title: Validity and Acceptability of Kimberley Mum's Mood Scale to Screen for Perinatal Anxiety and Depression in Remote Aboriginal Health Care Settings.
abstract: BACKGROUND
  The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum's Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview.
  
  
  METHODS
  Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS' acceptability.
  
  
  RESULTS
  Part 1 had high internal consistency (Cronbach's alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them.
  
  
  CONCLUSIONS
  KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.
authors.affiliation: The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia.|Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia.
authors.forename: Julia V
authors.identifier: http://orcid.org/0000-0003-1014-4860
authors.initials: JV
authors.lastname: Marley
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia.
authors.forename: Jayne
authors.initials: J
authors.lastname: Kotz
authors.affiliation: Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia.|The Rural Clinical School of Western Australia, The University of Western Australia, Kununurra, Western Australia, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Engelke
authors.affiliation: Western Australian County Health Service, Broome, Western Australia, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Williams
authors.affiliation: Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia.
authors.forename: Donna
authors.initials: D
authors.lastname: Stephen
authors.affiliation: Independent Consultant, Broome, Western Australia, Australia.
authors.forename: Sudha
authors.initials: S
authors.lastname: Coutinho
authors.affiliation: Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia.|Kununurra Medical, Kununurra, Western Australia, Australia.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Trust
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D001007:Anxiety / Q000175:diagnosis*; D003695:Delivery of Health Care; D019052:Depression, Postpartum / Q000175:diagnosis*; D005260:Female; D058005:General Practitioners; D006801:Humans; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012015:Reference Standards; D015203:Reproducibility of Results; D012307:Risk Factors; D014904:Western Australia; D055815:Young Adult