Measuring perinatal mental health risk

Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools

BACKGROUND

Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use.

OBJECTIVE

Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences.

DESIGN

Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy.

FINDINGS

We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported.

CONCLUSIONS

Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.

Combining the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale in Early Pregnancy in Danish Antenatal Care-A Qualitative Descriptive Study

Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.

‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme

OBJECTIVE

to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions.

DESIGN

a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations.

SETTING

nine community-based and hospital-based midwife clinics in the North Region of Denmark.

INTERVENTION

a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated.

PARTICIPANTS AND DATA

15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted.

FINDINGS

contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship.

CONCLUSION

midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.

Gender-Oriented Mental Health Prevention: A Reappraisal

Many studies have investigated the impact of gender on mental health, but only a few have addressed gender differences in mental health risk and prevention. We conducted a narrative review to assess the current state of knowledge on gender-specific mental health preventive interventions, along with an analysis of gender-based risk factors and available screening strategies. Out of 1598 articles screened using a comprehensive electronic search of the PubMed, Web-of-Science, Scopus, and Cochrane databases, 53 were included for review. Among risk factors for mental health problems, there are individual, familiar, social, and healthcare factors. Individual factors include childhood adversities, which show gender differences in distribution rates. However, current childhood abuse prevention programs are not gender-specific. Familiar factors for mental health problems include maternity issues and intimate partner violence, and for both, some gender-specific preventive interventions are available. Social risk factors for mental health problems are related to education, employment, discrimination, and relationships. They all display gender differences, but these differences are rarely taken into account in mental health prevention programs. Lastly, despite gender differences in mental health service use being widely known, mental health services appear to be slow in developing strategies that guarantee equal access to care for all individuals.

Missingness patterns in a comprehensive instrument identifying psychosocial and substance use risk in antenatal care

BACKGROUND

Psychosocial vulnerabilities (e.g. inadequate social support, financial insecurity, stress) and substance use elevate risks for adverse perinatal outcomes and maternal mental health morbidities. However, various barriers, including paucity of validated, simple and usable comprehensive instruments, impede execution of the recommendations to screen for such vulnerabilities in the first antenatal care visit. The current study presents findings from a newly implemented self-report tool created to overcome screening barriers in outpatient antenatal clinics.

METHODS

This was a retrospective chart-review of 904 women who completed the Profile for Maternal & Obstetric Treatment Effectiveness (PROMOTE) during their first antenatal visit between June and December 2019. The PROMOTE includes the 4-item NIDA Quick Screen and 15 additional items that each assess a different psychosocial vulnerability. Statistical analysis included evaluation of missing data, and exploration of missing data patterns using univariate correlations and hierarchical clustering.

RESULTS

Three quarters of women (70.0%) had no missing items. In the entire sample, all but four PROMOTE items (opioid use, planned pregnancy, educational level, and financial state) had < 5% missing values, suggesting good acceptability and feasibility. Several respondent-related characteristics such as lower education, less family support, and greater stress were associated with greater likelihood of missing items. Instrument-related characteristics associated with missing values were completing the PROMOTE in Spanish or question positioning at the end of the instrument.

CONCLUSIONS AND IMPLICATIONS

Conducting a comprehensive screening of theoretically and clinically meaningful vulnerabilities in an outpatient setting is feasible. Study findings will inform modifications of the PROMOTE and subsequent digitisation.

The antenatal risk questionnaire-revised: Development, use and test-retest reliability in a community sample of pregnant women in Australia

BACKGROUND

Routine psychosocial assessment during pregnancy and the first postnatal year is a public health strategy that prioritises early identification of known risk factors for poor perinatal mental health. We aimed to report on the development and use of the Antenatal Risk Questionnaire-Revised (ANRQ-R), contribute normative data for a community sample of pregnant women and examine its test-retest reliability.

METHODS

The ANRQ-R was developed in consultation with an expert advisory group. Women completed the ANRQ-R with their midwife at their first antenatal appointment. Test-retest analysis was restricted to women who consented to follow-up and completed a repeat ANRQ-R within four weeks.

RESULTS

7183 women completed the ANRQ-R (total score M = 12.05, Mdn=10; range =5-49). There were some statistically significant differences in total score across maternal age group (χ²=69.75, p<.001), country of birth (χ²=144.01, p<.001) and socioeconomic quintiles (χ²=20.13, p<.001), however the effect sizes of all differences were either small or not clinically significant. Test-retest reliability for the ANRQ-R total score was good (N = 1670; ICC=0.77). Item-level test-retest reliabilities were moderate to good (ICC range=0.65-0.80; kappa coefficient range=0.31-0.74).

