Abstract
BackgroundMajor international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges.ObjectiveThe primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women’s preferences for e-screening and disclosure of mental health concerns.MethodsPregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin’s tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs.ResultsOf the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women’s disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure.ConclusionsThe findings suggest that mental health e-screening is feasible and acceptable to pregnant women.Trial RegistrationClinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb)
Highlights
The Need for Mental Health ScreeningDepression and anxiety are among the most common morbidities in pregnancy, with prevalence rates of 13%-29% [1,2,3], and are the leading causes of maternal mortality in Western countries [4]
To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P
In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure
Summary
The Need for Mental Health ScreeningDepression and anxiety are among the most common morbidities in pregnancy, with prevalence rates of 13%-29% [1,2,3], and are the leading causes of maternal mortality in Western countries [4]. In the absence of routine screening, mental health problems are severely underdetected and undertreated in perinatal settings [12,13]. This is, in part, due to the fact that the majority of pregnant and postpartum women do not volunteer information about their mental health without being prompted by a perinatal care provider [14,15,16,17,18]. Our studies have identified other common barriers that deter women from self-identifying mental health problems, including “false” reassurance that they have received from friends or family, not knowing whether their symptoms are “normal” or not during pregnancy, and stigma-induced concerns such as not wanting their care provider to see them as depressed or anxious and not wanting to be seen as a bad mother [19].
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