Preliminary experience aimed at identifying perinatal psychological discomfort in women at risk of obstetrics hospitalized in the department of Obstetrics

Journal title PSICOLOGIA DELLA SALUTE
Author/s Elisa Masserdotti, Silvia Tessarin, Maria Sofia Palmas, Margherita Capretti, Emanuela Beretta, Enrico Sartori, Rita Simonetti
Publishing Year 2022 Issue 2022/3 Language Italian
Pages 17 P. 137-153 File size 269 KB
DOI 10.3280/PDS2022-003011
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Through the following preliminary experience, we have tried to verify if the introduction of the mental health screening in the ***** obstetrics department proves to be effective in detecting the psychological discomfort of hospitalised women with obstetrical pathology. We have also tried to confirm its usefulness in preventing psychopathological outcomes. For this experiment, which aims at ensuring an adequate support for all women in need, 91 subjects were intercepted over 6 months in 2019 and 87 of them joined the screening programme. The following Operational Procedure was developed: identification of patients with pathological pregnancy who met the criteria for inclusion of the sample; presentation of the Department of Obstetric Psychology and delivery of the information brochure with refer-ences and contacts of the Structured Psychologist; filling of the informed consent; filling of the anamnestic form; first level of mental health screening through the General Health Ques-tionnaire (GENERAL HEALTH QUESTIONNAIRE GHQ-12), a self-administered ques-tionnaire. In case of positive result, a clinical in-depth interview was proposed for the second level of assessment, in addition to the administration of Patient Health Questionnaire-9 (PA-TIENT HEALTH QUESTIONNAIRE-9 (PHQ-9)) and General Anxiety Disorder-7 (GENERAL ANXIETY DISORDER-7 (GAD-7)) tests and the Risk Factors Sheet (modi-fied PDPI). In case of negative result, the possibility of a clinic meeting on request was nev-ertheless guaranteed. Finally, we present an emblematic clinical case to show how a hospital perinatal psychological health screening can allow us to detect women’s discomfort in advance, hopefully resulting in a fostering access to the psychological treatment.

Keywords: perinatal psychology, obstetrics, pregnancy at risk, perinatal discomfort, screening

  1. Adane A.A., Bailey H.D., Morgan V.A., Galbally M., Farrant B.M., Marriott R., ... & Shepherd C.C. (2021). The impact of maternal prenatal mental health disorders on stillbirth and infant mortality: a systematic review and meta-analysis. Archives of Women’s Mental Health, 24(4), 543-555.
  2. Altemus M., Neeb C.C., Davis A., Occhiogrosso M., Nguyen T. & Bleiberg K.L. (2012). Phenotypic Differences Between Pregnancy Onset and Postpartum-Onset Major Depressive Disorder. J Clin Psychiatry, 73(12), e1485-91.
  3. Antoniou E., Stamoulou P., Tzanoulinou M.D. & Orovou E. (2021, November). Perinatal Mental Health; The Role and the Effect of the Partner: A Systematic Review. Healthcare, 9(11), 1572. Multidisciplinary Digital Publishing Institute.
  4. American Psychiatric Association (2013). DSM- 5 Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing, Washington, DC (trad. it.: Manuale diagnostico e statistico dei disturbi mentali. Milano: Raffaello Cortina, 2014).
  5. Ammaniti M., Speranza A.M., Tambelli R., Odorisio F. & Vismara L. (2007). Sostegno alla genitorialità nelle madri a rischio: valutazione di un modello di assistenza domiciliare sullo sviluppo della prima infanzia. Infanzia e Adolescenza, 6(2): 67-83.
  6. Ayers S., Coates R. & Matthey S. (2015), Identifying perinatal anxiety. In Milgrom J. & Gemmill A. (Eds.), Identifying perinatal depression and anxiety: evidence-based practice in screening, psychosocial assessment and management (pp. 93-107). Hoboken: John Wiley & Sons.
  7. Austin M-P., Highet N. & the Expert Working Group (2017) Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence.
  8. Bellantuono C., Migliarese G., Maggioni F. e Imperatore G. (2007). L’impiego dei farmaci antidepressivi nel puerperio. Recenti Progressi in Medicina, 98 (1), 29-42.
