Article Figures & Data
Figures
- Figure 1.
Numbers of eligible and participating women.
a The number of ineligible women was based on estimates of non–English-literate women at each site.
b The number of women who refused participation was based on an estimated refusal rate of 54%, seen in a prior randomized controlled trial conducted in the same general location.31 Included in this group are 170 who explicitly refused (as stated on their enrollment form), 65 who completed an enrollment form but not the questionnaire, and an estimated 605 women who tacitly refused to participate (they did not explicitly state that they refused but demonstrated their unwillingness to participate by not returning a completed enrollment form).
c The estimated number of eligible mothers not offered an enrollment form was calculated by subtracting 506 mothers who participated and 840 mothers who refused from 1,556.
Tables
2-Question Screen26 1. During the past month, have you often been bothered by feeling down, depressed, or hopeless? (Yes/No) 2. During the past month, have you often been bothered by having little interest or pleasure in doing things? (Yes/No) PHQ-924 Not at All Several Days More Than One-Half the Days Nearly Every Day PHQ-9=9-item Patient Health Questionnaire. a Questions 1 and 2 constitute the 2-item Patient Health Questionnaire (PHQ-2).28 Developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer, Inc. Copyright 2005, Pifzer, Inc. All rights reserved. Reproduced with permission. Over the last 2 weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing thingsa 0 1 2 3 2. Feeling down, depressed, or hopelessa 0 1 2 3 3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3 4. Feeling tired or having little energy 0 1 2 3 5. Poor appetite or overeating 0 1 2 3 6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down 0 1 2 3 7. Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3 8. Moving or speaking so slowly that other people could have noticed? Or the opposite— being so fidgety or restless that you have been moving around a lot more than usual 0 1 2 3 9. Thoughts that you would be better off dead or of hurting yourself in some way 0 1 2 3 Characteristic Value Race/ethnicity, n (%) Native American 7 (1.4) Asian 34 (6.7) Black or African American 89 (17.6) Hispanic 14 (2.8) White 339 (67.0) Multiracial 17 (3.4) Other 6 (1.2) Marital status, n (%) Married 328 (64.8) Unmarried, living with partner 88 (17.5) Unmarried, not living with partner 80 (15.9) Other 7 (1.4) Total family annual income, n (%) <$20,000 133 (27.3) $20,000–$79,999 177 (36.3) ≥$80,000 178 (36.5) Education, n (%) <High school diploma 81 (16.1) High school diploma and some post–high school 160 (31.8) ≥4-Year degree 263 (52.2) Health insurance, n (%) Private 257 (55.3) Medical assistance 142 (30.5) Other 60 (12.9) None 6 (1.3) Employment: work at a job or are on leave, n (%) 322 (63.6) Have 1 child only, n (%) 207 (41.7) Mother’s age, mean (SD), year 29.1 (6.2) Characteristic Completers (n=469) Dropouts (n=34) P Value PHQ-9=9-item Patient Health Questionnaire. Note: Values were compared by t tests and χ2 analyses. Mother’s age, mean, years 29.3 25.6 .001 Number of children 1.9 2.5 .000 Married, n (%) 319 (68.0) 9 (26.5) .000 Post–high school education, n (%) 345 (73.4) 11 (32.4) .000 Family income ≥$20,000, n (%) 343 (75.4) 12 (36.4) .000 Positive PHQ-9 result, n (%) 30 (6.4) 7 (20.6) .008 - Table 4.
Validity of the Depression Screens at 0 to 1 Month Postpartum (n = 438 Women, 20 With Major Depression)
Major Depressiona Validity, % (n/n) Depression Screen and Result No Yes Total Sensitivity Specificity PPV NPV NPV = negative predictive value; PHQ-2 = 2-item Patient Health Questionnaire; PHQ-9 = 9-item Patient Health Questionnaire; PPV = positive predictive value. Note: Values are numbers of women unless otherwise indicated. a Women were defined as having major depression if they had a positive result on the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders - DSM-IV (SCID). b Consists of the first 2 questions of the PHQ-9. c Simple scoring: result is positive if sum of numbered responses is ≥10. d Complex scoring: result is positive if at least 5 symptoms are present, including symptom 1, symptom 2, or both, and each symptom present has a response score of 2 to 3, except for symptom 9, for which a response score of 1 to 3 was acceptable. 2-Question screen (yes/no) 100 (20/20) 62 (259/418) 11 (20/179) 100 (259/259) Negative 259 0 259 Positive 159 20 179 Total 418 20 438 PHQ-2 (Likert response)b 75 (15/20) 88 (368/416) 24 (15/63) 99 (368/373) Negative 368 5 373 Positive 48 15 63 Total 416 20 436 PHQ-9 with simple scoringc 75 (15/20) 91 (380/418) 28 (15/53) 99 (380/385) Negative 380 5 385 Positive 38 15 53 Total 418 20 438 PHQ-9 with complex scoringd 55 (11/20) 94 (394/418) 31 (11/35) 98 (394/403) Negative 394 9 403 Positive 24 11 35 Total 418 20 438 - Table 5.
Validity of the Depression Screens Over Entire Course of Study (N = 506 Women, 45 With Major Depression)
Major Depressiona Validity, % (n/n) Depression Screen and Result No Yes Total Sensitivity Specificity PPV NPV NPV = negative predictive value; PHQ-2 = 2-item Patient Health Questionnaire; PHQ-9 = 9-item Patient Health Questionnaire; PPV = positive predictive value. Note: Values are numbers of women unless otherwise indicated. a Women were defined as having major depression if they had a positive result on the Structured Clinical Interview for DSM-IV (SCID). b Consists of the first 2 questions of the PHQ-9. c Simple scoring: result is positive if the sum of the numbered responses is ≥10. d Complex scoring: result is positive if at least 5 symptoms are present, including symptom 1, symptom 2, or both, and each symptom present has a response score of 2 to 3, except for symptom 9, for which a response score of 1 to 3 was acceptable. 2-Question screen (yes/no) 100 (45/45) 44 (203/461) 15 (45/303) 100 (203/203) Negative 203 0 203 Positive 258 45 303 Total 461 45 506 PHQ-2 (Likert response)b 84 (38/45) 79 (363/461) 28 (38/136) 98 (363/370) Negative 363 7 370 Positive 98 38 136 Total 461 45 506 PHQ-9 with simple scoringc 82 (37/45) 84 (386/461) 33 (37/112) 98 (386/394) Negative 386 8 394 Positive 75 37 112 Total 461 45 506 PHQ-9 with complex scoringd 67 (30/45) 92 (422/461) 43 (30/69) 97 (422/437) Negative 422 15 437 Positive 39 30 69 Total 461 45 506
The Article in Brief
Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9
Dwenda Gjerdingen , and colleagues
Background Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for postpartum depression, and an ideal screening tool has not been identified. This study tests the effectiveness of 2 postpartum depression screening tools and the feasibility of screening for postpartum depression during well-child visits.
What This Study Found A 2-step screening procedure may be an effective way to identify women with postpartum depression. Women would first complete a 2-item screening test, and those who test positive would complete a longer (9-item) questionnaire to confirm the results. Those who test positive for the second step would be advised to get further evaluation and treatment. The study finds that the 2-item screen is highly sensitive for identifying those with postpartum depression, meaning it did not miss any cases. The longer questionnaire is highly specific for identifying postpartum depression.
Implications
- This 2-stage approach could be easily administered in the primary care setting, especially compared with other screening approaches that require specialized training.
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