Cost of PNDA in Australia

November 8, 2021 Kylianne Farrell

PNDA affects 1 in 5 mothers and 1 in 10 fathers in Australia, with psychological, social and physical factors increasing risk

Perinatal depression and anxiety (PNDA) is costing Australia $877 million annually, according to a 2019 PwC Australia analysis prepared for Gidget Foundation Australia, entitled, ‘The Cost of Perinatal Depression and Anxiety in Australia’.

PNDA touches not only the parent experiencing the condition but can also have impacts on the child and wider family, with some of these impacts lasting a lifetime. Understanding the cost of PNDA to Australia can ensure that support for families be available during the critical early parenthood stage where it is needed. The estimated cost of PNDA to the health system, economy and wellbeing of those impacted totalled $877m, comprising of:

health costs attributable to PNDA equalling $227m, comprising increased use of primary
and community health services and hospital health care services and increased risk of
certain conditions for both the parent and child
economic costs of $643m are attributable to productivity losses associated with
increased workforce exit, absenteeism, presenteeism and carer requirements
monetised social and wellbeing impacts include increased likelihood of developmental
issues, depression, anxiety and child ADHD diagnoses,
totalling $7m.

Beyond this are estimated lifetime impacts of $5.2b attributable to the increased risk of depression, anxiety and ADHD in the children of parents with PNDA, affecting wellbeing, productivity and health system use.

Perinatal Trauma Related Disorders

November 8, 2021 Kylianne Farrell

A parent (mother or partner) may experience or witness an event they find traumatic in the perinatal period, such as a difficult or complicated labour or birth, a medical emergency for parent or baby after birth, miscarriage, ectopic pregnancy, stillbirth or neonatal loss.

Sometimes, labour or birth may not involve medical trauma, but can still be psychologically traumatic for a parent if they feel disempowered, ignored, ill-informed or out of control.

For some people, this trauma will resolve over time without intervention. Some parents may find it helpful to talk about the event, feel supported and heard by others, and be able to process emotions associated with the trauma. Not all people who witness or experience a traumatic event will develop a trauma-related disorder but some do.

Some, however, may also develop a trauma-related disorder indirectly by hearing or learning about a traumatic event.

Acute stress disorder can occur immediately after a traumatic event and is a short-term condition often lasting only up to a month. A person who has ASD experiences psychological distress and its symptoms are similar to PTSD as explained below. ASD is a temporary condition and treatment focuses on decreasing symptoms, improving coping strategies, and preventing PTSD. In dealing with ASD, talking to family and friends and seeking community support is often enough to deal with the effects of trauma if it is not complicated or perceived as life-threatening. If symptoms are ongoing however it can develop into PTSD.

The most widely-recognised trauma disorder is post-traumatic stress disorder, commonly referred to as PTSD.

Some of the following symptoms may contribute to a perinatal PTSD diagnosis if they are distressing and do not start to recede several weeks after birth:

– Re-experiencing the trauma through vivid and distressing flashbacks or dreams

– Negative thoughts and feelings such as fear, anger, guilt, feeling flat or numb a lot of the time, thinking they are to blame for what happened

– Being in a constant state of ‘alertness’ – watching out for danger to themselves, their baby or other loved ones

– A stress response to noises, smells or sights that remind them of the traumatic event

– Avoiding particular places or situations that may evoke reminders of the traumatic event, for example not wanting to drive near the hospital

If a parent has one or more previous significant experiences of trauma, they are more vulnerable to PTSD in the perinatal period. These include sexual trauma, childhood abuse, bereavement of a significant person and family violence, previous adverse birth or pregnancy-related events.

Effective Professional Help for PNDA

November 8, 2021 Kylianne Farrell

Professional care and treatment options

The mental health system can seem complicated and overwhelming to someone who is already struggling. Medical professionals who can provide initial help with new parents’ concerns about their mental health include:

– Child and Family Health Nurse

– GP

– Midwife

– Obstetrician

These people can provide some initial assessment, information and support around perinatal mood disturbances.

If more specialised support is needed, a parent may be referred to additional services. The type of referral may depend on whether the parent’s distress appears mild, moderate or severe. These are some of the options:

– Perinatal psychologist or counsellor

– Psychiatrist

– Mental Health Social Worker

– Specialist support groups or a specialist telephone support service

– Online support tools

– A mother-baby unit (MBU) within a hospital

Risk Factors for PNDA

November 8, 2021 Kylianne Farrell

Some of the following background factors and circumstances can increase the risk of PNDA:

– A personal history of mental illness

– A family history of mental illness

– Pre-existing misuse of alcohol or other drugs

– Vulnerable personality factors such as low self-esteem or perfectionism

– A personal history of trauma, abuse or other adverse experiences

– Having settled in Australia from another country

– Financial difficulties

– Lack of social and/or practical support network

– LGBTQI+ parents, who can face discrimination and have their family or parenting questioned

– An unsupportive employer e.g. pressure to return to work or lack of flexible options

– Relationship difficulties with partner, mother, father or another key person

– Previous pregnancy, baby or child loss

– Birth of twins or multiples

– Pregnancy or birth complications

– Unplanned pregnancy

– Birth mother younger than 18 years old

– Fertility issues, including IVF or surrogacy

– A rural and remote location

– Culturally or linguistically diverse background

– Aboriginal or Torres Strait Islander background

– Birth mother older than 35

– A recent or significant bereavement

– Other stressful life events

What are perinatal depression/anxiety signs and symptoms?

November 8, 2021 Kylianne Farrell

An episode of perinatal depression and anxiety can be mild, moderate, or severe. It is diagnosed when several of the following symptoms occur for more than two weeks, causing significant distress or impairment:

– Depressed mood, including feeling sad, empty or hopeless

– Crying for no apparent reason

– Loss of interest or pleasure in life

– Physical symptoms: (changes in appetite, headaches, sweaty palms, heart racing)

– Insomnia or excessive sleep

– Moving more slowly or finding it harder to slow down

– Loss of energy or fatigue

– Not feeling attached or bonded with your baby

– Feelings of worthlessness, guilt, feeling trapped

– Impaired concentration or indecisiveness

– Thoughts of death, self-harm or a suicide attempt

– Difficulty concentrating or focussing

– Feeling unusually restless

– Fear that something awful might happen

– Excessive and generalised worry

– Irritability

– Panic attacks

– Muscle tension

– Sleep disturbance

– Appetite disturbance

– Obsessive or compulsive behaviours

– Other physical symptoms such as heart palpitations, sweaty hands, stomach complaints

If symptoms have been present for 14 days, and it is starting to impact a parents ability to have wellbeing and positive functioning it may be time to encourage professional support like The Gidget Foundation.

What is perinatal depression/anxiety?

November 8, 2021 Kylianne Farrell

Pregnancy and the first year of parenthood (the perinatal period) is a unique time and involves major changes in a person’s life. The challenges of this adjustment to parenthood are often underestimated within our society and cultures. All expectant and new parents, including both mums and dads or partners, will have some good days and bad days. Ups and downs are expected and common. But when bad days become the norm, a parent may be experiencing perinatal depression or anxiety.

Perinatal depression and anxiety affect almost 100,000 expectant and new parents in Australia each year. Often, estimates for anxiety and depression are combined because many new parents experience symptoms of both. Sometimes, one may present more strongly than the other.

Good Questions to Ask #3

October 4, 2021 Kylianne Farrell

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How have you been sleeping?

We know that poor sleep hygiene and quality is one of the symptoms that someone may experience is developing a mental health problem, in crisis, or experiencing the worsening of an existing illness.

This is a great question to start a conversation around why they think sleep is being impacted, and asking about what other cluster symptoms they may be noticing.

Good Questions to Ask #2

October 4, 2021 Kylianne Farrell

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Is there anything that has helped you in the past?

Gauging what resources, tools, strategies, and skills they may have used in the past, can open up a good conversation around some things they may feel positive about putting in place in the near future, to build them up that they know work for them.

Good Questions to Ask #1

October 4, 2021 Kylianne Farrell

How long have you been feeling this way?

Thinking back to the continuum of are these symptoms now at an intensity that they are impacting a persons ability to hold out meaningful relationships, engage and perform at work, study and live life the way they want to or once did? It is important to know how long the symptoms have been creating challenges.

This will allow you to ask some more questions around if they are now starting to impact their quality of life and if so, maybe it is the time to suggest some professional help.

What is a traumatic event?

September 7, 2021 Kylianne Farrell

A potentially traumatic event is a powerful and distressing experience that is life threatening or poses a significant threat to a person’s physical or psychological well-being.

Trauma is whatever the person perceives as trauma, what may be traumatic for one person may not for another. It is important to remember this when having conversations, not to put our own beliefs and opinions onto someone else.

How do they like information to be given?

September 7, 2021 Kylianne Farrell

When providing information to someone, a great question to ask is how they like to receive information?

Consider how you like to be given information?

Is it a video?

Websites?

Hard copy information?

Audio?

Ask the question!

