title: Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study.
abstract: OBJECTIVE
  Systems for efficient case finding of women with major depression during pregnancy and postpartum are needed. Here we assess the diagnostic accuracy of a modified 2-item patient health questionnaire (PHQ-2) as a pre-screen in assessing depression.
  
  
  METHODS
  Cross-sectional assessments at 15 weeks' gestation (n = 414), 30 weeks' gestation (n = 334), and 6 to 16 weeks postpartum (n = 193) among women from a diverse set of races/ethnicities, participating in the IMPLICIT maternal care quality improvement network. The Edinburgh Postnatal Depression Scale score (>or=13) was used as the criterion measure for the PHQ-2.
  
  
  RESULTS
  A positive 2-item screen had sensitivity of 93%, 82%, and 80% and specificity of 75%, 80%, and 86% for Edinburgh Postnatal Depression Scale score of >or=13 for assessment at 15 and 30 weeks gestational age and postpartum, respectively. The positive/negative predictive values for the PHQ-2 were 44/98, 24/91, and 30/98 for each time point, respectively. Areas under the receiver operating characteristic curve analysis suggested that 2-item assessments at each time point had approximately equal diagnostic validity.
  
  
  CONCLUSIONS
  Two questions were efficient to rule out depression and reduced the need for further screening of approximately 60% to 80% of women, depending on the point in pregnancy or postpartum. A diagnostic interview follow-up of women screening positive is still required.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. ian.bennett@uphs.upenn.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Andrew
authors.initials: A
authors.lastname: Coco
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: James
authors.initials: J
authors.lastname: Nicholson
authors.forename: Ellen
authors.initials: E
authors.lastname: Johnson
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Stephen
authors.initials: S
authors.lastname: Ratcliffe
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control*; D019052:Depression, Postpartum / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies