Identifying those at risk

The perinatal period (including pregnancy and the following year) is a time of great change in a woman’s life, and it is common for women to experience a wide range of emotions. For many women, feelings of worry and stress resolve by themselves. But in some women, pregnancy and early parenthood can trigger symptoms of more serious mental health problems. Health professionals play a key role in identifying those at risk.

Some women may be more vulnerable to mental health disorders in the perinatal period due to a combination of biological, genetic, physiological or social factors.

The risk is greater for women who have had mental health problems before, do not have enough emotional or practical support, or have been through difficult times (eg family problems, abuse or loss). Drug and alcohol use can also contribute to the development of mental health disorders.

Psychosocial risk assessment

Psychosocial risk factors are identified by asking a series of questions. This enquiry aims to identify psychosocial risk factors without detracting from the normal experiences of pregnancy and motherhood or highlighting the potential for depression and related disorders to occur in the perinatal period.

When to assess for psychosocial risk

As early as practical in pregnancy and 6–12 weeks after a birth, all women should be asked questions around psychosocial factors as part of normal care. If a woman confirms the presence of psychosocial factors, she should be asked whether she would like help with any of these issues.

How to assess psychosocial risk

Psychosocial risk can be assessed by asking a series of questions which reflect known riskfactors. The 2017 Clinical Guideline recommends that if a tool is used to assess psychosocial risk, that the Antenatal Risk Questionnaire (ANRQ) is used.  The ANRQ is a scale that calculates an overall risk score based on a woman’s response to as series of questions assessing aspects of psychosocial risk.

Instructions of how to use the ANRQ, the original ANRQ questionnaire template and ANRQ scoring guide can be downloaded in the links below.

ANRQ Instructions

ANRQ _Questionnaire*

ANRQ Scoring Guide

*Note:  This is the original ANRQ questionnaire which does not contain questions to enquire about family violence, drug and alcohol use or adaption to the postnatal period (see below).

Assessing family violence, drug and alcohol use and adaption to the postnatal context

It is important to recognise that the ANRQ did not include questions pertaining to Family Violence or Drug and Alcohol use (as these questions were asked at other times on the antenatal care process).

It is therefore recommended that these questions are also asked alongside the ANRQ as part of the risk assessment process. To support this we have added these questions to the existing ANRQ questionnaire (see links below).

For those health professionals assessing risk in the postnatal period, we also recommend asking additional items pertaining to adaption to the birth and postnatal period through the inclusion of three additional items – as displayed in the postnatal questionnaire below.

ANRQ Questionnaire with D&A and Family violence questions (recommended for use antenatally)

ANRQ Questionnaire with D&A, Family violence and postnatal items (recommended for use postnatally).

 

See also

When follow-up care is required