title: Digging over that old ground: an Australian perspective of women's experience of psychosocial assessment and depression screening in pregnancy and following birth.
abstract: BACKGROUND
  There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women's experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women's experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response.
  
  
  METHODS
  This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified.
  
  
  RESULTS
  Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; 'Unexpected: a bit out of the blue', 'Intrusive: very personal questions' and 'Uncomfortable: digging over that old ground', describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled:
  
  
  METHODS
  'sensitivity and care' and 'being watched'.
  
  
  CONCLUSIONS
  The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia. m.rollans@uws.edu.au
authors.forename: Mellanie
authors.initials: M
authors.lastname: Rollans
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
authors.forename: Lynn
authors.initials: L
authors.lastname: Kemp
authors.forename: Tanya
authors.initials: T
authors.lastname: Meade
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000517:prevention & control; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008880:Midwifery; D009517:New South Wales; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000517:prevention & control; D011296:Prenatal Diagnosis / Q000523:psychology*; D018907:Privacy / Q000523:psychology*; D015397:Program Evaluation; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires