Screening and pathways to maternal mental health care in a South African antenatal setting

Arch Womens Ment Health. 2013 Oct;16(5):371-9. doi: 10.1007/s00737-013-0343-1. Epub 2013 Apr 19.


In low-resource settings, a stepped care approach is necessary to screen and provide care for pregnant women with mental health problems. This study sought to identify screening items that were most robust at differentiating women experiencing psychological distress and requiring counselling [assessed by screening with the Edinburgh Postnatal Depression Scale (EPDS) and a Risk Factor Assessment (RFA)] from those with a psychiatric disorder as diagnosed by a psychiatrist. Case records of women in an antenatal mental health service in Cape Town were reviewed. Composite scores and individual items on screening scales (EPDS, RFA) of participants who qualified for counselling (n = 308) were compared to those of participants who were diagnosed with a psychiatric disorder (n = 58). All participants with a psychiatric disorder were diagnosed with either depression or anxiety disorders. These participants had higher mean scores on the EPDS and RFA than those who qualified for counselling (p < 0.01). Logistic regression and ROC analyses suggested that the best items to distinguish women with depression or anxiety from those qualifying for counselling were 'I have felt sad and miserable', 'I am not pleased about being pregnant' and 'I have had serious depression, panic attacks or problems with anxiety before' (sensitivity 0.655, specificity 0.750 for this combination of three items). A small number of items may be useful in screening for mental illness in pregnancy which requires higher levels of care. Such screening may contribute to a more efficient stepped care approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / diagnosis*
  • Anxiety / psychology
  • Counseling
  • Depression / diagnosis*
  • Depression / psychology
  • Female
  • Humans
  • Logistic Models
  • Mass Screening / methods*
  • Maternal Health Services / organization & administration
  • Maternal Health Services / statistics & numerical data
  • Mental Health Services / organization & administration
  • Mental Health Services / statistics & numerical data
  • Pregnancy
  • Psychiatric Status Rating Scales*
  • ROC Curve
  • Referral and Consultation / statistics & numerical data
  • Risk Factors
  • Sensitivity and Specificity
  • Socioeconomic Factors
  • South Africa
  • Stress, Psychological*
  • Surveys and Questionnaires
  • Young Adult