Whooley Questions Research Articles

Postpartum hair loss is associated with anxiety.

This study examined the relationship between postpartum hair loss and psychological symptoms. This questionnaire-based, cross-sectional study included postpartum women who had delivered at two facilities and completed the questionnaire 10-18 months after delivery. Study protocols were sent by mail in two parts. Baseline characteristics and information regarding the pregnancy, delivery, childcare, and postpartum hair loss were obtained via a questionnaire. Psychological symptoms were assessed via the Whooley Questions, Generalized Anxiety Disorder 2-item, and Edinburgh Postnatal Depression Scale. Participants were divided into two groups based on psychological symptoms. Multivariate analyses were performed. In total, 331 responses were analyzed. Women with very much hair loss felt significantly more anxious than those with no postpartum hair loss, as reported on the Generalized Anxiety Disorder 2-item anxiety subscale (odds ratio: 4.47). Multiple logistic regression analysis revealed that primiparity, greater amount of postpartum hair loss, and higher Athens Insomnia Scale scores were predictors of Generalized Anxiety Disorder 2-item anxiety. Adjusted odds ratio of having anxiety among those with very much postpartum hair loss was 4.58 (95% confidence interval, 1.18-17.74) compared to those with no postpartum hair loss. A greater amount of postpartum hair loss was independently associated with postpartum anxiety on the Generalized Anxiety Disorder 2-item.

Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study.

Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message-based screening protocols before such approaches can be implemented at the population level. This study aimed to examine sources of selection bias in a texting-based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eβ=0.99; P<.001) and 0.3% (eβ=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Findings from this study highlight the feasibility of text message-based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups.

Association between cognitive functioning and health-related quality of life and its mediation by depressive symptoms in older patients with kidney failure

BackgroundImpaired cognition, poor health-related quality of life (HRQoL) and depressive symptoms are common in older patients with kidney failure. Understanding what influences HRQoL is important, as older patients regard HRQoL as a health priority. This study examines whether cognitive functioning is associated with HRQoL and whether depressive symptoms mediate this effect in older patients with kidney failure.MethodsOutpatients aged ≥ 65 years from 35 Dutch and Belgian hospitals with eGFR 20–10 mL/min/1.73 m2 were included from the ongoing DIALOGICA study. Cognitive functioning was assessed using the Montreal Cognitive Assessment. Depressive symptoms were screened with 2 Whooley Questions and thereafter assessed with the 15-item Geriatric Depression Scale. HRQoL was assessed using the 12-item Short-Form Health Survey. To assess whether cognitive functioning is associated with HRQoL, cross-sectional multivariable linear regression analyses were performed. Subsequent mediation analyses were performed with PROCESS using the product method.ResultsIn total, 403 patients were included, with a mean age of 76.5 years (SD 5.8) and estimated glomerular filtration rate (eGFR) of 14.5 mL/min/1.73 m2 (SD 3.0). Cognitive functioning was associated with mental HRQoL (adjusted β 0.30, 95% CI 0.05;0.55) but not physical HRQoL (adjusted β 0.18, 95% CI -0.09;0.44). This effect is mediated by depressive symptoms (adjusted β 0.14, 95% CI 0.04;0.25).ConclusionLower cognitive functioning was negatively associated with mental HRQoL, which was mediated by depressive symptoms in older patients with kidney failure. Future research should explore whether cognitive interventions and treatment of depression improve HRQoL in this vulnerable patient population.Graphical

Perinatal depression screening by health cadres in Indonesia: EPDS or Whooley?

