Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9

• Published in: Annals of family medicine 2009, Vol.7 (1), p.63-70
• Main Authors: Gjerdingen, Dwenda, MD, MS, Crow, Scott, MD, McGovern, Patricia, PhD, MPH, Miner, Michael, PhD, Center, Bruce, PhD
• Format: Article
• Language: English
• Subjects: Adult; Depression, Postpartum - diagnosis; Depressive Disorder, Major - diagnosis; Feasibility Studies; Female; Humans; Infant, Newborn; Internal Medicine; Mass Screening - methods; Methodology; Mothers - psychology; Pediatrics - methods; Primary Health Care - methods; Psychometrics; Reproducibility of Results
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.933

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.