Validity and accuracy of the Whooley questions to identify maternal distress in Dutch pregnant women
The Journal of Mental Health Training, Education and Practice
Article publication date: 3 December 2018
Issue publication date: 3 January 2019
The purpose of this paper is to investigate the validity and accuracy of the Whooley questions for routine screening of maternal distress in Dutch antenatal care.
In this cohort design, the authors evaluated self-reported responses to the Whooley questions against the Edinburgh Depression Scale screening for antenatal depression, State-Trait Anxiety Inventory for general anxiety and the pregnancy-related anxiety questionnaire-revised screening for pregnancy-related anxiety, among Dutch pregnant women during the first and third trimester of pregnancy. The authors used standard diagnostic performance measures for the two case-finding items.
The Whooley items in this study showed a higher specificity than sensitivity. The Whooley results showed good evidence to identify women who are depressed or (trait)anxious in both trimesters of pregnancy, but the results showed weak to moderate evidence to identify pregnancy-related anxiety. The Whooley items had a low to moderate predictive ability for depression, trait-anxiety and pregnancy-related anxiety and a good ability for negative case-finding. The Whooley items proved to be more able to report how effective the case-finding questions are in identifying women without depression, trait-anxiety and pregnancy-related anxiety (ruling out) rather than how effective these are in identifying women with depression, trait-anxiety and pregnancy-related anxiety (ruling in). The Whooley items were accurate in identifying depression and trait-anxiety in both trimesters but were not very accurate to identify pregnancy-related anxiety.
Assessment of pregnancy-related anxiety using a case-finding tool requires further attention.
The two-item Whooley case-finding tool has shown good utility as a screening instrument for maternal distress. The continuous assessment of maternal emotional health during the childbearing period or, at least, revisiting the topic, would both support the woman and the midwife in regarding perinatal emotional wellbeing as an important remit of midwifery care.
A novel aspect of this paper is the proposition of applying the Whooley questions at later stages of pregnancy or presenting the Whooley questions in a written or digital form.
Disclosure of interest: there are no conflicts of interest to declare. The authors would like to thank the Regional Attention and Action for Knowledge research project funding (RAAK PRO, ref. 2-014) and the project group “Promoting Healthy Pregnancy” of the Zuyd University of Applied Sciences.
Fontein-Kuipers, Y. and Jomeen, J. (2019), "Validity and accuracy of the Whooley questions to identify maternal distress in Dutch pregnant women", The Journal of Mental Health Training, Education and Practice, Vol. 14 No. 1, pp. 33-45. https://doi.org/10.1108/JMHTEP-06-2018-0034
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