  9. Bellantuono C. e Orsolini L. (2016). Uso di psicofarmaci nel periodo perinatale in P. Grussu e A. Bramante. Manuale di Psicopatologia Perinatale (pp. 419-441). Trento: Erickson.
  10. Biaggi A., Conroy S., Pawlby S. & Pariante CM. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disorders, 191, 62-7.
  11. Bick D. & Howard L. (2010), When should women be screened for postnatal depression?. Expert review of Neurotherapeutics, 10(2), 151-154. Retrived from:
  12. Byatt N., Hicks-Courant K., Davidson, A., Levesque R., Mick E., Allison J. & Moore Simas T. (2014). Depression and anxiety among high-risk obstetric inpatients. General Hospital Psychiatry, 36(6), 644-649.
  13. Blom EA., Jansen PW., Verhulst FC., Hofman A., Raat H., Jaddoe VW. & Tiemeier H. (2010) Perinatal complication increase the risk of postpartum depression. The Generation R study. BJOG, 117(11), 1390-1398.
  14. Brandon A.R., Trivedi M.H. & Hynan L.S. (2008) Prenatal depression in women hospitalized for obstetric risk. J Clin Psychiatry 69(4), 635-643.
  15. Chung T, Lau TK, Yip A, Chiu H, Lee D. (2001) Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine 63(5), 830-834. DOI: 10.1097/00006842-200109000-00017
  16. Cole J.C.M., Moldenhauer J.S., Berger K., Cary M.S., Smith H., Martino V., Rendon N. & Howell L.J. (2016). Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality. Archives of Womens Mental Health, 19, 443-453.
  17. Cole J.C.M., Olkkola M., Zarrin H., Berger K. & Moldenhauer J.S. (2018). Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 47(1), 84-93.
  18. Cooper P.J. & Murray L. (1998). Postnatal depression. Clinical Review, 316(7148), 1884-1886.
  19. Cumberbatch C.J., Birndorf C. & Dresner N. (2005) Psychological implications of high-risk pregnancy. Int J Fertil Womens Med., 50(4), 180-6.
  20. D’Agati S., Teodoro M.C., Tomaselli T., Barbera N., D’agati A. e Zarbo G. (2011). Depressione post-partum: valutazione clinica e medico-legale. Giornale italiano di ostetricia e ginecologia, 33(1), 24-29.
  21. Della Vedova A.M. e Cristini C. (2011). La promozione della salute psichica perinatale, Roma: Carocci.
  22. Denis A., Michaux P. & Callahan S. (2012). Factors implicated in moderating the risk for depression and anxiety in high risk pregnancy. Journal of Reproductive and Infant Psychology, 30(2), 124-134. DOI: 10.1080/02646838.2012.67702
  23. Dennis C.L., Falah-Hassani K. & Shiri R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analsysis. British Journal of Psichiatry, 210(5), 315-323.
  24. Dieter J.N.I., Field T., Hernandez-Reif M., Jones N.A., Lecanuet J.P., Salman F.A. & Redzepi M. (2010). Maternal depression and increased fetal activity. Journal of Obstetrics and Gynaecology, 21, 468-473. Retrived from: DOI: 10.1080/01443610120072009
  25. Dowse E., Chan S., Ebert L., Wynne O., Thomas S., Jones D. ... & Oldmeadow C. (2020). Impact of perinatal depression and anxiety on birth outcomes: a retrospective data analysis. Maternal and child health journal, 24(6), 718-726.
  26. El-Den S., O’Reilly C.L. & Chen T.F. (2015), A systematic review on the acceptability of perinatal depression screening. Journal of Affective Disorders, 188, 284-303.
  27. Elisei S., Lucarini E., Murgia N., Ferranti L. & Attademo L. (2013) Perinatal depression: a study of prevalence and of risk and protective factors. Psychiatria Danubina, 25 (Suppl. 2), S258-262.
  28. Fabbro N. e Tripani A. (2014). Ruolo di fattori di rischio psicosociali dei sintomi depressivi in gravidanza e nel postparto. Cognitivismo Clinico, 11(1), 62-76.
