery 2016 Mar 8;34:15-20. Epub 2016 Feb 8.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Academic Centre for General Practice and Primary Health Care, University of Melbourne, Australia.

Objective: to describe the frequency, severity and persistence of dyspareunia in the first 18 months after the birth of a first child.

Design: prospective pregnancy cohort study.

Setting: Melbourne, Victoria, Australia.

Population: 1507 nulliparous women.

Methods: women ≤24 weeks gestation were recruited from six public hospitals. Self-administered written questionnaires were completed at recruitment and at three, six, 12 and 18 months post partum.

Outcome Measures: study-designed self-report measure of dyspareunia on first vaginal sex, and on second and subsequent sex at all time-points, utilising the rating scale from the McGill Pain Intensity Scale.

Findings: overall, 961/1122 (85.7%) of women experienced pain on first vaginal sex postnatally. The proportion of women experiencing dyspareunia reduced over time, from 431/964 (44.7%) at three months post partum to 261/1155 (22.6%) at 18 months post partum. Of the women who reported dyspareunia at each time-point, around 10% of women described the pain as׳distressing׳,׳horrible׳ or׳excruciating׳. Women who had a caesarean section were more likely to report more intense dyspareunia at six months post partum (aOR=2.35, 95% CI=1.2-4.6).

Conclusions: postnatal dyspareunia decreases over time, but persists beyond 12 months for one in five women. Caesarean section appears to be associated with more intense dyspareunia.
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http://dx.doi.org/10.1016/j.midw.2016.01.012DOI Listing
March 2016

Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a cross-sectional, population-based study.

BMJ Open 2016 Feb 23;6(2):e010286. Epub 2016 Feb 23.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, Victoria, Australia.

Objectives: Indigenous women continue to experience rates of stillbirth, preterm birth and low birth weight, two to three times higher than other women in high-income countries. The reasons for disparities are complex and multifactorial. We aimed to assess the extent to which adverse birth outcomes are associated with maternal cannabis use and exposure to stressful events and social health issues during pregnancy.

Design/setting: Cross-sectional, population-based survey of women giving birth to Aboriginal babies in South Australia, July 2011-June 2013. Data include: maternal cannabis use, exposure to stressful events/social health issues, infant birth weight and gestation.

Participants: 344 eligible women with a mean age of 25 years (range 15-43 years), enrolled in the study. Participants were representative in relation to maternal age, infant birth weight and gestation.

Results: 1 in 5 women (20.5%) used cannabis during pregnancy, and 52% smoked cigarettes. Compared with mothers not using cannabis or cigarettes, mothers using cannabis had babies on average 565 g lighter (95% CI -762 to -367), and were more likely to have infants with a low birth weight (OR=6.5, 95% CI 3.0 to 14.3), and small for gestational age (OR=3.8, 95% CI 1.9 to 7.6). Controlling for education and other social characteristics, including stressful events/social health issues did not alter the conclusion that mothers using cannabis experience a higher risk of negative birth outcomes (adjusted OR for odds of low birth weight 3.9, 95% CI 1.4 to 11.2).

Conclusions: The findings provide a compelling case for stronger efforts to address the clustering of risk for adverse outcomes in Aboriginal and Torres Strait Islander communities, and point to the need for antenatal care to address broader social determinants of adverse perinatal outcomes. Integrated responses--collaboratively developed with Aboriginal communities and organisations--that focus on constellations of risk factors, and a holistic approach to addressing social determinants of adverse birth outcomes, are required.
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http://dx.doi.org/10.1136/bmjopen-2015-010286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769386PMC
February 2016
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