A comparison of three screening tools to identify perinatal depression among low-income African American women

Abstract

Background The purpose of the current study was to determine the sensitivity, specificity, and positive predictive value of three depression screening tools among a low-income African American population of pregnant and recently delivered women enrolled in home visitation programs in a low-income urban community. Methods Ninety-five women enrolled in home visitation programs—32 who were pregnant and 63 with a child <6 months comprise the study sample. Each woman completed a structured clinical interview and three depression screening tools—the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Depression Inventory II (BDI-II). Results Over a quarter of women (28.4%) were experiencing major depression. Each screening tool was highly accurate in detecting major depression and major or minor depression among prenatal and postpartum women, with areas under the curve (AUCs) >0.90. Sensitivities of all screening tools were improved when using cutoffs lower than those considered standard by instrument developers. Limitations Participants were recruited from home visitation programs in an urban context which may limit generalizability to other populations of low-income African American women. Given that no women during pregnancy met criteria for minor depression, it was not possible to determine optimal prenatal cutoff scores. Conclusions Three depression screening tools—the EPDS, CES-D, and BDI-II—appear to be reliable and brief assessments of major and minor depression among low-income African American perinatal women. Providers using these tools should consider using lower cutoff scores to most effectively identify women in need of depression treatment.

Intimate Partner Violence During Pregnancy and Adverse Neonatal Outcomes in Low-Income Women

“…A sensitivity rate of 82% with a specificity of 95% has been previously demonstrated with this cutoff point in a similar population. 31 The Cronbach's a for the current study was 0.88.…”

Postpartum Psychosocial and Behavioral Health: A Systematic Review of Self-Administered Scales Validated for Postpartum Women in the United States

“…Comparable Spearman correlations for validity estimates were * Although scales used in these studies are self-administered scales, they were administered through interviews in these studies (Davis et al, 2013;Hanusa et al, 2008;Tandon et al, 2012). generally lower.…”

“…Because scale brevity is a particular concern in clinical applications (Dalrymple et al, 2013;Zimmerman & McGlinchey, 2008), the EPDS-2, PDSS-SF, PHQ-2, PHQ two dichotomous screening questions, and the various short PRAMS scales are of interest; however, each has limitations. The PDSS-SF was reported by Hanusa et al (2008) (Tandon et al, 2012).…”

“…Using SCID as reference standard and standard cutpoint, sensitivity ¼ 45.3 and specificity ¼ 91.1 for major depression; sensitivity ¼ 66.4 and specificity ¼ 93.0 for major or minor depression z (Chaudron et al, 2010). Sensitivity and specificity not reported with standard cutpoint for postpartum women * (Tandon et al, 2012). Center for Epidemiologic Studies Depression Scale (CES-D)…”

“…Sensitivity and specificity not reported with standard cutpoint for postpartum women * (Tandon et al, 2012).…”