Paper
Thursday, July 12, 2007
A Comparison Study of Screening Instruments for Detecting Depression During Pregnancy
Linda E. Jensen, RN, MN, PhD, Kearney Division, University of Nebraska Medical Center College of Nursing, Kearney, NE, USA, Glen A. Palmer, PhD, Behavioral Health Division, Mary Lanning Hospital, Hastings, NE, USA, Tanya Rasher-Miller, MS, ED, LMHP, NCC, CNEC, Central Nebraska Early Childhood Mental Health Systems of Care, Grand Island, NE, USA, and Camilo Charron, PhD, Psychology, Centre de Recherche en Psycholgie Cognition et Communication (CRPCC E.A. 1285). Rennes 2 University - IUFM of Bretagne, Rennes cedex, France.
| Learning Objective #1: identify the importance of depression screening during pregnancy and some survey instruments commonly used. |
| Learning Objective #2: identify problems with commonly used survey instruments and needs for further research. |
Perinatal depression is a serious mental disorder frequently diagnosed during pregnancy (prenatal) and the year after childbirth (postpartum) that has been shown to affect approximately 12-15% of childbearing women world-wide. Perinatal depression has the potential to have a significant effect on the health of the mother and the psychological development (social-emotional and behavioral health) of the child. Perinatal depression frequently goes undiagnosed; therefore women often do not receive necessary treatment. Several survey instruments are available to evaluate maternal mental health. However, little research has been done on the accuracy of these tools during the prenatal period, and there is no measure with acceptable predictive validity to accurately identify depression prenatally.
This study examined the use of three common screening instruments for
depression in a sample of women in the last trimester of pregnancy referred to an obstetrical speciality clinic. As part of the clinical interview, participants were evaluated according the Diagnostic and Statistical Manual of Mental Disorders, Fourth Addition, Text Revision’s (DSM-IV-TR) criteria for major depression. Women in the final trimester of pregnancy who met DSM-IV-TR criteria for major depression were compared with pregnant women without major depression on three commonly used depression screening instruments: Zung Self-rating Depression Scale (SDS), Edinburgh Postnatal Depression Scale (EPDS), and Center for Epidemiological Studies Screening for Depression (CES-D). Women meeting DSM-IV_TR depression criteria scored significantly higher on all three instruments when compared to matched controls. However, recommended cutoff scores on all three instruments were found to lack proper sensitivity for women with depression in the sample of obstetrical patients. The findings suggest that current cutoff scores might be too conservative in correctly identifying women with prenatal depression, and lowering of cutoff scores might be necessary in order to correctly identify and treat women with depression during pregnancy.