An innovative screen-and-advice model for psychopathology and psychosocial problems among urban pregnant women: an exploratory study

Abstract

Background: Increased adverse pregnancy outcomes related to psychiatric and psychosocial problems can be observed for urban areas when compared to national averages. We developed a personal digital assistant (PDA)-based self-report screening model that produces tailored intervention advices. After having adapted the model to local care pathways, we tested the reliability, validity and feasibility of the model in routine antenatal care. Methods: Observational study among pregnant women in a Dutch urban area included women with a booking visit. Women answered questions posed by the PDA-tool while waiting for their appointment. If the tool suggested specific interventions (screen result), this was discussed during booking visit. A randomly selected subsample of participants completed the questionnaire again at a subsequent pregnancy check (retest). After the study was conducted, prenatal caregivers and assistants were interviewed for feasibility judgments. Psychometric and diagnostic performance of this approach was established. Results: Response rate among invited pregnant women was 94% on weighted average (n = 621). Internal reliability ranged 0.88–0.90, test-retest reliability ranged 0.64–1.00. Positive predictive value was 86% and negative predictive value was 97%. No interpractice psychometrical differences were observed. Migrant women more often received an intervention advice than native women (p < 0.001). The approach was well accepted among prenatal caregivers for its time efficiency and patient-friendliness. Conclusion: Psychometric properties of our screen-and-advice tool were favorable under routine conditions, and the feasibility of this integral approach appeared good. The technical flexibility renders the model suitable for broader application. Local care pathways can easily be incorporated. We suggest implementation of this model in prenatal care in urbanized settings in order to make tailored mental healthcare broadly available.

Keywords::

• Healthcare system
• pregnancy
• psychiatry
• psychosocial problems
• screening

Acknowledgements

The obstetricians and midwives kindly provided opportunity for the screening through their practice assistants (Erasmus Medical Centre, the midwifery practices Rotterdam East and West and Barendrecht). Jaap Bakker and Ernie van der Weg from the Rotterdam Health Municipality provided local advice.

This paper was in part presented at the Annual Meeting of the Dutch Society of Psychiatrists, March 31, 2011. It was in part presented as poster at the Annual Meeting of the Dutch Society for Public Health (in Dutch: NCVGZ) on April 6, 2011.

Declaration of interest: The authors acknowledge ZonMW (grant no 100-002-032) who provided financial support for this study. There are no financial or other relationships that might lead to conflict of interests.

Current knowledge on this subject

• Despite the high prevalence of antenatal psychopathology and psychosocial problems, and evidence on their substantial impact on maternal and perinatal health, mental health problems often remain unnoticed by perinatal caregivers.

• Even if these problems are detected antenatally, perinatal caregivers often are unaware of the availability of interventions, where screen-positives can be referred to.

What this study adds

• We developed and tested a comprehensive screen-and-advice model for the detection and referral of pregnant women with psychopathology or psychosocial problems, including substance abuse.

• This screen-and-advice model showed good reliability and feasibility, and can easily be adapted to local healthcare systems or local care, and allows for broad application.