Capture My Mood: A pilot study to develop and validate a visual scale for women to self-monitor their mental wellbeing following birth Lois McKellar, Nirmal Lorensuhewa and Mary Steen
Introduction This project seeks to contribute to better maternal mental health by developing a visual scale Capture My Mood that provides women with a means to monitor their own mental wellbeing and may assist in detecting variations from positive mental health. WHO definition of mental health is: a state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community (WHO 00: ).
Approx. in 7 women - a mental health problem during the childbirth continuum Women who have an existing mental health problem are at > risk of relapse during pregnancy (NICE, 007). Approx. % non-pregnant women suffer from anxiety and depression This is > 8-0% during pregnancy >3% in the year following birth (WHO 03)
Midwives public health role Promoting positive mental health and wellbeing Routine and universal screening of all women during pregnancy and the postnatal period but there is ongoing debate about the appropriateness, timing and effectiveness of screening all women high number of false positives, as well as false negatives, where women go on to develop depression lack of consensus regarding the cut off score with some researchers advocating a lower cut off score in an attempt to capture a more accurate assessment of risk screening tools are typically used at a single point in time and only provide a snap shot of the woman s emotional there has also been concern that screening women adds to the medicalization of childbirth and motherhood
Developing the Capture My Mood scale Helpful to understand wellbeing as being made up of two key elements: Feeling good- experiencing positive emotions Functioning well- how a person is able to function The Warwick-Edinburgh Mental Well-being Scale (WEMWBS), developed in 006 through collaboration between Warwick and Edinburgh University, is a item scale with response categories which is added together to provide a single score ranging from -70. The scale is based on core components which cover both feeling and functioning aspects of mental wellbeing these are satisfying interpersonal relationships positive functioning positive affect hedonic perspective eudemonic perspective
Developing the CMM Developing a simple visual scale based on the core components of the WEMWBS would provide women with a means to self-asses their mental wellbeing and alert them to changes in wellbeing Specifically, this pilot study seeks to ascertain a correlation between the WEMWBS and the new visual scale and the useability for women during the perinatal period.
Developing the CMM The tool consists of a visual scale that is constructed from the five core concepts of the WEMWBS. These core concepts are associated with positive mental health as identified below: Connected (satisfying interpersonal relationships) Confident (positive functioning) Cheerful (positive affect) Contented (hedonic perspective) Capable (eudemonic perspective).
In the last few days I have felt Cheerful None of the time Not very often Some of the time 3 In the last few days I have felt Contented Very often All of the time Piloting the CMM scale 3 women who were recruited to the study during the antenatal period piloted the CMM scale None of the time Not very often Some of the time 3 In the last few days I have felt Capable Very often All of the time Mother s record their mood 3 times a week for weeks None of the time Not very often Some of the time 3 Very often All of the time Short questionnaire to complete at the end of weeks about using CMM scale In the last few days I have felt Connected None of the time Not very often Some of the time 3 Very often All of the time Also, complete - Warwick Edinburgh Mental Wellbeing Scale at the end of weeks In the last few days I have felt Confident None of the time Not very often Some of the time 3 Very often All of the time Compare results recorded to validate the CMM scale
WEMWBS Score at end of week Initial findings: Correlation CMM score shows a positive correlation with WEMWBS score Figure : Scatter plot showing each participant s (n = ) CMM score at end of week vs their WEMWBS score. Each bubble represents a participant. The dark linear line represents the best fit Pearsons Correlation. Curved grey lines shows the 9% confidence interval. CMM Score at end of week r = 0.7 p = 0.0
Initial findings: useability and usefulness An anonymous purpose designed questionnaire regarding their impression of the Capture My Mood scale, ease of use, helpfulness and satisfaction was completed by 3 women, women were born in Australia, with one woman born in south Korea and another in the Philippines. 7 6 3 0 Age (years) <0 0-6-30 3-3 >36 6 3 n=3 0 Education n=3 0 8 6 0 Number of children including this baby 3 or more n=3
Women were asked to provide a rating for the following statements: 8 7 6 3 0 I thought the CMM scale was easy to use Strongly agree Agree Unsure Disagree Strongly disagree n=3 0 8 6 0 I understood the meaning of the descriptor words used in the scale Strongly agree Agree Unsure Disagree Strongly disagree n=3
9 8 7 6 3 0 I felt comfortable using the CMM scale Strongly agree Agree Unsure Disagree Strongly disagree Missing n=3 0 8 6 0 I found the CMM scale helpful Strongly agree Agree Unsure Disagree Strongly disagree Missing n=3 While it was interesting to record my feelings and see them on paper. I didn t necessarily find it helpful. In the same token it was not unhelpful (W3)
7 I would use CMM scale again I would use a digital form of CMM scale (ie an app) 6 7 3 n=3 6 3 n=3 0 Strongly agree Agree Unsure Disagree Strongly disagree Missing 0 Strongly agree Agree Unsure Disagree Strongly disagree Missing Because I don t feel at risk of poor mental health and I often discuss my feelings with family and friends I m not sure that this diagnostic tool is particularly useful for me at this time (W7)
Written responses Very easy and simple to use (W) Helpful to get me thinking about feelings and state of mind (W3) It was a positive way to look at how things are feeling. I could see how things were changing for me (W) Different to other mood measures since it focusses on more practical factors like whether you feel competent rather than less specific feelings like whether you are happy (W 8) My general wellbeing has been great during the newborn period but it was good to take a moment to reflect (W9)
Other comments were helpful in considering the next stage of the development of this scale Once I understood what - stood for it allowed me to circle my response without too much thought (W 6) Maybe a little more info or examples of how each title could be interpreted eg connected with baby? Or connected with others or self (W) Would be good to know what the results mean (W 6) Being on paper it is very easy to misplace the paper and forget.. an App would be very good with reminders that would pop up (W0) Think an app would be a good idea (W) For the app-include a graph of overall moods (W) More visually appealing, interactive, delivers instantaneous feedback (ie if it were an app) would be more user friendly (W3)
Where to now Gain funding to develop an interactive app with access to educational resources and undertake a larger study..
References Maheswaran H, Weich S, Powell J and Stewart-Brown S, 0, Evaluating the responsiveness of the Warwick Edinburgh Mental Well- Being Scale (WEMWBS): Group and individual level analysis. Health and Quality of Life Outcomes 0:6 NHS Choices, 0, Your Health Your choices, WEMWBS self-assessment accessed January 0 http://www.nhs.uk/tools/pages/wellbeing-self-assessment.aspx?tag=self+assessments Ragonesi and Greigni 0 Mental Well-Being and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): an analysis of its psychometric performance in screening. PhD thesis, University of Bologna, Italy Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, Parkinson J, Secker J and Stewart-Brown S, 007, The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes :63 Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) NHS Health Scotland, University of Warwick and University of Edinburgh, 006, all rights reserved NHS 0 (used with permission) Yelland, J, Sutherland, G, Wiebe J and Brown, S 009 National approach to perinatal mental health in Australia: exercising caution in the roll-out of a public health initiative. Medical Journal of Australia 9 (): 76-79.
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