Validating the Kimberley Mum’s Mood Scale
Mental health during and after pregnancy is important for the well-being of mother and infant. Aboriginal women in remote Australia have high levels of anxiety and depression (25% in this study), which can have significant short and long-term impacts on both mother and child. The need for a culturally safe screening tool to identify women at risk of anxiety and depression led to the development of the Kimberley Mum’s Mood Scale (KMMS). The two part KMMS was designed to be administered by providers of perinatal care: Part 1 is a Kimberley version of the Edinburgh Postnatal Depression Scale (EPDS); Part 2 is a psychosocial tool.
We wanted to see if the KMMS is a reliable, valid and acceptable tool for identifying Kimberley Aboriginal women who are at risk of perinatal anxiety or depressive disorders when compared to a clinical diagnosis.
How was this study done?
From 9 May 2013 to 11 June 2014, 97 Aboriginal women aged 16 years and older, from 15 Kimberley towns and communities, who intended to continue with their pregnancy or had a baby within the previous 12 months enrolled in the study.
- Study personnel administered the KMMS and using the score from Part 1 and the psychosocial discussion (Part 2) gave an overall risk assessment of no risk, low risk, medium risk or high risk.
- 91 of these women were also seen by an experienced GP (most within 24 hours of the KMMS), who used DSM IV criteria to clinically diagnose anxiety and/or depressive disorders. The severity of diagnosis was based on the GP Mental State Examination. The GP did not know what the overall KMMS risk assessment was (this is the blinded reference standard).
- We compared the KMMS risk assessment to the diagnosis made by the study GP.
- Directly after the KMMS was administered participants were asked to complete a short questionnaire about their experience. After data collection, study personnel were also asked to complete a questionnaire; this was followed up by an interview with the study coordinator regarding their experiences in using the KMMS.
What did we find?
- Everyone with clinically moderate or high severity anxiety and/or depression were assessed as having a KMMS risk of moderate or high.
- Using the KMMS increased health service provider’s understanding of women’s underlying social and cultural issues and improved relationships between providers and their patients.
- The KMMS formed the basis for a mental health brief intervention.
- The KMMS was well accepted by participants and health service providers.
What does this mean?
- The KMMS is a good way to ask Aboriginal women about how they feel and to see if they are at risk of having anxiety and depression (feeling no good in your mind and lyian).
- The sensitivity of KMMS (83%) to detect anxiety and/or depression is similar to other studies using the EPDS (median 88.5%).
- The diagnostic accuracy and acceptability of the KMMS is better than current practice. Appropriate training and support will be crucial for the uptake of KMMS into routine screening.
- We think that adoption of KMMS will improve the screening process and provide a timelier diagnosis of perinatal anxiety and depressive disorders for Kimberley Aboriginal women.
What happens now?
- Kimberley health services have worked on the KMMS training package and this is being used across the Kimberley region as part of training for clinic staff. This started in 2014. For more information about the KMMS and training see: www.kimberleymumsmoodscale.weebly.com.
- Due to the relatively small numbers recruited in this study, further validation of KMMS will be required. We will incorporate this into the implementation of KMMS across the Kimberley.
Many thanks to patients, staff & Council of participating services. Without your help this research would not have been possible.
This study was a joint project between the Kimberley Aboriginal Medical Services, WA Country Health Service, and Rural Clinical School of Western Australia.
Publications
Marley JV, Kotz J, Engelke C, Williams M, Stephen D, Coutinho S, Trust S. Validity and acceptability of the Kimberley Mum’s Mood Scale to screen for perinatal anxiety and depression in remote Aboriginal Australian health care settings. Plos One 2017; 12:e0168969.
Kotz J, Munns A, Marriott R, Marley JV. Perinatal depression and screening among Aboriginal Australians in the Kimberley. Contemp Nurse 2016; 52:42-58. DOI: 10.1080/10376178.2016.1198710
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