LIMITATIONS

The study was conducted at a single site. Although there was significant diversity in terms of maternal age and country of birth, the majority of participants were partnered and resided in socio-economically advantaged areas, limiting the generalisability of results.

CONCLUSIONS

This study contributes significant normative data for the ANRQ-R and offers valuable insights for clinicians and researchers working with particular sub-groups of the perinatal population. Additional psychometric examination of the ANRQ-R, including its concurrent and predictive validity, is required.

Supporting routine psychosocial assessment in the perinatal period: The concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised

BACKGROUND

Australian clinical practice guidelines support comprehensive psychosocial assessment as a routine component of maternity care.

AIM

To examine the concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised (ANRQ-R) when used across the perinatal period.

METHODS

Women completed the ANRQ-R and a diagnostic reference standard (SAGE-SR) in the second and third trimesters and at 3-months postpartum. ANRQ-R test performance for cut-off scores at each time-point was assessed using Receiver Operator Characteristic (ROC) analysis.

FINDINGS

Overall sample sizes were N=1166 (second trimester), N=957 (third trimester) and N=796 (3-month postpartum). 6.5%, 5.6% and 6.2% of women met SAGE-SR criteria for any depressive or anxiety disorder at these time-points ('cases'), respectively. ROC analysis yielded acceptable areas under the curve (AUC) when the ANRQ-R was used to detect current (AUC=0.789-0.798) or predict future (AUC=0.705-0.789) depression or anxiety. Using an example cut-off score of 18 or more, the ANRQ-R correctly classified 72-76% of concurrent 'cases' and 'non-cases' (sensitivity=0.70-0.74, specificity=0.72-0.76) and correctly predicted 74-78% of postnatal 'cases' and 'non-cases' (sensitivity=0.52-0.72, specificity=0.75-0.79). Completion of the ANRQ-R earlier in pregnancy yielded greater positive likelihood ratios for predicting depression or anxiety at 3-months postpartum (cut-off ≥18: second trimester=3.8; third trimester=2.2).

CONCLUSION

The ANRQ-R is a structured psychosocial assessment questionnaire that can be scored to provide an overall measure of psychosocial risk. Cut-off scores need not be uniform across settings. Such decisions should be guided by factors including diagnostic prevalence rates, local needs and resource availability.

Preliminary Psychometric Testing of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in Portuguese Women

Introduction Postpartum depression (PPD) is a prevalent condition with a serious impact. The early identification of women at risk for developing PPD allows for primary prevention and the delivery of timely appropriate referrals. This study investigated the validity and reliability of the postnatal version of the Postpartum Depression Predictors Inventory-Revised (PDPI-R), an instrument widely studied internationally, in Portuguese women. Methods The sample consisted of 204 women who participated in an online cross-sectional survey. Participants completed the European Portuguese versions of the PDPI-R, the Edinburgh Postnatal Depression Scale (EPDS), and the Postnatal Negative Thoughts Questionnaire at 1-2 months postpartum. Additionally, ROC analyses were performed to conduct an exploratory analysis of the instruments' predictive validity. Results The prevalence rates of clinical postpartum depressive symptoms were 27.5 and 14.2% using the cut-off scores of 9 and 12, respectively, on the EPDS. The European Portuguese postnatal version of the PDPI-R demonstrated acceptable reliability and satisfactory construct and convergent validity. When using the EPDS > 9 cut-off score, the exploratory analyses yielded a sensitivity of 76.8% and a specificity of 73.0% with a cut-off score of 5.5 [area under the curve = 0.816]. Discussion These preliminary findings encourage the use of the postnatal version of the PDPI-R as a screening tool to identify Portuguese women at high risk for developing PPD. Subsequent assessments are needed to support the routine application of the PDPI-R both in research and for clinical purposes.

Predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Portuguese women

OBJECTIVE

This study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD).

DESIGN

Prospective longitudinal study conducted between November 2015 and September 2017.

SETTING

One public referral maternity hospital in the central region of Portugal.

PARTICIPANTS

A total of 140 Portuguese women participated in the study.

MEASUREMENTS

Participants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS.

FINDINGS

Rates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Despite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.

