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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
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.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Matthey S, Reilly N, Mule V, Robinson J, Della Vedova AM, Austin MP. Screening women for distress during pregnancy: the impact of including 'Possibly' as a response option. J Reprod Infant Psychol 2023; 41:528-539. [PMID: 35234553 DOI: 10.1080/02646838.2022.2042798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the impact of including the response option of 'Possibly' in the Distress question on the Matthey Generic Mood Questionnaire (MGMQ) during antenatal emotional health screening in English-speaking women. BACKGROUND Some distress screening questions only allow respondents to choose between 'Yes' or 'No' to the presence of distress. The MGMQ, however, allows respondents to chose between 'Yes', 'Possibly', or 'No', which may be preferable if a participant is reluctant to state she definitely feels distressed. METHOD In Study 1, women undergoing routine antenatal psychosocial screening were allocated to either completing the MGMQ Distress question with the usual three-option response format of 'Yes, Possibly, No' (N = 960), or just a 'Yes, No' response format (N = 771). The proportion of responses were compared in each group, as were the proportion then screening positive on the MGMQ's Bother question. In Study 2, women (N = 113) attending routine antenatal clinic appointments were asked about their preference between these response formats. RESULTS Including 'Possibly' resulted in only a slight increase in the proportion giving a positive response to the Distress question, and then also screening positive on the Bother question. In Study 2, a substantial majority of women (80%) preferred having 'Possibly' in the response options. CONCLUSION While the impact of including 'Possibly' is small, it allows for more women to communicate how they are feeling on the full MGMQ. Given the large majority of women preferring having 'Possibly' included, we believe that the Distress Question is enhanced by having this as a response option.
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Affiliation(s)
- S Matthey
- Academic Unit of Child Psychaitry, South Western Sydney Local Health District, Sydney, Australia
- School of Psychiatry, UNSW, Sydney, Australia
| | - N Reilly
- School of Psychiatry, UNSW, Sydney, Australia
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
| | - V Mule
- School of Psychiatry, UNSW, Sydney, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
| | - J Robinson
- Academic Unit of Child Psychaitry, South Western Sydney Local Health District, Sydney, Australia
| | - A M Della Vedova
- Dept of Clinical and Experimental Science (Area Disciplinare Medicina e Chirurgia), University of Brescia, Brescia, Italy
| | - M-P Austin
- School of Psychiatry, UNSW, Sydney, Australia
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Sydney, Austalia
- Royal Hospital for Women, Sydney, Australia
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O'Connor A, Shand AW, Schneuer FJ, Nassar N, Austin MP. Assessing the relationship between psychosocial risk and pregnancy outcomes using the perinatal integrated psychosocial assessment (PIPA) tool. Birth 2022; 49:648-660. [PMID: 35233836 DOI: 10.1111/birt.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA-determined psychosocial risk and obstetric and neonatal outcomes. METHODS Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017-2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At-risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors. RESULTS In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium-high/high risk. Compared with no/low-risk women, medium-high/high-risk women were more likely to remain in hospital for >72 hours (aOR 1.47 [95% CI 1.33-1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20-2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03-1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26-2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00-1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium-high/high-risk women referred for support. CONCLUSIONS The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high-risk women who were referred for extra support, suggesting that psychosocial review and referral for high-risk women may reduce the risk of adverse obstetric and neonatal outcomes.
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Affiliation(s)
- Anne O'Connor
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Antonia W Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Financial Markets Foundation for Children, Sydney, New South Wales, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital, Sydney, New South Wales, Australia
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Austin MPV, Mule V, Hadzi-Pavlovic D, Reilly N. Screening for anxiety disorders in third trimester pregnancy: a comparison of four brief measures. Arch Womens Ment Health 2022; 25:389-397. [PMID: 34350480 DOI: 10.1007/s00737-021-01166-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
Evidence regarding the accuracy of existing anxiety screeners used in pregnancy is limited. This study compares the psychometric characteristics of the Generalized Anxiety Disorder 2- and 7-item Scales (GAD-2 and GAD-7), the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS-3A) and the two anxiety items of the Antenatal Risk Questionnaire (ANRQ-2A). Nine hundred fifty-four women completed the screening measures and anxiety modules of a diagnostic reference standard (SAGE-SR) in the third trimester. Test performance characteristics of each measure was assessed using Receiver Operator Characteristic (ROC) analysis. We applied four previously recommended criteria to ascertain the value of each measure for widespread clinical use: area under the curve (AUC ≥ 0.8, Youden's index ≥ 0.5, negative predictive value (NPV) ≥ 0.8 and positive likelihood ratio (LR +) ≥ 4.0). Prevalence for any SAGE-SR anxiety disorder was 3%. All measures yielded an acceptable AUC of ≥ 0.8, Youden's index of ≥ 0.5 and NPV of ≥ 0.8. Only the EPDS-3A, at a cut-point ≥ 5, also achieved a LR + of ≥ 4.0 (4.35) but at this cut-point sensitivity was less than 0.75. The ANRQ-2A, at its optimal cut-point of ≥ 6, was the only measure to additionally attain both a sensitivity and specificity of ≥ .75. This study expands the evidence base for brief anxiety screening measures in the maternity setting and provides empirical support for the use of the EPDS-3A and ANRQ-2A in routine screening programmes. Studies assessing the performance of these measures in samples with higher disease prevalence and broader socio-economic status are warranted.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia. .,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia. .,Royal Hospital for Women, Barker St, Sydney, Randwick, NSW, 2031, Australia.
