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Table 1 Psychosocial risk variable s I–VII. NSW Department of Health (2009)

From: Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study

Variables (Risk factors) Suggested format for psychosocial assessment questions
I. Lack of support 1. Will you be able to get practical support with your baby?
2. Do you have someone you are able to talk to about your feelings or worries?
II. Recent major stressors in the last 12 months. 3. Have you had any major stressors, changes or losses recently (ie in the last 12 months) such as, financial problems, someone close to you dying, or any other serious worries?
III. Low self-esteem (includung lack of self-confidence, high anxiety and perfectionistic traits) 4. Generally, do you consider yourself a confident person?
5. Does it worry you a lot if things get messy or out of place?
IV. History of anxiety, depression or other mental health problems 6a. Have you ever felt anxious, mesirable,worried or depressed for more than a couple of weeks?
6b. If so, did it seriously interfere with your work and your relationships with friends and family?
7. Are you currently receiving, or have you in the past received, treatment for any emotional problems?
V. Couple’s relationship problems or dysfunction (if applicable) 8. How would you describe your relationship with your partner?
9. a). Antenatal: What do you think your relationship will be like after the birth
OR
9. b). Postnatal (in Community Health Setting): Has your relationship changed since having the baby?
VI. Adverse childhood experiences 10. Now that you are having a child of your own, you may think more about your own childhood and what it was like.
As a child were you hurt or abused in any way (physically, emotionally, sexually)?
VII. Domestic violence. 11. Within the last year have you been hit, slapped, or hurt in other ways by your partner or ex-partner?
Questions must be asked only when the woman can be interviewed away from partner or family member over the age of three years. Staff must undergo training in screening for domestic violence before administering questions 12. Are you frightened of your partner or ex-partner? (If the response to questions 11 & 12 is “No” then offer the DV information card and omit questions 13–18)
13. Are you safe here at home? /to go home when you leave here?
14. Has your child/children been hurt or witnessed violence?
15. Who is/are your children with now?
16. Are they safe?
17. Are you worried about your child/children’s safety?
18. Would you like assistance with this?
Opportunity to disclose further 19. Are there any other issues or worries you would like to mention?