Abstract
BackgroundHigh levels of stress due to diverse psychosocial factors have a direct impact on the mothers’ wellbeing during pregnancy and both direct and indirect effects on the fetus. In most cases, psychosocial risk factors present during pregnancy will not disappear after delivery and might influence the parent-child relationship, affecting the healthy development of the offspring in the long term.We introduce a short innovative prenatal assessment to detect psychosocial risk factors through an easy to use instrument for obstetrical medical staff in the daily clinical practice, the KINDEX Spanish Version.MethodsIn the present study midwives and gynecologists interviewed one hundred nineteen pregnant women in a public health center using the KINDEX Spanish Version. Sixty-seven women were then randomly selected to participate in an extended standardized validation interview conducted by a clinical psychologist using established questionnaires to assesses current stress (ESI, PSS-14), symptoms of psychopathology (HSCL-25, PDS) and traumatic experiences (PDS, CFV). Ethical approval was granted and informed consent was required for participation in this study.ResultsThe KINDEX sum score, as assessed by medical staff, correlated significantly with stress, psychopathology and trauma as measured during the clinical expert interview. The KINDEX shows strong concurrent validity. Its use by medical staff in daily clinical practice is feasible for public health contexts. Certain items in the KINDEX are related to the respective scales assessing the same risks (e.g.PSS-4 as the shorter version of the PSS-14 and items from the ESI) used in the validation interview.ConclusionsThe KINDEX Spanish Version is a valid tool in the hands of medical staff to identify women with multiple psychosocial risk factors in public health settings. The KINDEX Spanish Version could serve as a base-instrument for the referral of at-risk women to appropriate psychosocial intervention. Such early interventions could prove pivotal in preventing undesirable mother-child relationships and adverse child development.
Highlights
High levels of stress due to diverse psychosocial factors have a direct impact on the mothers’ wellbeing during pregnancy and both direct and indirect effects on the fetus
Concurrent validity: correlations between the KINDEX sum score and the global scores in the validation interview The KINDEX sum score positively correlated with the global stress score (r = .45; p ≤ .001), the global traumaload score (r = .38; p ≤ .001) and the global psychopathology score (r = .44; p ≤ .001)
KINDEX items’ association with the corresponding validation scales In relation to the items referring to mental health history, as illustrated in Table 5, results indicate that there are statistically significant differences between women who have ever received psychiatric diagnosis (n = 18) and women that had not (n = 49) in the scales of somatization (U = 255.5; p = .009) PTSD symptoms (U = 164.0; p ≤ .001) and depression (U = 284.0; p = .02) but no statistically significant differences were observed in the anxiety scale (U = 325.0; p = .09)
Summary
High levels of stress due to diverse psychosocial factors have a direct impact on the mothers’ wellbeing during pregnancy and both direct and indirect effects on the fetus. Psychosocial risk factors present during pregnancy will not disappear after delivery and might influence the parent-child relationship, affecting the healthy development of the offspring in the long term. There is ample evidence supporting the impact of different psychosocial risk factors on the unborn child [4,5] and the newborns later brain development [6]. 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 [9], Australia [10] and Canada [11]. Several risk factors have been identified as crucial for both maternal, fetal and later child development. Positively attached mothers have better prenatal health practices, such as abstinence from smoking, alcohol and drug abuse [20]. Several factors have been associated with elevated alcohol and drug consumption such as deteriorated mental health, physical health, peer and family relations, and educational status among others [23]
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