Nicole Reilly

Objective: To describe perinatal mental health outcomes among people with intellectual disability giving birth in New South Wales, Australia. Methods: This retrospective, descriptive cohort study included 30,257 people (2262 people with intellectual disability and 27,995 comparators without intellectual disability) aged 10+ years, discharged from New South Wales hospitals between 2002 and 2017 following a live singleton birth. We used administrative data from emergency departments, hospitals, ambulatory mental health services, Medicare-subsidised services and the Pharmaceutical Benefits Scheme. We defined the overall perinatal period as 140 days before to 365 days after birth. We also examined outcomes within four specific timeframes: 140 days to birth, 1–42, 43–90 and 91–365 days after birth. Results: Across the overall perinatal period, people with intellectual disability who gave birth had greater risk of having at least one mental health emergency department presentation (risk ratio = 7.01 (5.78–8.50)), mental health hospital admission (risk ratio = 8.97 (7.54–10.67)), ambulatory mental health service contact (risk ratio = 5.55 (4.90–6.28)) and Medicare-subsidised mental health service contact (risk ratio = 1.99 (1.82–2.16)) than comparators. The most common diagnoses among people with intellectual disability were mood (12.6%; risk ratio = 3.83 (3.38–4.35)) and anxiety, stress-related and somatoform disorders (11.9%; risk ratio = 3.62 (3.19–4.12)). People with intellectual disability were more likely to be dispensed antipsychotics (risk ratio = 9.29 (7.74–11.16)), anxiolytics (risk ratio = 3.03 (2.44–3.76)), hypnotics/sedatives (risk ratio = 2.08 (1.55–2.78)), antidepressants (risk ratio = 2.30 (2.13–2.49)) and psychostimulants (risk ratio = 4.00 (2.03–7.89)). Conclusion: Our findings show elevated use of mental health services by people with intellectual disability in the perinatal period and underscore the need for accessible and adequately equipped acute and community-based mental health services.

Background: Intimate partner violence (IPV) negatively affects the health of both the mother and the child. These risks are particularly critical during the perinatal period, a time of heightened vulnerability. However, the relationship between maternal IPV exposure and breastfeeding outcomes remains uncertain, and existing findings are inconsistent and inconclusive. Therefore, this systematic review and meta-analysis aimed to synthesise the existing evidence on the association between perinatal IPV and breastfeeding outcomes. Methods: A systematic literature search was conducted using relevant databases between June 15 and August 2, 2024. All peer-reviewed observational studies that specifically investigated the link between Perinatal (P)-IPV and breastfeeding outcomes, such as early initiation, exclusivity, and duration among the perinatal population, were included. Heterogeneity across the included studies was assessed using the Cochrane Q test and I² statistics. Publication bias was assessed through funnel plots and Egger’s test. Finally, a random effects model was used to estimate the pooled adjusted odds ratios and their 95% CIs. Results: Nineteen observational studies published between 2007 and 2024, comprising 347,706 mother-child pairs, were included in the review. Of these, 17 studies were eligible for the meta-analysis. A meta-analysis of nine studies indicated that P-IPV was associated with a 36% higher odds of delayed initiation of breastfeeding (AOR: 1.36; 95% CI: 1.14–1.63), with both physical (AOR: 1.20; 95% CI: 1.02–1.42) and psychological P-IPV (AOR: 1.38; 95% CI: 1.09–1.74) were associated with higher odds of not initiating breastfeeding within one hour of birth. Similarly, women exposed to P-IPV had higher odds of not exclusively breastfeeding (EBF) at six months (AOR: 1.50; 95% CI: 1.21–1.85), with similar associations observed for both physical (AOR: 1.52; 95% CI: 1.18–1.95) and psychological P-IPV (AOR: 1.56; 95% CI: 1.39–1.76). Conclusions: This review found that P-IPV was associated with delayed breastfeeding initiation and a lower likelihood of EBF at six months. The findings highlight the potential value of trauma-informed and trauma-sensitive screening, support, and referral pathways for women experiencing P-IPV.

