Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, these researchers explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, the researchers will work with their partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.
- The enduring disparity in Aboriginal maternal and child health outcomes, the high rates of Aboriginal perinatal depression, and the known consequences of untreated perinatal mental health disorders (including poorer psychological and development outcomes for children and reduced quality of life for women), continues to position Aboriginal women’s perinatal mental health as a matter of national significance.
- Participants spoke about the multiple stressors that many Pilbara Aboriginal women are negotiating while pregnant or having a small child. Violence, alcohol and drugs, homelessness, caring responsibilities, financial instability and not having family support were frequently mentioned as directly impacting on a woman’s wellbeing.
- Several participants suggested that family do not always have the capacity to ‘help take the load off’, particularly families that are struggling with the effects of intergenerational trauma and/or intergenerational alcohol misuse. Six women talked about the importance of their relationship with their midwife. Home visiting, feeling cared about, ‘worried for’, and the continuity of care during pregnancy were the commonly identified elements of value in the relationship. Four of the six women who spoke about the importance of the relationship with their midwife had inaccessible or weak family support.
- Kindness and an ability to listen were highly valued when having a ‘quiet word’ with Aboriginal women about their mental health and wellness. Broad and gentle questions were seen as ‘safe’ or the ‘right’ approach to engaging women about their mental health and wellbeing. Participants warned that direct questions when asking about relationships, current stressors and childhood experiences could cause a woman to ‘clam up’ or disengage. Starting broadly and gently was seen as an opportunity for Aboriginal women to assess their health care professionals to understand if they were ‘judgemental’, ‘bossy’ or ‘worrying for something else’ (not interested in the woman’s story). Once a health care professional was deemed trustworthy, participants stated that most Aboriginal women would ‘share’ their story.
Exploring what Aboriginal women in the Pilbara require from health services in terms of engagement and screening is an important precursor to advocating for their unique needs to be heard and upheld amongst the prevailing deductive approaches to perinatal mental health screening.