Associations between commonly used patient-reported outcome tools in postpartum depression clinical practice and the Hamilton Rating Scale for Depression

Moshe Fridman,Adi Eldar-Lissai,Paul Hodgkins,Vijayveer Bonthapally,Stephen J Kanes,Sarah Acaster,Samantha Meltzer-Brody,Margaret E Gerbasi

doi:10.1007/s00737-020-01042-y

Abstract

The objective of this study is to explore the associations between the patient-reported Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ)-9 and clinician-reported 17-item Hamilton Depression Rating Scale (HAMD-17) in order to facilitate clinical decision-making. An integrated efficacy dataset of three randomized placebo-controlled trials (NCT02614547, NCT02942004, and NCT02942017) evaluating brexanolone injection, a neuroactive steroid chemically identical to allopregnanolone, in women with postpartum depression was used for this post hoc analysis. Data were pooled across treatment arms. Associations were assessed at day 30 (end-of-trial follow-up). Pearson correlation assessed the relationship between EPDS and PHQ-9 item and total scores and HAMD-17 total score. Cohen’s kappa assessed agreement of EPDS remission (score < 10) and PHQ-9 remission (score < 5) with HAMD-17 remission (score ≤ 7). Ordinary least squares (OLS) regression models were used to develop equations estimating HAMD-17 total scores from EPDS and PHQ-9 scores, respectively. The total scores showed large correlations (HAMD-17/EPDS: r = 0.71, p < 0.001; HAMD-17/PHQ-9: r = 0.75, p < 0.001). Individual EPDS and PHQ-9 items significantly correlated (r= 0.35 to 0.67, all p < 0.001) with HAMD-17 total score. EPDS had 79% sensitivity and 67% specificity to detect HAMD-17 remission; corresponding estimates for PHQ-9 were 76% and 78%. OLS models yielded the following equations: HAMD-17 total = 2.66 + (EPDS total × 0.87) and HAMD-17 total = 3.99 + (PHQ-9 total × 0.97). There were large and statistically significant associations between patient-reported outcomes (EPDS, PHQ-9) and clinician-reported outcomes (HAMD-17) as clinical improvements were associated with patient-reported symptom improvement. These results provide tools to help translate clinical trial data to clinical practice, thus aiding shared decision-making for this critical population.

Highlights

Postpartum depression (PPD) is one of the most common medical complications during and after pregnancy, resulting in a substantial health-related quality of life burden for mothers, children, and partners (Callaghan et al 2010; Centers for Disease Control and Prevention 2018; Centers for Disease Control and Prevention 2019; De Sisto et al 2014; Ko et al 2017; Martin et al 2019; Moore Simas et al 2019; Roberts et al 2013; Vismara et al 2016)
The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool for PPD widely used to assess the likelihood of clinical depression and recently recommended by the American College of Obstetricians and Gynecologists (ACOG Committee Opinion No 757 2018; Cox et al 1987; Smith et al 2016)
The EPDS was developed as a screening tool, it is often used as an outcome measure in PPD studies and clinical practice (Appleby et al 1997; McCabeBeane et al 2016; Sharp et al 2010)

Summary

Introduction

Postpartum depression (PPD) is one of the most common medical complications during and after pregnancy, resulting in a substantial health-related quality of life burden for mothers, children, and partners (Callaghan et al 2010; Centers for Disease Control and Prevention 2018; Centers for Disease Control and Prevention 2019; De Sisto et al 2014; Ko et al 2017; Martin et al 2019; Moore Simas et al 2019; Roberts et al 2013; Vismara et al 2016). Clinicians treating perinatal women commonly use the Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire (PHQ)-9 as PPD screening tools. Both the EPDS and PHQ-9 are patient-reported instruments and provide unique perspective into the patient’s experience of their symptoms. The EPDS is a validated screening tool for PPD widely used to assess the likelihood of clinical depression and recently recommended by the American College of Obstetricians and Gynecologists (ACOG Committee Opinion No 757 2018; Cox et al 1987; Smith et al 2016). The PHQ-9 is a general depression screening questionnaire that is commonly used to screen for PPD, in primary care settings, has been found to be highly specific for identifying PPD, and has comparable psychometrics, sensitivity, and specificity to the EPDS (Flynn et al 2011; Gjerdingen et al 2009; Kroenke et al 2001; O'Connor et al 2016; Sidebottom et al 2012; Sit and Wisner 2009; Zhong et al 2014)

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