Diagnostic accuracy of case-finding questions to identify perinatal depression

TY - JOUR

T1 - Diagnostic accuracy of case-finding questions to identify perinatal depression

AU - Mann, Rachel

AU - Adamson, Joy

AU - Gilbody, Simon M

PY - 2012/5/15

Y1 - 2012/5/15

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84861176849&partnerID=8YFLogxK

U2 - 10.1503/cmaj.111213

DO - 10.1503/cmaj.111213

M3 - Article

C2 - 22451686

SN - 1488-2329

VL - 184

SP - E424-E430

JO - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

IS - 8

ER -