title: Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version.
abstract: BACKGROUND
  Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.
  
  
  METHODS
  Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.
  
  
  RESULTS
  Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.
  
  
  CONCLUSIONS
  Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.
authors.affiliation: University of Konstanz, Constance, Germany. andria.spyridou@uni-konstanz.de.|Department of Psychology, University of Konstanz, Clinical Psychology & Behavioral Neuroscience Unit, Post Box 905, Constance, D-78457, Germany. andria.spyridou@uni-konstanz.de.
authors.forename: Andria
authors.initials: A
authors.lastname: Spyridou
authors.affiliation: University of Konstanz, Constance, Germany. maggie.schauer@uni-konstanz.de.|Vivo international (www.vivo.org), Constance, Germany. maggie.schauer@uni-konstanz.de.
authors.forename: Maggie
authors.initials: M
authors.lastname: Schauer
authors.affiliation: University of Konstanz, Constance, Germany. martina.ruf@uni-konstanz.de.|Vivo international (www.vivo.org), Constance, Germany. martina.ruf@uni-konstanz.de.
authors.forename: Martina
authors.initials: M
authors.lastname: Ruf-Leuschner
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006115:Greece; D006801:Humans; D008603:Mental Health; D008880:Midwifery / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology; D037841:Pregnant People / Q000523:psychology; D011295:Prenatal Care / Q000379:methods; D011584:Psychology; D011594:Psychometrics; D011599:Psychopathology; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires