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Validation of screening tools for antenatal depression in Malawi--a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire.
J Affect Disord. 2013 Sep 25; 150(3):1041-7.JA

Abstract

BACKGROUND

The detection of antenatal depression in resource-limited settings such as Malawi, Africa, is important and requires an accurate and practical screening tool. It is not known which questionnaire would be most suitable for this purpose.

METHOD

A rigorously translated and modified Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS) was developed. The Chichewa EPDS and an existing Chichewa version of the Self Reporting Questionnaire (SRQ) were validated in women attending an antenatal clinic in rural Malawi, using DSM-IV major and major-or-minor depressive episode as the gold standard diagnoses, determined with Structured Clinical Interview for DSM-IV (SCID). Weighted test characteristics for each possible cut-off were calculated and Receiver Operator Characteristic (ROC) curves derived.

RESULTS

The participants were 224 pregnant women, 92 of whom were interviewed using the SCID. The area under the ROC curve (AUC) for detection of current major depressive disorder for the EPDS was 0.811 (95% CI 0.734-0.889) and for the SRQ was 0.833 (95% CI 0.770-0.897). AUC for major-or-minor depressive disorder for the EPDS was 0.767 (95% CI 0.695-0.839) and for the SRQ was 0.883 (95% CI 0.839-0.927). These were not significant differences. Internal consistency was high for both the SRQ (Cronbach's alpha 0.825) and the EPDS (Cronbach's alpha 0.904).

LIMITATIONS

Inter-rater reliability testing was not done. The relatively small sample size resulted in wide confidence intervals around AUCs. The study was conducted amongst antenatal clinic attenders only, limiting generalisability to all pregnant women in this setting.

CONCLUSION

The Chichewa versions of the EPDS and SRQ both show utility as brief screening measures for detection of antenatal depression in rural Malawi.

Authors+Show Affiliations

Institute of Brain, Behaviour and Mental Health, University of Manchester, UK. robcstewart@mac.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

23769290

Citation

Stewart, Robert C., et al. "Validation of Screening Tools for Antenatal Depression in Malawi--a Comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire." Journal of Affective Disorders, vol. 150, no. 3, 2013, pp. 1041-7.
Stewart RC, Umar E, Tomenson B, et al. Validation of screening tools for antenatal depression in Malawi--a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. J Affect Disord. 2013;150(3):1041-7.
Stewart, R. C., Umar, E., Tomenson, B., & Creed, F. (2013). Validation of screening tools for antenatal depression in Malawi--a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. Journal of Affective Disorders, 150(3), 1041-7. https://doi.org/10.1016/j.jad.2013.05.036
Stewart RC, et al. Validation of Screening Tools for Antenatal Depression in Malawi--a Comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. J Affect Disord. 2013 Sep 25;150(3):1041-7. PubMed PMID: 23769290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of screening tools for antenatal depression in Malawi--a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. AU - Stewart,Robert C, AU - Umar,Eric, AU - Tomenson,Barbara, AU - Creed,Francis, Y1 - 2013/06/14/ PY - 2013/03/19/received PY - 2013/05/15/revised PY - 2013/05/19/accepted PY - 2013/6/18/entrez PY - 2013/6/19/pubmed PY - 2014/5/13/medline KW - Antenatal KW - Depression KW - Low-income countries KW - Screening tools KW - Validation SP - 1041 EP - 7 JF - Journal of affective disorders JO - J Affect Disord VL - 150 IS - 3 N2 - BACKGROUND: The detection of antenatal depression in resource-limited settings such as Malawi, Africa, is important and requires an accurate and practical screening tool. It is not known which questionnaire would be most suitable for this purpose. METHOD: A rigorously translated and modified Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS) was developed. The Chichewa EPDS and an existing Chichewa version of the Self Reporting Questionnaire (SRQ) were validated in women attending an antenatal clinic in rural Malawi, using DSM-IV major and major-or-minor depressive episode as the gold standard diagnoses, determined with Structured Clinical Interview for DSM-IV (SCID). Weighted test characteristics for each possible cut-off were calculated and Receiver Operator Characteristic (ROC) curves derived. RESULTS: The participants were 224 pregnant women, 92 of whom were interviewed using the SCID. The area under the ROC curve (AUC) for detection of current major depressive disorder for the EPDS was 0.811 (95% CI 0.734-0.889) and for the SRQ was 0.833 (95% CI 0.770-0.897). AUC for major-or-minor depressive disorder for the EPDS was 0.767 (95% CI 0.695-0.839) and for the SRQ was 0.883 (95% CI 0.839-0.927). These were not significant differences. Internal consistency was high for both the SRQ (Cronbach's alpha 0.825) and the EPDS (Cronbach's alpha 0.904). LIMITATIONS: Inter-rater reliability testing was not done. The relatively small sample size resulted in wide confidence intervals around AUCs. The study was conducted amongst antenatal clinic attenders only, limiting generalisability to all pregnant women in this setting. CONCLUSION: The Chichewa versions of the EPDS and SRQ both show utility as brief screening measures for detection of antenatal depression in rural Malawi. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/23769290/Validation_of_screening_tools_for_antenatal_depression_in_Malawi__a_comparison_of_the_Edinburgh_Postnatal_Depression_Scale_and_Self_Reporting_Questionnaire_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(13)00415-1 DB - PRIME DP - Unbound Medicine ER -