Family nurture intervention for preterm infants facilitates positive mother-infant face-to-face engagement at 4 months

Although preterm infants are at risk for social deficits, interventions to improve mother-infant interaction in the neonatal intensive care unit (NICU) are not part of standard care (SC). Study participants were a subset from a randomized controlled trial of a new intervention for premature infants, the Family Nurture Intervention (FNI), designed to help mothers and infants establish an emotional connection. At infants' 4 months corrected age, mother-infant face-to-face interaction was filmed and coded on a 1-s time base for mother touch, infant vocal affect, mother gaze, and infant gaze. Time-series models assessed self- and interactive contingency. Comparing FNI to SC dyads, FNI mothers showed more touch and calmer touch patterns, and FNI infants showed more angry-protest but less cry. In maternal touch self-contingency, FNI mothers were more likely to sustain positive touch and to repair moments of negative touch by transitioning to positive touch. In maternal touch interactive contingency, when infants looked at mothers, FNI mothers were likely to respond with more positive touch. In infant vocal affect self-contingency, FNI infants were more likely to sustain positive vocal affect and to transition from negative to positive vocal affect. In maternal gaze interactive contingency, following infants' looking at mother, FNI mothers of male infants were more likely to look at their sons. In maternal gaze self-contingency, following mothers' looking away, FNI mothers of male infants were more likely to look at their sons. Documentation of positive effects of the FNI for 4-month mother-infant face-to-face communication is useful clinically and has important implications for an improved developmental trajectory of these infants. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Family physicians perceived role in perinatal mental health: an integrative review

Background

Responding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Family physicians are ideally placed to provide an effective response as it is recognised that they are responsible for organising care and supports for women and their families. This paper reports an integrative review undertaken to examine family physicians’ perceived role in perinatal mental health care and concludes with recommendations for health policy, research and practice.

Method

A systematic search of literature in seven databases from January 2000 to March 2016 identified a total of 1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored family physicians’ experiences of caring for women who experience perinatal mental health problems.

Results

Thirteen articles reporting 11 studies met the inclusion criteria for this review and quality of included studies were assessed using published criteria for the critical appraisal of qualitative and quantitative research methods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes: identification of perinatal mental health problems, management of perinatal mental health problems and barriers to care provision. While family physicians recognise their role in relation to perinatal mental health the collective interpretation revealed that; they receive variable levels of preparation for this role, no consistent approach to screening exists, pharmacological management of mood disorders is the main treatment modality and limited access to specialist perinatal mental health services exists which impacts on pharmacology decisions.

Conclusion

Family physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines. Research that examines training needs in relation to perinatal mental health could be used to inform family physician training programmes and curriculum development around perinatal mental health.

Gestation-related psychosocial factors in women from Medellin, Colombia

INTRODUCTION

Perinatal stress and the impact generated by adverse conditions could affect fetal development negatively with long term and short term manifestations and could increase the risk of maternal depression.

OBJECTIVE

To determine the psychosocial risk factors present in women with high-obstetric risk and hospitalized in a high complexity institution.

METHODS

A cross-sectional study that included 112 pregnant or immediate postpartum women, who were evaluated using a scale designed by the researchers and the Edinburgh Postnatal Depression Scale.

RESULTS

Median age was 24 (RIC 9) years; 39.3% of the women were pregnant, and 65.9% had a gestational age of more than 28 weeks. The main reason for hospitalization was threat of preterm delivery in 39.2%. 52.4% planned the pregnancy and 22.3% had depressive symptoms compatible with depression. Suicidal ideas and suicide attempts were more prevalent in the first trimester (7.2% and 3.6%).

DISCUSSION

The high prevalence of depressive symptoms in the population studied coincides with what was reported in similar studies in Latin America. The fact that pregnancy does not protect against suicide was confirmed.

CONCLUSIONS

Psychosocial screening is recommended in every pregnant woman and women in immediate postpartum to detect symptoms and risk factors for depression.

Identification and Treatment of Adolescents With Perinatal Anxiety and Depression

Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.].

Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings

The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.

Delusional ideation during the perinatal period in a community sample

BACKGROUND

Despite the prevalence of mental health problems during the perinatal period, little research has examined psychotic symptoms in a community sample across pregnancy and the postpartum. Exposure to environmental risk factors, and immigration in particular, are associated with increased risk for psychotic disorders. The current investigation examined whether psychosocial risk and immigrant status would predict levels of delusional ideation across the perinatal period when controlling for depression, anxiety, and demographic factors.

METHODS

A community sample of 316 pregnant women was assessed at 12-14 and 32-34weeks gestation during routine clinic visits, and at 7-9weeks postpartum during a home visit. Measures included self-report ratings of psychosocial risk (e.g., history of mental health problems or abuse, stressful life events, lack of social support), pregnancy-related anxiety, depressive symptomatology, and delusional ideation.

