PURPOSE Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for this condition, and an ideal screening tool has not been identifi ed. This study investigated (1) the validity of a 2-question screen and the 9-item Patient Health Questionnaire (PHQ-9) for identifying postpartum depression and (2) the feasibility of screening for postpartum depression during well-child visits.METHODS Study participants were English-literate mothers registering their 0-to 1-month-old infants for well-child visits at 7 family medicine or pediatric clinics. They were asked to complete questionnaires during well-child visits at 0 to 1, 2, 4, 6, and 9 months postpartum. Each questionnaire included 2 depression screens: the 2-question screen and the PHQ-9. The mothers also completed the depression component of the Structured Clinical Interview for DSM-IV (SCID) initially, and again at a subsequent interval if either screening result was positive for depression.
RESULTSThe response rate was 33%. Of the 506 women who participated, 45 (8.9%) had major depression (ie, they had a positive result on the SCID). The screen sensitivities/specifi cities over the course of the study were 100%/44% with the 2-question screen, 82%/84% with the PHQ-9 using simple scoring, and 67%/92% with the PHQ-9 using complex scoring. In addition, the corresponding values for the fi rst 2 items of the PHQ-9 (ie, the 2-item Patient Health Questionnaire or PHQ-2) were 84%/79%. Some 38% of women completed their 2-to 6-month questionnaires during well-child visits; the rest completed them by mail (29%) or telephone (33%).
CONCLUSIONSThe 2-question screen was highly sensitive and the PHQ-9 was highly specifi c for identifying postpartum depression. These results suggest the value of a 2-stage procedure for screening for postpartum depression, whereby a 2-question screen that is positive for depression is followed by a PHQ-9. These screens can be easily administered in primary care clinics; feasibility of screening during well-child visits was moderate but may be better in clinics using a massscreening approach.
INTRODUCTIONP ostpartum depression is increasingly recognized as a unique and serious complication of childbirth, with an estimated prevalence in the 12-month postpartum period of up to 21.9%.1 Mothers' depressive symptoms-diminished mood, pleasure, energy, concentration, and self-worth; psychomotor retardation; changes in appetite and sleep; and suicidal ideation-can markedly impair their sense of well-being, marital and other key relationships, 2 work performance and productivity, 3 relationships with their infants, 4 and infants' behavioral and cognitive development. 5 Recognizing the seriousness of this disorder, the US Preventive
S CR EENING F OR P OS T PA R T U M DEPR ES SIONServices Task Force has recommended routine depression screening for adults in practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up. 6 Most primary care practices do not h...