A systematic review of screening instruments for depression for use in antenatal services in low resource settings

Abstract

BackgroundIn low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings.MethodsSearching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots.ResultsEleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity.ConclusionThis review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity.Prospero registration CRD42015020316.

Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis

“…Estimate size also varied according to the tools used to measure depression. While the estimates from EPDS were the most consistent one with previous similar reviews, there was greater variation among estimates from studies using other tools [10,114,115].…”

Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model

“…Antenatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) developed by Cox and colleagues [52] and adapted for use in an Ethiopian context [55]. The EPDS, which is the most commonly used screening tool for antenatal depression [56][57][58][59][60], is a brief screening tool for symptoms of emotional distress during pregnancy that contains 10 specific questions with four Likert scale response options (most of the time, sometimes, not often, never) and is intended to measure the distress that pregnant women have experienced over the previous week. It is a simple and free to use tool, can be scored by simple addition and has been validated in urban settings of Ethiopia [61] with a sensitivity and specificity of 84.7 and 77.0%, respectively.…”

Postpartum obesity and weight gain among human immunodeficiency virus‐infected and human immunodeficiency virus‐uninfected women in South Africa

“…A composite poverty score developed by our research team, calculated from current employment, housing type and access to household assets, was used to categorize women as “most,” “moderate,” or “least” disadvantaged (Brittain et al, ). Perinatal depression was measured using the Edinburgh Postnatal Depression Scale (range 0–30; Chorwe‐Sungani & Chipps, ; Cox, Holden, & Sagovsky, ). A score of >13 was used to indicate probable depression (Redinger, Norris, Pearson, Richter, & Rochat, ).…”