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Efficiency of a Two-Item Pre-Screen to Reduce the Burden of Depression Screening in Pregnancy and Postpartum: An IMPLICIT Network Study

Department of Family Medicine and Community Health (IMB, JCC, JN), University of Pennsylvania School of Medicine, Philadelphia
Department of Psychiatry (JCC), University of Pennsylvania School of Medicine, Philadelphia
Leonard Davis Institute of Health Economics (IMB), University of Pennsylvania School of Medicine, Philadelphia
Lancaster General Hospital Department of Family and Community Medicine and Lousie von Hess Medical Research Institute (AC, MH, SR), Lancaster, PA
Department of Liaison Psychiatry, Leicester General Hospital (AJM), Leicestershire, UK
Good Samaritan Family Practice Residency Program (EJ), Lebanon, PA

Correspondence: Corresponding author: Ian M. Bennett, MD, PhD, Family Medicine and Community Health, University of Pennsylvania School of Medicine, 2nd Floor Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 (E-mail: ian.bennett{at}uphs.upenn.edu)

Objective: Systems for efficient case finding of women with major depression during pregnancy and postpartum are needed. Here we assess the diagnostic accuracy of a modified 2-item patient health questionnaire (PHQ-2) as a pre-screen in assessing depression.

Methods: Cross-sectional assessments at 15 weeks' gestation (n = 414), 30 weeks' gestation (n = 334), and 6 to 16 weeks postpartum (n = 193) among women from a diverse set of races/ethnicities, participating in the IMPLICIT maternal care quality improvement network. The Edinburgh Postnatal Depression Scale score (13) was used as the criterion measure for the PHQ-2.

Results: A positive 2-item screen had sensitivity of 93%, 82%, and 80% and specificity of 75%, 80%, and 86% for Edinburgh Postnatal Depression Scale score of 13 for assessment at 15 and 30 weeks gestational age and postpartum, respectively. The positive/negative predictive values for the PHQ-2 were 44/98, 24/91, and 30/98 for each time point, respectively. Areas under the receiver operating characteristic curve analysis suggested that 2-item assessments at each time point had approximately equal diagnostic validity.

Conclusions: Two questions were efficient to rule out depression and reduced the need for further screening of approximately 60% to 80% of women, depending on the point in pregnancy or postpartum. A diagnostic interview follow-up of women screening positive is still required.

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