Abstract
BackgroundThe Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview.MethodsAcross 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability.ResultsPart 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them.ConclusionKMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.
Highlights
Mental health during and after pregnancy is important for the well-being of mother and infant
Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the Kimberley Mum’s Mood Scale (KMMS) by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria
KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders
Summary
Mental health during and after pregnancy is important for the well-being of mother and infant. Anxiety and depressive disorders affect 20% of Australian pregnant women and mothers within the first year post birth [1, 2]. A recent 20 year prospective Australian cohort study (382 women with 560 pregnancies) found that 85% of women with perinatal depression had mental health issues prior to pregnancy [13]. Few access mental health support early [15], screening and timely culturally appropriate early intervention for perinatal anxiety and depression could result in significant benefits. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview
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