Depression in pregnancy can be underdiagnosed as a consequence of the symptoms being misattributed to "normal pregnancy." There are currently no validated clinician-rated scales that assess for depression specifically during pregnancy. We sought to develop a brief, convenient screening tool to identify depression in pregnant women in the community setting. Prospective mood data using the 28-item Hamilton Depression Rating Scale (HDRS) were collected monthly in 196 pregnant women with a history of a major depressive disorder. These data were analyzed to delineate those HDRS items associated (elevated) with normal pregnancy vs. those indicative of a pregnant woman meeting diagnostic criteria for a major depressive episode. Endorsement of symptoms on seven items of the HDRS were highly predictive of having a major depressive episode during pregnancy. We present a well-validated, brief scale to screen pregnant women for clinical depression. Whether this study will generalize to women who do not have a history of major depression remains to be studied.
"Several instruments examined only current emotional health, and thus are not part of this review, even though they may be used in conjunction with other tools measuring risk factors for predicting future emotional health. These include: the Pregnancy Depression Scale (Altshuler et al. 2008), the Edinburgh Depression Scale (EDS) (Bunevicius et al. 2009), the Beck Depression Inventory (Holcomb et al. 1996), the Postpartum Depression Predictors Inventory—Revised (Oppo et al. 2009), the Hospital Anxiety and Depression Scale (Jomeen and Martin 2004; Karimova and Martin 2003) and the Hamilton Rating Scale for Depression (Altshuler et al. 2008). Similarly, instruments that were limited to current anxiety, depression, somatic symptoms or social support (General Health Questionnaire (Kitamura et al. 1994), Hopkins Symptom Checklist—25 (Lee et al. 2008), Kessler 10 (Spies et al. 2009) and Maternal Social Support Scale (Webster et al. 2000)) which also did not capture the breadth of risk factors associated with future perinatal mental health risk were also excluded. "
[Show abstract][Hide abstract] ABSTRACT: The purpose of this review was to critically analyse existing tools to measure perinatal mental health risk and report on the psychometric properties of the various approaches using defined criteria. An initial literature search revealed 379 papers, from which 21 papers relating to ten instruments were included in the final review. A further four papers were identified from experts (one excluded) in the field. The psychometric properties of six multidimensional tools and/or criteria were assessed. None of the instruments met all of the requirements of the psychometric properties defined. Some had used large sample sizes but reported low positive predictive values (Antenatal Risk Questionnaire (ANRQ)) or insufficient information regarding their clinical performance (Antenatal Routine Psychosocial Assessment (ARPA)), while others had insufficient sample sizes (Antenatal Psychosocial Health Assessment Tool, Camberwell Assessment of Need-Mothers and Contextual Assessment of Maternity Experience). The ANRQ has fulfilled the requirements of this analysis more comprehensively than any other instrument examined based on the defined rating criteria. While it is desirable to recommend a tool for clinical practice, it is important that clinicians are made aware of their limitations. The ANRQ and ARPA represent multidimensional instruments commonly used within Australia, developed within large samples with either cutoff scores or numbers of risk factors related to service outcomes. Clinicians can use these tools, within the limitations presented here, to determine the need for further intervention or to refer women to mental health services. However, the effectiveness of routine perinatal psychosocial assessment continues to be debated, with further research required.
Archives of Women s Mental Health 08/2012; 15(5):375-86. DOI:10.1007/s00737-012-0297-8 · 2.16 Impact Factor
"Consequently, the present data suggests that the HRSD may be preferred when conducting longitudinal studies across pregnancy and the postpartum period, but the less costly BDI and EPDS may be preferred for cross-sectional studies. Consistent with our previous experience (Altshuler et al., 2008), the comparative performance of the HRSD 17 and HRSD 21 indicates that items 18e21 can be eliminated from the perinatal administration of the HRSD with little or no impact on the performance of the scale. Inclusion of items 18e21 elevated the optimal cutpoint within each perinatal epoch by only 0e1 points and produced no significant improvement in the ROC AUC, sensitivity, or specificity of the HRSD during pregnancy and the postpartum period. "
[Show abstract][Hide abstract] ABSTRACT: The objective of the current study was to delineate the optimal cutpoints for depression rating scales during pregnancy and the postpartum period and to assess the perinatal factors influencing these scores. Women participating in prospective investigations of maternal mental illness were enrolled prior to 28 weeks gestation and followed through 6 months postpartum. At each visit, subjects completed self-rated depression scales--Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) and clinician-rated scales--Hamilton Rating Scale for Depression (HRSD(17) and HRSD(21)). These scores were compared to the SCID Mood Module for the presence of fulfilling diagnostic criteria for a major depressive episode (MDE) during 6 perinatal windows: preconception; first trimester; 2nd trimester; 3rd trimester; early postpartum; and later postpartum. Optimal cutpoints were determined by maximizing the sum of each scale's sensitivity and specificity. Stratified ROC analyses determined the impact of previous pregnancy and comparison of initial to follow-up visits. A total of 534 women encompassing 640 pregnancies and 4025 follow-up visits were included. ROC analysis demonstrated that all 4 scales were highly predictive of MDE. The AUCs ranged from 0.857 to 0.971 and were all highly significant (p < .0001). Optimal cutpoints were higher at initial visits and for multigravidas and demonstrated more variability for the self-rated scales. These data indicate that both clinician-rated and self-rated scales can be effective tools in identifying perinatal episodes of major depression. However, the results also suggest that prior childbirth experiences and the use of scales longitudinally across the perinatal period influence optimal cutpoints.
Journal of Psychiatric Research 02/2011; 45(2):213-9. DOI:10.1016/j.jpsychires.2010.05.017 · 3.96 Impact Factor
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