The use of the Antenatal Psychosocial Health Assessment (ALPHA) tool in the detection of psychosocial risk factors for postpartum depression: a randomized controlled trial.
OBJECTIVE
Eliciting known risk factors for postpartum depression (PPD) during pregnancy may enable primary health care providers to identify women at increased risk of becoming depressed. The purpose of this study was to examine how well the Antenatal Psychosocial Health Assessment (ALPHA) form identified antenatal risk factors for PPD, compared with routine care, in a sample of pregnant women.


METHODS
A randomized controlled trial was conducted to assess the effectiveness of the ALPHA form in detecting antenatal risk factors associated with the adverse postpartum outcomes of postpartum depression, intimate partner violence, child abuse, and couple dysfunction. The participants were primary antenatal care providers--family physicians, obstetricians, and midwives--from four diverse communities in Ontario. These providers were matched and then randomly allocated into the intervention group, who used the ALPHA form, or into the control group, who administered usual care. In total, 227 pregnant women were recruited: 98 in the ALPHA group and 129 in the control group. The data presented in this paper are from a secondary analysis focusing on PPD as the outcome.


RESULTS
Providers randomized to the ALPHA group identified a statistically significantly higher proportion of women with antenatal psychosocial risk factors for PPD (36% vs. 26%) and a significantly higher number of risk factors per woman compared with the control group (mean 2.1 vs.1.8) (z = -1.96, P = 0.05). Providers in the ALPHA group also identified significantly more women having a "previous history of depression" (16% vs. 6%) (chi2 = 5.243, df = 1, P = 0.03) and "[having] witnessed or experienced abuse as a child" (17% vs. 3%) (chi2 = 12.488, df = 1, P = 0.0005), which are both established risk factors for PPD.


CONCLUSIONS
The ALPHA provides a systematic means of eliciting antenatal psychosocial risk factors for PPD for primary care providers, and it may be particularly useful for raising and discussing sensitive issues. The detection of depressive symptomatology during pregnancy remains problematic, however, and detection may be improved by administering a simple standardized measure of depressive symptomatology during routine antenatal care.
Blackmore
Emma Robertson
ER
University of Rochester, Rochester NY.
Carroll
June
J
Department of Family and Community Medicine, University of Toronto ON.
Reid
Anthony
A
Department of Family and Community Medicine, University of Toronto ON.
Biringer
Anne
A
Department of Family and Community Medicine, University of Toronto ON.
Glazier
Richard H
RH
Department of Family and Community Medicine, University of Toronto ON.
Midmer
Deana
D
Department of Family and Community Medicine, University of Toronto ON.
Permaul
Joanne A
JA
Department of Family Medicine, Mount Sinai Hospital Toronto ON.
Stewart
Donna E
DE
University Health Network, University of Toronto ON.
D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis; D005194:Family Practice; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D008880:Midwifery; D009774:Obstetrics; D009864:Ontario; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D011594:Psychometrics; D012307:Risk Factors; D011795:Surveys and Questionnaires