Comparing the Acceptability, Clinical-, and Cost-effectiveness of Mental Health E-screening to Paper-based Screening in Pregnant Women: a Randomized, Parallel-group, Superiority Trial

Abstract

Substantial barriers to prenatal mental health screening exist. The primary objective of this randomized controlled trial is to evaluate the acceptability of computer tablet-based prenatal screening compared to paper-based screening. Secondary objectives are to compare the two screening modes on: (1) detection of depression/anxiety symptoms; (2) disclosure of symptoms; (3) factors associated with acceptability, and disclosure; (4) psychometric properties of the e-version of the tools; and (5) cost-effectiveness. Pregnant women were recruited from maternity clinics in an urban Canadian city, and were eligible if they were: 1) able to speak/read English; 2) willing to have a diagnostic interview within 1 week. Allocation was by computer-generated randomization. Women in the intervention group completed screening on a computer tablet and those in the control group completed the same assessment in paper-based form. Intention-to-treat analyses compared groups on primary and secondary outcomes. Multivariable logistic regression will identify predictors of intervention acceptability and disclosure. Preliminary Results – Recruitment was completed on December 8, 2014 (n=587). Mean age of women was 28.7 years (SD 4.7) with 96% partnered and 77% completing at least some post-secondary education. One-third (32.3%) had been treated previously for a mental health problem. Over 90% of women in the intervention and control groups indicated they found/would find computer-based screening acceptable and could fully disclose their concerns. No significant differences in mean depression or anxiety scores were found between groups. Additional results to be generated for presentation Implications Clinical and cost data will inform approaches to routine prenatal mental health screening.