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

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Figure 1.
Proportionate accuracy of the PHQ-2 versus EPDS (12 vs 13) per 100 unselected patients.

Table 1.

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

Descriptive Variables	15 Week Pregnancy		30 Week Pregnancy		Postpartum
Descriptive Variables	Total (n = 414)	EPDS ≥13 (n = 72)	Total (n = 334)	EPDS ≥13(n = 44)	Total (n = 193)	EPDS ≥13 (n = 10)
Demographic variables
Age
14–18	53 (13)	11 (15)	45 (14)	8 (18)	21 (11)	0
19–24	220 (53)	39 (54)	172 (51)	23 (52)	103 (53)	5 (50)
25–29	95 (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
Hispanic	20 (5)	4 (6)	15 (5)	1 (2)	10 (5)	0
African-American	125 (30)	27 (38)	88 (26)	15 (34)	41 (21)	2 (20)
White	258 (62)	39 (54)	226 (68)	28 (64)	137 (71)	8 (80)
Other	11 (3)	2 (3)	5 (2)	0	5 (3)	0
Education
<High school	94 (23)	20 (28)	76 (23)	16 (36)	43 (22)	1 (10)
Still in high school	42 (10)	6 (8)	36 (11)	6 (14)	17 (9)	0
High school or equivalent	172 (42)	29 (40)	136 (41)	14 (32)	89 (46)	7 (70)
Any college or more	106 (26)	17 (24)	86 (26)	8 (18)	44 (22)	2 (20)
Parity (previous live births)
0	185 (45)	27 (38)	142 (43)	14 (32)	81 (42)	3 (30)
1	117 (28)	23 (32)	89 (27)	16 (36)	54 (28)	4 (40)
2–5	112 (27)	22 (31)	103 (31)	14 (32)	58 (30)	3 (30)
Insurance
Medical assistance
Self-pay	375 (91)	70 (97)	301 (90)	42 (96)	168 (87)	10 (100)
Private	39 (9)	2 (3)	33 (10)	2 (5)	25 (13)	0
Depression measures
History of depression	122 (30)	45 (63)	97 (29)	23 (52)	54 (28)	5 (50)
Two-item screen positive	151 (37)	67 (93)	94 (28)	36 (82)	33 (17)	8 (80)
Two-item screen and history of depression	42 (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).

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-2	0.80 (0.69–0.91)	93	75	44	98
PHQ-2 and history of depression	0.85 (0.76–0.94)
Cut point 1/2		97	61	59	91
Cut point 2		58	92	21	99
30 weeks' EGA
PHQ-2	0.81 (0.74–0.88)	82	80	24	91
PHQ-2 and history of depression	0.85 (0.76–0.94)
Cut Point 1/2		93	63	42	91
Cut Point 2		41	91	22	98
Postpartum
PHQ-2	0.83 (0.68–0.98)	80	86	30	98
PHQ-2 and history of depression	0.83 (0.70–0.97)
Cut point 1/2		90	67	44	96
Cut point 2		60	96	11	99

* 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.