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Providing appropriate, early, and ongoing mental health care to refugees and asylum seekers benefits not only the individual but the host nation, as it improves the chances of successful reintegration, which has long-term benefits for the social and economic capital of that country, which will likely impact not only the displaced generation but the second generation as well [15]. Bringing together the global literature on the prevalence of mental illness in refugee and asylum-seeker populations would also enable the research community to move ahead and focus on different components of the mental health needs of this population, for example, on interventions, on less well-understood mental health conditions, or longitudinal mental health trajectories. Studies were included if (1) the sample solely comprised adult refugees and/or asylum seekers residing outside their country of origin, (2) had a sample size larger than 50, and (3) reported quantitative prevalence estimates of a mental illness as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM) [17] or the International Classification of Disease (ICD) [18]. Data analysis Using a fixed protocol, two review authors (RB and MG-H) independently extracted statistical data and study characteristics: host country, publication year, sample size, country or region of origin, sampling method, diagnostic tool and criteria, use of interpreter, age, proportion of female participants, visa status, duration of displacement, and prevalence of mental illness (numerator and denominator).

The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included \"COVID,\" \"corona,\" and \"pandemic.\" A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including \"worried\" (n=165, 19.9%), \"risk\" (n=143, 17.2%), \"anxiety\" (n=98, 11.8%), \"concerns\" (n=74, 8.8%), and \"stress\" (n=69, 8.3%). Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.

Background The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. Methods Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. Results Overall, 5874 studies were identified and 23 were included ( n  = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes. Conclusions Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.

Background Relatively little is known about changes in women’s working conditions despite increases in labour force participation in recent decades. This study examines trends in adverse working conditions among Australian women in paid employment and identifies the factors associated with adverse working conditions. Methods Longitudinal population-based data from the Australian Longitudinal Study on Women’s Health, following a cohort of women aged 18–23 years at baseline (1996) through to ages 40–45 years (2018). Mixed-effect regression examined the factors associated with long working hours and shift work. Results The proportion of women working long hours increased from 23.7% in 1996 to 36.1% in 2018. By 2018, women had 1.77 times higher odds of working long hours compared to 1996 (95% CI: 1.58–1.97). Factors associated with long working hours included a degree/higher degree [AOR 1.91, 95%CI, 1.76–2.07]and being non-partnered [AOR 1.45, 95%CI, 1.37–1.53]. The proportion of women engaged in shift work declined from 24.9% in 1996 to 10.1% in 2018. By 2018, the adjusted odds of working shifts were significantly lower than in 1996 [AOR: 0.20 (95% CI: 0.16–0.24)]. Factors associated with a higher likelihood of shift work included blue-collar occupation [AOR 1.41, 95%CI, 1.06–1.33], and holding a degree/higher degree [AOR 1.27, 95%CI, 1.10–1.45]. Conclusion Between 1996 and 2018, working conditions for a cohort of Australian women of reproductive age changed significantly. There was a notable decline in shift and night work, alongside a significant increase in long working hours. The results likely reflect a combination of modified working conditions, women’s career transitions and changes in personal/caring responsibilities. The potential health implications of long working hours require careful monitoring.

Globally, over half of pregnancies in developed countries are unplanned. Identifying and understanding the prevalence and complexity surrounding pregnancy preparation among Australian women is vital to enable sensitive, responsive approaches to addressing preconception and long-term health improvements for these women with varying motivation levels. This study evaluated the reliability and validity of a comprehensive pregnancy planning/intention measure (London Measure of Unplanned Pregnancy) in a population of pregnant women (over 18 years of age) in Australia. A psychometric evaluation, within a cross-sectional study comprising cognitive interviews (to assess comprehension and acceptability) and a field test. Pregnant women aged over 18 years were recruited in early pregnancy (approximately 12 weeks' gestation). Reliability (internal consistency) was assessed using Cronbach's alpha, corrected item-total correlations and inter-item correlations, and stability via a test-retest. Construct validity was assessed using principal components analysis and hypothesis testing. Six women participated in cognitive interviews and 317 in the field test. The London Measure of Unplanned Pregnancy was acceptable and well comprehended. Reliability testing demonstrated good internal consistency (alpha = 0.81, all corrected item-total correlations >0.20, all inter-item correlations positive) and excellent stability (weighted kappa = 0.92). Validity testing confirmed the unidimensional structure of the measure and all hypotheses were confirmed. The London Measure of Unplanned Pregnancy is a valid and reliable measure of pregnancy planning/intention for the Australian population. Implementation of this measure into all maternity healthcare, research and policy settings will provide accurate population-level pregnancy planning estimates to inform, monitor and evaluate interventions to improve preconception health in Australia.

