The development of an ultra-short, maternal mental health screening tool in South Africa.

T Van Heyningen,S Honikman,M Tomlinson,L Myer,S Field

doi:10.1017/gmh.2019.21

T Van Heyningen, S Honikman + Show 3 more

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https://doi.org/10.1017/gmh.2019.21

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Abstract

The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation. A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis. The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78-0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%. This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.

Highlights

Approximately 10% of women in highincome countries (HIC) and more than 25% in low-and-middle-income countries (LMIC) are affected by mental disorders in the perinatal period (Fisher et al 2012; Howard et al 2014; World Psychiatric Association, 2015)
The unemployment rate was 55%, with 43% of women living below the Statistics South Africa (SSA) poverty line (Statistics South Africa, 2015) and 42% reporting food insecurity
Significant associations were found between major depressive episode (MDE) and anxiety diagnoses with food insecurity, having more than one child, having an unintended and unwanted pregnancy, suicidal ideation and behaviour, current use of substances other than alcohol as reported on the Mini-International Neuropsychiatric Interview (MINI), perceived lack of partner support, current experience of domestic violence or of past physical, sexual or emotional abuse, self-reported history of mental health problems and experience of major, adverse life events in the past year

Summary

Introduction

Approximately 10% of women in highincome countries (HIC) and more than 25% in low-and-middle-income countries (LMIC) are affected by mental disorders in the perinatal period (Fisher et al 2012; Howard et al 2014; World Psychiatric Association, 2015). The perinatal period is recognised as a time of increased risk for onset of mental health problems (National Collaborating Centre for Mental Health (NICE), 2014; Meltzer-Brody & Brandon, 2015) The impact of such morbidity includes adverse outcomes for pregnancy, disrupted maternal functioning, disordered mother-infant interactions; impaired growth and development as well as increased psychological, behavioural and cognitive difficulties in offspring (Glover & O’Connor, 2002; Hanlon et al 2009; Manikkam & Burns, 2012; Parsons et al 2012; Brittain et al 2015; Gentile, 2015; Herba et al 2016). Mental disorders during the perinatal period are associated with a higher prevalence of maternal suicidal ideation and behaviour (Onah et al 2016a; Orsolini et al 2016) These consequences are heightened in contexts of chronic poverty and social adversity, where there are multiple contributing risk factors and stressors (Howard et al 2014; Langer et al 2015; van Heyningen et al 2016)

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