Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women

Abstract

BackgroundAntenatal depression and anxiety disorders are highly prevalent in low and middle-income countries. Screening of pregnant women in primary care antenatal settings provides an opportunity for entry to care, but data are needed on the performance of different screening tools. We compared five widely-used questionnaires in a sample of pregnant women in urban South Africa.MethodPregnant women attending a primary care antenatal clinic were administered five tools by trained research assistants: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), the Kessler Psychological Distress scale (K10) and a shortened 6-item version (K6), the Whooley questions and the two-item Generalised Anxiety Disorder scale (GAD-2). Following this, a registered mental health counsellor administered the MINI Plus, a structured clinical diagnostic interview. The Area Under the Curve (AUC) from Receiver Operator Characteristic curve analysis was used to summarise screening test performance and Cronbach’s α used to assess internal consistency.ResultsOf 376 participants, 32% were diagnosed with either MDE and/or anxiety disorders. All five questionnaires demonstrated moderate to high performance (AUC = 0.78–0.85). The EPDS was the best performing instrument for detecting MDE and the K10 and K6 for anxiety disorder. For MDE and/or anxiety disorders, the EPDS had the highest AUC (0.83). Of the short instruments, the K10 (AUC = 0.85) and the K6 (AUC = 0.85) performed the best, with the K6 showing good balance between sensitivity (74%) and specificity (85%) and a good positive predictive value (70%). The Whooley questions (AUC = 0.81) were the best performing ultra-short instrument. Internal consistency ranged from good to acceptable (α = 0.89–0.71). However, the PPV of the questionnaires compared with the diagnostic interview, ranged from 54% to 71% at the optimal cut-off scores.ConclusionsUniversal screening for case identification of antenatal depression and anxiety disorders in low-resource settings can be conducted with a number of commonly used screening instruments. Short and ultra-short screening instruments such as the K6 and the Whooley questions may be feasible and acceptable for use in these settings.

The development of an ultra-short, maternal mental health screening tool in South Africa

“…2018). We used these results as a starting point to conduct the primary logistic regression to identify screening items that were independently predictive of MDE and anxiety diagnoses (see Table 2).…”

“…A high level of sensitivity in a screening tool is important for first-level screening purposes, however in resource-constrained areas this needs to be balanced with adequate specificity so as not to flood the system with false positives. The sensitivity (78%) and specificity (82%) of our tool in detecting MDE and anxiety disorders seems favourable compared to the EPDS (75%; 78%) and the PHQ9 (66%; 76%), as well as ultra-short versions of these: the 3-item EPDS (70%; 77%), the PHQ2 (75%; 69%) and the Whooley questions (66%; 87%) (van Heyningen et al 2018). …”

“…2018). However, the fourth advantage of our tool over existing tools is its sensitivity and reliability.…”

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

“…In addition, studies addressing structural factors showed promising results with integration of postpartum care into routine care for the child or family [66] [67], mHealth reminders and cash transfers [68][69][70][71][72]. Ongoing studies will evaluate effects of mHealth strategies [73,74], reaching women with mental health challenges in pregnancy and postpartum [75,76] and adherence clubs/decentralized care [77]. Women in different contexts will require different types of support [78,79] and an adaptive trial design [80] may be an efficient way to evaluate strategies to combine intervention elements to support women to remain in care [81].…”

The Food, Feelings, and Family Study: Comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study.

“…The EPDS is a ten-question self-rating scale developed to assess depressive symptoms in the postnatal period [32]. This scale can also be used to identify depression in the antenatal period [33][34][35]. On the EPDS, respondents are asked to identify the answer that most closely represents how they felt in the previous seven days.…”