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Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study.

ABSTRACT: BACKGROUND:Screening women for postnatal depression (PND) provides an opportunity to reach undetected cases and enhance pregnancy outcomes. In Zimbabwe, no validation of depression screening tools has been done on postnatal women in rural settings. OBJECTIVES:This study aims to determine criterion validity of the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9) and the Center for Epidemiological Studies-Depression (CES-D) scale using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria as the reference standard. METHODS:Women (n=462) attending postnatal care at 7 or 42 days at two rural district hospitals in Zimbabwe will be assessed for depressive symptoms using the EPDS, PHQ-9 and CES-D. The women will be interviewed by a clinical psychologist using DSM-5 criteria. Sensitivities, specificities, positive predictive values, negative predictive values and test efficiencies will be calculated for each of the three tools. The area under the receiver operating curve will quantify the overall ability of the three tests to discriminate between those mothers with PND and those without. DISCUSSION:Findings from this study will add to the body of knowledge on PND among women in resource-limited settings. Identifying women with PND will enable healthcare providers to link them with care, which will ultimately improve maternal and child health outcomes. Furthermore, this study will provide evidence on which screening tool would be best for screening PND in rural settings of Zimbabwe.

SUBMITTER: January J

PROVIDER: S-EPMC5914896 | biostudies-other | 2018 Apr

REPOSITORIES: biostudies-other

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Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study.

January James J Chimbari Moses John MJ

BMJ open 20180419 4

<h4>Background</h4>Screening women for postnatal depression (PND) provides an opportunity to reach undetected cases and enhance pregnancy outcomes. In Zimbabwe, no validation of depression screening tools has been done on postnatal women in rural settings.<h4>Objectives</h4>This study aims to determine criterion validity of the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9) and the Center for Epidemiological Studies-Depression (CES-D) scale using the Diagno ...[more]

PMID: 29674363

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Project description:BackgroundAnxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers.MethodsWe used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2-11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS.ResultsThe presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS.ConclusionsThe EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative.

Project description:BACKGROUND:The Edinburgh Postnatal Depression Scale (EPDS) is widely used in many countries to screen women for depression in the perinatal period. However, across studies the psychometric properties and cutoff scores of the EPDS have varied considerably; potentially due to different depression criteria and diagnostic systems being used. Therefore, we validated the Danish EPDS against a depression diagnosis according to both DSM-5 and ICD-10. Furthermore, we examined whether the Danish EPDS is multidimensional, as it has previously been suggested. METHODS:Women (N?=?324) were recruited after routine screenings with the EPDS between 2 and 10?months postpartum (T1). At a subsequent home visit (T2), the EPDS and the Structured Clinical Interview for DSM-5 were administered. Diagnostic interviews were audio recorded to enable subsequent coding for ICD-10 diagnoses and inter-rater reliability analysis. A two-phase stratified sampling strategy with three sampling categories (EPDS-score at T1) was used. Using the distribution of 4931?T1 EPDS-scores from the same population from which we sampled the participants, we used sampling weighing to reweight the sample. The calculation of weights was based upon the mother's sampling category at T1 (i.e. the probability of being sampled) and the weights were applied when assessing the receiver operation characteristics (ROCs) of the EPDS. Sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve were computed from the reweighted data for all relevant cutoff values. CIs were computed by embedding the calculations in a weighted logistic regression. Exploratory factor analysis was done using oblique rotation. Parallel analysis was used to assess the number of factors. RESULTS:A score of 11 or more was found to be the optimal cutoff for depression according to both DSM-5 and ICD-10 criteria. Factor analysis suggested that the Danish EPDS consists of three factors, including an 'anxiety factor'. CONCLUSIONS:The Danish EPDS has reasonable sensitivity and specificity at a cutoff score of 11 or more. There are no notable differences with respect to using ICD-10 or DSM-5 criteria for depression in terms of optimal cutoff. The variation in cutoff scores is likely to be due to cultural variations in the expression of depressive symptoms.

Project description:Background:Screening instruments for antenatal depression vary in performance. This study aimed at assessing the performance of a range of screening instruments in detecting depressive symptoms in antenatal clinics in Blantyre district, Malawi. Methods:A cross-sectional study was conducted to screen for depression among women attending 8 selected antenatal clinics in Blantyre district using 3-item screener, Edinburgh Postnatal Depression Scale (EPDS), Hopkins Symptoms Checklist-15 (HSCL-15), Self-Reporting Questionnaire (SRQ) and Pregnancy Risk Questionnaire (PRQ). The instruments were administered to a random sample of 480 pregnant women. Data were analysed using SPSS 22.0 testing for performance differences in proportions of screen positives and how screen positive results might differ by particular variables. Results:The prevalence estimates yielded by screening instruments ranged from 12.9% (SRQ) to 42.1% (3-item screener). There were no significant differences in prevalence estimates for EPDS, HSCL-15, PRQ and SRQ. There were performance differences in the proportions of screen positives with significant systematic differences between proportions of screen positives of PRQ and SRQ (p<.001), EPDS and HSCL-15 (p=.001), HSCL and PRQ (p<.001), and EPDS and SRQ (p<.001). Screen positive results on HSCL-15, PRQ, 3-item screener and EPDS were found to differ by variables such as "not being supported by partner" which resulted in respondents having ?3 times chances to screen positive on these four instruments. The screen positive results on SRQ were found not to differ by age, education, employment status, marital status, setting, gestation and number of pregnancies. Conclusions:There were minimal variations in the performance of the EPDS, SRQ and HSCL-15 as standard public health screening instruments. However, systematic differences between proportions of screen positives exist and screen positive results from these instruments differed by demographics. It is important to validate screening instruments against a gold standard to ensure relevant clinical outcomes for pregnant women with depression.

Dataset Information

Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study.

Publications

Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study.

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