Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care

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Abstract

Background

Around 6 % of births in Australia are to Aboriginal and Torres Strait Islander families. Aboriginal and Torres Strait Islander women are 2–3 times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia.

Methods

Population-based study of mothers of Aboriginal babies born in South Australia, July 2011 to June 2013.

Mothers completed a structured questionnaire at a mean of 7 months postpartum. The questionnaire included measures of stressful events and social health issues during pregnancy and maternal psychological distress assessed using the Kessler-5 scale.

Results

Three hundred forty-four women took part in the study, with a mean age of 25 years (range 15–43). Over half (56.1 %) experienced three or more social health issues during pregnancy; one in four (27 %) experienced 5–12 issues. The six most commonly reported issues were: being upset by family arguments (55 %), housing problems (43 %), family member/friend passing away (41 %), being scared by others people’s behavior (31 %), being pestered for money (31 %) and having to leave home because of family arguments (27 %). More than a third of women reporting three or more social health issues in pregnancy experienced high/very high postpartum psychological distress (35.6 % versus 11.1 % of women reporting no issues in pregnancy, Adjusted Odds Ratio = 5.4, 95 % confidence interval 1.9–14.9).

Conclusions

The findings highlight unacceptably high rates of social health issues affecting Aboriginal women and families during pregnancy and high levels of associated postpartum psychological distress. In order to improve Aboriginal maternal and child health outcomes, there is an urgent need to combine high quality clinical care with a public health approach that gives priority to addressing modifiable social risk factors for poor health outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0867-2) contains supplementary material, which is available to authorized users.

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Most cited references 25

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Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap.

Theo Vos, Bridget Barker, Stephen Begg … (2009)

Disparities in health status between Aboriginal and Torres Strait Islander peoples and the total Australian population have been documented in a fragmentary manner using disparate health outcome measures. We applied the burden of disease approach to national population health datasets and Indigenous-specific epidemiological studies. The main outcome measure is the Indigenous health gap, i.e. the difference between current rates of Disability-Adjusted Life Years (DALYs) by age, sex and cause for Indigenous Australians and DALY rates if the same level of mortality and disability as in the total Australian population had applied. The Indigenous health gap accounted for 59% of the total burden of disease for Indigenous Australians in 2003 indicating a very large potential for health gain. Non-communicable diseases explained 70% of the health gap. Tobacco (17%), high body mass (16%), physical inactivity (12%), high blood cholesterol (7%) and alcohol (4%) were the main risk factors contributing to the health gap. While the 26% of Indigenous Australians residing in remote areas experienced a disproportionate amount of the health gap (40%) compared with non-remote areas, the majority of the health gap affects residents of non-remote areas. Comprehensive information on the burden of disease for Indigenous Australians is essential for informed health priority setting. This assessment has identified large health gaps which translate into opportunities for large health gains. It provides the empirical base to determine a more equitable and efficient funding of Indigenous health in Australia. The methods are replicable and would benefit priority setting in other countries with great disparities in health experienced by Indigenous peoples or other disadvantaged population groups.

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Annual Research Review: Prenatal stress and the origins of psychopathology: an evolutionary perspective.

Vivette Glover (2011)

If a mother is stressed or anxious while pregnant her child is more likely to show a range of symptoms such as those of attention deficit hyperactivity disorder, conduct disorder, aggression or anxiety. While there remains some debate about what proportion of these effects are due to the prenatal or the postnatal environment, and the role of genetics, there is good evidence that prenatal stress exposure can increase the risk for later psychopathology. Why should this be? In our evolutionary history it is possible that some increase in these characteristics in some individuals was adaptive in a stressful environment, and that this type of fetal programming prepared the child or group for the environment in which they were going to find themselves. Anxiety may have been associated with increased vigilance, distractible attention with more perception of danger, impulsivity with more exploration, conduct disorder with a willingness to break rules, and aggression with the ability to fight intruders or predators. This adaptation for a future dangerous environment may explain why stress and anxiety, rather than depression, seem to have these programming effects; why there is a dose-response relationship with prenatal stress from moderate to severe and it is not only toxic stress that has consequences; why not all children are affected and why individual children are affected in different ways; and why the outcomes affected can depend on the sex of the offspring. An evolutionary perspective may give a different understanding of children in our society with these symptoms, and suggest new directions for research. For example, there is some evidence that the type of cognitive deficits observed after prenatal stress have specific characteristics; these may be those which were adaptive in a past environment. © 2011 The Author. Journal of Child Psychology and Psychiatry. © 2011 Association for Child and Adolescent Mental Health.

