STePPS CRE Purpose

An Urgent National Health Problem

Over 300,000 women give birth in Australia each year and up to 20% experience clinical depression 1-3. The lifetime economic and social burdens, mostly borne by children, are estimated at $7.3 billion for every annual cohort of births1. Yet only 1 out of every 10 cases is adequately treated to remission4. Critically, perinatal depression disrupts the first 1000 days of life, which are foundational to an infant’s development, creating an enduring intergenerational problem.

The situation is stubbornly persistent. Despite decades of policy initiatives and intervention research, consumer uptake of treatment remains poor4. This central problem of low treatment rates stems from both a lack of widespread implementation of evidence-based interventions and barriers to access (stigma, distance etc.). Digitally delivered mental health interventions can help to break this impasse by increasing accessibility5.

Why the STePPS CRE is needed now

Psychological approaches for treating perinatal depression in new and expectant mothers have a robust evidence base8, 9. The STePPS team have established a powerful nucleus of rigorously evaluated digital supports, programs and perinatal depression treatments and a national stepped-care model for delivery. What is needed now is shifting these evidence-based approaches to scale, making this part of the healthcare system, in order to unleash the potential of e-interventions to massively improve the persistent gap in uptake and effectiveness in the real world. In addition, though less well researched, perinatal anxiety and trauma are frequently associated with perinatal depression and have severe consequences on the wellbeing of parents and children. Integrating these into treatment needs to be addressed urgently. Furthermore, there remain critical gaps as perinatal depression affects the entire family. Currently interventions for partners and for mitigating disruptions to the mother-infant relationship are not part of routine care.

This CRE will Generate New Knowledge: Building on the core approaches to depression treatments that we have pioneered, we will extend the scope of existing e-interventions, beginning in the pre-conception period, and innovate and evaluate the best methods to improve real-world effectiveness, and health economic impact. We will pioneer effective integration into health care systems.

This CRE will enable effective transfer of research outcomes: The STePPs team will leverage their extensive professional networks and leadership roles to disseminate and exchange information. Importantly we will foster community involvement. Our website will provide a platform for knowledge synthesis and reporting.

This CRE will develop the health and medical research workforce: The STePPS team are world leading experts, well placed to foster capacity-building in PhD candidates, early and mid-career researchers, clinical, primary care workforces, with mentoring and training programs.

This CRE will facilitate collaboration: We will leverage our very strong and global collaboration to drive translation into policy and practice, to apply the outputs of the CRE, ensuring strong governance structures and processes.

On the national level the tangible outcome of all of STePPS CRE’s activities will be: Sustainable Reductions in Parental & Infant Morbidity from Perinatal Mental Illness.

What STePPS CRE will do

We will address the urgent need to maximise reach of effective prevention and treatment for perinatal depression and related disorders, in the first 1,000 days (from conception to 2 years). We will make major inroads in increasing uptake and reducing the enduring burden of disease.

  • This CRE will drive the development and implementation of responsive, sustainable and digitally enabled mental health systems for perinatal depression.
  • The first stream of work (see infographic below) will leverage the vast body of high-quality perinatal depression e-prevention and e-treatment programs for new and expectant mothers currently pioneered within the STePPS team, to expand their scope and integrate into health care.
  • Three further streams of work will focus on unavailability of e-interventions in critical gap areas (related disorders, infants, fathers) and all streams will address implementation and diversity.
  • Our STePPS collaboration will provide a powerful basis to deliver training, build workforce capacity and translation into policy and practice.
  • This innovative, digitally-enabled system of care will be achieved by bringing together leading national and international experts in perinatal mental health, digital health and mental health economics, in partnership with consumers.

Digital technology offers the opportunity to modernise service delivery in a coherent stepped-care model6, 7. The upsurge in need for mental health prevention and treatment due to COVID-19 makes the provision of e-mental health responses integrated with existing services more urgent than ever.

This CRE will address this through research grounded in 4 streams of work and two cross-cutting themes

Stream 1. Perinatal Depression in Mothers

There is clear evidence e-depression treatments work for women10-12. What we need to know is how to scale these up. This CRE will conduct pragmatic perinatal e-mental health implementation trials utilising innovative engagement strategies.

Stream 2. Related Disorders

The STePPS CRE will innovate new digital approaches to address anxiety and trauma in order to provide comprehensive perinatal e-mental health treatments.

Stream 3. Very Early Intervention

Despite government recommendations about the importance of early intervention, provision of mother-infant interventions following postnatal depression is rare. This CRE will establish effective ways to include infant e-interventions within existing services.

Stream 4. Family Units

Most attention in the field has hitherto been focused, understandably, upon mothers. This CRE will use e-interventions in a stepped-care model to widen the scope of treatments and preventions to include fathers, partners and singles, and address difficulties in couple relationships.

Graphic of STePPS CRE Streams

Cross-Cutting Themes

In all work, an Implementation theme will focus on partnering with healthcare organisations, embedding effective e-interventions sustainably, moving beyond efficacy trials to establish effectiveness, predictive modelling for precision delivery, and co-design with consumers. This CRE will address Diversity by researching pragmatic ways to widen the relevance of e-mental health interventions to culturally diverse and Indigenous communities, to increase engagement and uptake.

References

  1. Gidget, PANDA. The cost of perinatal depression and anxiety in Australia. Report by PwC Consulting. 2019.
  2. Australian Institute of Health and Welfare. Australia’s mothers and babies. Australian Institute of Health and Welfare, Australian Government; 2021.
  3. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071-83.
  4. Gavin NI, Meltzer-Brody S, Glover V, Gaynes BN. Is population-based identification of perinatal depression and anxiety desirable? A public health perspective on the perinatal depression care continuum. In: Milgrom J, Gemmill AW, editors. Identifying Perinatal Depression and Anxiety: Evidence-based Practice in Screening, Psychosocial Assessment and Management. Chichester, UK: Wiley; 2015. p. 11-31.
  5. National Mental Health Commission. Contributing Lives, Thriving Communities – Report of the National Review of Mental Health Programmes and Services. Sydney: National Mental Health Commission, Australian Government; 2014.
  6. O’Donohue WT, Draper C. The case for evidence-based stepped care as part of a reformed delivery system. Stepped care and e-health: Springer; 2011. p. 1-16.
  7. Ho FY-Y, Yeung W-F, Ng TH-Y, Chan CS. The efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: a systematic review and meta-analysis. Scientific reports. 2016;6(1):1-10.
  8. Dennis CL, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal dperession. Cochrane Database of Systematic Reviews. 2007(3).
  9. Cuijpers P. Indirect prevention and treatment of depression: an emerging paradigm. Clin Psychol Eur. 2021.
  10. Lee EW, Denison FC, Hor K, Reynolds RM. Web-based interventions for prevention and treatment of perinatal mood disorders: A systematic review. BMC Pregnancy and Childbirth. 2016;16(1).
  11. Ashford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: A systematic review. J Affect Disord. 2016;197:134-46.
  12. Lau Y, Htun TP, Wong SN, Tam WSW, Klainin-Yobas P. Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis. Journal of Medical Internet Research. 2017;19(4).