RESULTS

There was less delusional ideation during the postpartum period than during early pregnancy. Across all time points, levels of delusional ideation were lower than in the general population. Analyses using multilevel modeling indicated significant fixed-effects for the variables time, age, partnership, being religious and prenatal anxiety, but not depressive symptomatology, on delusional ideation. Immigrant status moderated the effect of psychosocial risk such that greater psychosocial risk predicted more symptoms of delusional ideation among immigrants, but not non-immigrants.

CONCLUSION

Psychosocial risk factors place immigrant women at an increased likelihood for experiencing delusional ideation during the perinatal period.

Early Maternal Reflective Functioning and Infant Emotional Regulation in a Preterm Infant Sample at 6 Months Corrected Age

OBJECTIVE

This study investigated the influence of maternal reflective functioning (RF) on 6-month-old infants' emotional self-regulating abilities in preterm infant-mother dyads.

METHODS

25 preterm (gestational age 28-34.5 weeks) infants' affect, gaze toward mother, and self-soothing behaviors (thumb-sucking and playing with clothing) were measured during the still-face procedure at 6 months corrected age. Maternal RF was measured at 7-15 days post-delivery using the Parent Development Interview.

RESULTS

Infants with high RF mothers showed the most negative affect during the still-face episode (M = 21.33s, SE = 5.44), whereas infants with low RF mothers showed the most negative affect in the reunion episode (M = 18.14s, SE = 3.69). Infants with high RF mothers showed significantly more self-soothing behaviors when distressed (Ms > 14.5s) than infants with low RF mothers (Ms < 1s), p's < .01.

CONCLUSION

Maternal RF was associated with infants' self-regulating behavior, providing preliminary evidence for the regulatory role of maternal RF in preterm infants' emotion regulation capacity.

Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France

BACKGROUND

Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors.

METHOD

Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership.

RESULTS

Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy.

CONCLUSIONS

Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.

Attachment security and recent stressful life events predict oxytocin levels: a pilot study of pregnant women with high levels of cumulative psychosocial adversity

PURPOSE

Recent reports indicate that prenatal levels of the neuropeptide oxytocin (OT) are inversely related to depressive symptomatology and positively associated with more optimal interactive behaviors in mothers with high levels of cumulative psychosocial adversity (CPA). In the present pilot study, we aimed to identify factors associated with high versus low levels of OT in pregnant women with high levels of CPA. We hypothesized that insecurely attached women, and those who recently experienced stressful life events (SLE), would have lower levels of prenatal OT.

METHODS

Thirty pregnant women with mood and anxiety disorders and high levels of CPA were recruited from the perinatal mental health service of a general hospital. Participants completed self-report measures of psychosocial stress and adult attachment style, and blood was then drawn to assess OT.

RESULTS AND CONCLUSIONS

Lower OT levels were found among those who were insecurely attached, and among those who experienced SLE within the last year. In a multiple linear regression, both attachment security and SLE significantly contributed to a model of prenatal OT levels. These individual difference factors explained 38% of the variance in prenatal OT, which may in turn predict poorer maternal mental health and caregiving outcomes during the postpartum period.

Development and psychometric testing of the Chinese Postnatal Risk Factors Questionnaire (CPRFQ) for postpartum depression

This article describes the development and psychometric assessment of the Chinese Postnatal Risk Factors Questionnaire (CPRFQ). There were four phases in this process: (1) the items were generated using a literature review and a focus group, (2) content validity was evaluated by an expert panel, (3) a pilot study was conducted with 45 postpartum women to refine the scale, and (4) a convenience sample of 256 postpartum women in China was recruited to complete the questionnaire. Construct validity was established by exploratory factor analysis; a four-factor structure of the scale was accepted (social and family, personality and relationship, mother and infant, maternal feelings and 'doing the month'). These factors explained 47.46 % of the variance. Pearson's correlation coefficient was conducted to test convergent validity with the Edinburgh Postnatal Depression Scale (EPDS) (r = 0.54; p < 0.001). The Cronbach's alpha coefficient of the four subscales ranged from 0.58 to 0.71. The final 18-item version of the questionnaire is potentially a valuable tool for assessing postnatal risk factors in Chinese postpartum mothers.

A psychometric systematic review of self-report instruments to identify anxiety in pregnancy

AIMS

To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument.

BACKGROUND

Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.

DESIGN

Psychometric systematic review.

DATA SOURCES

A systematic literature search of the multiple databases (1990-September 2014).

REVIEW METHODS

Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability.

RESULTS

Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category.

CONCLUSION

Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy.

Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version

Background

Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.

Methods

Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.

Results

Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.

Conclusions

Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.

