title: The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting.
abstract: OBJECTIVE
  To assess the value of the antenatal risk questionnaire (ANRQ) as a predictor of postnatal depression, to evaluate its acceptability to pregnant women and midwives, and to consider its use as part of a model for integrated psychosocial risk assessment in the antenatal setting.
  
  
  METHODS
  This paper further analysed published data from the pregnancy risk questionnaire in a sample of 1196 women. We extracted 12 items from the original 23 item pregnancy risk questionnaire to assess how the shorter ANRQ would perform, and undertook the analysis in the subset who were administered the composite international diagnostic interview (CIDI) at 2 or 4 months postpartum to assess for major depression (N=276). We also sampled a subset of pregnant participants (N=378) and midwives (N=44) to assess the tool's acceptability to these groups respectively.
  
  
  RESULTS
  ROC curve analysis for the ANRQ yielded an acceptable area under the curve of 0.69. The most 'clinically' useful cut off on the ANRQ was a score of 23 or more, yielding a sensitivity of 0.62 and specificity of 0.64 with positive predictive value of 0.3. The odds that a woman scoring 23 or more on the ANRQ is also a case was 6.3 times greater than for a woman scoring less than 23. Acceptability of the ANRQ was high among both women and midwives.
  
  
  CONCLUSIONS
  The ANRQ is a highly acceptable self-report psychosocial assessment tool which aids in the prediction of women who go on to develop postnatal depression. In combination with a symptom based screening measure (e.g., the Edinburgh postnatal depression scale) and routine questions relating to drug and alcohol use and domestic violence, the ANRQ becomes most useful as a key element of a "screening intervention" aimed at the early identification of mental health risk and morbidity across the perinatal period. Evaluation of this model in terms of clinical outcomes remains to be undertaken.
authors.affiliation: Perinatal and Women's Mental Health Unit, St John of God Health Care & School of Psychiatry; University of New South Wales, Sydney, Australia. m.austin@unsw.edu.au
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Austin
authors.forename: Jana
authors.initials: J
authors.lastname: Colton
authors.forename: Susan
authors.initials: S
authors.lastname: Priest
authors.forename: Nicole
authors.initials: N
authors.lastname: Reilly
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi-Pavlovic
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008403:Mass Screening; D009721:Nurse Midwives / Q000523:psychology; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013315:Stress, Psychological; D011795:Surveys and Questionnaires