Strength Spot

September 7, 2021 Kylianne Farrell

When having mental health conversations, we are always on the look out for what maybe isn’t going so great. This is vitally important to help someone get on the road to recovery, however, it is just as important to help someone see what is going right and what their strengths are that will help them in their journey forward!

Point out people’s strengths to them, be on the look out for the things they do well and that bring them energy!

Barriers to help seeking #3

August 5, 2021 Kylianne Farrell

Knowing What Help is Available

When struggling with a mental illness, it can feel overwhelming to take steps to get help at times. A big barrier can be knowing what help is available based on the challenges being faced.

When supporting this is something we can help with.

The Who Can Help resource on our website will give lots of information when it comes to searching for the best next step for someone when they are seeking help and want to know what is available.

Still not sure? Send an email we are happy to help where we can!

Barriers to help seeking #2

August 5, 2021 Kylianne Farrell

Previous Bad Experience

People are locks and keys. Not everyone will be a good fit!

Its important to encourage someone to try again after a previous bad experience. Whether that be a helpline, face to face session or type of professional.

It’s ok for it to take some time to find a good fit when it comes to professional help.

Find out what works for the person you are supporting, what type of help they would like to access and do some research to try your best together, to get their foot in the best possible door.

Barriers to help seeking #1

August 5, 2021 Kylianne Farrell

Financial Barriers

There are many barriers that get in the way of people taking steps to getting professional help over the next few quick tips we will explore what some are and how as mental health first aiders we can help overcome them.

Therapy can be expensive. A lot of people are not aware of the Mental Health Care Plan that is available through a government Medicare initiative, that allows people to access up to 20 free or minimal charge sessions with eligible mental health professionals.

To access a referral from a GP is required. GP’s will refer to access 6 sessions at a time. For more information see the link below.

Tip Six - Be A better listener

June 30, 2021 Kylianne Farrell

Ask Questions

When you finally do respond, try to not simply hammer your own point. Refuse the impulse to tell your story on the topic. Ask open questions such as “How do you interpret this?” , they are powerful tools to deepen a conversation and uncover hidden reasoning.

For example, if someone is sharing how they are sad about a lost pet, do not respond by talking about when this last happened to you. Instead, ask them a follow-up question to show that you care about their experience.

Show your attentiveness using sentences such as “I can imagine how sad you must have been,” or in a happy update, “I hope you are impressed with yourself!”

By showing respect in your response, you show the speaker that they are worthy of respect. The more you practice these tips, the entire process of active listening will feel more fluid.

Tip Five - Be a better listener

June 30, 2021 Kylianne Farrell

Paraphrase

Paraphrasing is another powerful communication tool. Starting with sentences such as “So you are saying that…” or repeating in your own words what you believe the other person said, are ways to show that you followed the conversation and understand.

You can also paraphrase by asking the speaker a question, such as, “So are you saying that you felt uncomfortable in that experience?” or “What did you do after this happened?”

A recent study found that while paraphrasing does not necessarily make people feel understood, it does create a greater sense of closeness and intimacy in a conversation. This is a key part of building trust and possible friendships.

Tip Four - Be a better listener

June 30, 2021 Kylianne Farrell

Tolerate silence.

Resist the urge to fill moments of silence. There are different types of silence. Respecting quiet moments can a powerful tool for a deep conversation. It gives the speaker and receiver a chance to reflect and continue with this process. So often we rush to “fill” silence, right before someone has a breakthrough thought to share.

If you find silence difficult, you can encourage the person to continue by asking open questions such as “What do you make of this?” or “Tell me more about what happened.”

Do not underestimate silence for a potentially rich conversation.

Tip Three - Be A better listener

June 30, 2021 Kylianne Farrell

Practice Non-Judgment.

Being mindful means practicing non-judgment. There is no need to agree or disagree with what is being said or evaluate the statements being made.

Remember that offering your active presence is more important than having their deeper question answered. A skilful active listener is able to simply receive the message without the need to judge or respond with their own bias.

Tip Two - Be a better listener

June 30, 2021 Kylianne Farrell

Pay attention to the speaker, not your own thoughts.

Devote your whole attention to the speaker. Being mindful means being present in the moment and paying attention to what is happening right now. In a conversation, this means observing the speaker while they are sharing their story.

Be aware of subtle changes in their voice, the way they mimic you, the words they use and the emotions they are experiencing. Try to truly understand the thought process of your conversation partner.

Observe your own thoughts, but from a distance, and resist the temptation to engage in them.

We want to raise awareness that movement, play, adventure and exploration in the outdoors has the power to bring the incredible mental wellbeing benefits.

We want to inspire our community through the power of story telling, to light a fire within them to step outside of their comfort zone.