PurposeThis study aims to investigate the feasibility of health cadres in Indonesia to take perinatal depression screening in the community using Edinburgh Postnatal Depression Scale (EPDS) and Whooley.Design/methodology/approachThe field study involved 11 health cadres (community volunteers who assist in maternal and child health) who were trained to administrate EPDS and Whooley towards 36 pregnant and postpartum mothers in a low resource urban setting for a month. A comparison of scores from both tools, the number and type of mistakes made by the cadres, and cadres perception about the tools were combined to determine the most feasible tool for cadres in identifying depression symptoms.FindingsThe results show both tools are comparable for screening depression symptoms in mothers; however, EPDS was better at differentiating the level of symptoms. Whooley, with two case-finding questions, is simpler for cadres, whereas the EPDS is more difficult to be computed by cadres. Cadres support the implementation of such a screening, as it provides a channel for mothers to express their negative feelings.Research limitations/implicationsThe findings indicate Whooley is sufficient for first-level screening in the community by cadres, whereas the EPDS should be used by qualified health-care workers for further evaluation at primary health clinics.Practical implicationsHealth cadres could potentially be trained to use standardized yet simple psychological tools. Involving trained health cadres in integrated maternal mental health services in primary health care in Surabaya, Indonesia is promising.Originality/valueThe use of the EPDS and the Whooley questions has not been applied in Indonesia particularly among health cadres despite their long-lasting role in primary health-care system.

Evaluation of perinatal anxiety assessment measures: a cognitive interview study

BackgroundAnxiety in pregnancy and postpartum is highly prevalent but under-recognised. To identify perinatal anxiety, assessment tools must be acceptable, relevant, and easy to use for women in the perinatal period.MethodsTo determine the acceptability and ease of use of anxiety measures to pregnant or postpartum women (n = 41) we examined five versions of four measures: the Generalised Anxiety Disorder scale (GAD) 2-item and 7-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS). Cognitive interviews were used to examine ease of comprehension, judgement, retrieval and responding.ResultsAll measures were acceptable. Some items were deemed less relevant to the perinatal period e.g., difficulties sleeping. Ease of comprehension, judgement, retrieval and responding varied, with all measures having strengths and weaknesses. The SAAS and CORE-10 had the lowest mean number of problematic components. The GAD had the highest mean number of problematic components​. Non-binary response options were preferred. Preferences for time frames (e.g. one week, one month) varied. Qualitative data provides in-depth information on responses to each measure.ConclusionsFindings can be used to inform clinical guidelines and research on acceptable anxiety assessment in pregnancy and after birth.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

ObjectiveTo assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.DesignA prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks’ gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).SettingSeven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.ParticipantsPregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.FindingsThe most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner’s income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.ConclusionsEarly screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Validation of the Chinese version of the Whooley questions for community screening of postpartum depression

BackgroundThe study aims to validate the Whooley questions for screening postpartum depression in Chinese women in a community setting. MethodsThe Whooley questions was translated into Chinese following Beaton's intercultural debugging guidelines. From December 1, 2020 to June 30, 2021, primary maternal and child health workers in Kaifu District and Changsha County in Changsha City recruited women aged 18 years or older who had recently given birth during home visits within seven days of discharge from hospital. Participants women completed the Whooley questions online and underwent a diagnostic interview for DSM-IV within 7 days of the visit. We evaluated Cronbach's alpha, split-half reliability, area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and optimal cut-off value of the Whooley questions. ResultsOf the 3,004 eligible women, 1,862 completed the Whooley questions and diagnostic interviews. Sixty-two women (3.3%) were diagnosed with depressive disorders. The Cronbach's alpha coefficient was 0.64, the split-half reliability was 0.64. The optimal cut-off value was when at least one questions was answered “yes”, with an AUC of 0.84 (SE=0.03, 95%CI 0.78–0.90, P<0.001), sensitivity of 0.77 (95%CI 0.65–0.87), specificity of 0.89 (95%CI 0.88–0.90), PPV of 0.20 (95%CI 0.15–0.25) and NPV of 0.99 (95%CI 0.98–1.00). ConclusionThis study shows that the Chinese version of the Whooley questions is a reliable tool for screening postpartum depression in the community, but it may lead to many false positive cases.

Assessment of perinatal anxiety: diagnostic accuracy of five measures.

Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately. To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective). We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI). The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure. This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.

Prevalence of and optimal screening tool for postpartum depression in a community-based population in China

BackgroundPostpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. MethodsWe sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires—the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsOut of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one “yes”) with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LimitationsDue to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. ConclusionsThe prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.

Identification of depression and anxiety during pregnancy: Asystematic review and meta-analysis of test accuracy.

Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). PROSPERO CRD42021236333. We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92). Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

An economic evaluation of universal and targeted case-finding strategies for identifying antenatal depression: a model-based analysis comparing common case-finding instruments.

Half of women with depression in the perinatal period are not identified in routine care, and missed cases reflect inequalities in other areas of maternity care. Case finding (screening) for depression in pregnant women may be a cost-effective strategy to improve identification, and targeted case finding directs finite resources towards the greatest need. We compared the cost-effectiveness of three case-finding strategies: no case finding, universal (all pregnant women), and targeted (only pregnant women with risk factors for antenatal depression, i.e. history of anxiety/depression, age < 20 years, and adverse life events). A decision tree model was developed to represent case finding (at around 20 weeks gestation) and subsequent treatment for antenatal depression (up to 40 weeks gestation). Costs include case finding and treatment. Health benefits are measured as quality-adjusted life years (QALYs). The sensitivity and specificity of case-finding instruments and prevalence and severity of antenatal depression were estimated from a cohort study of pregnant women. Other model parameters were derived from published literature and expert consultation. The most cost-effective case-finding strategy was a two-stage strategy comprising the Whooley questions followed by the PHQ-9. The mean costs were £52 (universal), £61 (no case finding), and £62 (targeted case finding). Both case-finding strategies improve health compared with no case finding. Universal case finding is cost-saving. Costs associated with targeted case finding are similar to no case finding, with greater health gains, although targeted case finding is not cost-effective compared with universal case finding. Universal case finding for antenatal depression is cost-saving compared to no case finding and more cost-effective than targeted case finding.

Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers

BackgroundPregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women’s mental health, diminishing anxiety and depression during pregnancy.Methods/designAdult pregnant women (weeks 12–14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated.DiscussionThis study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women’s anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up.Trial registrationClinical Trials ID NCT05756205.

Exploring the cost-effectiveness of case-finding for antenatal depression: an economic modelling study.

The NHS has limited human and financial resources, with particular pressures in primary care. The National Institute for Health and Care Excellence (NICE) makes decisions on which services can be commissioned within the NHS. Many women experiencing antenatal depression are not identified as such in routine care and so may not access support. Current NICE guidance does not recommend universal case-finding for antenatal depression; however, a programme targeted towards pregnant women with risk factors (for example, previous mental illness, traumatic life events) has not been considered. To explore the cost-effectiveness of case-finding for antenatal depression: targeted vs. universal vs. no case-finding. The following case-finding tools were evaluated: Edinburgh Postnatal Depression Scale, Whooley questions, PHQ-9. One- and two-stage strategies were considered (second tool administered following positive response to Whooley questions). A decision tree model of costs and health outcomes from 20-40 weeks' gestation was developed. Health was measured as quality-adjusted-life-years (QALYs). Costs included case-finding and treatment for depression. The two-stage Whooley/PHQ-9 option was the most cost-effective case-finding strategy. Implementing a universal case-finding strategy was associated with lower costs than no case-finding (£52 vs £61) and more QALYs (0.3458 vs 0.3455). Targeted case-finding has similar costs to no case-finding and more QALYs (0.3459), requiring a spend of £1775 to improve health by 1 QALY. Universal case-finding for antenatal depression is cost-saving and improves health compared with no case-finding. It should be considered by policymakers to improve the identification and support of women experiencing antenatal depression in primary and maternity care.

Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort

ObjectiveTo assess the feasibility of the family paediatrician’s (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.Design, setting and participantsData for this...

Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic.

Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.

