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Analysis of brief screening tools for the detection of postpartum depression: Comparisons of the PRAMS 6-item instrument, PHQ-9, and structured interviews

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Abstract

Postpartum depression (PPD) is an important mental health issue affecting approximately 10 % of women. Self-report screening measures represent utility for detecting PPD in both clinical and research settings. The current study sought to inspect the accuracy of two screening measures compared to clinical interviews. As part of an ongoing clinical trial, 1,392 women between the ages of 18 and 45 were screened for PPD using the Patient Health Questionnaire-9 (PHQ-9) and a six-item scale developed from CDC Pregnancy Risk Assessment questions (PRAMS-6). Three item subscales of the PRAMS-6 were also inspected—three depression (PRAMS-3D) and three anxiety items (PRAMS-3A). Receiver operating characteristics compared the diagnostic accuracy of the PHQ-9, PRAMS-6, PRAMS-3D, and PRAMS-3A to both the Structured Clinical Interview for the DSM-IV (SCID) and the Hamilton Rating Scale for Depression. The PHQ-9, PRAMS-6, and PRAMS-3D all showed moderate accuracy at diagnosing PPD. Diagnostic cut points are provided. The PRAMS-6 instrument is a brief and effective screening tool for PPD. The time frame of symptom assessment may account for some variability in accuracy between the PHQ-9 and PRAMS screening instruments.

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Acknowledgments

The treatment trial from which these data were extracted was funded by a grant from the National Institute of Mental Health (MH074919). Medication for the treatment trial was supplied by Pfizer. Drs. Zlotnick, Pearlstein, and Stuart received research support from Pfizer. Dr. Pearlstein has acted as a consultant for Ironwood Pharmaceuticals. Other authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

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Authors and Affiliations

  1. Women and Infants Hospital, Providence, RI, USA

    Kristina Davis & Caron Zlotnick

  2. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Teri Pearlstein & Caron Zlotnick

  3. Women’s Health Collaborative, Providence, RI, USA

    Teri Pearlstein

  4. University of Iowa, Iowa City, IA, USA

    Scott Stuart & Michael O’Hara

Authors
  1. Kristina Davis
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  2. Teri Pearlstein
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  3. Scott Stuart
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  4. Michael O’Hara
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  5. Caron Zlotnick
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Correspondence to Kristina Davis.

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Davis, K., Pearlstein, T., Stuart, S. et al. Analysis of brief screening tools for the detection of postpartum depression: Comparisons of the PRAMS 6-item instrument, PHQ-9, and structured interviews. Arch Womens Ment Health 16, 271–277 (2013). https://doi.org/10.1007/s00737-013-0345-z

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  • DOI: https://doi.org/10.1007/s00737-013-0345-z

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