Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum

Valerie Slavin; Debra K. Creedy; Jenny Gamble

doi:10.1186/s12884-020-02891-2

Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum

Valerie Slavin, Debra K. Creedy, Jenny Gamble

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

22 Downloads (Pure)

Abstract

Background: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. Methods: A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (≥ 13) and postpartum (≥ 10) and for 'probable major depression' during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Results: Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%). Conclusions: Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

Original language	English
Article number	211
Number of pages	15
Journal	BMC Pregnancy and Childbirth
Volume	20
DOIs	https://doi.org/10.1186/s12884-020-02891-2
Publication status	Published - 14 Apr 2020
Externally published	Yes

Bibliographical note

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Funder

Funding Information:
The MoMeNT study was supported by a grant awarded by the Gold Coast Hospital and Health Service Research Grants Committee (Ref: 015–01.02.17). The funding body played no role in the study design, data collection, data analysis or interpretation of findings.

Keywords

Case-identification
Core outcome set
Depression
Outcome measurement instrument
Patient Health Questionnaire (PHQ)
Patient reported outcome measure (PROM)
Postpartum
Pregnancy
Screening accuracy
Screening tool

ASJC Scopus subject areas

Obstetrics and Gynaecology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12884-020-02891-2Licence: CC BY

PublishedFinal published version, 1.87 MBLicence: CC BY

Cite this

@article{978d5a53a05f442ca0ba03c5cbcfedff,

title = "Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum",

abstract = "Background: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. Methods: A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (≥ 13) and postpartum (≥ 10) and for 'probable major depression' during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Results: Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%). Conclusions: Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.",

keywords = "Case-identification, Core outcome set, Depression, Outcome measurement instrument, Patient Health Questionnaire (PHQ), Patient reported outcome measure (PROM), Postpartum, Pregnancy, Screening accuracy, Screening tool",

author = "Valerie Slavin and Creedy, {Debra K.} and Jenny Gamble",

note = "Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.",

year = "2020",

month = apr,

day = "14",

doi = "10.1186/s12884-020-02891-2",

language = "English",

volume = "20",

journal = "BMC Pregnancy and Childbirth",

issn = "1471-2393",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum

AU - Slavin, Valerie

AU - Creedy, Debra K.

AU - Gamble, Jenny

N1 - Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

PY - 2020/4/14

Y1 - 2020/4/14

N2 - Background: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. Methods: A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (≥ 13) and postpartum (≥ 10) and for 'probable major depression' during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Results: Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%). Conclusions: Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

AB - Background: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. Methods: A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (≥ 13) and postpartum (≥ 10) and for 'probable major depression' during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Results: Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%). Conclusions: Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

KW - Case-identification

KW - Core outcome set

KW - Depression

KW - Outcome measurement instrument

KW - Patient Health Questionnaire (PHQ)

KW - Patient reported outcome measure (PROM)

KW - Postpartum

KW - Pregnancy

KW - Screening accuracy

KW - Screening tool

UR - http://www.scopus.com/inward/record.url?scp=85083415107&partnerID=8YFLogxK

U2 - 10.1186/s12884-020-02891-2

DO - 10.1186/s12884-020-02891-2

M3 - Article

C2 - 32290813

AN - SCOPUS:85083415107

SN - 1471-2393

VL - 20

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

M1 - 211

ER -

Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum

Abstract

Bibliographical note

Funder

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this