Skip to main content

Advertisement

Log in

Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18–44 years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia.

Methods

Two hundred sixty-one rural and remote women, pregnant with an Indigenous infant, from New South Wales in Australia were invited to provide data regarding social disadvantage then complete the Kessler-10 and Stressful Life Events surveys via self-report during each trimester of their pregnancy. Descriptive statistics, Pearson’s correlations, Mann–Whitney U and Kruskal–Wallis tests were performed to determine the burden of and any associations between the variables of interest.

Results

High rates of psychological distress were reported by participants with 16.9% scoring severe distress levels during their pregnancy. Participants also reported high rates of stressful life events with almost 25% experiencing the death of a family member or friend, almost 14% living in overcrowded accommodation, 11% having someone close to them jailed and 8% experience separation from their partner, during their pregnancies. Distress was associated with numerous stressful life events (e.g. witnessing violence, a family member in jail and overcrowding) and one aspect of social disadvantage (smoking status).

Conclusions

Immediate attention needs to focus on the development of interventions to address the high levels of psychological distress and provide appropriate support services during periods of major life events for pregnant Australian Indigenous women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Material

The data set is available upon appropriate consultation with an Indigenous Advisory Committee and approval from the ethics committee. Please contact the corresponding author.

Abbreviations

EPNDS:

Edinburgh Postnatal Depression Scale

K-10:

Kessler–10

NATSISS:

National Aboriginal and Torres Strait Islander Social Survey

SLE:

Stressful life event

References

  1. Usher K, et al. Indigenous resilience in Australia: a scoping review using a reflective decolonizing collective dialogue. Frontiers in Public Health. 2021;9:630601.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kramer M, et al. Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol. 2009;169(11):1319–26.

    Article  PubMed  Google Scholar 

  3. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. 2019. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4715.0Main%20Features72018-19?opendocument&tabname=Summary&prodno=4715.0&issue=2018-19&num=&view=. Accessed 5 Jan 2020.

  4. King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. The Lancet. 2009;374(9683):76–85.

    Article  Google Scholar 

  5. Young C, et al. Stressful life events and resilience among carers of Aboriginal children in urban New South Wales: cross-sectional findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMJ Open. 2018;8(6):e021687.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust. 2011;194(10):512–3.

    Article  PubMed  Google Scholar 

  7. Marwick A, et al. Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: a cross-sectional population based study. Soc Sci Med. 2015;128:178–87.

    Article  Google Scholar 

  8. Al-Yaman, F., M. Van Doeland, and M. Wallis, Family violence among Aboriginal and Torres Strait Islander peoples., A.I.o.H.a. Welfare, Editor. 2006, Australian Institute of Health and Welfare: Canberra.

  9. Bailey C, Powell M, Brubacher S. Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions. Child Abuse Negl. 2017;68:74–80.

    Article  PubMed  Google Scholar 

  10. Owais S, et al. The perinatal mental health of indigenous women: a systematic review and meta-analysis. The Canadian Journal of Psychiatry. 2020;65(3):149–63.

    PubMed  Google Scholar 

  11. World Health Organsiation, Who are indigenous peoples?, U. Nations, Editor. 2021.

  12. Mah B, et al. Pregnancy stress, healthy pregnancy and birth outcomes–the need for early preventative approaches in pregnant Australian Indigenous women: a prospective longitudinal cohort study. J Dev Orig Health Dis. 2019;10(1):31–8.

  13. Kessler R, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76.

    Article  CAS  PubMed  Google Scholar 

  14. Torche F. The effect of maternal stress on birth outcomes: exploiting a natural experiment. Demography. 2011;48(4):1473–91.

    Article  PubMed  Google Scholar 

  15. Shapiro GD, et al. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med. 2013;41(6):631–45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Centre for Epidemiology and Evidence, New South Wales mothers and babies 2012, NSW Ministry of Health, Editor. 2014: Sydney.

  17. Barker D, et al. Fetal nutrition and cardiovascular disease in adult life. The Lancet. 2003;341(8850):938–41.

    Article  Google Scholar 

  18. Hoy W, Nicol JL. Birthweight and natural deaths in a remote Australian Aboriginal community. Medical Journal of Australia. 2010;192(1):14–9.

    Article  PubMed  Google Scholar 

  19. Ashman A, et al. A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study. J Dev Orig Health Dis. 2016;7(4):357–68.

    Article  CAS  PubMed  Google Scholar 

  20. Australian Institute of Health and Welfare. Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. Canberra: AIHW; 2009.

    Google Scholar 

  21. McNamara BJ, et al. Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: a comparison of the K-10 and K-5. Aust N Z J Public Health. 2014;38(6):567–73.

    Article  PubMed  Google Scholar 

  22. Andrews G, Slade T. Interpreting scores on the Kessler psychological distress scale (K10). Aust N Z J Public Health. 2001;25(6):494–7.

    Article  CAS  PubMed  Google Scholar 

  23. Spies G, et al. Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women. Arch Womens Ment Health. 2009;12(2):69–74.

    Article  CAS  PubMed  Google Scholar 

  24. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Social Survey, 2014–15. 2016. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4714.0~2014-15~Main%20Features~Key%20findings~1. Accessed 9 May 2020.

  25. IBM Corp, IBM SPSS Statistics for Windows, Version 23.0. 2015, IBM Corp: Armonk, NY.

  26. Lee KJ, et al. Framework for the treatment and reporting of missing data in observational studies: the treatment and reporting of missing data in observational studies framework. J Clin Epidemiol. 2021;134:79–88.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Huang L, et al. Maternal age and risk of stillbirth: a systematic review. Can Med Assoc J. 2008;178(2):165–72.

