Screening for antenatal psychological distress

Abstract

Effective psychological screening within the perinatal period has been an increasing priority for maternity services. The screening questions recommended by the National Institute of Health and Clinical Excellence (NICE) guidance for antenatal care (2008) screen only for depression and do not give an indication of severity. This service development looked at staff confidence in psychological assessment after the provision of training. It also used the Hospital Anxiety and Depression Scale (HADS) ( Zigmond and Snaith, 1983 ) as a screening measure for anxiety and depression during the booking interview with a community midwife. It was found that training significantly increased staff confidence in their ability to identify and manage psychological distress. HADS is not validated in perinatal populations; trends suggest prevalence of antenatal anxiety in this sample is equal to that of antenatal depression. The questions sometimes referred to as the ‘Whooley questions’ ( Whooley et al, 1997 ) are identical to the Patient Health Questionnaire (PHQ-2) and will be referred to as such throughout this article. Comparison between the HADS and the PHQ-2 indicated that the latter is less sensitive to anxiety, especially when a woman scores in the borderline ranges.