BACKGROUND: Guidelines for perinatal mental health care recommend the use of two case-finding questions about depressed feelings and loss of interest in activities, despite the absence of validation studies in this context. We examined the diagnostic accuracy of these questions and of a third question about the need for help asked of women receiving perinatal care. METHODS: We evaluated self-reported responses to two case-finding questions against an interviewer-assessed diagnostic standard (DSM-IV criteria for major depressive disorder) among 152 women receiving antenatal care at 26-28 weeks' gestation and postnatal care at 5-13 weeks after delivery. Among women who answered "yes" to either question, we assessed the usefulness of asking a third question about the need for help. We calculated sensitivity, specificity and likelihood ratios for the two case-finding questions and for the added question about the need for help. RESULTS: Antenatally, the two case-finding questions had a sensitivity of 100% (95% confidence interval [CI] 77%-100%), a specificity of 68% (95% CI 58%-76%), a positive likelihood ratio of 3.03 (95% CI 2.28-4.02) and a negative likelihood ratio of 0.041 (95% CI 0.003-0.63) in identifying perinatal depression. Postnatal results were similar. Among the women who screened positive antenatally, the additional question about the need for help had a sensitivity of 58% (95% CI 38%-76%), a specificity of 91% (95% CI 78%-97%), a positive likelihood ratio of 6.86 (95% CI 2.16-21.7) and a negative likelihood ratio of 0.45 (95% CI 0.25-0.80), with lower sensitivity and higher specificity postnatally. INTERPRETATION: Negative responses to both of the case-finding questions showed acceptable accuracy for ruling out perinatal depression. For positive responses, the use of a third question about the need for help improved specificity and the ability to rule in depression.
BACKGROUND: Guidelines for perinatal mental health care recommend the use of two case-finding questions about depressed feelings and loss of interest in activities, despite the absence of validation studies in this context. We examined the diagnostic accuracy of these questions and of a third question about the need for help asked of women receiving perinatal care. METHODS: We evaluated self-reported responses to two case-finding questions against an interviewer-assessed diagnostic standard (DSM-IV criteria for major depressive disorder) among 152 women receiving antenatal care at 26-28 weeks' gestation and postnatal care at 5-13 weeks after delivery. Among women who answered "yes" to either question, we assessed the usefulness of asking a third question about the need for help. We calculated sensitivity, specificity and likelihood ratios for the two case-finding questions and for the added question about the need for help. RESULTS: Antenatally, the two case-finding questions had a sensitivity of 100% (95% confidence interval [CI] 77%-100%), a specificity of 68% (95% CI 58%-76%), a positive likelihood ratio of 3.03 (95% CI 2.28-4.02) and a negative likelihood ratio of 0.041 (95% CI 0.003-0.63) in identifying perinatal depression. Postnatal results were similar. Among the women who screened positive antenatally, the additional question about the need for help had a sensitivity of 58% (95% CI 38%-76%), a specificity of 91% (95% CI 78%-97%), a positive likelihood ratio of 6.86 (95% CI 2.16-21.7) and a negative likelihood ratio of 0.45 (95% CI 0.25-0.80), with lower sensitivity and higher specificity postnatally. INTERPRETATION: Negative responses to both of the case-finding questions showed acceptable accuracy for ruling out perinatal depression. For positive responses, the use of a third question about the need for help improved specificity and the ability to rule in depression.
Authors: Harriet L MacMillan; Christopher J S Patterson; C Nadine Wathen; John W Feightner; Paul Bessette; R Wayne Elford; Denice S Feig; Joanne Langley; Valerie A Palda; Christopher Patterson; Bruce A Reeder; Ruth Walton Journal: CMAJ Date: 2005-01-04 Impact factor: 8.262
Authors: Katharine Bosanquet; Della Bailey; Simon Gilbody; Melissa Harden; Laura Manea; Sarah Nutbrown; Dean McMillan Journal: BMJ Open Date: 2015-12-09 Impact factor: 2.692
Authors: Elizabeth Littlewood; Shehzad Ali; Pat Ansell; Lisa Dyson; Samantha Gascoyne; Catherine Hewitt; Ada Keding; Rachel Mann; Dean McMillan; Deborah Morgan; Kelly Swan; Bev Waterhouse; Simon Gilbody Journal: BMJ Open Date: 2016-06-13 Impact factor: 2.692
Authors: Stephanie L Prady; Kate E Pickett; Emily S Petherick; Simon Gilbody; Tim Croudace; Dan Mason; Trevor A Sheldon; John Wright Journal: Br J Psychiatry Date: 2016-01-21 Impact factor: 9.319