A systematic review of screening instruments for depression for use in antenatal services in low resource settings

Genesis Chorwe-Sungani,Jennifer Chipps

doi:10.1186/s12888-017-1273-7

Abstract

BackgroundIn low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings.MethodsSearching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots.ResultsEleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity.ConclusionThis review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity.Prospero registrationCRD42015020316.

Highlights

In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care
Antenatal depression can lead to poor uptake of antenatal care, adverse birth outcomes [3] and is a risk factor for postnatal depression [5]
Low resource settings were defined as health care settings synonymous with those found in low income and lower middle income countries as defined by World Bank [12] and some health care settings in upper middle income countries (UMICs), such as South Africa, where disparities in the public health infrastructure or supplies or human resources [13] are found

Summary

Introduction

Short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings. There are some challenges in these settings as many women may be ashamed to speak about depression as there is a cultural expectation of pregnancy happiness These settings are understaffed, lack consultation rooms, have heavy workloads with high midwife to pregnant woman ratios. Chorwe-Sungani and Chipps BMC Psychiatry (2017) 17:112 women [8] In this setting, screening instruments suitable for the early detection of depression must be effective in the identification of individuals who are cases and those who are not [9]. Suitable instruments must demonstrate both high sensitivity and specificity [9]

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Discussion

Conclusion