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

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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Center for Global Health and Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA

    Alexander C. Tsai

  2. Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai

  3. Department of Psychology, Stellenbosch University, Stellenbosch, South Africa

    Mark Tomlinson

  4. Health Systems Research Unit, Medical Research Council of South Africa, Tygerberg, South Africa

    Sarah Dewing

  5. Philani Child Health and Nutrition Project, Khayelitsha, Elonwabeni, Cape Town, South Africa

    Ingrid M. le Roux

  6. Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA

    Jessica M. Harwood & Mary Jane Rotheram-Borus

  7. Health Section, United Nations Children’s Fund, New York, NY, USA

    Mickey Chopra

  8. Global Center for Child and Families, University of California at Los Angeles, Los Angeles, CA, USA

    Mary Jane Rotheram-Borus

  9. Mbarara University of Science and Technology, Mbarara, Uganda

    Alexander C. Tsai

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  1. Alexander C. Tsai
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Tsai, A.C., Tomlinson, M., Dewing, S. et al. Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application. Arch Womens Ment Health 17, 423–431 (2014). https://doi.org/10.1007/s00737-014-0426-7

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