Background: Many parents today use digital or mobile health (mHealth) resources for parenting information and support. Thus, interventions or programs to support parenting delivered in this way are a rapidly growing area of innovation and research. Evidence indicates that face-to-face interventions that provide education and support for parents about infant sleep can have positive impacts on both infant sleep and maternal mood. However, there is limited research on the delivery of such interventions via digital or mHealth platforms. SleepWellBaby is an infant sleep mobile app for parents with infants and young children. The app provides parents with a 7-day program that may be repeated according to individual user demand, with information and interactive features aimed at supporting parents to understand infant sleep, and providing advice about strategies to support sleep in a responsive way. Objective: The study objectives were (1) to determine engagement with, and acceptability of, an mHealth-delivered parenting program to support infant sleep and (2) to investigate the impact of the program on parental fatigue, emotional health, and parenting competence, confidence, and self-efficacy. Methods: A multimethod quasi-experimental pre-post study design was used. Participants were parents of infants aged under 6 months, recruited through online advertising. Participants completed baseline questionnaires, then 2 further follow-up questionnaires at 7 days and 30 days post baseline. These questionnaires captured participant demographics (baseline) and perceptions of the program (follow-up), in addition to measuring parental fatigue (Fatigue Severity Scale), parent sense of competence, confidence, and self-efficacy (Me as a Parent Scale), and symptoms of anxiety (Generalized Anxiety Disorder 7-item scale) and depression (Edinburgh Postnatal Depression Scale) at all time points. Open-ended text responses were also collected at the 2 follow-up surveys. Questionnaire data were linked with participants’ engagement with the program (Engagement Index), measured using app analytics. Results: Participants’ (baseline: n=700; 7-d follow-up: n=339; and 30-d follow-up: n=220) engagement with the program varied; however, the majority reported cessation of app use by 1 month. Most participants were broadly satisfied with the program, finding the app easy to use and understand, and reported they could trust the information on the app. Those participants who had higher engagement or found the program most helpful for their sleep and their infant’s sleep showed the greatest improvement in their fatigue. Qualitative feedback from participants noted that while many found the app a lifeline with helpful information and features, others noted unintended negative impacts, such as spending too much time on their phone. Conclusions: Delivery of an infant sleep program via mHealth is effective for and acceptable to many parents. While not preferred by all parents, mHealth is an accessible, low-cost, and high-reach mode of providing information and management strategies for parents experiencing early parenting difficulties.

Issue Addressed: Effective mental health promotion strategies that engage a variety of health and non‐health sectors are an important component of the mental health intervention spectrum. Community sport is one such avenue for promoting mental health and potentially reducing stigma around help seeking. This study aimed to identify priority actions of community sports‐based mental health promotion initiatives and report on factors facilitating and inhibiting successful implementation of these initiatives.Methods: Thirty‐one project managers from 24 sports clubs and organisations funded to deliver mental health promotion initiatives across New South Wales, Australia, participated in the independent evaluation. Data were collected using a brief survey and a semi‐structured interview, and were analysed using descriptive and thematic analysis.Results: Building wellness and resilience was the most common priority action area of the funded initiatives. Key enablers of implementation identified by project managers included the contribution of key personnel, partnerships, buy‐in from the organisation, sport clubs as a mental health promotion setting, and grant funding. The most frequently reported barrier to implementation was the limited timeframe available. Other inhibiting factors included lack of human resources (particularly volunteers) and stigma surrounding mental health issues.Conclusions: Sports clubs and organisations faced several barriers to the implementation of their mental health promotion initiatives. However, a range of factors enabled successful implementation. Findings of this study can inform the development of resources, programmes and policies to promote mental health in this setting.So What?: When planning and implementing sports‐based mental health promotion initiatives, it is essential to ensure the presence of enabling factors such as recruitment of the right key personnel, establishment of strong partnerships, and securing organisational buy‐in. Concurrently, strategies should be employed to mitigate barriers including timing and timeframes, limited human resources, and existing stigma, to maximise the likelihood of success and achievement of positive outcomes.

Background: Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women’s awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers.Objective: The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined.Methods: Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later.Results: A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help.Conclusions: Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.