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Validity and accuracy of the Whooley questions to identify maternal distress in Dutch pregnant women

Fontein-Kuipers, Yvonne; Jomeen, Julie


Julie Jomeen


Purpose – 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.

Design/methodology/approach – 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.

Findings – 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.

Research limitations/implications – Assessment of pregnancy-related anxiety using a case-finding tool requires further attention.

Practical implications – 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.

Originality/value – 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

Journal Article Type Article
Acceptance Date Nov 15, 2018
Online Publication Date Dec 3, 2018
Publication Date Jan 14, 2019
Deposit Date Jan 10, 2022
Journal The Journal of Mental Health Training, Education and Practice
Print ISSN 1755-6228
Publisher Emerald
Peer Reviewed Peer Reviewed
Volume 14
Issue 1
Pages 33-45
Keywords Antenatal anxiety; Antenatal depression; Case-finding; Maternal distress; Pregnancy-related anxiety; Whooley
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