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia.,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia
| | | | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, PO Box 261, 23 Grantham St, NSW, 2134, Burwood, Australia.,School of Psychiatry, UNSW Medicine, Sydney, NSW, 2052, Australia.,Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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The antenatal risk questionnaire-revised: Development, use and test-retest reliability in a community sample of pregnant women in Australia. J Affect Disord 2021; 293:43-50. [PMID: 34166908 DOI: 10.1016/j.jad.2021.05.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/05/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
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.
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Chambers GM, Botha W, Reilly N, Black E, Kingston D, Austin MP. The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study. Women Birth 2021; 35:e133-e141. [PMID: 34099393 DOI: 10.1016/j.wombi.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Although perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain. AIM To compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA). METHODS Women attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an 'at-risk' flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the 'at-risk' flag for PIPA than for Usual-Care. Each model's performance was evaluated using the midwife's agreement with the 'at-risk' flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach. FINDINGS Both models performed well at identifying 'at-risk' women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying 'at-risk' women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted. DISCUSSION Overall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as 'at-risk' and 'not at-risk' of perinatal psychosocial morbidity.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Willings Botha
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia
| | - Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia; Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia.
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Reilly N, Hadzi-Pavlovic D, Loxton D, Black E, Mule V, Austin MP. Supporting routine psychosocial assessment in the perinatal period: The concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised. Women Birth 2021; 35:e118-e124. [PMID: 33896760 DOI: 10.1016/j.wombi.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/07/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Nicole Reilly
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW, Australia; Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia; School of Psychiatry, UNSW Medicine, NSW, Australia.
| | | | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, NSW, Australia; Australian Longitudinal Study on Women's Health, University of Newcastle, NSW, Australia
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW and Discipline of Addiction Medicine, University of Sydney, NSW, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital, Australia; School of Psychiatry, UNSW Medicine, NSW, Australia; Royal Hospital for Women, NSW, Australia
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Austin MPV, Reilly N, Mule V, Kingston D, Black E, Hadzi-Pavlovic D. Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment. Women Birth 2021; 35:e125-e132. [PMID: 33895108 DOI: 10.1016/j.wombi.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician. AIMS To assess the impact of psychosocial risk, current symptoms and mode of assessment on women's honesty of disclosure at psychosocial assessment. METHODS Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were 'always honest' and 'not always honest'. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk. FINDINGS 10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18-2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16-2.62, p<0.05; aOR=2.08, 95%CI: 1.11-3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest. DISCUSSION A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback. CONCLUSION Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.
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Affiliation(s)
- Marie-Paule V Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Royal Hospital for Women, Sydney, Barker St, Randwick, NSW 2031, Australia.
| | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia; Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia
| | - Victoria Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia; School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada
| | - Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia
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Why do some pregnant women not fully disclose at comprehensive psychosocial assessment with their midwife? Women Birth 2021; 35:80-86. [PMID: 33781709 DOI: 10.1016/j.wombi.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022]
Abstract
PROBLEM While comprehensive psychosocial assessment is recommended as part of routine maternity care, unless women engage and disclose, psychosocial risk will not be identified or referred in a timely manner. We need to better understand and where possible overcome the barriers to disclosure if we are to reduce mental health morbidity and complex psychosocial adversity. AIMS To assess pregnant women's attitude to, and reasons for non-disclosure at, comprehensive psychosocial assessment with their midwife. METHODS Data from 1796 pregnant women were analysed using a mixed method approach. After ascertaining women's comfort with, attitude to, and non-disclosure at psychosocial screening, thematic analysis was used to understand the reasons underpinning non-disclosure. FINDINGS 99% of participants were comfortable with the assessment, however 11.1% (N = 193) reported some level of nondisclosure. Key themes for non-disclosure included (1) Normalising and negative self-perception, (2) Fear of negative perceptions from others, (3) Lack of trust of midwife, (4) Differing expectation of appointment and (5) Mode of assessment and time issues. DISCUSSION Factors associated with high comfort and disclosure levels in this sample include an experienced and skilled midwifery workforce at the study site and a relatively advantaged and mental health literate sample. Proper implementation of psychosocial assessment policy; setting clear expectations for women and, for more vulnerable women, extending assessment time, modifying mode of assessment, and offering continuity of midwifery care will help build rapport, improve disclosure, and increase the chance of early identification and intervention. CONCLUSIONS This study informs approaches to improving comprehensive psychosocial assessment in the maternity setting.
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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11
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Reilly N, Kingston D, Loxton D, Talcevska K, Austin MP. A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 2020; 33:51-59. [DOI: 10.1016/j.wombi.2019.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
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Reilly N, Brake E, Kalra H, Austin MP. Insights into implementation of routine depression screening and psychosocial assessment in a private hospital setting: A qualitative study. Aust N Z J Obstet Gynaecol 2019; 60:419-424. [PMID: 31650543 DOI: 10.1111/ajo.13083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/06/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies continue to show that women who give birth in the private maternity sector are less likely to receive depression screening and psychosocial assessment as a routine component of maternity care. However, examples of successfully implemented routine psychosocial assessment programs are beginning to emerge, and there is great value in better understanding the factors that can contribute to the successful delivery of emotional health care in this context. AIM The aim of this study was to identify factors that facilitated successful implementation of antenatal psychosocial assessment in a private hospital setting. METHODS This study employed a qualitative research design. Semi-structured interviews were used to explore the views and experiences of health professionals involved in implementation of the program at the participating site. RESULTS Nine health professionals participated in the study (three midwives, three obstetricians, two managers and one mental health worker). Factors that facilitated successful implementation of the program were reflected in five key themes: (i) multidisciplinary support for the program; (ii) training and clinical supervision; (iii) allocation of sufficient resources; (iv) availability of local referral pathways; and (v) normalisation of the process. CONCLUSION This study shows that barriers to implementation of perinatal depression screening and psychosocial assessment are surmountable and will provide confidence to other services, that routine 'mental health assessment' as required under updated Medical Benefits Scheme items for obstetric services, can be successfully implemented and sustained in private hospital settings.
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Affiliation(s)
- Nicole Reilly
- Research Centre for Generational Health and Ageing, School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Elloise Brake
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Harish Kalra
- Raphael Services, St John of God Health Care Social Outreach, Ballarat, Australia.,University of Notre Dame, Ballarat, Australia
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia.,Royal Hospital for Women, Randwick, Australia
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13
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A comparison of the interviewer-administered phone and self-complete online versions of the computerized eMINI 6.0 in a sample of pregnant women. J Affect Disord 2019; 242:265-269. [PMID: 30236801 DOI: 10.1016/j.jad.2018.08.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/26/2018] [Accepted: 08/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study compares the prevalence rates of depressive and anxiety disorders identified during pregnancy using an interviewer-administered phone version and a self-complete online version of the computerized eMINI 6.0. METHODS 888 pregnant women completed the computerized eMINI 6.0 (interviewer-administered phone, n = 253; self-complete online, n = 635). RESULTS There were no significant differences in the proportions of women meeting eMINI 6.0 criteria for current major depression, any current anxiety disorder, or lifetime panic or depressive disorder, by mode of administration. However, a greater proportion of women in the interviewer-administered phone group than in the self-complete online group met criteria for current minor depression (2.0% vs 0.2%, p = .008). LIMITATIONS Study limitations include its non-randomized design, overall low prevalence of depressive and anxiety disorders in the sample and inclusion of only a select number of eMINI 6.0 modules. CONCLUSIONS This study demonstrated few differences in the rates of DSM-IV depressive and anxiety disorders identified between the interviewer-administered and self-administered versions of the eMINI 6.0. Findings provide preliminary support the practical value of self-completed computerized interviews in large scale studies examining common mental disorders in pregnant women.
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