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Quick Screening Tools May Help Identify Postpartum Depression

Posted Jan 27 2009 7:17pm
Laurie Barclay, MD
January 23, 2009 — Two easily administered screening tools may help to identify postpartum depression at well-child visits, according to the results of a study reported in the January/February issue of Annals of Family Medicine.

"Postpartum depression affects up to 22% of women who have recently given birth," write Dwenda Gjerdingen, MD, MS, from the University of Minnesota in Minneapolis, and colleagues. "Most mothers are not screened for this condition, and an ideal screening tool has not been identified. 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."

At 7 family medicine or pediatric clinics, English-literate mothers registering their 0- to 1-month-old infants for well-child visits were asked to complete questionnaires during these visits at 0 to 1 month, 2, 4, 6, and 9 months postpartum. Each questionnaire included the 2-question screen and the PHQ-9 to screen for depression. The depression component of the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was also completed at the first visit and repeated at a subsequent visit if either screening test result was positive for depression.

The response rate was 33%. Of 506 participants, 45 (8.9%) had major depression based on a positive result on the SCID. During the entire course of the study, the 2-question screen had 100% sensitivity and 44% specificity. With use of simple scoring, the sensitivity of the PHQ-9 was 82% and specificity was 84%; with complex scoring, these were 67% and 92%, respectively. Also during the course of the study, the corresponding values were 84% and 79% for the first 2 items of the PHQ-9.

Completion of the 2- to 6-month questionnaires took place during well-child visits (38%), by mail (29%), or by telephone (33%).

Limitations of this study include low initial rate of participation and failure to compare the validity of the 2-question screen or PHQ-9 vs other postpartum depression screens, such as the Edinburgh Postnatal Depression Scale.

"The 2-question screen was highly sensitive and the PHQ-9 was highly specific for identifying postpartum depression," the study authors write. "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 mass screening approach."

The National Institute of Mental Health funded this study. The study authors have disclosed no relevant financial relationships.

Ann Fam Med. 2009;7:63-70.

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