Archives of Women's Mental Health

, Volume 17, Issue 5, pp 423–431 | Cite as

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

  • Alexander C. Tsai
  • Mark Tomlinson
  • Sarah Dewing
  • Ingrid M. le Roux
  • Jessica M. Harwood
  • Mickey Chopra
  • Mary Jane Rotheram-Borus
Original Article


Randomized controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N = 1,144 and N = 361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥ 13. The prevalence of probable depression (475/1144 [42 %] and 165/361 [46 %]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach’s α ranged from 0.55 to 0.58). All four subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91 to 0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.


Antenatal depression Case finding South Africa 



Study 1 was funded by the US National Institutes of Health (NIH) R01AA017104 and supported by NIH P30MH058107, NIH P30AI028697, and NIH UL1TR000124. Study 2 was funded by the Medical Research Council of South Africa and NIH R25MH060482. MT acknowledges the support of the National Research Foundation (South Africa) and the Department for International Development (DfID-UK). ACT also acknowledges salary support from NIH K23MH096620 and the Robert Wood Johnson Health and Society Scholars Program. We thank Mary J. O’Connor, Carol M. Worthman, Nokwanele Mbweu, Jacqueline Stewart, Mary Hartley, Dallas Swendeman, W. Scott Comulada, and Robert E. Weiss for their contributions to the design and implementation of study 1 and Novakuye Sijeku and the Philani outreach workers for data collection in study 2.

Declaration of interest



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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Alexander C. Tsai
    • 1
    • 2
    • 9
  • Mark Tomlinson
    • 3
  • Sarah Dewing
    • 4
  • Ingrid M. le Roux
    • 5
  • Jessica M. Harwood
    • 6
  • Mickey Chopra
    • 7
  • Mary Jane Rotheram-Borus
    • 6
    • 8
  1. 1.Center for Global Health and Chester M. Pierce, MD Division of Global PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
  4. 4.Health Systems Research Unit, Medical Research Council of South AfricaTygerbergSouth Africa
  5. 5.Philani Child Health and Nutrition Project, Khayelitsha, ElonwabeniCape TownSouth Africa
  6. 6.Semel Institute for Neuroscience and Human Behavior, Department of PsychiatryUniversity of California at Los AngelesLos AngelesUSA
  7. 7.Health Section, United Nations Children’s FundNew YorkUSA
  8. 8.Global Center for Child and FamiliesUniversity of California at Los AngelesLos AngelesUSA
  9. 9.Mbarara University of Science and TechnologyMbararaUganda

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