Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

Abstract

BackgroundThis study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women. MethodsNine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity. ResultsSix studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81–0.99), pooled specificity was 0.60 (0.44–0.74), pooled positive likelihood ratio was 2.4 (1.6–3.4), pooled negative likelihood ratio was 0.09 (0.02–0.32), and pooled diagnostic odds ratio was 27 (7–106); heterogeneity was substantial (I2 = 0.90, 0.81–1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity. ConclusionsThe Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.