Antenatal Risk Questionnaire (ANRQ)

Abstract

The Antenatal Risk Questionnaire (ANRQ) is a brief, self-report screening instrument designed for use in maternity settings to identify pregnant women who are at elevated risk of developing perinatal depression and anxiety. Developed by Marie-Paule Austin and colleagues, the scale focuses on identifying key psychosocial and historical factors known to contribute to maternal psychiatric morbidity. The ANRQ serves as a critical component of structured psychosocial risk assessment, facilitating early intervention and targeted support pathways for vulnerable individuals during the antenatal period.

Keywords

Antenatal, Psychosocial Risk, Screening, Perinatal Depression, Anxiety, Maternal Health, Risk Assessment, Trauma History, Social Support.

Authors

Marie-Paule Austin, S. Kildea, E. Sullivan, J. Colton, S. Priest, N. Reilly, D. Hadzi-Pavlovic.

Purpose

The primary purpose of the ANRQ is to provide clinicians, such as midwives and obstetricians, with a standardized and acceptable method for assessing the vulnerability of pregnant women to future mental health problems. By administering the questionnaire during the antenatal period, healthcare providers can proactively identify women requiring enhanced psychological support or referral to specialist perinatal mental health services.

This instrument is specifically designed to be brief and easily integrated into routine prenatal care, minimizing administrative burden while maximizing the detection rate of significant risk factors. Early identification allows for preventative measures and timely therapeutic interventions, potentially mitigating the severity and impact of postpartum mood disorders.

Construct

The ANRQ measures a composite psychological and historical construct defined as vulnerability to perinatal psychiatric morbidity. This construct is operationalized through a series of questions that assess multiple, recognized risk domains, including:

• Personal and Family History: Past psychiatric episodes (e.g., history of bipolar disorder, depression, psychosis) and childhood experiences of emotional support or abuse.
• Current Stressors: Recent significant life events, changes, or losses experienced in the last 12 months (e.g., unemployment, bereavement).
• Social and Relationship Support: The quality of emotional support provided by the current partner and the availability of a dependable support network for the baby.
• Personality Traits: General tendencies toward worry or need for control/order.
• Trauma History: History of physical, sexual, or emotional abuse.

Validity

Research, particularly the validation study published by Austin et al. (2013), supports the clinical utility and acceptability of the ANRQ for psychosocial risk assessment in maternity settings. The instrument demonstrates strong face validity, as its items directly address known predictors of perinatal mood disorders.

The ANRQ exhibits predictive validity, meaning scores are significantly associated with subsequent psychiatric morbidity observed during the postnatal period. While not a diagnostic tool, its efficacy lies in accurately stratifying risk, allowing resources to be focused on the highest-risk group. The scale’s inclusion of detailed questions regarding the severity and impairment caused by past mental health issues (Question 2c) enhances its ability to distinguish high-risk individuals.

Reliability

The reliability of the ANRQ is generally considered satisfactory for a screening tool designed for clinical practice. Studies evaluating its psychometric properties indicate good internal consistency across its multi-dimensional factor structure. Furthermore, the instrument maintains high acceptability among pregnant women, which is a crucial aspect of reliability in clinical screening—ensuring consistent and honest responses.

Factor Analysis

Although the ANRQ is typically scored as a composite risk index rather than separate subscales, factor analytical studies of similar comprehensive psychosocial screening tools suggest that the items cluster into distinct, yet correlated, domains. These domains reflect the core constructs assessed: historical vulnerability (past mental health, childhood abuse), current environmental stress (recent losses, relationship quality), and personality disposition (worry, need for order). The overall weighted score provides a quantifiable measure of cumulative risk.

Instrument

Test Type: Self-report Psychosocial Risk Screening Questionnaire

Format: Structured questionnaire combining Likert-type scales (e.g., 1-5 rating of severity/support) and dichotomous (Yes/No) response items, often requiring brief specifications or listings of stressors.

Language Available: Primarily English (Australian context). Translations may exist in other clinical settings.

Population Group: Pregnant women (antenatal population).

Age Group: Adult women of childbearing age.

