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3 results

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

  • T. van Heyningen, L. Myer, M. Tomlinson, S. Field, S. Honikman
  • Journal:
    Global Mental Health / Volume 6 / 2019
    Published online by Cambridge University Press:
    07 October 2019, e24
    • Article
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      • Open access
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  • Purpose.

    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.

    Methods.

    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.

    Results.

    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%.

    Conclusion.

    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.

  • CHAPTER 5 - Antenatal fetal abnormality screening

    • By Donna Kirwan, NHS Fetal Anomaly Screening Programme, UK National Screening Committee, Alan Cameron, Southern General Hospital
  • Edited by Tahir Mahmood, Philip Owen, Sabaratnam Arulkumaran, Charnjit Dhillon
  • Book:
    Models of Care in Maternity Services
    Published online:
    05 July 2014
    Print publication:
    01 November 2010, pp 48-58

  • Summary

    To bring conformity at a national level, the UK National Screening Committee integrated different screening programmes into three main domains, each reflecting the stages of the health screening lifecycle. These domains are the fetal, maternal and child health group, the adult screening and cancer screening programmes. High-quality guidance, specifically policy and programme standards, is a necessity for trusts offering a screening service and, for easy access. There is much commonality between the Down syndrome screening and fetal anomaly screening programme standards, in that good screening programmes need a central coordinating group. In understanding the complexities of the woman's journey through the Down syndrome and ultrasound screening system, a number of care pathways have been produced. Since 2001, a succession of national audits has been undertaken that have proved fruitful in terms of improving services. The past 30 years have seen astonishing advances in antenatal screening.

  • Antenatal screening in the community: the views and experience of women in one general practice

  • Jill E. Thistlethwaite, Joanne Jordan
  • Journal:
    Primary Health Care Research & Development / Volume 1 / Issue 1 / January 2000
    Published online by Cambridge University Press:
    31 October 2006, pp. 29-38
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  • The publication of the Department of Health's 1993 report Changing Childbirth has prompted major changes in the organization of maternity care, with an emphasis on returning antenatal care to the community. Serum screening for Down's syndrome (triple test) is usually carried out and followed up in secondary care, and work relating to the psychosocial effects of the test has been hospital-based. The aims of this study were to examine the views of women regarding the process and effects of delivering the test as part of routine general practice-based antenatal care, with a view to considering how this care might be most appropriately managed. We sent a questionnaire to all women registered with a fundholding practice who were offered the triple test between 1992 and 1997. The main outcome measures were satisfaction with the way in which the test was offered, what women understood by positive/negative results, why some women declined the test, and satisfaction with obtaining results/follow-up. The response rate was 60.7%. The majority of women were satisfied with the way in which the test was discussed, but there was ambivalence with regard to the procedure for receiving results, including the counselling offered. Confusion over the meaning of the results (particularly negative results) was apparent. The test caused anxiety in many women. The need for continuity of advice and support when women are subsequently referred to secondary care for further tests was highlighted. The majority of women wish the test to be available for all. The conclusion we draw is that no abnormalities have been detected during the study period, raising questions about cost-effectiveness. However, the majority of women view the test as a means of making informed decisions about their pregnancies. Although limited to one practice, the issues associated with a broad range of aspects of care identified through an analysis of the experience both of women declining the test and those accepting it provide important insights into the practicalities of delivering antenatal screening tests in primary care.