  29. Farren J., Jalmbrant M., Falconieri N., Mitchell-Jones N., Bobdiwala S., Al-Memar M., Tapp S., Van Calster B., Wynants L., Timmerman D. & Bourne T. (2020). Post traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. American Journal of Obstetrics & Gynecology, 222(4), 367.
  30. Fawcett E.J., Fairbrother N., Cox M.L., White I.R. & Fawcett J.M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian metaanalysis. The Journal of clinical psychiatry, 80(4), 1181.
  31. Fiskin G., Kaydirak M.M. & Oskay U.Y. (2017). Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews on Evidence-Based Nursing 14(1), 55-64.
  32. Gentile S. (2017). Untreated depession during pregnancy: short- and long-term effects in offspring. A systematic review. Neuroscience, 342, 154-166.
  33. Giardinelli L., Innocenti A., Benni L., Stefanini M. C., Lino G., Lunardi C., Svelto V., Afshar S., Bovani R., Castellini G. & Faravelli C. (2012). Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health, 15(1), 21-30.
  34. Gnambs T. & Staunfenbl T. (2018) The structure of the General Health Questionnaire (GENERAL HEALTH QUESTIONNAIRE GHQ-12): two meta-analytic factor analyses. Health Psychol Rev., 12 (2), 179-194. DOI: 10.1080/17437199.2018.1426484.
  35. Goldberg D.P. & Hillier V.F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine, 9(1), 139-145.
  36. Grussu P. e Bramante A. (2016). Manuale di psicopatologia perinatale. Profili psicopatologici e modalità di intervento. Trento: Erickson.
  37. Hasanjanzadeh, P., & Faramarzi, M. (2017). Relationship between maternal general and specific-pregnancy stress, anxiety, and depression symptoms and pregnancy outcome. Journal of clinical and diagnostic research: JCDR, 11(4), VC04.
  38. Hellberg C., Österberg M., Jonsson A., Fundell S., Trönnberg F., Jonsson M. & Skalkidou A. (2021). Important research outcomes for treatment studies of perinatal depression: systematic overview and development of a core outcome set. An International Journal of Obstetrics & Gynaecology, 128(13), 2141-2149.
  39. Howard L.M., Molyneaux E., Dennis C.L., Rochat T., Stein A. & Milgrom J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775-1788. DOI: 10.1016/S0140-6736(14)61276-
  40. Jones I., Chandra C.S., Dazzan P. & Howard L.M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799. DOI: 10.1016/S0140-6736(14)61278-2
  41. Kingston D., Austin M.P., Heaman M., McDonald S., Lasiuk G., Sword W. ... & Biringer A. (2015). Barriers and facilitators of mental health screening in pregnancy. Journal of affective disorders, 186, 350-357.
  42. Kingston D., Janes-Kelley S., Tyrrell J., Clark L., Hamza D., Holmes P., Parkes C., Moyo N., McDonald S. & Austin M.P. (2015). An Integrated Web-Based Mental Health Intervention of Assessment-Referral-Care to Reduce Stress, Anxiety, and Depression in Hospitalized Pregnant Women with Medically High-Risk Pregnancies: A Feasibility Study Protocol of Hospital-Based Implementation. JMIR Res Protocol, 4(1), 1-15.
  43. Kleiman K. (2017). Guarire dalla depressione postpartum. Indicazioni cliniche e psicoterapia. (Edizione italiana a cura di Rosa Maria Quatraro e Pietro Grussu). Trento: Edizioni Centro Studi Erickson.
  44. Kroenke K., Spitzer R.L. & Williams J.B. (2001), The patient health questionnaire-9 (PHQ-9): validity of a brief depression severity measure. Journal Gen Intern Med, 16(9): 606-613.
  45. Leach L.S., Poyser C. & Fairweather‐Schmidt K. (2017). Maternal perinatal anxiety: a review of prevalence and correlates. Clinical Psychologist, 21(1), 4-19.
  46. Marino M., Battaglia E., Massimini M. & Aguglia E. (2012). Risk factors in post partum depression. Riv Psichiatr, 47(3), 187-194. DOI: 10.1708/1128.12439.
  47. Martini J., Petzoldt J., Einsle F., Beesdo-Baum K., Hofler M., Wittchen H.U. (2015). Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: A prospective longitudinal study. J Affect Disorders, 175, 385-95.