    Article  Google Scholar 

  28. Sunderland M, Mahoney A, Andrews G. Investigating the factor structure of the Kessler psychological distress scale in community and clinical samples of the Australian population. J Psychopathol Behav Assess. 2012;34:253–9.

    Article  Google Scholar 

  29. Milgrom J, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1):147–57.

    Article  PubMed  Google Scholar 

  30. Deave T, et al. The impact of maternal depression in pregnancy on early child development. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(8):1043–51.

    Article  CAS  Google Scholar 

  31. Brown A. Addressing cardiovascular inequalities among indigenous Australians. Global Cardiology Science and Practice. 2012;2012(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Grigoriadis S, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74(4):e321-341.

    Article  PubMed  Google Scholar 

  33. Australian Institute of Health and Welfare, 2010 Australian National Infant Feeding Survey: indicator results. 2011: Canberra.

  34. Allen J, Hector D. Benefits of breastfeeding. N S W Public Health Bull. 2005;16(4):42–6.

    Article  PubMed  Google Scholar 

  35. Renzaho AMN, et al. Stressful life events and the onset of chronic diseases among Australian adults: findings from a longitudinal survey. Eur J Pub Health. 2014;24(1):57–62.

    Article  Google Scholar 

  36. Australian Bureau of Statistics. Education and work, Australia, May 2019. 2019. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/mf/6227.0. Accessed 9 May 2020.

  37. Greenhalgh, E., C. Ford, and M. Winstanley, Tobacco in Australia: facts and issues. Pregnancy and smoking, C. Council, Editor. 2020, Cancer Council: Melbourne.

  38. Australian Bureau of Statistics, Census of Population and housing: reflecting Australia 2016, A.B.o. Statistics, Editor. 2018, Australian Government: Canberra.

  39. Melbourne Institute Poverty Lines: Australia, March Quarter 2019. 2019.

  40. Wood L, et al. Indigenous women and smoking during pregnancy: knowledge, cultural contexts and barriers to cessation. Soc Sci Med. 2008;66(11):2378–89.

    Article  PubMed  Google Scholar 

  41. Australian Bureau of Statistics. Prisoners in Australia. 2016. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4517.02016?OpenDocument. Accessed 09 Nov 2021.

  42. Chojenta C, Loxton D, Lucke J. How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? J Midwifery Womens Health. 2012;57(2):145–50.

    Article  PubMed  Google Scholar 

  43. Bailie RS, Stevens M, McDonald EL. Impact of housing improvement and the socio-physical environment on the mental health of children’s carers: a cohort study in Australian Aboriginal communities. BMC Public Health. 2014;14:472.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ketheesan S, et al. Stress, allostatic load and mental health in Indigenous Australians. Stress. 2020;23(5):509–18.

    Article  CAS  PubMed  Google Scholar 

  45. Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health. 2010;10:771.

    Article  PubMed  PubMed Central  Google Scholar 

  46. DiGiacomo M, et al. Stressful life events, resources, and access: key considerations in quitting smoking at an Aboriginal Medical Service. Aust N Z J Public Health. 2007;31(2):174–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to pay their respects to Elders past, present, and emerging and also extend that respect to any Indigenous readers. The authors would like to acknowledge Lyniece Keogh, Kathryn Sutherland, Jodie Herden, Paris Knox, Loretta Weatherall, Megan Naden and Stella Sands (all Aboriginal women), who assisted in the collection of the data for this study and their substantial contributions to the success of this study. Further, we acknowledge research team members, Prof. Roger Smith, Emeritus Prof. Eugenie Lumbers, Prof Caroline Blackwell, Prof Clare Collins, Dr Amy Ashman, Dr Yu Qi Lee and Dr Tracy Schumacher, for their significant contributions to this project. We also acknowledge the local obstetric team in preparation of this publication, Dr Keith Hollebone and Dr Kenneth Apen. The contributions of the participants and the community in which we worked were substantial, and we are grateful for their generosity and trust in us.

Funding

This work was supported by the National Health and Medical Research Council [grant numbers 569239 & 1026733], Prime Minister and Cabinet Indigenous Advancement Strategy and philanthropic donations obtained through the Hunter Medical Research Institute.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualisation: B.M. and K.M.R.

Methodology: B.M., K.G.P. and K.M.R

Formal analysis and investigation: B.M. and K.M.R.

Writing-original draft preparation: B.M. and K.M.R.

Writing-review and editing: B.M., A.B., S.E., K.G.P. and K.M.R.

Cultural guidance and oversight: S.E., A.B. and the Gomeroi gaaynggal Advisory Committee.

All authors were responsible for completion of manuscript.

Corresponding author

Correspondence to K. M. Rae.

Ethics declarations

Ethics Approval

This study was approved by the Hunter New England Local Health District Human Research Ethics Committee (HNEHREC ref no: 08/05/21/4.01, NSWHREC ref. no. 08/HNE/129), the University of Newcastle Human Research Ethics Committee (H-2009–0177) and the Aboriginal Health and Medical Research Council Ethics Committee of NSW (Ref no: 654/08).

Consent to Participate

All participants provided written consent to participate, as per ethics committee requirements.

Consent for Publication

All authors consent to the publication of this paper. The authors have sought the consent of a local Indigenous Advisory Committee prior to publication.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mah, B.L., Brown, A., Eades, S. et al. Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study. J. Racial and Ethnic Health Disparities 9, 2197–2207 (2022). https://doi.org/10.1007/s40615-021-01159-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-021-01159-5

Keywords

Navigation