Dataset Information

Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya.

ABSTRACT: BACKGROUND:African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women. METHODS:We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes. RESULTS:Most participants preferred to answer the PHQ-9 in Kiswahili (N =?15; 52%). Among the 20 interview participants, 12 (60%) had scores ?5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., "watching television") and double-barreled items (e.g., "poor appetite or overeating"). They were hesitant to endorse items related to "duties as a wife and mother" and suicidal ideation. Most participants had difficulty distinguishing between response options of "several days" and "more than half the days". CONCLUSIONS:We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women.

SUBMITTER: Velloza J

PROVIDER: S-EPMC6990517 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya.

Velloza Jennifer J Njoroge John J Ngure Kenneth K Thuo Nicholas N Kiptinness Catherine C Momanyi Richard R Ayub Snaidah S Gakuo Stephen S Mugo Nelly N Simoni Jane J Heffron Renee R

BMC psychiatry 20200129 1

<h4>Background</h4>African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women.<h4>Methods</h4>We administered ...[more]

PMID: 31996166

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Project description:OBJECTIVE:To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. DESIGN:Individual participant data meta-analysis. DATA SOURCES:Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018). ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics. RESULTS:Individual participant data were obtained from 58 of 83 eligible studies (70%; 15?557 of 22?788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women. CONCLUSIONS:An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria. REGISTRATION:PROSPERO (CRD42015024785).

Dataset Information

Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya.

Publications

Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya.

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