Community-based prenatal screening for postpartum depression in a South African township.
OBJECTIVE
To assess the feasibility of using community health workers to administer short or ultra-short screening instruments during routine community-based prenatal outreach for detecting probable depression at 12 weeks postpartum.


METHODS
During pregnancy and at 12 weeks postpartum, the 10-item Edinburgh Postnatal Depression Scale (EPDS-10) was administered to 249 Xhosa-speaking black African women living in Khayelitsha, South Africa. We compared the operating characteristics of the prenatal EPDS-10, as well as 4 short and ultra-short subscales, with the criterion standard of probable postpartum depression.


RESULTS
Seventy-nine (31.7%) women were assessed as having probable postpartum depression. A prenatal EPDS-10 score of 13 or higher had 0.67 sensitivity and 0.67 specificity for detecting probable postpartum depression. Briefer subscales performed similarly.


CONCLUSIONS
Community health workers successfully conducted community-based screening for depression in a resource-limited setting using short or ultra-short screening instruments. However, overall feasibility was limited because prenatal screening failed to accurately predict probable depression during the postpartum period.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA. Electronic address: khung@bidmc.harvard.edu.
Kristin J
KJ
Hung
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Mark
M
Tomlinson
Philani Maternal Child Health and Nutrition Project, Cape Town, South Africa.
Ingrid M
IM
le Roux
Health Systems Research Unit, Medical Research Council of South Africa, Tygerberg, South Africa.
Sarah
S
Dewing
Health Section, United Nations Children's Fund, NY, USA.
Mickey
M
Chopra
Center for Global Health, Massachusetts General Hospital, Boston, USA; Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Mbarara University of Science and Technology, Mbarara, Uganda.
Alexander C
AC
Tsai
D000328:Adult; D003150:Community Health Workers; D019052:Depression, Postpartum / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D013019:South Africa; D055815:Young Adult
Postpartum depression; Screening; Sub-Saharan Africa