While most agree that there is a need for improved detection of anxiety and mood disorders in pregnant and postpartum women, there remain questions regarding the best instruments to use for screening. The Edinburgh Postnatal Depression Scale (a questionnaire consisting of 10 items) has long been used to screen women for postpartum depression (PPD); however, it is unclear how well these questions could be incorporated into larger surveillance programs, such as the CDC-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) which was designed to assess health behaviors and to screen for health problems, including depression and anxiety, in pregnant and postpartum women.
The purpose of a recent study from Dr. Michael O’Hara and colleagues was to validate two or three questions which could be used to detect depression and anxiety among postpartum women. A comprehensive set of 16 depression and anxiety items was developed and responses were scored on a 5-point scale ranging from never (1) to always (5). The items were tested in a sample of 1077 postpartum women, 353 of whom also completed the Structured Clinical Interview for DSM-IV (SCID) to confirm the presence of a major depressive episode (MDE) and generalized anxiety disorder (GAD).
For depression screening, the combination of depressed mood, felt hopeless, and felt slowed down with a score of >?9 (out of a possible total of 15) yielded the highest positive predictive value (PPV=60). In other words, 60% of the women scoring > 9 were true positives (i.e., met DSM-IV criteria for a major depressive episode). This set of 3 items also measured the prevalence of MDE most accurately (24.4% vs. 25.4% true prevalence).
For anxiety screening, the combination of felt panicky, felt restless, and problems sleeping with a score of > 9 estimated GAD prevalence most accurately (20.2% vs. 15.7% true prevalence) and had a high specificity (83%).
This study indicates that depression and anxiety can be detected using very few items. It would be possible to include these questions in surveillance systems, such as PRAMS, and in primary care settings where there may be limited time and resources available for screening.
Ruta Nonacs, MD PhD
O’Hara MW, Stuart S, Watson D, et al. Brief scales to detect postpartum depression and anxiety symptoms. J Womens Health (Larchmt). 2012 Dec;21(12):1237-43.