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Developing a Contextually Specific Maternal Mental Health Screening Tool

In order to facilitate entry in to care, a mental health screening process was designed to be integrated into routine history taking procedures as part of the first ‘booking’ antenatal visit. The Edinburgh Depression Scale (EDS) was used to screen for depression and anxiety symptoms as it has been validated in a wide range of settings globally, including in South Africa (Vythilingum et al. 2013). To supplement this tool, the Risk Factor Assessment (RFA), was developed, involving compiling 11 risk factors into a binary ‘yes/no’ questionnaire. These factors were drawn from local and global literature, as well as the experience of local health workers in the field. The RFA was introduced to detect contextual conditions that make emotional distress likely, due to concerns over the socio-cultural validity of symptom-related items on the EDS. Women qualified for referral for a counselling intervention on the basis of a positive EDS screen (>12, as per international convention and local validation studies) or on the basis of experiencing three or more risk factors on the RFA. Over time, it was noticed that maternity care staff struggled with the Likert-type format of the EDS, which requires more time and more complex score calculations than the RFA. Thus, the PMHP is in process of designing and validating a very brief ‘yes/no’ screen that includes symptom and risk items (Van Heyningen et al. 2014). All screening instruments have been translated and back-translated with health staff and service users into the three official languages of the province as well as French.

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