The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy

• Published in: PloS one 2021-11, Vol.16 (11), p.e0260596-e0260596
• Main Authors: Gigantesco, Antonella, Palumbo, Gabriella, Cena, Loredana, Camoni, Laura, Trainini, Alice, Stefana, Alberto, Mirabella, Fiorino
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Adult; Clinical medicine; Clinical psychology; Depression - diagnosis; Depression - epidemiology; Depression, Postpartum - diagnosis; Depression, Postpartum - epidemiology; Diagnosis; Evaluation; Female; Gynecology; Health aspects; Health care; Health care policy; Health risks; Humans; Intervention; Italy - epidemiology; Likelihood ratio; Major depressive disorder; Mass Screening; Maternal health services; Medical screening; Medicine and Health Sciences; Mental depression; Mental health; Mental health screening; Methods; Mothers; Neurosciences; Observatories; Obstetrics; Patient Health Questionnaire; Pediatrics; People and places; Perinatal Care; Postpartum; Postpartum depression; Postpartum Period; Predictive Value of Tests; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - epidemiology; Pregnant women; Prognosis; Psychological aspects; Psychologists; Psychosis; Questionnaires; Risk factors; Sensitivity; Social Sciences; Sociodemographics; Surveys; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0260596

The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women. A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated. During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68). Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.