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Validity and accuracy of the Whooley questions and Fear of Childbirth Scale to identify antenatal reduced emotional wellbeing

Kuipers, Yvonne



Background: Because of the considerable prevalences of reduced antenatal emotional wellbeing including depression, general anxiety and childbirth-related anxiety, and appreciating the time constraints that midwives perceive to routinely assess women’s antenatal emotional wellbeing, it is important that midwives can identify women with, depression, anxiety and/or a more severe fear of birth with an easy to administer, validated tool.

Aim(s): To investigate the validity and the diagnostic accuracy of (i) the two Whooley items compared with the Edinburgh Depression Scale screening and the State-Trait Anxiety Inventory, and (ii) the two-item Fear of Childbirth Scale (FOBS) compared with the 16-item Tilburg Pregnancy Distress Scale.

Methods: A diagnostic accuracy study was performed, including 829 Dutch women with uncomplicated pregnancies. Sensitivity, specificity, positive and negative predictive values and accuracy and discriminant ability were determined.
Results: The Whooley items showed a higher specificity than sensitivity. The Whooley items had a low to moderate predictive ability for depression, trait-anxiety and a good ability for negative case-finding. The Whooley items were accurate in identifying depression and trait-anxiety. The FOBS showed a higher specificity than sensitivity to detect fear of childbirth. The FOBS items had a good predictive ability for fear and worries about the forthcoming birth and a conclusive ability for negative case-finding. The FOBS showed good accuracy.

Discussion: The Whooley items and the FOBS proved to be able to report how effective the case-finding questions are in identifying women without depression and trait and state anxiety (ruling out).

Implications and future perspectives: The findings indicate the potential for midwives to use four case-finding questions during antenatal care, to effectively assess relevant aspects of antenatal emotional wellbeing of Dutch women with uncomplicated pregnancies.

Presentation Conference Type Conference Paper (unpublished)
Conference Name 41st Annual SRIP Conference, Society for Reproductive and Infant Psychology
Start Date Sep 8, 2021
End Date Sep 9, 2022
Deposit Date May 20, 2022
Keywords screening, maternal emotional wellbeing, perinatal mental health, validation study
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