Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

Smith, Robert; Shing, Jeffrey S.Y.; Lin, J.; Bosanquet, Kate; Fong, Daniel Yee Tak; Lok, Kris Yuet Wan

doi:10.1016/j.jad.2022.07.026

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…Fourteen primary studies and 10 existing systematic reviews were included that examined the test accuracy of screening for depression (eTables 5 and 6 in the Supplement). The existing systematic reviews covered various versions of the PHQ, 2- and 3-item Whooley screening questions, CES-D, and EPDS.…”

Section: Resultsmentioning

confidence: 99%

Depression and Suicide Risk Screening

O’Connor

Perdue

Coppola

et al. 2023

JAMA

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ImportanceDepression is common and associated with substantial burden. Suicide rates have increased over the past decade, and both suicide attempts and deaths have devastating effects on individuals and families.ObjectiveTo review the benefits and harms of screening and treatment for depression and suicide risk and the accuracy of instruments to detect these conditions among primary care patients.Data SourcesMEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022.Study SelectionEnglish-language studies of screening or treatment compared with control conditions, or test accuracy of screening instruments (for depression, instruments were selected a priori; for suicide risk, all were included). Existing systematic reviews were used for treatment and test accuracy for depression.Data Extraction and SynthesisOne investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Findings were synthesized qualitatively, including reporting of meta-analysis results from existing systematic reviews; meta-analyses were conducted on original research when evidence was sufficient.Main Outcomes and MeasuresDepression outcomes; suicidal ideation, attempts, and deaths; sensitivity and specificity of screening tools.ResultsFor depression, 105 studies were included: 32 original studies (N=385 607) and 73 systematic reviews (including ≈2138 studies [N ≈ 9.8 million]). Depression screening interventions, many of which included additional components beyond screening, were associated with a lower prevalence of depression or clinically important depressive symptomatology after 6 to 12 months (pooled odds ratio, 0.60 [95% CI, 0.50-0.73]; reported in 8 randomized clinical trials [n=10 244]; I2 = 0%). Several instruments demonstrated adequate test accuracy (eg, for the 9-item Patient Health Questionnaire at a cutoff of 10 or greater, the pooled sensitivity was 0.85 [95% CI, 0.79-0.89] and specificity was 0.85 [95% CI, 0.82-0.88]; reported in 47 studies [n = 11 234]). A large body of evidence supported benefits of psychological and pharmacologic treatment of depression. A pooled estimate from trials used for US Food and Drug Administration approval suggested a very small increase in the absolute risk of a suicide attempt with second-generation antidepressants (odds ratio, 1.53 [95% CI, 1.09-2.15]; n = 40 857; 0.7% of antidepressant users had a suicide attempt vs 0.3% of placebo users; median follow-up, 8 weeks). Twenty-seven studies (n = 24 826) addressed suicide risk. One randomized clinical trial (n=443) of a suicide risk screening intervention found no difference in suicidal ideation after 2 weeks between primary care patients who were and were not screened for suicide risk. Three studies of suicide risk test accuracy were included; none included replication of any instrument. The included suicide prevention studies generally did not demonstrate an improvement over usual care, which typically included specialty mental health treatment.Conclusions and RelevanceEvidence supported depression screening in primary care settings, including during pregnancy and postpartum. There are numerous important gaps in the evidence for suicide risk screening in primary care settings.

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Section: Resultsmentioning

confidence: 99%

Depression and Suicide Risk Screening

O’Connor

Perdue

Coppola

et al. 2023

JAMA

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“…Of the 23 included articles, seven were systematic reviews with similar or broader inclusion criteria than ours 10,16–18,20,41,42 . These were not included in the analyses but reference lists were checked for potential additional studies.…”

Section: Resultsmentioning

confidence: 99%

“…If sensitivity is prioritized, the Wooley questions might be an alternative. In a recent systematic review, 16 (Continues) also important to remember that identification of women scoring above any predefined cutoff point is not likely to be effective unless it is followed by clinical assessment by a mental health specialist and appropriate intervention.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…[12][13][14][15] There is, however, a general consensus among professionals that identification of women with possible antenatal depression or anxiety by trained health care staff is good clinical practice 5 and that identification can be facilitated by the use of structured approaches, such as standard identification questions 12 or specific assessment tools. 5 With regard to the diagnostic test accuracy (DTA) of screening instruments aimed at identifying cases of antenatal depression or anxiety, earlier reviews have typically validated one scale at the time, most commonly in a postnatal or perinatal population, [16][17][18] and have shown sparse data for several instruments, 12 indicating a need for further DTA validations. Earlier reviews have also suggested that cultural differences may affect test accuracy.…”

Section: Introductionmentioning

confidence: 99%

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Identification of depression and anxiety during pregnancy: A systematic review and meta‐analysis of test accuracy

Rondung,

Massoudi,

Nieminen

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionDepression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta‐analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS‐3A, Patient Health Questionnaire [PHQ‐9]‐, PHQ‐2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD‐7], GAD‐2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries.Material and methodsOn January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case‐identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM‐IV or DSM‐5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD‐10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full‐texts for relevance and evaluated the risk of bias using QUADAS‐2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Registration: PROSPERO CRD42021236333.ResultsWe screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD‐2, MGMQ, PHQ‐9, PHQ‐2, and Whooley questions, and no articles for the EPDS‐3A or GAD‐7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75–0.90) and specificity (0.87, 95% CI: 0.79–0.92).ConclusionsFindings from the meta‐analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case‐identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

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“…Several limitations have to be kept in mind when interpreting the results of this study: first of all, as already mentioned, Whooley questions serve as screening tools only, and cannot establish diagnosis of depression without other tests. As suggested by a recent meta-analysis, 63 using the Whooley questions followed by a secondary case-finding tool could Open access reduce the misdiagnosis risk. Maternity and primary care services require simple, quick screening tools to know who to refer for care.…”

Section: Discussionmentioning

confidence: 99%

Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort

et al. 2023

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ObjectiveTo assess the feasibility of the family paediatrician’s (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.Design, setting and participantsData for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60–90 days after childbirth). Moreover, on the third visit (5–7 months after childbirth) the FP was asked to answer ‘yes’ or ‘no’ to a question on the parental postpartum depression, based on his knowledge and on the acquired information.ResultsIn 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as ‘likely depressed’. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).ConclusionsThe findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.Trial registration numberNCT03894566; Pre-results.

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Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

Cited by 10 publications

References 31 publications

Depression and Suicide Risk Screening

Depression and Suicide Risk Screening

Identification of depression and anxiety during pregnancy: A systematic review and meta‐analysis of test accuracy

Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort

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