Extending EPDS screening in perinatal consultation-liaison care: A pragmatic framework for risk assessment

AI Summary

EPDS symptom screening alone can miss perinatal psychiatric risk associated with psychosocial adversity and somatic illness including IPV and hyperemesis gravidarum.
TPRA augments universal screening by triangulating symptom assessment, psychosocial risk, and somatic burden to inform consultation-liaison stage formulation and care allocation.
TPRA may be low-burden and sustainable within consultation-liaison services but requires prospective evaluation of feasibility, workload, referral and false positive burdens and clinical impact.

AI Summary

This perspective proposes a consultation-liaison framework that augments, but does not replace, universal screening.Intimate partner violence and hyperemesis gravidarum are associated with substantial psychiatric morbidity that may not be fully reflected by EPDS scores, yet are inconsistently captured by symptom-based screening.ConclusionThe Triangulated Perinatal Risk Assessment (TPRA) framework is a hypothesis-generating consultation-liaison framework that builds on established psychosocial risk-assessment approaches, including the Antenatal Risk Questionnaire and Psychosocial Risk Assessment Model.

TPRA operates after initial risk flagging and integrates symptom assessment, psychosocial risk, and somatic burden to support CL-stage formulation and care allocation.

Where perinatal liaison nursing capacity exists, TPRA may provide a pragmatic structure for organising information already gathered in routine care.TPRA may be relatively low-burden and potentially sustainable within existing consultation-liaison structures, but its feasibility, workload, referral burden, false-positive burden, and clinical impact remain unevaluated and require prospective study.

Basic summary

Australas Psychiatry. 2026 Jul 17:10398562261469339. doi: 10.1177/10398562261469339. Online ahead of print.

ABSTRACT

ObjectiveSymptom-based screening alone is insufficient for identifying perinatal mental health risk in general hospital settings. Although Edinburgh Postnatal Depression Scale (EPDS)-centred screening is embedded in Australian policy, psychosocial adversity and somatic illness may contribute to psychiatric morbidity that is not captured by symptom screening alone. This perspective proposes a consultation-liaison framework that augments, but does not replace, universal screening.Intimate partner violence and hyperemesis gravidarum are associated with substantial psychiatric morbidity that may not be fully reflected by EPDS scores, yet are inconsistently captured by symptom-based screening.ConclusionThe Triangulated Perinatal Risk Assessment (TPRA) framework is a hypothesis-generating consultation-liaison framework that builds on established psychosocial risk-assessment approaches, including the Antenatal Risk Questionnaire and Psychosocial Risk Assessment Model. TPRA operates after initial risk flagging and integrates symptom assessment, psychosocial risk, and somatic burden to support CL-stage formulation and care allocation. Where perinatal liaison nursing capacity exists, TPRA may provide a pragmatic structure for organising information already gathered in routine care.TPRA may be relatively low-burden and potentially sustainable within existing consultation-liaison structures, but its feasibility, workload, referral burden, false-positive burden, and clinical impact remain unevaluated and require prospective study.

PMID:42464851 | DOI:10.1177/10398562261469339

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