Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study

Journal Name: 
J Am Board Fam Pract
Authors: 
Bennett,I.M.
Coco,A.
Coyne,J.C.
Mitchell,A.J.
Nicholson,J.
Johnson,E.
Horst,M.
Ratcliffe,S.
Abstract: 
OBJECTIVE: Systems for efficient case finding of women with major depression during pregnancy and postpartum are needed. Here we assess the diagnostic accuracy of a modified 2-item patient health questionnaire (PHQ-2) as a pre-screen in assessing depression. METHODS: Cross-sectional assessments at 15 weeks' gestation (n = 414), 30 weeks' gestation (n = 334), and 6 to 16 weeks postpartum (n = 193) among women from a diverse set of races/ethnicities, participating in the IMPLICIT maternal care quality improvement network. The Edinburgh Postnatal Depression Scale score (>or=13) was used as the criterion measure for the PHQ-2. RESULTS: A positive 2-item screen had sensitivity of 93%, 82%, and 80% and specificity of 75%, 80%, and 86% for Edinburgh Postnatal Depression Scale score of >or=13 for assessment at 15 and 30 weeks gestational age and postpartum, respectively. The positive/negative predictive values for the PHQ-2 were 44/98, 24/91, and 30/98 for each time point, respectively. Areas under the receiver operating characteristic curve analysis suggested that 2-item assessments at each time point had approximately equal diagnostic validity. CONCLUSIONS: Two questions were efficient to rule out depression and reduced the need for further screening of approximately 60% to 80% of women, depending on the point in pregnancy or postpartum. A diagnostic interview follow-up of women screening positive is still required
7
2008
Volume: 
21
Pages: 
317-325
Keywords: 
analysis, community, Depression, diagnostic, Efficiency, Family, Health, Medicine, Methods, patient, Pennsylvania, Philadelphia, Pregnancy, quality, quality improvement, Research, Research Support, support, system, Universities, women