Spyridou Andria, Schauer Maggie, Ruf-Leuschner Martina
Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457, Konstanz, Germany.
vivo international, .
BMC Pregnancy Childbirth. 2016 Jan 22;16:13. doi: 10.1186/s12884-016-0799-x.
Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother's health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.
The study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy.
We found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk.
The relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.
产前压力及其他产前风险因素（如亲密伴侣暴力）会对母亲健康、胎儿发育产生负面影响，还会对儿童的神经认知、行为及身体健康造成持久的不良影响。社会经济地位较低的母亲，尤其是那些生活在犯罪高发地区的母亲，更容易受到一系列风险因素的影响。在极端暴力、贫困和不平等的社会中，往往难以向最需要的人群提供足够的心理健康护理。在利马家庭暴力发生率最高的一个郊区，助产士使用一种名为KINDEX的简短标准化工具来评估11种不同的风险因素，以识别有风险的孕妇。该工具旨在供医务人员用于识别高危生育妇女，并根据结果将她们转介到适当的心理或社会支持机构。本研究的目的是首次评估在一个拉丁美洲国家使用KINDEX进行社会心理筛查的可行性，并探讨KINDEX与三个主要风险领域、母亲精神病理学、感知压力和创伤经历之间的关系。
本研究与利马一个郊区的一家综合医院的妇科合作开展。九名助产士使用KINDEX对在该医院妇科就诊的95名孕妇进行了访谈。其中，40名孕妇由一名临床心理学家使用既定工具进行了再次访谈，以评估在公共卫生环境中进行产前评估的可行性，以及KINDEX与母亲感知压力、精神病理学症状和孕期创伤负荷之间的关系。
我们发现，被检查的孕妇中风险因素的发生率较高，与普通人群中的发生率相当。在临床专家访谈中评估发现，KINDEX总分与压力、精神病理学和创伤负荷这三个风险领域之间存在显著相关性。KINDEX评估的不同风险与更高水平的压力、精神病理学和创伤负荷相关，但因风险不同而异。
过去的不良经历和当前的压力源与母亲感知压力、精神病理学症状和创伤经历之间的关系，证实了产前评估社会心理风险的重要性。在秘鲁城市为孕妇提供产科护理的助产士使用KINDEX是可行的，可用于识别高危妇女，并将她们转介到适当的心理健康或社会服务机构，以获得必要的关注和支持。早期干预对于减轻母亲压力、创伤和精神病理学对胎儿和儿童的不利影响至关重要。
