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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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    Figure 1.

    Proportionate accuracy of the PHQ-2 versus EPDS (12 vs 13) per 100 unselected patients.

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    Table 1.

    Characteristics of the Study Sample of Pregnant and Postpartum Women with Prevalence of Depressive Symptomatology*

    Descriptive Variables15 Week Pregnancy30 Week PregnancyPostpartum
    Total (n = 414)EPDS ≥13 (n = 72)Total (n = 334)EPDS ≥13(n = 44)Total (n = 193)EPDS ≥13 (n = 10)
    Demographic variables
        Age
            14–1853 (13)11 (15)45 (14)8 (18)21 (11)0
            19–24220 (53)39 (54)172 (51)23 (52)103 (53)5 (50)
            25–2995 (23)18 (25)76 (22)10 (23)43 (22)3 (30)
            30+46 (11)4 (6)41 (12)3 (7)26 (14)2 (20)
        Race
            Hispanic20 (5)4 (6)15 (5)1 (2)10 (5)0
            African-American125 (30)27 (38)88 (26)15 (34)41 (21)2 (20)
            White258 (62)39 (54)226 (68)28 (64)137 (71)8 (80)
            Other11 (3)2 (3)5 (2)05 (3)0
        Education
            <High school94 (23)20 (28)76 (23)16 (36)43 (22)1 (10)
            Still in high school42 (10)6 (8)36 (11)6 (14)17 (9)0
            High school or equivalent172 (42)29 (40)136 (41)14 (32)89 (46)7 (70)
            Any college or more106 (26)17 (24)86 (26)8 (18)44 (22)2 (20)
        Parity (previous live births)
            0185 (45)27 (38)142 (43)14 (32)81 (42)3 (30)
            1117 (28)23 (32)89 (27)16 (36)54 (28)4 (40)
            2–5112 (27)22 (31)103 (31)14 (32)58 (30)3 (30)
        Insurance
            Medical assistance
            Self-pay375 (91)70 (97)301 (90)42 (96)168 (87)10 (100)
            Private39 (9)2 (3)33 (10)2 (5)25 (13)0
        Depression measures
            History of depression122 (30)45 (63)97 (29)23 (52)54 (28)5 (50)
            Two-item screen positive151 (37)67 (93)94 (28)36 (82)33 (17)8 (80)
            Two-item screen and history of depression42 (50)70 (97)148 (44)41 (93)54 (37)9 (90)
    • * Edinburgh Postnatal Depression Scale score ≥13.

    • All values provided a n (%). Bolded values indicate significant association (P < .05; Pearson's χ2 or Fisher's exact test if cells contain ≤5).

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    Table 2.

    Diagnostic Validity of the Two-Item Patient Health Questionnaire for the Edinburgh Postnatal Depression Scale*

    Variable(s)AUROC Curve (95% CI)Sensitivity (%)Specificity (%)PPV (%)NPV (%)
    EPDS ≥13
        15 weeks' EGA
            PHQ-20.80 (0.69–0.91)93754498
            PHQ-2 and history of depression0.85 (0.76–0.94)
            Cut point 1/297615991
            Cut point 258922199
        30 weeks' EGA
            PHQ-20.81 (0.74–0.88)82802491
            PHQ-2 and history of depression0.85 (0.76–0.94)
            Cut Point 1/293634291
            Cut Point 241912298
        Postpartum
            PHQ-20.83 (0.68–0.98)80863098
            PHQ-2 and history of depression0.83 (0.70–0.97)
            Cut point 1/290674496
            Cut point 260961199
    • * Edinburgh Postnatal Depression Scale (EPDS) score ≥13.

    • PHQ-2, 2-item Patient Health Questionaire; AUROC, area under the receiving operator characteristic; PPV, positive predictive value; NPV, negative predictive value; EGA, estimated gestational age; Cut point 1/2, one of 2 screening items positive; Cut point 2, both screening items positive.

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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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  • 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
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