Depression and Domestic Violence
Work to expand the application of the 4P’s Plus© to include screening for depression and domestic violence was begun in 2000. Preliminary data among a population of approximately 10,000 women in Fresno, California, had demonstrated a 65% correlation between substance abuse and domestic violence. High rates of depression also were found in the clinical populations. It was thus decided to add straightforward, nonjudgmental questions regarding risk for domestic violence and depression to more fully explore these areas and to give the woman an opportunity to talk with her provider about her experiences with abuse or depression. Such an approach through routine and multiple screenings by skilled health care providers, when conducted face to face, markedly increases the identification of domestic violence and depression.
Developing Questions for Depression Screening
In developing questions for depression screening, there were several depression screening instruments available, most of which were easy to use and could be administered in less than five minutes. However, a study on a hospitalized population of armed services veterans demonstrated that simply asking two questions about depressed mood and anhydonia detected a majority of depressed patients, and, in some cases, performed better than the original instrument from which they were derived. However, these two areas of questioning had never been validated in pregnant women. Through a series of three generations of questions, tested against the Edinburgh Postnatal Depression Scale and a comprehensive psychosocial clinical interview, we were able to validate two questions regarding depression and two questions regarding risk for domestic violence.
By incorporating the questions for domestic violence and depression into the original substance abuse screen, The 4P’s Plus Screen for Behavioral Health Risk in Pregnancy© (still called the 4P’s Plus©) is the first validated instrument that has been developed to screen for alcohol, tobacco, and illicit drug use, depression, and domestic violence in pregnant women. (6)