Tools for perinatal mental health and psychosocial screening
Screening may take the form of a questionnaire with defined response options or may comprise of open-ended questions discussed with a health care provider. Screening is usually undertaken using pen and paper and more recently through digital tools such as the iCOPE digital perinatal mental health screening platform.
The iCOPE screening platform, developed by the Centre of Perinatal Excellent (COPE), includes the questions from the Edinburgh Postnatal Depression Scale (EPDS) and Antenatal Risk Questionnaire (ANRQ) and enables automated clinical scoring; it delivers timely reports to clinicians and patient record systems.
Mental health and psychosocial screening tools that have been validated are perceived as credible by health professionals, provide a framework for initiating conversations with mothers about sensitive topics and improve diagnosis and timely access to care (Willey et al. 2020). There are several established and validated screening tools that are recommended by the Australian clinical practice guidelines for mental health care in the perinatal period (National guideline) (Highet et al. 2023), which are routinely offered to women during pregnancy and in the postnatal period in Australia and aim to detect different aspects of mental health and psychosocial risk:
Depression risk is most commonly screened for using the Edinburgh Postnatal Depression Scale (EPDS) but may also be screened for using other tools such as the depression module of the Patient Health Questionnaire (PHQ-9), the Whooley Questions, the Kessler Psychological Distress Scale (K-10) and the Depression, Anxiety and Stress Scale (DASS). Perinatal mental health screening tools specific for First Nations women have also been developed including Part 1 of the Kimberley Mum's Mood Scale (KMMS), Baby Coming You Ready? (BCYR) and the Mount Isa Depression Scale.
Psychosocial risk factor screening is commonly conducted using the Antenatal/ Postnatal Risk Questionnaire (ANRQ/PNRQ) or Safe Start psychosocial questions. (See Safe Start Guidelines: Improving Mental Health Outcomes for Parents & Infants) Other tools include the ANRQ-Revised (ANRQ-R) (Reilly et al. 2021), Part 2 of the KMMS and BCYR. These screening tools ask about a range of psychosocial risk factors, including the mother’s mental health history, social support system and if they are experiencing or have ever experienced abuse or family violence.
Note – Family violence is a psychosocial risk factor that is not specifically asked by the ANRQ. To bridge this gap, the iCOPE screening platform, which includes the ANRQ, asks additional questions relating to perceptions of safety, and problems with drugs and alcohol within the relationship.
Anxiety risk is commonly determined through the anxiety-related items in the depression and psychosocial risk factor screening tool used. The Generalised Anxiety Disorder 7-Item Scale (GAD-7) may also be used.
Exploring and amplifying strengths and protective factors raised by a person may be a more effective way to promote mental health, rather than trying to reduce risk factors (KMMS 2023). For example, social support has been found to play a role in protecting against perinatal depression (Milgrom et al. 2019) and childbirth-related post-traumatic stress disorder (PTSD) (Ayers et al. 2016). Current research in Queensland is exploring the role of protective factors and potential benefits of their inclusion in perinatal mental health screening tools such as the iCOPE screening platform.
Things to consider
It should be noted that scoring high on a perinatal mental health screening tool does not represent a diagnosis.
Clinical screening tools allow health care providers to gather information about a patient to identify potential risk factors, and enable clinical decision-making to provide support, formal mental health assessment and referral.
Risk factors may be identified:
- by specific item(s) in the tool – for example, answering ‘Yes’ to the Antenatal Risk Questionnaire (ANRQ) question ‘Have you ever been sexually or physically abused?’ identifies a history of abuse.
- by a combination of items in the tool – for example, responses to items in the Edinburgh Postnatal Depression Scale (EPDS) are scored from zero to 3, and a combined score of 5 or higher for the items ‘I have blamed myself unnecessarily when things went wrong,’ ‘I have been anxious or worried for no good reason,’ and ‘I have felt scared or panicky for no very good reason,’ identifies a risk of anxiety.
- by overall score – for example, a total score for all items in the EPDS of 13 or higher identifies a risk of depression.
- by more than one tool – for example, both the ANRQ and EPDS have items that may identify a risk of anxiety.
Refer to the Glossary for more information about terms and clinical tools. This report focuses on mental health and psychosocial risk factor screening, which can also include screening for family violence. For more information about family violence data see Family, domestic and sexual violence: National data landscape 2022.
Ayers S, Bond R, Bertullies S and Wijma K (2016) ‘The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework’. Psychological Medicine, 46(6):1121–34, doi:10.1017/S0033291715002706.
Highet NJ, the Expert Working Group and Expert Subcommittees (2023 Effective Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline, Centre of Perinatal Excellence (COPE), accessed 26 September 2023.
Kimberley Mum’s Mood Scale (KMMS) (2023) KMMS Training Manual, accessed 17 August 2023.
Milgrom J, Hirshler Y, Reece J, Holt C, Gemmill AW (2019) ‘Social Support—A Protective Factor for Depressed Perinatal Women?’, International Journal of Environmental Research and Public Health, 16(8):1426, doi:10.3390/ijerph16081426.
Reilly N, Loxton D, Black E, and Austin M-P (2021) ‘The Antenatal Risk Questionnaire-Revised: development, use and test-retest reliability in a community sample of pregnant women in Australia’, Journal of Affective Disorders, 293:43–50, doi:10.1016/j.jad.2021.05.081.
Willey SM, Blackmore RP, Gibson-Helm ME, Ali R, Boyd LM, McBride J and Boyle JA (2020) ‘“If you don’t ask… you don’t tell”: Refugee women’s perspectives on perinatal mental health screening’, Women and Birth, 33(5):e429–e437, doi:10.1016/j.wombi.2019.10.003.