RESUMEN
OBJECTIVES: Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden. METHODS: All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized 'early support' institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders. RESULTS: The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the 'early support' intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07-0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10-1.14) and reported reduced stress due to the child's demands (0.40, 0.15-1.10) compared to the control group. Childcare indicators did not differ between the 2 groups. CONCLUSIONS: In mothers at high psychosocial risk, the 'early support' intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year.
RESUMEN
BACKGROUND: The well-being and healthy development of children are at risk in families with severe psychosocial stress. In Germany, simple and valid screening instruments are lacking to identify families in need of early support. OBJECTIVES: We aimed to examine the diagnostic accuracy of a simple perinatal screening form to identify families at high psychosocial risk. METHODS: For every mother giving birth at Charité Berlin between January and August 2013 the short Babylotse-Plus screening form with 27 items was filled out by medical staff. Completing the form took about 5 min. After calculating a sum score, values of ≥3 were defined as "likely at risk". A one-hour comprehensive standardized interview with the parents after birth served as the reference standard for assessing family resources and stress factors. RESULTS: Among the 279 participants included in the analyses, 215 were "likely at risk" and 64 had a low or no risk, the latter were randomly selected among all families with scores <3. The screening form had an excellent sensitivity (98.9 %; 95 % confidence interval 93.4-99.9 %) to detect families likely at risk, whereas its specificity was only low (33.0 %; 95 % confidence interval 30.5-33.5 %). This resulted in a rather poor positive likelihood ratio of 1.5 but a very good negative likelihood ratio of 0.03. CONCLUSIONS: The screening form identified families with psychosocial risks well, but many families with low or no risk were falsely defined as being at risk. Before recommending the screening instrument for clinical practice, further studies are needed in different settings to improve the specificity without reducing its high sensitivity.
