Methodoligical considerations
depressive
RECRUITMENT
Strengths of the study include recruitment of a relatively large sample of both mothers and fathers from the CHCs at which the PSQ-S is intended to be used. This adds to the ecological validity of the instrument in the Swedish CHS setting and the knowledge base particularly regarding fathers, which is inadequate at present. The methodical adaptation process involved in developing the Swedish version of the PSQ may also be seen as conducive to its applicability in clinical pratice. This should be further evaluated within the framework of the randomized trial.The standardized instruments for comparison were mostly ones considered optimal albeit less than “gold standards”. In addition, logistical and cost constraints precluded a thorough clinical evaluation for all parents in the study. There is a risk that the standard instruments used here did not accurately identify the phenomena they were intended to measure [The sample in the present study differed in several ways compared to the population in general. The extent to which this may have influenced the results cannot be evaluated, but as the sample is not representive with regard to gender, educational level or country of birth, generalisability of the results may have been affected.For all the risk factors, the proportion of parents with a positive screen was higher in the study sample compared to parents who completed the PSQ-S at child health visits during the first months of the intervention in Dalarna county (financial worries 21%, depressive symptoms 33%, parental stress 20%, alcohol misuse 5%, IPV 11%, any positive screen 58%). This may relate to skewing due to self-selection, e.g. those who chose to participte may have experienced psychosocial problems in the past or at the time of the study, or they may represent a group that is more inclined to disclose such problems. However, the differences in rates could also be an influence of the setting. Results from a previous national survey in Sweden using the same questions regarding IPV showed prevalence rates similar to those found here, which suggests that the context in which the questions are asked may affect the respondents’ willingness to disclose psychosocial problems [