A Systematic Review of Screening Instruments for Depression in Antenatal Services in Low Resource Settings

Purpose:

A review of screening instruments for depression for use in antenatal services in low resource settings was conducted. It is important to assess methodological quality of articles which reported psychometrics of an instrument because gives insight in quality of study designs. A good instrument should have high sensitivity and specificity which makes it effective in ruling in pregnant women with depression and ruling out those who do not have. The aim of the review was to appraise the evidence on sensitivity and specificity of screening instruments for depression and recommend a suitable tool for use in antenatal services in low resource settings.

 Methods:

The questions for this review were: (1) what is the methodological quality of articles for validated screening instruments for depression in antenatal in low resource settings? and (2) which instruments would be recommended for use in antenatal care services in low resource settings? 

Search terms were identifed relevant to databases and included "depression" AND "screening" AND " antenatal". Databases, namely ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES were searched.Searching, quality assessment using the QUADAS, selection and data abstraction was done by two reviewers. Studies were evaluated for relevancy using PICO and whether they reported sensitivity, specificity and Area Under Receivers’ Operator Characteristics (AUROC) curve.  Pooling of sensitivity of instruments was done using a forest plot.

Results:

Eleven articles were included in the review. Their methodological quality ranged from adequate to excellent. There were variations in level of accuracy, sensitivity and specificity of Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Index, Centre for Epidemiologic Studies Depression Scale, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire 20. EPDS had highest level of accuracy (AUROC=.965) and sensitivity (1). 

Conclusion:

The review considered instruments for screening depression in antenatal in low resource settings. Articles which reported accuracy, sensitivity and specificity for screening instruments were assessed for methodological quality. This review suggests that EPDS can be a suitable instrument of preference for screening antenatal depression in low resource settings because its level of accuracy ranged from moderate to high in various settings. The EPDS had the high level of accuracy, sensitivity, specificity and it was validated by studies which had either good or excellent methodological quality. However, it is crucial that the instrument is validated using methodologically rigorous studies before use in a particular setting.