Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS)

Abstract

Risk of antenatal depression has been shown to be elevated in Southern Africa and can impact maternal and child outcomes, especially in the context of the Human Immunodeficiency Virus (HIV). Brief screening methods may optimize access to care during pregnancy, particularly where resources are scarce. This research evaluated shorter versions of the Edinburgh Postnatal Depression Scale (EPDS) to detect antenatal depression. This cross-sectional study at a large primary health care (PHC) facility recruited a consecutive series of 109 antenatal attendees in rural South Africa. Women were in the second half of pregnancy and completed the EPDS and Structured Clinical Interview for Depression (SCID). The recommended EPDS cutoff (≥13) was used to determine probable depression. Four versions, including the 10-item scale, seven-item depression, and novel three- and five-item versions developed through regression analysis, were evaluated using receiver operating characteristic (ROC) analysis. High numbers of women 51/109 (47 %) were depressed, most depression was chronic, and nearly half of the women were HIV positive 49/109 (45 %). The novel three-item version had improved positive predictive value (PPV) over the 10-item version and equivalent specificity to the seven-item depression subscale; the novel five-item provided the best overall performance in terms of ROC and Cronbach's reliability statistics and had improved specificity. The brevity, sensitivity, and reliability of the short and ultrashort versions could facilitate widespread community screening. The usefulness of the novel three- and five-item versions are underscored by the fact that sensitivity is important at first screening, while specificity becomes more important at higher levels of care. Replication in larger samples is required.

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

“…Among Xhosa-speaking women, several studies have supported the construct validity, criterion-related validity, and factor structure of the EPDS-10 (De Bruin et al 2004; Hartley et al 2011; Lawrie et al 1998), and it has also been shown to have a high sensitivity for detecting postnatal depression in numerous other settings worldwide (Tsai et al 2013). Similar to Kabir et al (2008) and Rochat et al (2013), we defined 4 short and ultra-short versions of the EPDS-10: the 2-item analogue of the Patient Health Questionnaire (EPDS-2) (Lowe et al 2005; Monahan et al 2009), the 3-item anxiety subscale (EPDS-3), an abbreviated 5-item version of the depressive symptoms subscale (EPDS-5) (Rochat et al 2013), and the 7-item depressive symptoms subscale (EPDS-7) (Box 1). Following previous studies in this population, we employed a cutoff score of EPDS-10 ≥13 to define the criterion standard of probable antenatal depression (Honikman et al 2012; Rochat et al 2006; Tomlinson et al 2013).…”

“…However, it is also notable that, although determinations based on the conventional EPDS-10 threshold of ≥13 are commonly assumed to result in over-diagnosis, this has actually not been found to be the case in IsiZulu-speaking South African women. In a study conducted among pregnant women in rural KwaZulu-Natal, the prevalence of major depressive disorder as determined by structured clinical interview (47%) closely matched the prevalence of probable depression as determined using the EPDS-10 (44%) (Rochat et al 2011; Rochat et al 2013). …”

“…In the first of these studies, which was conducted among young women in the U.S., the EPDS-3 had 0.95 sensitivity and 0.80 specificity for detecting probable postnatal depression, while the EPDS-7 had 0.59 sensitivity and 1.0 specificity (Kabir et al 2008). Rochat et al (2013) used a structured clinical interview to determine the reference criterion of a major depressive episode among 109 young Zulu-speaking South African women (Rochat et al 2011). In their ROC analysis, the 3-, 5-, and 7-item versions of the EPDS performed similarly, with sensitivities ranging between 0.61-0.65 and specificities ranging from 0.86-0.90.…”

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

“…The EPDS score was obtained by summing all item scores, creating a continuous variable. A cutoff score of 13 [16, 28, 33] was used to categorise the sample into distressed and non-distressed respondents.…”

Managing Missing Data in Patient Registries

“…24 Broadly, inverse probability of missingness weights allow fully observed individuals to "standin" for partially observed individuals. For example, consider a study of 500 women and 500 men, in which 100 women and 200 men were missing a measurement of outcome.…”