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Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial

June C. Carroll^*, Anthony J. Reid^*¶, Anne Biringer^*, Deana Midmer^*, Richard H. Glazier^*, Lynn Wilson^*, Joanne A. Permaul, Patricia Pugh, Beverley Chalmers, Freda Seddon and Donna E. Stewart^**

*Department of Family and Community Medicine, University of Toronto; Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital; Inner City Health Research Unit and Department of Family and Community Medicine, St. Michael's Hospital; Department of Family and Community Medicine, St. Joseph's Health Centre; ¶Canadian Family Physician, College of Family Physicians of Canada; **Department of Women's Health, University Health Network and University of Toronto

Correspondence to: Dr.June Carroll, Mount Sinai Hospital, 600 University Ave., Suite 413, Toronto ON M5G 1X5; jcarroll{at}mtsinai.on.ca

Background: A pregnant woman's psychological health is a significant predictor of postpartum outcomes. The Antenatal Psychosocial Health Assessment (ALPHA) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse, child abuse, postpartum depression and couple dysfunction. We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care.

Methods: A randomized controlled trial was conducted in 4 communities in Ontario. Family physicians, obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each. Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women. The control group provided usual care. After the women delivered, both groups of providers identified concerns related to the 15 risk factors on the ALPHA form for each patient and rated the level of concern. The primary outcome was the number of psychosocial concerns identified. Results were controlled for clustering.

Results: There were 21 (44%) providers randomly assigned to the ALPHA group and 27 (56%) to the control group. A total of 227 patients participated: 98 (43%) in the ALPHA group and 129 (57%) in the control group. ALPHA group providers were more likely than control group providers to identify psychosocial concerns (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–3.0; p = 0.02) and to rate the level of concern as "high" (OR 4.8, 95% CI 1.1–20.2; p = 0.03). ALPHA group providers were also more likely to detect concerns related to family violence (OR 4.8, 95% CI 1.9–12.3; p = 0.001).

Interpretation: Using the ALPHA form helped health care providers detect more psychosocial risk factors for poor postpartum outcomes, especially those related to family violence. It is a useful prenatal tool, identifying women who would benefit from additional support and interventions.

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