Disclosure during prenatal mental health screening Dawn E. Kingston a,n , Anne Biringer b , Amy Toosi c , Maureen I. Heaman d , Gerri C. Lasiuk c , Sheila W. McDonald e , Joshua Kingston f , Wendy Sword g , Karly Jarema c , Marie-Paule Austin h a Faculty of Nursing, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada b Department of Family and Community Medicine, University of Toronto, Ada and Slaight Family Director of Maternity Care, Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada c Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada d College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada e Population, Public, and Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada f Faculty of Science (Computer Science), MacEwan University, Edmonton, Alberta, Canada g School of Nursing and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada h St. John of God Chair Perinatal & Women’s Mental Health, School of Psychiatry, University of New South Wales, Sydney, Australia article info Article history: Received 30 April 2015 Received in revised form 15 June 2015 Accepted 3 July 2015 Available online 21 July 2015 Keywords: Pregnancy Mental health Screening Depression Anxiety abstract Background: While women and healthcare providers have generally viewed perinatal mental health screening favorably, some qualitative studies suggest that some women intentionally decide not to reveal their symptoms during screening. Purpose: The purpose of this study was to describe women's reported willingness to disclose mental health concerns during screening and factors associated with this. Methods: This cross-sectional study included pregnant women who were 416 years of age and could speak/read English. Women were recruited from five maternity clinics and two community hospitals in Alberta, Canada (May–December, 2013). Eligible women completed the online Barriers and Facilitators of Mental Health Screening Questionnaire on recruitment. The primary outcome for this analysis was wo- men's level of honesty about mental health concerns (completely vs somewhat/not at all honest) during screening. Analyses included descriptive statistics and multivariable logistic regressions to identify fac- tors associated with honesty. Results: Participation rate was 92% (460/500). Seventy-nine percent of women indicated that they could be ‘completely honest’ during screening. Women who feared their provider would view them as bad mothers were less likely to be honest. We found a significant association between ‘less anonymous’ modes of screening and honesty. Limitations: Over eighty percent of women in this study were well-educated, partnered, Caucasian women. As such, generalizability of the study findings may be limited. Conclusions: Most women indicated they could be honest during screening. Stigma-related factors and screening mode influenced women's willingness to disclose. Strategies to reduce stigma during screening are warranted to enhance early detection of prenatal mental illness. & 2015 Elsevier B.V. All rights reserved. 1. Background Depression and anxiety are among the most common preg- nancy-related complications (Grant et al., 2008; Kingston et al., 2012; Milgrom et al., 2008). Historically, prenatal depression and anxiety were thought to be self-limiting; however recent evidence suggests otherwise. Two longitudinal birth cohorts in Australia (Giallo et al., 2015; Woolhouse et al., 2014) and France (van der Waerden et al., 2015) describe strikingly similar patterns whereby 30–40% of pregnant women experienced persistent depressive symptoms of moderate and high severity from pregnancy to 4–5 years postpartum. Other studies are clear that the longer depres- sion remains untreated, the less favorable the treatment outcomes (Ghio et al., 2014). Thus, early detection through formal screening has potential to increase access to treatment and improve ma- ternal and child outcomes (Yawn et al., 2012). A major focus of perinatal screening research is improving the Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.07.003 0165-0327/& 2015 Elsevier B.V. All rights reserved. n Correspondence to: 5-258 Edmonton Clinic Health Academy, University of Al- berta, 11405-87 Ave, Edmonton, Alberta, Canada T6G 1C9. Fax: þ780 492 2551. E-mail address: dawn.kingston@ualberta.ca (D.E. Kingston). Journal of Affective Disorders 186 (2015) 90–94