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Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health.

Anita Raj, Elizabeth Reed, Riva Touger-Decker … (2006)

To conduct a population-based assessment of associations of intimate partner violence in the year prior to and during pregnancy with maternal and neonatal morbidity. Data from women giving birth in 26 U.S. states and participating in the 2000 to 2003 Pregnancy Risk Assessment Monitoring System (n = 118,579) were analyzed. Women reporting intimate partner violence in the year prior to pregnancy were at increased risk for high blood pressure or edema (adjusted odds ratio 1.37-1.40), vaginal bleeding (adjusted odds ratio 1.54-1.66), severe nausea, vomiting or dehydration (adjusted odds ratio 1.48-1.63), kidney infection or urinary tract infection (adjusted odds ratio 1.43-1.55), hospital visits related to such morbidity (adjusted odds ratio 1.45-1.48), and delivery preterm (adjusted odds ratio 1.37), of a low-birthweight infant (adjusted odds ratio 1.17), and an infant requiring intensive care unit care (adjusted odds ratio 1.31-1.33) compared with those not reporting intimate partner violence. Women reporting intimate partner violence during but not prior to pregnancy experienced higher rates of a subset of these concerns. Women experiencing intimate partner violence both prior to and during pregnancy are at risk for multiple poor maternal and infant health outcomes, suggesting prenatal risks to children from mothers' abusive partners.

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Author and article information

Contributors

Donna Weetra: donna.weetra@mcri.edu.au

Karen Glover: Karen.glover@sahmri.com

Mary Buckskin: amanda.mitchell@ahcsa.org.au

Jackie Ah Kit: Jackie.ahkit@health.sa.gov.au

Cathy Leane: cathy.leane@health.sa.gov.au

Amanda Mitchell: amanda.mitchell@ahcsa.org.au

Deanna Stuart-Butler: Deanna.stuart-butler@health.sa.gov.au

May Turner: annie.mcauley@mcri.edu.au

Jane Yelland: jane.yelland@mcri.edu.au

Deirdre Gartland: deirdre.gartland@mcri.edu.au

Stephanie J Brown: stephanie.brown@mcri.edu.au

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 26 April 2016

Publication date PMC-release: 26 April 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 88

Affiliations

[ ]Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC 3052 Australia

[ ]South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000 Australia

[ ]Aboriginal Health Council of South Australia Inc, 220 Franklin Street, Adelaide, South Australia 5000 Australia

[ ]Women’s and Children’s Health Network, 295 South Terrace, Adelaide, South Australia 5000 Australia

[ ]Council of Aboriginal Elders Inc, 50-60 Sussex St, North Adelaide, South Australia 5006 Australia

[ ]General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, VIC 3052 Australia

[ ]School of Population and Global Health, General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, VIC 3052 Australia

Article

Publisher ID: 867

DOI: 10.1186/s12884-016-0867-2

PMC ID: 4845352

PubMed ID: 27118001

SO-VID: 22457d96-dd88-43d9-a5c8-1c83705e16ba

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 21 February 2015

Date accepted : 8 April 2016

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ScienceOpen disciplines: Obstetrics & Gynecology

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ScienceOpen disciplines: Obstetrics & Gynecology

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Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care

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Advocacy for Maternal and Women’s Health

Most cited references 25

Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap.

Annual Research Review: Prenatal stress and the origins of psychopathology: an evolutionary perspective.

Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health.

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Cited by 6

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