Postpartum depression screening at well-child visits: Validity of a 2-question screen and the PHQ-9

Dwenda Gjerdincjen, Scott Crow, Patricia McGovern, Michael Miner, Bruce Center

Research output: Contribution to journalArticlepeer-review

148 Scopus citations

Abstract

PURPOSE Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for this condition, and an ideal screening tool has not been identified. This study investigated (1) the validity of a 2-question screen and the 9-item Patient Health Questionnaire (PHQ-9) for identifying postpartum depression and (2) the feasibility of screening for postpartum depression during well-child visits. METHODS Study participants were English-literate mothers registering their 0- to 1-month-old infants for well-child visits at 7 family medicine or pediatric clinics. They were asked to complete questionnaires during well-child visits at 0 to 1, 2, 4, 6, and 9 months postpartum. Each questionnaire included 2 depression screens: the 2-question screen and the PHQ-9. The mothers also completed the depression component of the Structured Clinical Interview for DSM-IV (SCID) initially, and again at a subsequent interval if either screening result was positive for depression. RESULTS The response rate was 33%. Of the 506 women who participated, 45 (8.9%) had major depression (ie, they had a positive result on the SCID). The screen sensitivities/specificities over the course of the study were 100%/44% with the 2-question screen, 82%/84% with the PHQ-9 using simple scoring, and 67%/92% with the PHQ-9 using complex scoring. In addition, the corresponding values for the first 2 items of the PHQ-9 (ie, the 2-item Patient Health Questionnaire or PHQ-2) were 84%/79%. Some 38% of women completed their 2- to 6-month questionnaires during well-child visits; the rest completed them by mail (29%) or telephone (33%). CONCLUSIONS The 2-question screen was highly sensitive and the PHQ-9 was highly specific for identifying postpartum depression. These results suggest the value of a 2-stage procedure for screening for postpartum depression, whereby a 2-question screen that is positive for depression is followed by a PHQ-9. These screens can be easily administered in primary care clinics; feasibility of screening during well-child visits was moderate but may be better in clinics using a mass- screening approach.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalAnnals of family medicine
Volume7
Issue number1
DOIs
StatePublished - 2009

Bibliographical note

Funding Information:
Funding support: This study was funded by the National Institute of Mental Health (Dr Gjerdingen: R34 MH072925; Dr Crow: K02-MH65919; P30 DK50456).

Keywords

  • Depression
  • PHQ-9
  • Postnatal care
  • Postnatal depression
  • Postpartum depression
  • Postpartum period
  • Practice-based research
  • Preventive health services
  • Primary care
  • Screening

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