  48. Matthey S. & Bilbao F. (2018). A comparison of the PHQ-2 and MGMQ for screening for emotional health difficulties during pregnancy. J. Affect Disorders, 234, 174-179.
  49. McDonagh M., Matthews A., Phillipi C., Romm J., Peterson K., Thakurta S., Guise J-M. (2014). Antidepressant treatment of depression during pregnancy and the postpartum period:evidence report/technology assessment no.216 (prepared by the Pacific Northwest Evidence-based Practice centre under contract no.290-2007- 10057-I), AHQR Pubblication, 14-E003-EF, Rockville, MD Agency for Healthcare Research and quality. DOI: 10.23970/AHRQEPCERTA216
  50. McCoyd J.L.M., Curran L. & Munch S. (2020). They Say, “If You Don’t Relax … You’re Going to Make Something Bad Happen”: Women’s Emotion Management During Medically High-Risk Pregnancy. Psychology of Women Quarterly, 44(1), 117-129. DOI: 10.1177/036168431988319
  51. Nemoda Z. & Szuf M. (2017). Epigenetic Alterations and Prenatal Maternal Depression. Birth Defects Res., 109(12), 888-897.
  52. NICE (2015). Antenatal and postnatal mental health: clinical management and service guidance: NICE Clinical Guideline 192, National Institute for Health and Clinical Excellence (NICE).
  53. National Istitute for Health and Clinical Excellence (2007). Antenatal and postnatal mental health. Clinical guideline, CG 45. www.nice.org.uk/nicemedia/live11004/30431/30431. pdf
  54. Palumbo G., Mirabella F. & Gigantesco A. (2017). Positive screening and risk factors for postpartum depression. European Psychiatry, 42, 77-85.
  55. Paschetta E, Berrisford G, Coccia F, Whitmore J, Wood A. G., Pretlove S. & Ismail K. M. K. (2014). Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol, 210(6), 501-509.e6.
  56. Pisoni C., Garofoli F., Baiardini I., Chryssoula T. & Stronati M. (2014). The development of parents-infant relationship in high-risk pregnancies and preterm birth. Journal of Pediatric and Neonatal Individualized Medicina, 3(2). DOI: 10.7363/030233
  57. Quatraro R.M. e Grussu P. (2018). Psicologia clinica perinatale, dalla teoria alla pratica. Trento: Edizioni Centro Studi Erickson.
  58. Rallis S., Skouteris H. & Milgrom J. (2014). A prospective examination of depression, anxiety and stress throughout pregnancy. Women Birth, 27(4), e36-e42.
  59. Rubertsson C., Hellstrom J., Cross M. & Sydsjo G. (2014). Anxiety in early pregnancy: Prevalence and contributing factors. Arch Womens Ment Health, 17, 221-228.
  60. Spitzer R.L., Kroenke K., Williams J.B. & Lowe B. (2006). A brief measure for assessing generalized anxiety disorder: the GENERAL ANXIETY DISORDER-7 (GAD-7). Arch Intern Med., 166 (10), 1092-1097.
  61. Stein A., Pearson R.M., Goodman S.H., Rapa E., Rahman A., MCallum M., Howard L. M., Pariante C.M. (2014). Effects of perinatal mental disorders on the fetus and child. The Lancet, 384(9956), 1800-1819. DOI: 10.1016/S0140-6736(14)61277-0
  62. Venkatesh K.K., Nadel H., Blewett D., Freeman M.P., Kaimal A.J. & Riley L.E. (2016). Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care. Am. J. Obstet. Gynecol., 215(4), 517.e1-8.
  63. Woody C.A., Ferrari A.J., Siskind D.J., Whiteford H.A. & Harris M.G. (2017). A systematic review and meta regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86-92.

Elisa Masserdotti, Silvia Tessarin, Maria Sofia Palmas, Margherita Capretti, Emanuela Beretta, Enrico Sartori, Rita Simonetti, Esperienza preliminare finalizzata all’individuazione del disagio psicologico perinatale in donne a rischio ostetrico ricoverate nel reparto di Ostetricia in "PSICOLOGIA DELLA SALUTE" 3/2022, pp 137-153, DOI: 10.3280/PDS2022-003011