Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview

Abstract

BackgroundPrenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother’s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.MethodsThe study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy.ResultsWe found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk.ConclusionsThe relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.

Socioeconomic conditions, gestacional risk and importance of relationship between obstetrician and high risk pregnant women / Condições socioeconômicas, risco gestacional e importância da relação entre pré-natalista e gestantes de alto risco...

“…Mulheres muito jovens e de idade mais avançada são consideradas de maior risco para resultados adversos e complicações de gravidez, parto e perinatais (6) e vem se observando um aumento progressivo da idade materna com maior percentual de gestantes com idade superior a 34 anos (7) . A literatura é controversa sobre a influência da situação conjugal na gestação, existindo trabalhos que mostram a ausência de influência sobre a gestação (4) , mas também há artigos que confirmam os achados deste estudo, onde a situação conjugal insegura, violência doméstica e conflitos familiares fazem parte das características desfavoráveis à gestação (8)(9) . A baixa renda familiar contribui para uma alimentação deficiente, além das preocupações econômicas relacionadas desde o enxoval do bebê, contas que não podem pagar ou até mesmo à sobrevivência, aumentando a ansiedade materna (8)(9)(10) .…”

“…Existe uma falta de qualidade de moradia entre as gestantes de alto risco, que influencia na qualidade de vida das mulheres e pode interferir no risco gravídico e puerperal. O ato de gestar contribui para profundas alterações emocionais na mulher, seja por alterações hormonais ou por eventos associados à condição socioeconômica, e essa situação se agrava quando a mulher se encontra diante de uma gravidez de alto risco, fazendo-se necessário o apoio de familiares durante todo o processo gestacional (8)(9) . A baixa escolaridade e a pobreza estão intimamente relacionadas com as más condições habitacionais, de higiene, alimentares, estando diretamente ligadas a altas taxas de morbidade e mortalidade infantis, influenciando, por consequência, na qualidade de vida do ser humano (13) .…”

Pogimdyminių Depresinių Sutrikimų Ankstyvoji Diagnostika - Efektyvios Prevencijos Pagrindas

“…Dažniausiai naudojami atrankos klausimynai: 1) Schauer ir Ruf-Leuschner sukurtas KINDEX rizikos veiksnių klausimynas validizuotas Vokietijoje [27,28], 2) ALPHA Form [16,17] ir 3) the Antenatal Risk Questionnaire (ANRQ) [29]. KINDEX skalė buvo sudaryta 2009 metais, remiantis tyrimais, nustatytais vaikų raidos rizikos veiksniais (5 lentelė).…”

Die KINDEX-App - ein Instrument zur Erfassung und unmittelbaren Auswertung von psychosozialen Belastungen bei Schwangeren in der täglichen Praxis bei Gynäkologinnen, Hebammen und in Frauenkliniken

“…Bisher existieren allerdings nur wenige Studien, die von der Entwicklung, Evaluation und Implementierung pränataler Screening-Instrumente für psychosoziale Belastungsfaktoren in der Schwangerschaft sowie von darauf aufbauenden Präventions-und Interventionsprogrammen berichten [Austin et al, 2013;Carroll, 2005;Harrison und Sidebottom, 2008;Karatas et al, 2009] Bollini et al, 2009;Carroll, 2005;Glazier et al, 2004;Heilig, 2014;Laucht et al, 2000;Lyons-Ruth und Block, 1996;Magura und Laudet, 1996] [Spyridou et al, 2015], Spanien [Spyridou et al, 2014] und Peru [Spyridou et al, 2016] Spyridou et al, 2014Spyridou et al, , 2015Spyridou et al, , 2016 Spyridou et al, 2014Spyridou et al, , 2015Spyridou et al, , 2016. Im «Adminbereich Ärztin/Arzt/Hebamme» hat die Gynäkologin bzw.…”

“…Dies ist vergleichbar mit der internen Konsistenz in den Studien von Spyridou et al [2014Spyridou et al [ , 2015Spyridou et al [ , 2016: α = 0,67. …”