Evaluating the diagnostic properties of the Whooley questionnaire as a case-finding instrument for depression among Chinese women during and after pregnancy

Purpose: There is a rising prevalence in undetected perinatal depression in many countries, more effort in screening and early identification of perinatal depression is needed. While the Whooley questionnaire is the recommended case-finding strategy for perinatal depression, there is no validated Chinese version. The aim was to evaluate the diagnostic accuracy and stability of the translated Chinese Whooley questionnaire against gold standard measurement during and early after pregnancy. Materials and Methods: This observational study recruited 131 pregnant women from an antenatal clinic in Hong Kong from September 2019 to May 2020. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer-assessed diagnostic standard (DSM-IV criteria) in 107 women at 26–28 gestational weeks. We calculated sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis as the gold standard. Results: The Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4–93.9), a specificity of 97% (95% CI 90.4–99.3), a positive likelihood ratio of 23.2 (95% CI 7.4–72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1–0.5) in identifying perinatal depression. Conclusion: The translated Chinese Whooley questionnaire has an acceptable diagnostic accuracy in identifying perinatal depression. It can be implemented in health services among Cantonesespeaking Chinese population.

Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model

BackgroundAlthough the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening.MethodsA decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data.ResultsIn a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option.ConclusionsAll three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed.Clinical trials registrationN/A

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Psychological health of pregnant and postpartum women before and during the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic is likely to influence psychological health of pregnant and postpartum women.MethodsWe conducted a non-concurrent cross-sectional study among 1145 women living in the Dutch-speaking part of Belgium, 541 pregnant and 604 postpartum women. We measured psychological health with the Whooley questions, Generalized Anxiety Disorder 2-item (GAD-2) and the Edinburgh Postnatal Depression Scale (EPDS) and compared the scores of pregnant and postpartum women before and during the COVID-19 pandemic.ResultsNo differences were observed in the Whooley, GAD-2 or EPDS scores among pregnant women. The postpartum total GAD-2 scores before vs during the pandemic showed significant differences. Controlling for confounders, we observed a small main positive effect of having an infant during time of COVID-19 (F(1.13) = 5.06, p.025, d.27). The effect was significantly larger for women with (a history of) perinatal psychological problems (F(1.12) = 51.44, p < .001, d.82). Emotional support was significantly related to GAD-2 scores of postpartum women during the pandemic (F(1.90) = 35.54, p < .001). Postpartum women reported significant higher effects of the pandemic on their behavior compared to pregnant women (p.034).ConclusionThe COVID-19 pandemic seems to have a positive effect on postpartum women during the first year postpartum, in particular for women with (a history of) perinatal psychological problems and for those women who experienced emotional support. The findings suggest that less external stimuli caused by lockdown restrictions might have a positive effect on postpartum women’s emotional wellbeing. The sample consisted of white, educated women in a relationship and information regarding the extent of exposure to adverse COVID-19 consequences was lacking. We relied on self-selection and self-report. The postpartum pandemic sample was small.

The Prevalence of Depression Symptoms among Pregnant Women during the Second Wave of COVID-19

BACKGROUND: Pregnant women are vulnerable to depression. We hypothesized that the COVID-19 pandemic would increase depression in pregnancy leading to complications to both mother and fetus. AIM: This study is aimed to identify antenatal depression symptoms during the second wave COVID-19 pandemic. METHODS: This was a community-based, cross-sectional study conducted from 10 to 21 June 2021. A number of 130 pregnant women were recruited through both convenience and snowball sampling. An online survey with self-administered Whooley questions was used to assess antenatal depression symptoms. RESULTS: We found elevated antenatal depression symptoms similar to other countries during the COVID-19 pandemic. The prevalence of pregnant women with depression symptoms was 42.3%. The majority of pregnant women who had antenatal depression symptoms had the following characteristics: About 44.75% lived outside Jakarta, 60% had low education (Junior high school and below), 42.9% aged 20–35 years, and 44.8% of them were housewives. CONCLUSION: In Indonesia, the second wave of COVID-19 pandemic affected increasing symptoms of depression among pregnant women. Positive protective factors should be taken to prevent negative impacts of both unidentified and untreated antenatal depression among the pregnant women for the sake of maternal and child health.