Evaluation of the BSI-18 for measurement of psychological distress in pregnant women

Abstract

IN PREGNANT WOMEN ASAD SHEIKH, RHONDA JOHNSON, MADHURI MULEKAR, CHERYL CRICHLEY, PATRICIA SCOTT, University of South Alabama, Obstetrics and Gynecology, Mobile, Alabama, University of Oklahoma, Department of Obstetrics and Gynecology, Oklahoma City, Oklahoma, University of South Alabama, Mobile, Alabama OBJECTIVE: Psychological distress (PS) is the emotional experience of an individual that may interfere with their ability to cope. It may not be evident to the health care provider until the patient reaches an observable crisis event. Obstetric care providers are frequently faced with management dilemmas of pregnant patients with possible psychological distress. Clinicians could greatly benefit from a rapid, simple, accurate and inexpensive screening tool to identify those patients in distress and to monitor therapy. The Brief Symptom Index – 18 (BSI-18) has been developed as a rapid (four minutes to complete) tool to screen for distress in cancer and psychiatric patients. We hypothesized that the distress scores on the BSI-18 and Brief Symptom Index (BSI) will be highly comparable in pregnant women also. STUDY DESIGN: 78 pregnant women attending the high risk clinic at the University of Oklahoma were enrolled. They were given the BSI test. A subset of 18 questions composing the BSI-18 was also separately analyzed. The degree of psychological distress was reported as the Global Severity Index (GSI). Data were analyzed by paired t-test, Chi-square, ANOVA, Pearson’s correlation coefficient and regression analysis. Differences were considered significant when P!0.05. RESULTS: The BSI-18 is an abbreviated form of the BSI and evaluates three symptom scales (depression, anxiety and somatization) and one global index (GSI). In contrast, the BSI measures nine symptom scales and three global indexes. The correlation between the BSI and BSI-18 was extremely strong (r = 0.98). Similarly, the scores for the anxiety and somatization subscales as well as the GSI were highly correlated between the two test forms (r = 0.95, r = 0.87 and r = 0.89 respectively). CONCLUSION: The results support the use of the BSI-18 in pregnancy as a psychological screening tool for distress. 283 LOWER BIRTHWEIGHTS IN GRAVID AFRICAN AMERICANS WITH DIABETES KALEE AHLIN, JENNIFER AHN, LAURA DIGIOVANNI, University of Chicago, OB/GYN, Chicago, Illinois OBJECTIVE: Maternal diabetes and maternal obesity are important risk factors for the development of fetal macrosomia. In contrast, certain racial ethnicities, particularly African Americans, are at increased risk for low birthweight infants. Our objective was to determine if African American ethnicity is a protective factor against macrosomia in pregnancies complicated with diabetes. STUDY DESIGN: We performed a retrospective chart review of all pregnancies complicated with diabetes at the University of Chicago from January 1, 1999-December 31, 2004. Inclusion criteria were: 1) singleton pregnancy, 2) gestational age 36 weeks at delivery, and 3) Diabetic White classification A-R. Subjects were classified by maternal ethnicity as Caucasian, African American, Hispanic, Asian or Other. A total of 767 patients met inclusion criteria for the study. We compared the differences in prevalence of macrosomia or birthweight across each ethnic group using univariant or multivariant analysis. RESULTS: Development of macrosomia (O4000 gm) between the different ethnic groups was not statistically significant (p=0.74). Univariate analysis also found similar birthweights in each ethnic group (p=0.21). However, in a multivariante regression analysis using baby weight, with race, age, Body Mass Index (BMI), hypertension and glycosylated hemoglobin as covariants, our African American patients had significantly lower birthweights compared with the referenced Caucasian group (3352 gm and 3395 gm, respectively, p=0.03). Our African American patients had a larger than average BMI (38.5GSD 9.04 kg/m) compared with other ethnic groups (BMI 33.1 GSD 6.48 kg/m) (p!0.001). CONCLUSION: There was no statistical difference in the development of macrosomia among each ethnic group. However, despite having significantly higher BMIs, the African American patients with pregnancies complicated by diabetes had smaller birthweight infants. This study suggests that ethnicity may be a protective factor against larger infants in gravid African American patients with diabetes.