In a study of 1,955 primigravidae who gave birth to a live singleton baby, 227 (11.6%) scored 'positive' (7+) in an antenatal Health Questionnaire enquiring into pre-pregnancy emotional disturbances. This group of mothers had more frequent depression, and this was of longer duration after their delivery compared with those scoring less than 7 (less than or equal to 6). Those scoring 7+ were less likely to breast-feed and the infants were more often ill during the first year of life. There were also differences in 'minor obstetric complications' between the two survey groups. This suggests that the application of this Health Questionnaire antenatally can identify emotionally vulnerable women, who could benefit from support and education during the antenatal period.

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An important task in antenatal care is to identify mothers at risk during pregnancy, with the aim of minimizing morbidity and mortality. This paper describes the outcome of a health questionnaire distributed antenatally to 2086 primigravidae during the Tayside Infant Morbidity and Mortality Study 1980-81. The aim of this study was to test a health questionnaire, known to identify mothers with emotional disturbances, and investigate the outcome of their pregnancies. Two hundred and thirty-eight mothers (11.4%) had a 'positive' score in this study. This rather small group of women had a significantly higher incidence of psycho-social risk factors. The questionnaire return rate was high, more than 99%, suggesting that such a questionnaire could be used as a screening instrument to identify 'risk mothers'.

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Working for Patients (DOH, 1989) has provided considerable impetus to the development of medical audit. The Royal College of Psychiatrists (1989) Preliminary Report on Medical Audit defined and distinguished between clinical audit, peer review and performance indicators, and referred to some of the particular problems affecting the development of audit in psychiatric practice. There are special concerns for child and adolescent psychiatrists developing medical audit programmes because of the wide diversity of child and adolescent practice and the considerable variability of resources in the subspecialty. Nicol (1989) has described the initial concern of the National Child Psychiatry Section's Working Group on audit with the Korner Report (HMSO, 1982) and the proposals on performance indicators outlined by the DHSS in 1987.