Edinburgh Napier University

  Background: Because of the considerable prevalences of reduced antenatal emotional wellbeing including depression, general anxiety and childbirth-related anxiety, and appreciating the time constraints that midwives perceive to routinely assess women’s antenatal emotional wellbeing, it is important that midwives can identify women with, depression, anxiety and/or a more severe fear of birth with an easy to administer, validated tool.

Aim(s): To investigate the validity and the diagnostic accuracy of (i) the two Whooley items compared with the Edinburgh Depression Scale screening and the State-Trait Anxiety Inventory, and (ii) the two-item Fear of Childbirth Scale (FOBS) compared with the 16-item Tilburg Pregnancy Distress Scale.

Methods: A diagnostic accuracy study was performed, including 829 Dutch women with uncomplicated pregnancies. Sensitivity, specificity, positive and negative predictive values and accuracy and discriminant ability were determined.
Results: The Whooley items showed a higher specificity than sensitivity. The Whooley items had a low to moderate predictive ability for depression, trait-anxiety and a good ability for negative case-finding. The Whooley items were accurate in identifying depression and trait-anxiety. The FOBS showed a higher specificity than sensitivity to detect fear of childbirth. The FOBS items had a good predictive ability for fear and worries about the forthcoming birth and a conclusive ability for negative case-finding. The FOBS showed good accuracy.

Discussion: The Whooley items and the FOBS proved to be able to report how effective the case-finding questions are in identifying women without depression and trait and state anxiety (ruling out).

Implications and future perspectives: The findings indicate the potential for midwives to use four case-finding questions during antenatal care, to effectively assess relevant aspects of antenatal emotional wellbeing of Dutch women with uncomplicated pregnancies.