Outcome of routine psychosocial assessment: A pilot study of the relationship between risk factors, service utilisation and outcomes in women at 6 weeks and 12 months after birth

Abstract

In NSW health policy mandates psychosocial risk assessment and depression screening with routine care during pregnancy and following birth. This assessment is embedded in a network of support and health-related services for mothers, infants and families. Midwives conduct the assessment in pregnancy. To date there is no research reporting the outcomes of routine psychosocial assessment. The aim of this paper is to report on the relationship between psychosocial risk factors (identified in pregnancy), women's service utilisation (universal, specialist and mental health services), and mental health and parenting outcomes 12 months after birth. This was a pilot study to test the feasibility of conducting prospective longitudinal study of the outcomes of psychosocial assessment. Data were collected using a structured survey at five time points (4 weeks after the antenatal booking visit, at 36 weeks pregnant, and 6 weeks, 6 and 12 months postnatal). Results: 86 women participated in this study. In pregnancy, 13 (15.9%) were highly anxious, 9 (11%) had an EPDS greater than 13; and 32 (37%) were considered ‘at risk’ according to the Antenatal Risk Questionnaire (ANRQ). At 6 weeks postnatal, higher antenatal risk (ANRQ) was associated with a more negative experience of being a mother (r = 0.369). However at 12 months, antenatal risk ANRQ) showed no relationship with parenting outcomes. Regression analysis demonstrated that antenatal EPDS score and a woman's level of personal confidence predicted quality of life at 12 months (r2 = 0.332). Quality of Life and maternal–infant attachment at 12 months predicted women's experience of being a mother (r2 = 0.484). There was no relationship between service use and outcomes. High numbers of women were identified as at risk yet few took upservices. Midwives have a key role in ensuring women are referred appropriately and are encouraged to use services.