Brand new findings for a mental health policy puzzle
Monash Business School researchers have cast new light on one of the big problems in mental health – how to get pregnant women and new mothers treated for depression and anxiety.
Depression and anxiety among pregnant woman and new mothers is very common. It affects up to 20 per cent of women in this stage of life. The condition is associated with problems in women’s relationship with their baby and their partner, as well as with mental health problems in later life.
We know from earlier research that in Australia, as many as 40 per cent of pregnant women and new mothers suffering from depression and anxiety miss out on appropriate treatment, explains Dr Jemimah Ride from the Centre for Health Economics, the lead researcher of a new study on the issue.
“Those women suffer the distressing and debilitating symptoms of depression and anxiety, when they could get help,” said Dr Ride.
The problem is not a lack of treatment options. Counseling, medication and peer support are all shown to be effective. The problem is women either do not seek treatment, or seek treatments that have not been proven effective, such as acupuncture, massage, traditional Chinese medicine, homeopathy and herbal therapy.
Putting good treatment to work
The question for policy makers is how to reduce the share of women who miss out on treatment and the share that do not choose proven treatments. The issue is close to Dr Ride's heart, who is a qualified medical doctor with experience in public health.
“In my past work with services who were trying to increase uptake and access to these kind of treatments they’ve wondered - if we offer childcare, or if we offer home visits will that be what makes the big difference?” she said.
To address the question, Dr Ride and her colleague Associate Professor Emily Lancsar began a detailed study.
The research process used 217 Australian women – all of them pregnant or new mothers – to determine which factors were most important in choosing a treatment.
The women in the study showed a strong preference for individual counseling. It was more popular than group counseling or a combination of counseling and medication.
Would it be providing childcare so the experience was more convenient? Subsidising the cost? Providing treatment over the internet or over the phone? Something else?
The researchers used a procedure known as a discrete choice experiment, creating treatment options with different attributes. The 217 research subjects were asked to imagine they had been diagnosed as experiencing depression and/or anxiety, and to choose between treatment options. The process allows researchers to see which characteristics emerge as most important.
The hip pocket matters
The research came back with several clear messages – the most important of which was the primacy of cost. A charge of $50 or $100 was substantially more relevant than any other factor in determining whether a treatment would be preferred.
The research found home visits, telephone consultations or childcare would not substantially increase uptake of recommended services.
The next big finding was the role of the type of treatment. The women in the study showed a strong preference for individual counseling. It was more popular than group counseling or a combination of counseling and medication.
The survey also revealed a preference not to take medication, even if it is the only effective treatment on offer.
The desire for medication-free treatment was strongest among pregnant and breastfeeding mothers and weakest among new mothers who were not breastfeeding. This suggests that the preference is informed – at least in part – by not wanting to transmit medication to a child.
Concern about medication could be a major factor in women choosing non-recommended treatment types, Dr Ride said. Subsidising and promoting counselling may therefore be especially effective in encouraging uptake of treatment. It is proven popular and doesn't need to involve medication.
The research modeled likely uptake of recommended treatment options if they were subsidised. It predicts uptake of recommended treatment nearly doubles with subsidies (from 27% to 52%) while non-treatment would reduce from 40% to 28%, and the use of non-recommended treatments would drop from 33% to 20%.
That could translate to thousands of lives improved for the better. Australia alone sees 300,000 births per year and 30,000 to 60,000 women experiencing associated depression and anxiety. But this pioneering research – the first of its kind – may also be applicable in the rest of the world.
By Jason Murphy