Identification of psychosocial problems in routine antenatal care in Ethiopia: A facility-based cross-sectional study

In this facility-based cross-sectional survey in primary health care centres in southern Ethiopia, women attending for antenatal care (ANC) were screened for depression (PHQ-9; score ≥ 5 and functionally impaired), anxiety symptoms (GAD-7; score ≥ 10), post-traumatic stress disorder (PCL-5 score ≥ 31), intimate partner violence (IPV; non-graphic language screening test) and risky substance use (ASSIST). Clinical notes were reviewed post-consultation for evidence of health worker recognition of psychosocial concerns and actions taken. Of the 2,079 interviewed women, 24.9% had at least one psychosocial problem, and 7.3% had two or more. The most common psychosocial problem was probable IPV (n = 289; 13.9%, 95% CI: [12.57-15.25]), followed by risky khat use (n = 134; 6.5%, 95% CI: [3.72-10.94]) and depression (n = 110; 5.3%, 95% CI: [3.98-7.00]). Identification by ANC professionals was low: 2.7% of women with probable depression, none with probable IPV had it recorded. A history of mental health problems was not documented in 99.7% and only 47.3% (n = 938) reported being asked how they were feeling emotionally. Systemic changes to provider training and procedures are required to promote person-centred maternal care and improve identification of psychosocial problems in ANC in rural Ethiopia.