Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9

Abstract

PURPOSE Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for this condition, and an ideal screening tool has not been identifi ed. This study investigated (1) the validity of a 2-question screen and the 9-item Patient Health Questionnaire (PHQ-9) for identifying postpartum depression and (2) the feasibility of screening for postpartum depression during well-child visits.METHODS Study participants were English-literate mothers registering their 0-to 1-month-old infants for well-child visits at 7 family medicine or pediatric clinics. They were asked to complete questionnaires during well-child visits at 0 to 1, 2, 4, 6, and 9 months postpartum. Each questionnaire included 2 depression screens: the 2-question screen and the PHQ-9. The mothers also completed the depression component of the Structured Clinical Interview for DSM-IV (SCID) initially, and again at a subsequent interval if either screening result was positive for depression. RESULTSThe response rate was 33%. Of the 506 women who participated, 45 (8.9%) had major depression (ie, they had a positive result on the SCID). The screen sensitivities/specifi cities over the course of the study were 100%/44% with the 2-question screen, 82%/84% with the PHQ-9 using simple scoring, and 67%/92% with the PHQ-9 using complex scoring. In addition, the corresponding values for the fi rst 2 items of the PHQ-9 (ie, the 2-item Patient Health Questionnaire or PHQ-2) were 84%/79%. Some 38% of women completed their 2-to 6-month questionnaires during well-child visits; the rest completed them by mail (29%) or telephone (33%). CONCLUSIONSThe 2-question screen was highly sensitive and the PHQ-9 was highly specifi c for identifying postpartum depression. These results suggest the value of a 2-stage procedure for screening for postpartum depression, whereby a 2-question screen that is positive for depression is followed by a PHQ-9. These screens can be easily administered in primary care clinics; feasibility of screening during well-child visits was moderate but may be better in clinics using a massscreening approach. INTRODUCTIONP ostpartum depression is increasingly recognized as a unique and serious complication of childbirth, with an estimated prevalence in the 12-month postpartum period of up to 21.9%.1 Mothers' depressive symptoms-diminished mood, pleasure, energy, concentration, and self-worth; psychomotor retardation; changes in appetite and sleep; and suicidal ideation-can markedly impair their sense of well-being, marital and other key relationships, 2 work performance and productivity, 3 relationships with their infants, 4 and infants' behavioral and cognitive development. 5 Recognizing the seriousness of this disorder, the US Preventive S CR EENING F OR P OS T PA R T U M DEPR ES SIONServices Task Force has recommended routine depression screening for adults in practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up. 6 Most primary care practices do not h...

Prevalencia De Depresión Posparto en Primigestas Y Multíparas Valoradas Por La Escala De Edimburgo

“…Los resultados obtenidos en estas mujeres, las cuales fueron evaluadas con la EPDS cerca de la quinta semana de puerperio, demuestran un riesgo elevado de depresión postparto tanto en multíparas como primíparas, con pruebas de tamizaje positivo en alrededor del 90%; teniendo en consideración que no se trata de un método diagnóstico, sino de rastreo; sus resultados deben ser comparados con una prueba más específica para obtener un diagnóstico certero de la patología. Así, al compararse con los resultados del DSM-IV se obtuvo una prevalencia del 22%; cifra similar a las encontradas por otros autores en la literatura internacional (16), lo cual hace patente el grave problema de subdiagnóstico observado en instituciones de asistencia materno-infantil, principalmente en aquellas como la estudiada donde no se aplica ningún test de rastreo durante el período puerperal.…”

Changes in Depressive Symptoms over 0–9 Months Postpartum

“…When compared to study completers, these dropouts were younger (26 vs. 29 years old, p ¼ 0.001), less educated (32% vs. 73% had some posthigh school education, p ¼ 0.000), less likely to be married (27% vs. 68%, p ¼ 0.000), and had more children (2.5 vs. 1.9, p ¼ 0.000), lower family incomes (64% vs. 25% had annual income <$20,000, p ¼ 0.000), and more depressive symptoms (21% vs. 6% had a positive PHQ-9, p ¼ 0.008). 7 …”

“…5 The PHQ-9 has more recently been validated in postpartum samples. 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.…”

Factores de riesgo de depresión posparto en puérperas venezolanas valoradas por medio de la escala de Edimburgo

“…Los resultados de esta investigación demuestran un riesgo elevado de depresión, con pruebas de tamizaje positivo en alrededor del 90%, mostrando el instrumento una alta sensibilidad (90%) similar a la reportada por otros autores (14); sin embargo, al compararse con los resultados del DSM-IV se obtuvo una prevalencia del 22%; cifra similar a las encontradas por otros autores en la literatura internacional (15), lo cual hace patente el grave problema de sub-diagnóstico observado en instituciones de asistencia maternoinfantil, principalmente en aquellas como la estudiada donde no se aplica ningún test de rastreo durante el período puerperal Como pudo verse, la población del estudio tuvo un mayor porcentaje de mujeres quienes reportaron una prueba positiva en el EPDS, resultados similares a los obtenidos por Morris y cols (9), quienes encontraron un número considerable de pruebas positivas lo cual fue relacionado esto al menor estado socioeconómico de la muestra evaluada. Sin embargo, estos resultados difieren de los encontrados tanto por Moreno y cols (1) como Pérez y cols (4), en serie realizadas en Brasil y Chile respectivamente, donde la frecuencia de test positivo según esta escala en ambos estudios fue de 22%; así como del 29% de incidencia de depresión según EDPS publicada por Wójcik y cols (16).…”

“…Los factores sociales tienen un rol importante en el desencadenamiento de la DPP, se ha encontrado una relación inversamente proporcional entre nivel socioeconómico y prevalencia de depresión posparto (1,2,6,9,15,16,27); independiente del grado de desarrollo del país, el nivel socioeconómico bajo de las personas constituye un factor de riesgo para sufrir esta patología (2). Se ha observado que tanto los factores psicológicos como los sociales son los de mayor importancia en la presentación de la DPP, por lo que han sido denominados factores de riesgo mayores (28).…”