Summary
Objectives
To assess the value of the Antenatal Risk Questionnaire (ANRQ) as a predictor of postnatal
depression, to evaluate its acceptability to pregnant women and midwives, and to consider
its use as part of a model for integrated psychosocial risk assessment in the antenatal
setting.
Method
This paper further analysed published data from the Pregnancy Risk Questionnaire in
a sample of 1196 women. We extracted 12 items from the original 23 item Pregnancy
Risk Questionnaire to assess how the shorter ANRQ would perform, and undertook the
analysis in the subset who were administered the Composite International Diagnostic
Interview (CIDI) at 2 or 4 months postpartum to assess for major depression (N = 276). We also sampled a subset of pregnant participants (N = 378) and midwives (N = 44) to assess the tool's acceptability to these groups respectively.
Findings
ROC curve analysis for the ANRQ yielded an acceptable area under the curve of 0.69.
The most ‘clinically’ useful cut off on the ANRQ was a score of 23 or more, yielding
a sensitivity of 0.62 and specificity of 0.64 with positive predictive value of 0.3.
The odds that a woman scoring 23 or more on the ANRQ is also a case was 6.3 times
greater than for a woman scoring less than 23. Acceptability of the ANRQ was high
among both women and midwives.
Conclusion
The ANRQ is a highly acceptable self-report psychosocial assessment tool which aids
in the prediction of women who go on to develop postnatal depression. In combination
with a symptom based screening measure (e.g., the Edinburgh Postnatal Depression Scale)
and routine questions relating to drug and alcohol use and domestic violence, the
ANRQ becomes most useful as a key element of a “screening intervention” aimed at the
early identification of mental health risk and morbidity across the perinatal period.
Evaluation of this model in terms of clinical outcomes remains to be undertaken.
Keywords
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References
beyondblue: the national depression initiative. National Action Plan for Perinatal Mental Health 2008. http://wwwbeyondblueorgau/indexaspx?link_id=4665&tmp=FileDownload&fid=1057 [accessed September 2009].
National Institute for Health and Clinical Excellence (NICE). Antenatal and postnatal mental health: The NICE guidelines on clinical management and service guidance CG45. National Collaborating Centre for Mental Health The British Psychological Society & The Royal College of Psychiatrists; 2007.
Austin M-P, Highet N, and the Guideline Expert Advisory Committee. The beyondblue clinical practice guidelines for depression and related disorders — anxiety, bipolar disorder and puerperal psychosis — in the perinatal period. A guideline for primary care health professionals providing care in the perinatal period. Melbourne: beyondblue: the national depression initiative; 2011.
- Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting.Medical Journal of Australia. 2007; 186: 364-367
- Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality.British Medical Bulletin. 2003; 67: 219-229
- Antenatal anxiety predicts child behavioural/emotional problems independently of postnatal depression.Journal of the American Academy of Child and Adolescent Psychiatry. 2002; 41: 1470-1477
- Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care.Psychosomatic Medicine. 2006; 68: 938-946
- Association between life stress during pregnancy and infant crying in the first six months postpartum: a prospective longitudinal study.Early Human Development. 2006; 82: 341-349
- Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style.Journal of Affective Disorders. 2005; 84: 15-24
- Effects of early maternal depression on patterns of infant–mother attachment: a meta-analytic investigation.Journal of Child Psychology and Psychiatry. 2000; 41: 737-746
- Maternal depression and infant temperament characteristics.Infant Behavior and Development. 2008; 31: 71-80
- The effect of postnatal depression on mother–infant interaction, infant response to the still-face perturbation, and performance on an instrumental learning task.Development and Psychopathology. 2004; 16: 1-18
- The impact of postnatal depression and associated adversity on early mother–infant interactions and later infant outcome.Child Development. 1996; 67: 2512-2526
- Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding.Archives of Women's Mental Health. 2006; 9: 273-278
- Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and gender.Infant Behavior and Development. 2005; 28: 407-417
- The impact of postnatal depression on infant development.Journal of Child Psychology and Psychiatry. 1992; 33: 543-561
- The mediating role of maternal responsiveness in some longer term effects of postnatal depression on infant development.Infant Behavior and Development. 2004; 27: 443-454
- Depression in first-time mothers: mother–infant interaction and depression chronicity.Developmental Psychology. 1995; 31: 349-357
- Postnatal depression and child outcome at 11 years: the importance of accurate diagnosis.Journal of Affective Disorders. 2008; 197: 241-245
- Perceived and observed mother–child interaction at time of hospitalization and release in postpartum depression and psychosis.Archives of Women's Mental Health. 2008; 11: 49-56
- Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study.Journal of Affective Disorders. 2007; 97: 145-154
- Psychosocial and psychological interventions for treating postpartum depression.Cochrane Database of Systematic Reviews. 2007; 4: CD006116
- Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.Birth. 2006; 33: 210-220
- Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother–child relationship and child outcome.British Journal of Psychiatry. 2003; 182: 420-427
- Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomised controlled trial.Journal of Paediatrics and Child Health. 2000; 36: 555-562
- Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders.Acta Psychiatrica Scandinavica. 2005; 112: 97-104
- Detection of postnatal depression: development of the 10 item Edinburgh postnatal depression scale.British Journal of Psychiatry. 1987; 150: 782-786
- A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women.BMC Public Health. 2006; 6: 211
Buist A, Bilszta J. The beyondblue national postnatal depression program, prevention and early intervention 2001–2005, Final Report. Volume 1: National Screening Program. beyondblue: the national depression initiative; 2006.
