What are we screening for? Development of a psychiatric referral tool for use with adolescent pregnant women.

Objective: Psychiatric disorders commonly occur during pregnancy and in the postpartum period, posing substantial risks to both mother and unborn child. Consequently, screening for maternal psychiatric disorder during pregnancy and in the postnatal period has been advocated. In this paper, we describe the development and evaluation of a screening tool for use with a 'high risk' demographic group--adolescent women seeking maternity care.

Conclusions: The tool was developed to identify women with, or at risk of, psychiatric disorders requiring specialist assessment and/or treatment, rather than only those with psychosocial concerns and/or distress, or with depressive symptoms alone. The tool was administered by midwives and used during discussion at the maternity team multidisciplinary meeting to facilitate referral or seek advice through secondary consultation. The tool was well accepted by the women attending the clinic. All women in the group who received psychiatric care later--either during confinement or during the 6-week postnatal period of follow-up--had already been identified by the tool in the antenatal period. Arguably, the tool enabled early intervention, treatment planning and effective care. We suggest that rather than adopting a 'one size fits all' approach, any screening should be tailored to the population of interest.