Supporting routine psychosocial assessment in the perinatal period: The concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised

BackgroundAustralian clinical practice guidelines support comprehensive psychosocial assessment as a routine component of maternity care.AimTo examine the concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised (ANRQ-R) when used across the perinatal period.MethodsWomen completed the ANRQ-R and a diagnostic reference standard (SAGE-SR) in the second and third trimesters and at 3-months postpartum. ANRQ-R test performance for cut-off scores at each time-point was assessed using Receiver Operator Characteristic (ROC) analysis.FindingsOverall sample sizes were N = 1166 (second trimester), N = 957 (third trimester) and N = 796 (3-month postpartum). 6.5%, 5.6% and 6.2% of women met SAGE-SR criteria for any depressive or anxiety disorder at these time-points (‘cases’), respectively. ROC analysis yielded acceptable areas under the curve (AUC) when the ANRQ-R was used to detect current (AUC = 0.789?0.798) or predict future (AUC = 0.705?0.789) depression or anxiety. Using an example cut-off score of 18 or more, the ANRQ-R correctly classified 72–76% of concurrent ‘cases’ and ‘non-cases’ (sensitivity = 0.70?0.74, specificity = 0.72?0.76) and correctly predicted 74–78% of postnatal ‘cases’ and ‘non-cases’ (sensitivity = 0.52?0.72, specificity = 0.75?0.79). Completion of the ANRQ-R earlier in pregnancy yielded greater positive likelihood ratios for predicting depression or anxiety at 3-months postpartum (cut-off ≥18: second trimester = 3.8; third trimester = 2.2).ConclusionThe ANRQ-R is a structured psychosocial assessment questionnaire that can be scored to provide an overall measure of psychosocial risk. Cut-off scores need not be uniform across settings. Such decisions should be guided by factors including diagnostic prevalence rates, local needs and resource availability.