Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version.

Andria Spyridou,Martina Ruf-Leuschner,Maggie Schauer

doi:10.1186/s12884-015-0462-y

Andria Spyridou, Martina Ruf-Leuschner + Show 1 more

Open Access

https://doi.org/10.1186/s12884-015-0462-y

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Abstract

BackgroundPrenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.MethodsTwo obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.ResultsSignificant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.ConclusionsPrenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.

Highlights

Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care
We examine the referral accuracy of the medical staff through comparisons between the participants that were referred and those that were not with regard to the KINDEX (Mann–Whitney U test) sum score and the global scores of stress, psychopathology and trauma-load
Concurrent validity: correlations between the KINDEX sum score and the global scores in the validation interview To examine the concurrent validity of the KINDEX, a sum score was calculated including the 27 dichotomous items (Mdn = 4.0, M = 4.76, min = 0, max = 13, and SD = 2.66)

Summary

Introduction

Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. Psychological and social risk factors existing during the prenatal period increase the risk of adverse obstetrical, neonatal and postnatal outcomes. Their persistence into the postnatal period compromises positive motherchild interaction and presents further challenges to the child and their emotional, behavioral and social development [2,3] as well as neuropsychological development [4,5]. There are only a few studies reporting the development, evaluation and implementation of screening tools for psychosocial risk factors in pregnant women and subsequent intervention and prevention programs in community health centers in the U.S [8], Australia [9] and Canada [10]

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