Population Details: Used universally for all women receiving routine maternity care, regardless of existing risk level, to ensure comprehensive screening.

Test Methodology: Typically administered by a midwife or healthcare professional during the first or second trimester of pregnancy as part of routine antenatal assessment. Scoring involves assigning weighted values to responses that indicate higher risk (e.g., history of severe mental illness, lack of support, or exposure to domestic violence).

Keywords

Maternity Care, Prenatal Screening, Psychological Assessment, Risk Indicators, Mood Disorders, Postpartum Depression, Trauma.

Authors

Author ORCID Identifier: N/A (Information not provided in source material; typically requires searching specific author profiles, e.g., Marie-Paule Austin).

Affiliation Email addresses: N/A (Information not provided in source material).

Correspondence Address: N/A (Information not provided in source material; generally associated with the University of New South Wales or Black Dog Institute at the time of publication).

Permissions & Fee and Test Year

The ANRQ is often used freely within public health systems, particularly in Australia, where it was developed for clinical guideline implementation. Users should confirm local licensing and permission requirements with the authors or the Black Dog Institute, which often hosts related clinical materials.

Test Year: The core version of the ANRQ was developed around 2007 and refined leading up to the 2011/2013 publications detailing its clinical use and acceptability.

Reference’s

• Austin, M.P., Kildea, S., Sullivan, E. (2007). Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting. Medical Journal of Australia, 186:364–367.

• Austin, Marie-Paule., Colton J., Priest S., Reilly, N., Hadzi-Pavlovic, D. (2013). The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth. 26(1):17-25.

• The instrument and related clinical guidelines can be accessed via the following links. The original PDF for clinicians can be downloaded here: http://www.blackdoginstitute.org.au/docs/ANRQclinicians.pdf.

• A broader Clinical Guideline discussing perinatal screening, which includes the ANRQ, is available as a PDF: Clinical Guideline (PDF).

Items of the Antenatal Risk Questionnaire (ANRQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. When you were growing up‚ did you feel your mother was emotionally supportive of you? (If you had no mother circle 6).

1- very much‚ 2‚ 3- somewhat‚ 4‚ 5- not at all‚ 6

2. a) Have you ever had 2 weeks or more when you felt particularly worried‚ miserable or depressed?

 Yes ž No ž

2. b) Do you have any other history of mental health problems? (e.g. eating disorders‚ psychosis‚ bipolar disorder‚ schizophrenia. Please specify) :____________________________

Yes ž No ž

If Yes to 2a or 2b‚ did this:

c) Seriously interfere with your work and your relationships with friends and family?

1-not at all‚ 2‚ 3- somewhat‚ 4‚ 5- very much

d) Lead you to seek professional help?  Yes ž No ž

Did you see a: Psychiatrist …‚ Psychologist/Counselor …‚ GP …

e) Did you take tablets/herbal medicine?  Nož Yes ž Please specify: _______________

3. Is your relationship with your partner an emotionally supportive one? (If you have no partner circle 6)

1- very much‚ 2‚ 3- somewhat‚ 4‚ 5- not at all‚ 6

4. a) Have you had any stresses‚ changes or losses in the last 12 months (e.g separation‚ domestic violence‚ unemployment‚ bereavement ?) Yes ž No ž

Please list:________________________________________

4. b) How distressed were you by these stresses‚ changes or losses?

1-not at all‚ 2‚ 3- somewhat‚ 4‚ 5- very much

5. Would you generally consider yourself a worrier?

1-not at all‚ 2‚ 3- somewhat‚ 4‚ 5- very much

6. In general‚ do you become upset if you do not have order in your life (e.g. regular time table‚ a tidy house)?

1-not at all‚ 2‚ 3- somewhat‚ 4‚ 5- very much

7. Do you feel you have people you can depend on for support with your baby?

1- very much‚ 2‚ 3- somewhat‚ 4‚ 5- not at all

8. Were you emotionally abused when you were growing up? Yes ž No ž

9. Have you ever been sexually… or physically … abused? Yes ž No ž

If you would like to seek some help with any of these issues please discuss this with your midwife or doctor.