Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening
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The study was designed to validate the Patient Health Questionnaire (PHQ-9) for depression risk identification among pregnant women. Pregnant women were routinely administered the Prenatal Risk Overview, a comprehensive psychosocial screening interview, which included the PHQ-9, at their prenatal intake appointment at three community clinics. Study participants completed the Structured Clinical Interview for DSM-IV (SCID) at a later appointment. PHQ-9 risk classifications were cross-tabulated with SCID diagnostic categories to examine concordance, sensitivity, specificity, and positive and negative predictive values. The study sample included 745 women. Prevalence of a current major depressive episode was 3.6 %; an additional 7.0 % were classified as meeting subdiagnostic criteria of three or more depressive symptoms. A PHQ-9 score cutoff of 10 yielded sensitivity and specificity rates of 85 and 84 %, respectively, for a depression diagnosis and 75 and 88 % for a subdiagnosis, respectively. Positive predictive value was higher for the expanded group (43 %) than that of the diagnosis-only group (17 %). The PHQ-9, embedded within a multidimensional risk screening interview, effectively identified pregnant women who met criteria for current depression. The moderate risk score cutoff also identified women with subdiagnostic symptom levels who may benefit from interventions to alleviate their distress and improve pregnancy outcomes.
KeywordsDepression Risk screening Prenatal care Healthy Start
This research was funded by grant number R40MC07840 from the Department of Health and Human Services, Health Resources and Services Administration. The authors acknowledge Stacye Ballard for conducting the diagnostic interviews at study sites and Carol B. Peterson for providing SCID training to the research team. The Community University Health Care Center and NorthPoint Health and Wellness Center in Minneapolis and West Side Community Health Services East Side Family Clinic in St. Paul served as study sites.
Conflicts of interest
The authors have no financial conflicts of interest.
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