PMH-C Assessment and Screening 5 — Questions and Answers
Question 1: Which of the following questions is part of a structured suicide risk assessment for perinatal patients?
- How many prenatal vitamins do you take daily?
- Do you have access to means such as firearms or medications? (Correct answer)
- Are you planning to breastfeed?
- What is your support network for childcare?
Correct answer: Do you have access to means such as firearms or medications?
Means assessment — asking whether the patient has access to lethal means such as firearms or stockpiled medications — is a core component of suicide risk assessment.
Question 2: A perinatal mental health specialist is conducting a comprehensive intake. Which domain is least likely to directly inform the mental health risk assessment?
- History of childhood adversity
- Insurance type and coverage plan (Correct answer)
- Social determinants of health including housing stability
- Relationship quality and domestic violence history
Correct answer: Insurance type and coverage plan
While insurance information is important for care coordination, it does not directly inform clinical risk assessment in the way that trauma history, social determinants, and relationship safety do.
Question 3: Which screening approach is recommended for identifying intimate partner violence (IPV) during the perinatal period?
- Ask only at the first prenatal visit to avoid redundancy
- Screen at each trimester and postpartum using a validated tool such as HITS or WAST (Correct answer)
- Ask the patient's partner to complete a questionnaire on her behalf
- Screen only if bruising or injury is visibly apparent
Correct answer: Screen at each trimester and postpartum using a validated tool such as HITS or WAST
Best practice guidelines recommend repeated IPV screening throughout the perinatal period using validated tools like HITS (Hurt, Insult, Threaten, Scream) or WAST (Woman Abuse Screening Tool).
Question 4: A patient with a previous perinatal psychiatric episode presents for a new pregnancy. How should the initial assessment differ from a first-time patient?
- The same standard EPDS screen is sufficient
- A comprehensive psychiatric history should be obtained and risk stratified early in pregnancy (Correct answer)
- Screening should begin postpartum only, since prenatal episodes are rare
- Psychiatric history is irrelevant if she is currently asymptomatic
Correct answer: A comprehensive psychiatric history should be obtained and risk stratified early in pregnancy
A prior perinatal psychiatric episode significantly increases the risk of recurrence, making early and thorough psychiatric history-taking and risk stratification essential.
Question 5: Which of the following correctly describes the difference between the EPDS and the PHQ-9 in perinatal settings?
- The PHQ-9 excludes somatic symptoms making it better suited for pregnancy
- The EPDS excludes somatic symptoms that overlap with normal pregnancy, reducing false positives (Correct answer)
- The PHQ-9 is longer and therefore less accurate than the EPDS
- Both tools are interchangeable with no meaningful clinical difference
Correct answer: The EPDS excludes somatic symptoms that overlap with normal pregnancy, reducing false positives
The EPDS was specifically developed for perinatal populations and excludes somatic items (e.g., fatigue, appetite change) that commonly overlap with normal pregnancy, thereby reducing false positives.
Question 6: A patient who screens positive for anxiety on the GAD-7 also reports insomnia and hypervigilance. What additional clinical consideration is most important?
- Assume the anxiety is adjustment related and monitor only
- Consider trauma history and screen for PTSD given symptom overlap (Correct answer)
- Refer directly to a sleep specialist
- Discontinue the GAD-7 and administer the PHQ-9 instead
Correct answer: Consider trauma history and screen for PTSD given symptom overlap
Insomnia and hypervigilance are also hallmark symptoms of PTSD; when anxiety and trauma-related symptoms co-occur, clinicians should screen for PTSD to avoid missing a comorbid diagnosis.
Question 7: Which of the following practices reflects a trauma-informed approach to perinatal mental health screening?
- Handing the patient a screening form without explanation
- Explaining the purpose of screening, ensuring privacy, and inviting questions before administration (Correct answer)
- Conducting the screening in the presence of a family member to increase accuracy
- Administering the screening tool only after the patient discloses trauma history
Correct answer: Explaining the purpose of screening, ensuring privacy, and inviting questions before administration
Trauma-informed screening involves explaining the purpose, ensuring a private and safe environment, and giving the patient agency — all before administering the tool.
PMH-C Assessment and Screening 5
Which of the following questions is part of a structured suicide risk assessment for perinatal patients?