From the Guidelines
Yes, there are several evidence-based questionnaires to assess maternal mental health during antenatal appointments, with the Edinburgh Postnatal Depression Scale (EPDS) being the most widely used and validated screening tool. The EPDS is a 10-item, self-reported measure that takes about 5 minutes to complete and screens for depression symptoms, despite its name, it's appropriate for both antenatal and postnatal periods 1. Other effective tools include:
- The Patient Health Questionnaire-9 (PHQ-9), which assesses depression severity
- The Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms
- The Whooley Questions, which consist of just two initial screening questions about mood and interest in activities
- The Antenatal Risk Questionnaire (ANRQ) for a more comprehensive assessment of psychosocial risk factors
These questionnaires have been evaluated in various studies, including those conducted in pregnant and postpartum women, and have demonstrated moderate to high accuracy in screening for anxiety and depression 1. The US Preventive Services Task Force has also recommended routine screening for depression in all adults, including pregnant women, using validated self-report screening measures such as the EPDS, PHQ-9, and Hospital Anxiety and Depression Scale 1.
Healthcare providers should implement these screenings at the first antenatal visit and at least once in each trimester, as early identification of mental health concerns allows for timely intervention, which can significantly improve outcomes for both mother and baby, as untreated maternal mental health conditions can affect pregnancy outcomes, mother-infant bonding, and child development 1.
From the Research
Evidence-Based Questionnaires for Maternal Mental Health
There are several evidence-based questionnaires that can be used to assess maternal mental health during antenatal appointments. Some of the most commonly used questionnaires include:
- Edinburgh Postnatal Depression Scale (EPDS) 2, 3, 4, 5
- Generalised Anxiety Disorder-7 item (GAD-7) 2, 4, 6
- Antenatal Risk Questionnaire (ANRQ-2A) 6
Validation of Questionnaires
These questionnaires have been validated in various studies to assess their effectiveness in screening for maternal mental health disorders. For example:
- The EPDS has been found to have a sensitivity of 75% and specificity of 87.6% in screening for postnatal depression 2
- The GAD-7 has been found to have a sensitivity of 61.3% and specificity of 72.7% in screening for generalized anxiety disorder in pregnant and postpartum women 4
- The ANRQ-2A has been found to have a sensitivity of 75% and specificity of 75% in screening for anxiety disorders in third trimester pregnancy 6
Comparison of Questionnaires
Some studies have compared the effectiveness of these questionnaires in screening for maternal mental health disorders. For example:
- A study found that the EPDS had a higher sensitivity and specificity than the GAD-7 in screening for postnatal depression 5
- Another study found that the ANRQ-2A had a higher sensitivity and specificity than the EPDS-3A in screening for anxiety disorders in third trimester pregnancy 6
Limitations and Future Directions
While these questionnaires have been found to be effective in screening for maternal mental health disorders, there are some limitations to their use. For example:
- The EPDS has been found to have limited validity in certain populations, such as women with a history of trauma 3
- The GAD-7 has been found to have limited sensitivity in screening for generalized anxiety disorder in pregnant and postpartum women 4
- Further research is needed to validate these questionnaires in diverse populations and to develop new questionnaires that can more accurately screen for maternal mental health disorders.