- Acceptability of routine screening for perinatal depression.Journal of Affective Disorders. 2006; 93: 233-237
- Acceptability of antenatal screening for depression in routine antenatal care.Australian Journal of Advanced Nursing. 2007; 24: 14-18
- The development and validation of a predictive index for postpartum depression.Psychological Medicine. 1996; 36: 627-634
- Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire.Acta Psychiatrica Scandinavica. 2005; 112: 310-317
- Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial.Canadian Medical Association Journal. 2005; 173: 253-259
- Postpartum depression: identification of women at risk.British Journal of Obstetrics and Gynaecology. 2000; 107: 1210-1217
- Antenatal screening for postnatal depression: a systematic review.Acta Psychiatrica Scandanavica. 2003; 107: 10-17
- Antenatal psychosocial assessment for reducing antenatal and postnatal mental health morbidity.Cochrane Database of Systematic Reviews. 2008; 4 (doi:10.1002/14651858.CD005124.pub2, Art. no.: CD005124)
- The use of the Antenatal Psychosocial Health Assessment (ALPHA) tool in the detection of psychosocial risk factors for postpartum depression: a randomised controlled trial.Journal of Obstetrics and Gynaecology Canada. 2006; 28: 873-878
- Routine psychosocial assessment of women in the antenatal period: frequency of risk factors and implications for clinical services.Archives of Women's Mental Health. 2004; 7: 223-229
- Rates and risk of post-partum depression: a meta-analysis.International Review of Psychiatry. 1996; 8: 37-54
WHO. World Health Organisation CIDI: Autoversion 2.1, Administrator's Guide. Sydney: World Health Organisation; 1997.
- Rates and risk of postpartum depression: a meta-analysis.International Review of Psychiatry. 1996; 8: 37-54
- Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.Biometrics. 1988; 44: 837-845
- Evaluating medical tests: objective and quantitative guidelines.Sage Publications, Newbury Park, CA1992
- Women's views of being screened for postnatal depression.Community Practice. 2006; 79: 363-367
- The impact on midwives of undertaking screening for domestic violence: focus group findings.Birth Issues. 2005; 14: 49-56
- Midwives’ perceptions and experiences of routine enquiry for domestic violence BJOG.An International Journal of Obstetrics & Gynaecology. 2003; 110: 744-752
- Antenatal psychosocial risk assessment project.Australian College of Midwives Inc Journal. 2000; 13: 7-13
- Midwives’ emotional wellbeing: impact of conducting a structured, antenatal psychosocial, assessment (SAPSA).Women and Birth. 2009; 22: 82-88
- Screening for depression in adults: a summary of the evidence for the U.S, Preventive Services Task Force.Annals of Internal Medicine. 2002; 136: 765-776
Jones CJ, Creedy DK, Gamble JA. Australian midwives’ awareness and management of antenatal and postpartum depression. Women and Birth. doi:10.1016/j.wombi.2011.03.001.
Department of Health and Ageing. National perinatal depression initiative 2008–2013. http://wwwhealthgovau/internet/main/publishingnsf/Content/mental-perinat [accessed May 2011].
beyondblue: the national depression initiative. beyondblue online learning. beyond babyblues: detecting and managing perinatal mental health disorders in primary care. http://thinkgpcomau/beyondblue [accessed May 2011].
beyondblue: the national depression initiative. State and territory perinatal mental health training programs. http://wwwbeyondblueorgau/indexaspx?link_id=941193 [accessed May 2011].
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. College statement C-Gen 11: perinatal depression. July 2010. http://wwwranzcogeduau/fellows/collegestatementsshtml [accessed May 2011].
- A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings.Archives of Womens Mental Health. 2008; 11: 307-317
- Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis.Mayo Clinic Proceedings. 2010;
- Childhood sexual abuse: a risk factor for postpartum depression?.Australian and New Zealand Journal of Psychiatry. 1995; 29: 604-608
Article info
Publication history
Published online: July 18, 2011
Accepted:
June 23,
2011
Received in revised form:
May 30,
2011
Received:
April 27,
2011
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2011 Published by Elsevier Inc.
