‘Unexpected, intrusive but important’: Women's experiences of psychosocial assessment and depression screening

Abstract

This paper exploreswomen’s experience of psychosocial assessment and depression screening before and after birth. Background: In NSW health policy recommends psychosocial assessment and depression screening for all women at the antenatal booking visit and after birth. Few studies exist that explore women’s experience of assessmentand their subsequentdisclosureof sensitive information. Thiswas a qualitative ethnographic study. Datawere collected through observations of 34 women antenatally in the clinic with 18 midwives. Twenty of these women were then observed in interactions with 13 child and family health nurses (CFHNs) after birth in the home or the clinic environment. An observational tool (4D&4R) together with field notes was used to record observations and were analysed descriptively using content analysis and reporting frequencies of actions. Women also participated in faceto-face interviews. Field note and interview data was analysed thematically. Women reported it was important to be asked the psychosocial questions; however, they were surprised by the sensitive nature of the questions.Womenwho had a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; ‘Unexpected – a bit out of the blue’, ‘Intrusive – very personal questions’ and ‘Uncomfortable – digging over that old ground’, describe the impact that assessment had on women. Women’s experience of assessment and screening was influenced by the approach the midwife or nurse took when addressing a woman’s disclosure. This is reflected in the themes titled: Approach: ‘sensitivity and care’ and ‘being watched’. The findingsemphasise thatwomenwouldbenefit frombeingprepared for this assessment prior to and after birth. Ongoing training and support is needed for midwives (and nurses) to deliver care that is empathetic and sensitive to women who are disclosing personal information.