Assessing psychosocial risk

Psychosocial risk assessment

Psychosocial risk factors are identified by asking a series of questions (click here for some examples). This enquiry aims to identify psychosocial risk factors without detracting from the normal experiences of pregnancy and motherhood or highlighting the potential for depression and related disorders to occur in the perinatal period.

When to assess for psychosocial risk

As early as practical in pregnancy and 6–12 weeks after a birth, all women should be asked questions around psychosocial factors as part of normal care. If a woman confirms the presence of psychosocial factors, she should be asked whether she would like help with any of these issues.

Psychosocial questions

Below are some example questions that can provide a basis for discussion and can be adapted to the woman.

Past or current mental health problems

• Have you ever had a period of 2 weeks or more when you felt particularly low or down?
• Do you sometimes worry so much that it affects your day-to-day life?
• Have you ever needed treatment for a mental health condition such as depression, anxiety disorder, bipolar disorder or psychosis?
• Has anyone in your immediate family (e.g. grandparents, parents, siblings) experienced severe mental health problems?

Previous or current abuse

• When you were growing up, did you always feel cared for and protected
• If you currently have a partner, do you feel safe in this relationship?

Drugs and alcohol

• Do you or others think that you (or your partner) may have a problem with drugs or alcohol?

Recent life stressors

• Have you had any major stressors, changes or losses in the last 12 months (e.g. moving house, financial worries, relationship problems, loss of someone close to you, illness, pregnancy loss, problems conceiving)?

Practical and emotional support

• When you were growing up, was your mother emotionally supportive of you?
• If you found yourself struggling, what practical support would you have available? Who could help provide that?
• If you found yourself struggling, what emotional support would you have available? Who could help provide that?

The discussion does not need to be restricted to the key questions and it may include the woman’s wider psychosocial context.

Best practice is to use a range of styles of questioning (e.g. using a closed question to begin discussion about an area, then open-ended questions to seek further detail and explore the woman’s perspective).