Postnatal Questionnaire

Due to the nature of your appointment, we will require you to complete 2 questionnaires (EPDS + ANRQ). The questions below are designed to help you and your clinician understand whether you may benefit from some extra support during this time of change. You may find some questions challenging, but please choose the answers that best apply to you. There are no right or wrong answers.

Please complete all questions, unless instructed to SKIP a question. Once you have completed the questions, your clinician will discuss your responses with you. If you have any concerns about any of the questions, please let your clinician know.

Edinburgh Postnatal Depression Scale (EPDS)

We would like to know how you have been feeling in the past week. Please indicate which of the following comes closest to how you have felt in the past week, not just how you feel today. Please TICK for each question, which is the closest to how you have felt in the PAST SEVEN DAYS.

Full name

Date of birth

1. I have been able to laugh and see the funny side of things

As much as I always could Not quite so much now Definitely not so much now Not at all

2. I have looked forward with enjoyment to things

As much as I ever did Rather less than I used to Definitely less than I used to Hardly at all

3. I have blamed myself unnecessarily when things went wrong

Yes, most of the time Yes, some of the time Not very often No, never

4. I have been anxious or worried for no good reason

No, not at all Hardly ever Yes, sometimes Yes, very often

5. I have felt scared or panicky for no very good reason

Yes, quite a lot Yes, sometimes No, not much No, not at all

6. Things have been getting on top of me

Yes, most of the time I haven't been able to cope at all Yes, sometimes I haven't been coping as well as usual No, most of the time I have coped quite well No, I have been coping as well as ever

7. I have been so unhappy that I have had difficulty sleeping

Yes, most of the time Yes, sometimes Not very often No, not at all

8. I have felt sad or miserable

Yes, most of the time Yes, quite often Not very often No, not at all

9. I have been so unhappy that I have been crying

Yes, most of the time Yes, quite often Only occasionally No, not at all

10. The thought of harming myself has occurred to me

Yes, quite often Sometimes Hardly ever Never

Psychosocial Risk Questionnaire (ANRQ)

Please complete all questions, unless instructed to SKIP a question. Once you have completed the questions, your doctor will discuss your responses with you. If you have any concerns about any of the questions, please let your doctor know.

1. Have you ever had a period of 2 weeks or more when you felt particularly worried, miserable or depressed?

Yes No

* If No, skip to 1c. If Yes, please answer 1a, 1b, and 1c.

1a. If Yes, did this seriously interfere with your work and your relationships with family and friends?

Not at all A little Somewhat Quite a lot Very much

1.b Did this lead you to seek professional help?

Yes No

If yes, name of the professional:

If yes, did you take tablets/herbal medicine?

Yes No

If yes, list medications(s):

Were they:

Psychiatrist Psychologist/counsellor GP

1.c Do you have any other history of mental health problems? (e.g eating disorders, psychosis, bipolar, schizophrenia)

Yes No

If yes, please list other mental health problems:

2. Is your relationship with your partner an emotionally supportive one?

Very much Quite a lot Somewhat A little Not at all No partner

3. Have you had any stressors, changes or losses in the past 12 months? (e.g. only: separation, domestic violence, job loss, bereavement etc.)

Yes No

If yes, please specify:

* If No, skip to 4. If Yes, please answer 3a

3a. How distressed were you by these stressors, changes or losses?

Not at all A Litte Somewhat Quite alot Very much

4. Would you generally consider yourself a worrier?

Not at all A Little Somewhat Quite alot Very much

5. In general, do you become upset if you do not have order in your life? (e.g. regular timetable, tidy house)

Not at all A little Somewhat Quite alot Very much

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

Very Much Quite alot Somewhat A Little Not at all

Now you are having your own baby, you may be starting to think about your own childhoods and what it was like:

7. Were you emotionally abused when you were growing up?

Yes No

8. Have you ever been sexually or physically abused?

Yes No

If yes, tick all that apply

Sexually Physically

9. When you were growing up, did you feel your mother was emotionally supportive of you?

Very much Quite a lot Somewhat A little Not at all No mother

If you have already had your baby, please complete the following questions about your experiences:

10. Was your experience of giving birth to this baby disappointing or frightening?

Not at all A Litte Somewhat Quite a lot Very much

11. Has your experience of parenting this baby been a positive one?

Not at all A little Somewhat Quite a lot Very much

12. Overall, has your baby been unsettled or feeding poorly?

Not at all A little Somewhat Quite a lot Very much

And finally.......

13. Do you feel safe with your current partner?

Not at all A little Somewhat Quite a lot Very much

14. Do you think that you (or your partner) may have a problem with drugs or alcohol?

Not at all A little Somewhat Quite a lot Very much

15. Do you have any other concerns that you would like to talk about today?