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OtherEvidence-Based Clinical Medicine

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

Ian M. Bennett, Andrew Coco, James C. Coyne, Alex J. Mitchell, James Nicholson, Ellen Johnson, Michael Horst and Stephen Ratcliffe
The Journal of the American Board of Family Medicine July 2008, 21 (4) 317-325; DOI: https://doi.org/10.3122/jabfm.2008.04.080048
Ian M. Bennett
MD, PhD
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Andrew Coco
MD
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James C. Coyne
PhD
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Alex J. Mitchell
MBBS
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James Nicholson
MD, MSCE
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Ellen Johnson
MD
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Michael Horst
PhD
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Stephen Ratcliffe
MD, MSPH
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Abstract

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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The Journal of the American Board of Family Medicine: 21 (4)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 4
July-August 2008
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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
Ian M. Bennett, Andrew Coco, James C. Coyne, Alex J. Mitchell, James Nicholson, Ellen Johnson, Michael Horst, Stephen Ratcliffe
The Journal of the American Board of Family Medicine Jul 2008, 21 (4) 317-325; DOI: 10.3122/jabfm.2008.04.080048

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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
Ian M. Bennett, Andrew Coco, James C. Coyne, Alex J. Mitchell, James Nicholson, Ellen Johnson, Michael Horst, Stephen Ratcliffe
The Journal of the American Board of Family Medicine Jul 2008, 21 (4) 317-325; DOI: 10.3122/jabfm.2008.04.080048
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  • Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study
  • TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management
  • Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women
  • Improving Maternal Care with a Continuous Quality Improvement Strategy: A Report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network
  • The 3 item anxiety subscale of the Edinburgh Postpartum Depression Scale may detect postnatal depression as well as the 10 item full scale
  • Third Journal of the American Board of Family Medicine Practice-based Research Theme Issue
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