Abstract
BackgroundStress, depression, and anxiety affect 15% to 25% of pregnant women. However, substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. Moreover, pregnant women are often reluctant to disclose their mental health concerns to a healthcare provider. Identifying screening and assessment tools and procedures that are acceptable to both women and service providers, cost-effective, and clinically useful is needed.Methods/DesignThe primary objective of this randomized, parallel-group, superiority trial is to evaluate the feasibility and acceptability of a computer tablet-based prenatal psychosocial assessment (e-screening) compared to paper-based screening. Secondary objectives are to compare the two modes of screening on: (1) the level of detection of prenatal depression and anxiety symptoms and psychosocial risk; (2) the level of disclosure of symptoms; (3) the factors associated with feasibility, acceptability, and disclosure; (4) the psychometric properties of the e-version of the assessment tools; and (5) cost-effectiveness. A sample of 542 women will be recruited from large, primary care maternity clinics and a high-risk antenatal unit in an urban Canadian city. Pregnant women are eligible to participate if they: (1) receive care at one of the recruitment sites; (2) are able to speak/read English; (3) are willing to be randomized to e-screening; and (4) are willing to participate in a follow-up diagnostic interview within 1 week of recruitment. Allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment on a computer tablet, while those in the control group will complete the same assessment in paper-based form. All women will complete baseline questionnaires at the time of recruitment and will participate in a diagnostic interview within 1 week of recruitment. Research assistants conducting diagnostic interviews and physicians will be blinded. A qualitative descriptive study involving healthcare providers from the recruitment sites and women will provide data on feasibility and acceptability of the intervention. We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening.Trial registrationClinicalTrials.gov Identifier: NCT01899534.
Highlights
Stress, depression, and anxiety affect 15% to 25% of pregnant women
There are significant barriers that prevent the majority of pregnant and postpartum women from seeking mental healthcare and disclosing concerns. These include the stigma of mental health, lack of understanding of whether symptoms are abnormal or a typical pregnancy experience, having providers or support persons underestimate their symptoms and concerns, and fear that reporting symptoms will lead others to think that they will be an incompetent mother, prevent the majority of pregnant and postpartum women from seeking mental healthcare and disclosing concerns [15,16,17,18,19]. Such barriers may prevent women from accessing support on their own, only 4% of women refuse mental health screening when offered by healthcare providers [20,21]
We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening
Summary
Depression, and anxiety affect 15% to 25% of pregnant women. substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. These include the stigma of mental health, lack of understanding of whether symptoms are abnormal or a typical pregnancy experience, having providers or support persons underestimate their symptoms and concerns, and fear that reporting symptoms will lead others to think that they will be an incompetent mother, prevent the majority of pregnant and postpartum women from seeking mental healthcare and disclosing concerns [15,16,17,18,19] Such barriers may prevent women from accessing support on their own, only 4% of women refuse mental health screening when offered by healthcare providers [20,21]
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