Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy.

Louise Michele Howard,Fraser Anderson,Sarah Byford,Polly Sands,Sheila O'Connor,Amanda Bye,Andrew Pickles,Jill Demilew,Elizabeth G Ryan,Jeannette Milgrom,Debra Bick,Kylee Trevillion

doi:10.1192/bjp.2017.9

Abstract

There is limited evidence on the prevalence and identification of antenatal mental disorders. Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR. Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate. Population prevalence was 27% (95% CI 22-32): 11% (95% CI 8-14) depression; 15% (95% CI 11-19) anxiety disorders; 2% (95% CI 1-4) obsessive-compulsive disorder; 0.8% (95% CI 0-1) post-traumatic stress disorder; 2% (95% CI 0.4-3) eating disorders; 0.3% (95% CI 0.1-1) bipolar disorder I, 0.3% (95% CI 0.1-1%) bipolar disorder II; 0.7% (95% CI 0-1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6). Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available. Declaration of interest L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012-2014.

Highlights

There is limited evidence on the prevalence and identification of antenatal mental disorders.disorder
The emerging evidence on the prevalence and impact of perinatal mental disorders across the diagnostic spectrum suggests that the ideal tool for case identification would indicate whether depression and other mental disorders may be present
Most research has focused on identification of perinatal depression, with a recent evidence review[7] recommending the Edinburgh Postnatal Depression Scale (EPDS),[8] based on sensitivities of around 0.8 and specificities of 0.87, values varied depending on the characteristics of the study population

Summary

Background

There is limited evidence on the prevalence and identification of antenatal mental disorders. Likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6). Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR. Method Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate

Conclusions

Results

Study design

Discussion

Strengths and limitations