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Quarter of pregnant women have mental health problems

Simple questions can identify problems, say researchers

Adrian O'Dowd

Thursday, 04 January 2018

Around a quarter of pregnant women have mental health problems – more common than the fifth of women previously thought – suggest a King’s College London study,* published today in the British Journal of Psychiatry.

However, researchers carrying out what they described as the first UK study to examine the prevalence of mental health problems or mental disorders when seen by a midwife for pregnancy care, found that two simple questions could help identify these problems so that women could be treated.

It is already known that mental illness during pregnancy is associated with adverse outcomes for women, the pregnancy itself, and for the child from birth through to adolescence.

Health professionals are therefore keen to diagnose these disorders as early as possible.

For their National Institute for Health Research (NIHR) funded study, researchers from King’s College London sought to establish the best way of identifying problems.

The researchers recruited 545 pregnant women, over the age of 16, attending their antenatal booking appointment at an inner city maternity service in south-east London between November 2014 and June 2016.

They found that when interviewed with a diagnostic gold standard interview, a quarter of women had a mental illness including depression (found in 11%) anxiety (found in 15%), eating disorders (2%), obsessive-compulsive disorder (2%), PTSD in just under 1% and less commonly, bipolar disorder and other disorders.

The study went on to evaluate how well a two-question screen (known as the Whooley questions) which is asked by midwives, identified these disorders and compared it with a 10-item self-complete questionnaire known as the Edinburgh Postnatal Depression Scale (EPDS), and compared both methods with a gold standard diagnostic interview.

Results showed that the two-questions asked by midwives performed similarly well in identifying whether a woman had “any disorder” compared with the 10-question self-complete EPDS measure.

There was also evidence that identification of depression was more difficult to identify in older women than younger women.

Report author Professor Louise Howard of the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, said: “In clinical practice, maternity professionals need to identify whether or not a woman has any mental disorder, not only mood disorders which until recently have been the main focus of concern.

“It is therefore encouraging that, in this study, there was little difference in diagnostic accuracy between the commonly used tools – the Whooley questions and the EPDS - in identifying a mental disorder.

“This study supports the NICE recommendation that women should be asked, by a non-judgemental and supportive health professional, at all contacts in pregnancy and after birth about their emotional wellbeing and are given the opportunity to respond to these structured questions (the Whooley or the EPDS).

“A positive identification then needs to be followed by a clinical assessment by an appropriate health practitioner to establish the clinical diagnosis and appropriate intervention.”

* Howard LM, Ryan, EG, Trevillion K, et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. The British Journal of Psychiatry (2018) 212, 50–56. DOI: 10.1192/bjp.2017.9

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