Background Pregnancy is a time of increased risk for developing or re‐experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems‐level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory‐informed, evidence‐based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university‐based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. Methods In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision‐making by healthcare organizations. Results Using a behavioural change framework (Capability, Opportunity, Motivation–Behaviour Model), the key barriers, processes and outcomes are described for a real‐world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven‐stage implementation guide is presented for use in a range of healthcare settings. Conclusions These findings describe an equity‐informed, evidence‐based approach that can be used by healthcare organizations to address common systems and individual‐level barriers to implement perinatal depression and anxiety screening guidelines. Patient or Public Contribution These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well‐being, the NGO COPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study.

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives’ knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives’ self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from ( n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants ( n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic ( n = 244; 72%). Most ( n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives’ provision of pre and interconception care.

ObjectiveTo examine the geospatial distribution of gestational diabetes mellitus (GDM) over time in Australia.DesignAn ecological study was conducted using data from the National Diabetes Services Scheme (GDM cases). Data at Statistical Area Level 2 (SA2) level, a medium-sized spatial unit, on population denominators (women who gave birth) were obtained from the Australian Bureau of Statistics. The spatiotemporal distribution of GDM was explored at the SA2 level over three periods: 2016–2017, 2018–2019 and 2020–2021. Hotspot and cluster analyses were undertaken using Getis-Ord Gi* and local Moran’s I statistics.SettingA nationwide study in Australia was conducted between 2016 and 2021.ParticipantsWomen diagnosed with GDM and those who gave birth were included.Outcome measuresAge-standardised and crude incidence of GDM per SA2.ResultsDuring 2016–2021, 1 718 963 eligible women who gave birth in Australia were included. Hotspot areas of GDM were consistently observed in Victoria (Southwest and North Melbourne); Western Australia (South and Southwest Perth); Australian Capital Territory (ACT) (East and North Canberra); Queensland (North Brisbane) and New South Wales (West and Southwest Sydney and Southeast New South Wales). ACT (South Canberra), North Tasmania, Northern Territory (North Darwin) and Victoria (South East Melbourne) had new hotspot regions recorded in the last two consecutive study periods.ConclusionGDM incidence varies by geographical area over time, with hotspots in specific regions suggesting the need for geographically targeted policy interventions to curb the growing burden of GDM.

The original Monash gestational diabetes mellitus (GDM) risk prediction in early pregnancy model is internationally externally validated and clinically implemented. We temporally validate and update this model in a contemporary population with a universal screening context and revised diagnostic criteria and ethnicity categories, thereby improving model performance and generalizability. The updating dataset comprised of routinely collected health data for singleton pregnancies delivered in Melbourne, Australia from 2016 to 2018. Model predictors included age, body mass index, ethnicity, diabetes family history, GDM history, and poor obstetric outcome history. Model updating methods were recalibration-in-the-large (Model A), intercept and slope re-estimation (Model B), and coefficient revision using logistic regression (Model C1, original ethnicity categories; Model C2, revised ethnicity categories). Analysis included 10-fold cross-validation, assessment of performance measures (c-statistic, calibration-in-the-large, calibration slope, and expected-observed ratio), and a closed-loop testing procedure to compare models’ log-likelihood and akaike information criterion scores. In 26,474 singleton pregnancies (4,756, 18% with GDM), the original model demonstrated reasonable temporal validation (c-statistic = 0.698) but suboptimal calibration (expected-observed ratio = 0.485). Updated model C2 was preferred, with a high c-statistic (0.732) and significantly better performance in closed testing. We demonstrated updating methods to sustain predictive performance in a contemporary population, highlighting the value and versatility of prediction models for guiding risk-stratified GDM care.

Introduction There is evidence that consumer and community involvement (CCI) improves the quality and outcomes of health research. However, there is currently limited support for organisations to plan, implement and evaluate CCI activity. We aimed to codesign an audit tool that will enable organisations, researchers, community members and funders to measure the extent and nature of CCI in their respective settings. The tool was based on the Western Australian Health Translation Network's CCI Handbook. Methods We offered optional online workshops to inform participants about the study (total n = 9). Following this, we obtained feedback on the appropriateness of the Handbook and audit tool (n = 11). Finally, using Qualtrics surveys, we assessed the quality and effectiveness of the tool in evaluating CCI with 10 researchers, 6 funders, and 1 community member (total n = 17) sourced from networks within Monash University and the Perron Institute for Neurological and Translational Science. Results Overall participants had a positive response to the audit tool and believed it had value in quantifying direct implementation of CCI in their workplaces. Gaps identified included the need to address health and research literacy of community members, culturally responsive approaches when working with community members from migrant backgrounds and an identified need for visual and digital resources. Conclusions Application of the tool enabled participants to identify their respective CCI strengths, weakness and opportunities for improving the meaningful involvement of community members and community in their research activities and to support equity in these processes. Patient or Public Contribution The public participated in workshops providing feedback on the general structure of the audit tool as well as testing it within their research projects.