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Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women.
PLoS One. 2018; 13(4):e0193697.Plos

Abstract

BACKGROUND

Antenatal depression and anxiety disorders are highly prevalent in low and middle-income countries. Screening of pregnant women in primary care antenatal settings provides an opportunity for entry to care, but data are needed on the performance of different screening tools. We compared five widely-used questionnaires in a sample of pregnant women in urban South Africa.

METHOD

Pregnant women attending a primary care antenatal clinic were administered five tools by trained research assistants: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), the Kessler Psychological Distress scale (K10) and a shortened 6-item version (K6), the Whooley questions and the two-item Generalised Anxiety Disorder scale (GAD-2). Following this, a registered mental health counsellor administered the MINI Plus, a structured clinical diagnostic interview. The Area Under the Curve (AUC) from Receiver Operator Characteristic curve analysis was used to summarise screening test performance and Cronbach's α used to assess internal consistency.

RESULTS

Of 376 participants, 32% were diagnosed with either MDE and/or anxiety disorders. All five questionnaires demonstrated moderate to high performance (AUC = 0.78-0.85). The EPDS was the best performing instrument for detecting MDE and the K10 and K6 for anxiety disorder. For MDE and/or anxiety disorders, the EPDS had the highest AUC (0.83). Of the short instruments, the K10 (AUC = 0.85) and the K6 (AUC = 0.85) performed the best, with the K6 showing good balance between sensitivity (74%) and specificity (85%) and a good positive predictive value (70%). The Whooley questions (AUC = 0.81) were the best performing ultra-short instrument. Internal consistency ranged from good to acceptable (α = 0.89-0.71). However, the PPV of the questionnaires compared with the diagnostic interview, ranged from 54% to 71% at the optimal cut-off scores.

CONCLUSIONS

Universal screening for case identification of antenatal depression and anxiety disorders in low-resource settings can be conducted with a number of commonly used screening instruments. Short and ultra-short screening instruments such as the K6 and the Whooley questions may be feasible and acceptable for use in these settings.

Authors+Show Affiliations

Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. Lead investigator of the Centre of Excellence in Human Development, University Witwatersrand, Johannesburg, South Africa.Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Pub Type(s)

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

Language

eng

PubMed ID

29668725

Citation

van Heyningen, Thandi, et al. "Comparison of Mental Health Screening Tools for Detecting Antenatal Depression and Anxiety Disorders in South African Women." PloS One, vol. 13, no. 4, 2018, pp. e0193697.
van Heyningen T, Honikman S, Tomlinson M, et al. Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women. PLoS One. 2018;13(4):e0193697.
van Heyningen, T., Honikman, S., Tomlinson, M., Field, S., & Myer, L. (2018). Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women. PloS One, 13(4), e0193697. https://doi.org/10.1371/journal.pone.0193697
van Heyningen T, et al. Comparison of Mental Health Screening Tools for Detecting Antenatal Depression and Anxiety Disorders in South African Women. PLoS One. 2018;13(4):e0193697. PubMed PMID: 29668725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women. AU - van Heyningen,Thandi, AU - Honikman,Simone, AU - Tomlinson,Mark, AU - Field,Sally, AU - Myer,Landon, Y1 - 2018/04/18/ PY - 2017/04/03/received PY - 2018/02/18/accepted PY - 2018/4/19/entrez PY - 2018/4/19/pubmed PY - 2018/7/11/medline SP - e0193697 EP - e0193697 JF - PloS one JO - PLoS One VL - 13 IS - 4 N2 - BACKGROUND: Antenatal depression and anxiety disorders are highly prevalent in low and middle-income countries. Screening of pregnant women in primary care antenatal settings provides an opportunity for entry to care, but data are needed on the performance of different screening tools. We compared five widely-used questionnaires in a sample of pregnant women in urban South Africa. METHOD: Pregnant women attending a primary care antenatal clinic were administered five tools by trained research assistants: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), the Kessler Psychological Distress scale (K10) and a shortened 6-item version (K6), the Whooley questions and the two-item Generalised Anxiety Disorder scale (GAD-2). Following this, a registered mental health counsellor administered the MINI Plus, a structured clinical diagnostic interview. The Area Under the Curve (AUC) from Receiver Operator Characteristic curve analysis was used to summarise screening test performance and Cronbach's α used to assess internal consistency. RESULTS: Of 376 participants, 32% were diagnosed with either MDE and/or anxiety disorders. All five questionnaires demonstrated moderate to high performance (AUC = 0.78-0.85). The EPDS was the best performing instrument for detecting MDE and the K10 and K6 for anxiety disorder. For MDE and/or anxiety disorders, the EPDS had the highest AUC (0.83). Of the short instruments, the K10 (AUC = 0.85) and the K6 (AUC = 0.85) performed the best, with the K6 showing good balance between sensitivity (74%) and specificity (85%) and a good positive predictive value (70%). The Whooley questions (AUC = 0.81) were the best performing ultra-short instrument. Internal consistency ranged from good to acceptable (α = 0.89-0.71). However, the PPV of the questionnaires compared with the diagnostic interview, ranged from 54% to 71% at the optimal cut-off scores. CONCLUSIONS: Universal screening for case identification of antenatal depression and anxiety disorders in low-resource settings can be conducted with a number of commonly used screening instruments. Short and ultra-short screening instruments such as the K6 and the Whooley questions may be feasible and acceptable for use in these settings. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/29668725/Comparison_of_mental_health_screening_tools_for_detecting_antenatal_depression_and_anxiety_disorders_in_South_African_women_ L2 - https://dx.plos.org/10.1371/journal.pone.0193697 DB - PRIME DP - Unbound Medicine ER -