The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy.

Antonella Gigantesco,Fiorino Mirabella,Loredana Cena,Alberto Stefana,Alice Trainini,Laura Camoni,Gabriella Palumbo

doi:10.1371/journal.pone.0260596

Abstract

The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women. A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated. During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68). Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.

Highlights

In Italy, the proportion of women who experience depression during pregnancy and postpartum ranges from 6% [1] to 12% [2, 3] and from 7 to 20% [1, 4], respectively
Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice
The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression

Summary

Introduction

In Italy, the proportion of women who experience depression during pregnancy and postpartum ranges from 6% [1] to 12% [2, 3] and from 7 to 20% [1, 4], respectively. Perinatal depression has been associated with poorer outcomes such as a reduction in a woman’s ability to perform daily activities and parenting [5], which increases the risk of significant adverse consequences over the years for the psychological well-being and health of the family [6]. Given that effective psychosocial interventions (e.g., the WHO Thinking Healthy Programme) [8] and psychological therapies (e.g., cognitive behavioural therapy and interpersonal therapy) are available [9], the importance of early detection of perinatal depression cannot be overstated. In light of the points mentioned above, several authors have called for identification procedures for perinatal depression to be introduced in clinical practice such as in obstetrics/gynaecology, paediatrics, or internal/family medicine settings [10, 11]. We aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women

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Conclusion