Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

Abstract

Objectives:To compare the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) as screening tools for postpartum depression.Methods: This study population included the first 500 women to enroll and return their packets during an ongoing study of postpartum depression.Results: The primary outcome of this study was to find rates of concordance and discordance in the EPDS and PHQ-9 categories of "normal" and "increased risk for major depressive disorder." Overall, 97% of eligible women enrolled and 70% returned the packets that included the EPDS and PHQ-9. Four hundred eighty-one of the first 500 packets had complete data, with elevated EPDS or PHQ-9 scores in 138 and 132 women, respectively. Concordance of the EPDS and PHQ-9 were present in 399 women (83%): 326 (67.8%) had "normal" score on both, and 73 (15.2%) had elevated scores for both. Discordant scores in 82 women included 17 with elevated PHQ-9 scores but normal EPDS scores and 65 with elevated EPDS scores and PHQ-9 scores <10. In multivariate logistic regression modeling, only age >30 and low education level were predictive of discordant scores, using EPDS and PHQ-9 scores of >10 as elevated (odds ratio, 1.9 and P ‫؍‬ .02; and odds ratio, 2.3 and P ‫؍‬ .01, respectively). PHQ-9 scores of 5 to 9 have been referred to as consistent with "mild depressive symptoms" and appropriate for "watchful waiting" and repeat PHQ-9 at follow-up. Using this follow-up approach would require reevaluation of 120 (25%) of the women screened.Conclusions: Postpartum depression screening is feasible in primary care practices, and for most women the EPDS and PHQ-9 scores were concordant. Further work is required to identify reasons for the 17% discordant scores as well as to provide definitive recommendations for PHQ-9 scores of 5 to 9.

Practice-based Research Network Studies and Institutional Review Boards: Two New Issues

“…The involvement of each practice lasts for approximately 36 months. 11 Human subjects training was required for all practice personnel who would be involved in the patient consent process, as well as for the lead study physician and nurse coordinator from each site. The required training varied by site and in many instances was specified by the site's IRB.…”

“…[1][2][3][4][5][6][7][8][9][10][11] These issues include obtaining approval for sites that are not affiliated with a local or regional IRB, 1 the need to obtain approvals from multiple site-specific IRBs, 1,3,4,6 the variation in requirements for submission and local rules for study assessments among multiple IRBs, and requirements for varying types of human subject training. 11 Solutions have been recommended and adopted for many of these issues. 1,2,10,12 For example, central IRBs that review and approve PBRN protocols on behalf of multiple sites and other IRBs have been proposed and tested with at least limited success.…”

Changes in Depressive Symptoms over 0–9 Months Postpartum

“…Although one small study (n ¼ 13 depressed women) found the PHQ-9 to be less accurate than the EPDS or Postpartum Depression Screening Scale (PDSS), 6 the remaining three studies found the PHQ-9 to be sensitive and specific in identifying PPD, 7 better than or at least comparable to the EPDS. 8,9 Therefore, it appears that the PHQ-9, which was used in the present study, may be a valuable tool for studying PPD prevalence.…”

Preventing the Voltage Drop: Keeping Practice-based Research Network (PBRN) Practices Engaged in Studies

“…Despite the variety of topics and varying study designs, many of the same implementation strategies and support techniques proved to be useful across studies. Each of the studies introduced a practice change: using spirometry to evaluate patients with asthma and chronic obstructive pulmonary disorder 20 ; introducing screening, diagnosis, and management support for postpartum depression [21][22][23][24] ; using new asthma tools (asthma APGAR tools) in managing children and adults with asthma 25 ; and assessing the effect of 2 classes of long-acting bronchodilators on exacerbation rates in black adults with asthma.…”