Obstetric care providers assessing psychosocial risk factors during pregnancy: validation of a short screening tool - the KINDEX Spanish Version

BACKGROUND

High levels of stress due to diverse psychosocial factors have a direct impact on the mothers' wellbeing during pregnancy and both direct and indirect effects on the fetus. In most cases, psychosocial risk factors present during pregnancy will not disappear after delivery and might influence the parent-child relationship, affecting the healthy development of the offspring in the long term. We introduce a short innovative prenatal assessment to detect psychosocial risk factors through an easy to use instrument for obstetrical medical staff in the daily clinical practice, the KINDEX Spanish Version.

METHODS

In the present study midwives and gynecologists interviewed one hundred nineteen pregnant women in a public health center using the KINDEX Spanish Version. Sixty-seven women were then randomly selected to participate in an extended standardized validation interview conducted by a clinical psychologist using established questionnaires to assesses current stress (ESI, PSS-14), symptoms of psychopathology (HSCL-25, PDS) and traumatic experiences (PDS, CFV). Ethical approval was granted and informed consent was required for participation in this study.

RESULTS

The KINDEX sum score, as assessed by medical staff, correlated significantly with stress, psychopathology and trauma as measured during the clinical expert interview. The KINDEX shows strong concurrent validity. Its use by medical staff in daily clinical practice is feasible for public health contexts. Certain items in the KINDEX are related to the respective scales assessing the same risks (e.g.PSS-4 as the shorter version of the PSS-14 and items from the ESI) used in the validation interview.

CONCLUSIONS

The KINDEX Spanish Version is a valid tool in the hands of medical staff to identify women with multiple psychosocial risk factors in public health settings. The KINDEX Spanish Version could serve as a base-instrument for the referral of at-risk women to appropriate psychosocial intervention. Such early interventions could prove pivotal in preventing undesirable mother-child relationships and adverse child development.

Developing and Testing of an Oral Health Screening Tool for Midwives to Assess Pregnant Woman

Maternal oral health is important, and midwives are encouraged to screen women for dental problems. We aimed to develop and test a midwifery oral health screening tool. A three-item tool was tested as part of a trial involving 300 women in Southwestern Sydney. A two-item combination showed better sensitivity (98%) and had a positive predictive value of 88%. Specificity was 40%, and negative predictive value was 80%. A two-item screening tool has been identified that is sensitive to identifying dental problems and facilitating referrals. Further validation using a larger sample is required to reassess the tool's specificity.

Zur Bedeutung von sozialer Unterstützung während der Schwangerschaft

Eine wachsende Zahl an Studien dokumentiert die negativen Auswirkungen von mütterlichen psychosozialen Stressoren (z. B. mütterliche Depression) und gesundheitsrelevanten Verhaltensweisen (z. B. Nikotin- und Alkoholkonsum) während der Schwangerschaft auf den Geburtsausgang. Jedoch werden mütterliche Ressourcen in diesem Kontext noch unzureichend berücksichtigt. Das Ziel ist es daher, die Bedeutung sozialer Unterstützung als frühe Ressource im Schwangerschaftsverlauf und zum Zeitpunkt der Geburt im Hinblick auf das Gesundheitsverhalten der Schwangeren und im Hinblick auf Geburtsmaße zu untersuchen. Die Datenbanken Web of Science und PubMed wurden entsprechend nach deutsch- und englischsprachigen Beiträgen für den Zeitraum 2003 bis 2013 durchsucht. 23 Studien erfüllten die Auswahlkriterien. Die Ergebnisse verdeutlichen, dass die Befundlage sehr inkonsistent ist, was teilweise auf die unterschiedlichen Definitionen sozialer Unterstützung und die Nutzung verschiedener Erhebungsinstrumente zurückzuführen ist. Des Weiteren fehlt es an Studien zur Bedeutung sozialer Unterstützung im Kontext mütterlicher psychosozialer Stressoren und Geburtsmaßen. Es bedarf weiterer Studien an Risiko- und Allgemeinpopulationen, die auf der Basis eines fundierten Rahmenkonzeptes mögliche Effekte der sozialen Unterstützung differenziert analysieren können.

Digging over that old ground: an Australian perspective of women's experience of psychosocial assessment and depression screening in pregnancy and following birth

Background

There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women’s experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women’s experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response.

Methods

This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified.

Results

Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; ’Unexpected: a bit out of the blue’, ‘Intrusive: very personal questions’ and ‘Uncomfortable: digging over that old ground’, describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled: Approach: ’sensitivity and care’ and ’being watched’.

Conclusions

The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information.