Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression.
OBJECTIVE
We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women.


METHODS
This cross-sectional study included 1517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen׳s kappa.


RESULTS
Both scales had good internal consistency (Cronbach׳s alpha>0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, "somatization", "depression and suicidal ideation", "anxiety and depression", and "anhedonia". The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen׳s kappa being 0.46.


CONCLUSIONS
Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings.
Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States.
Qiuyue
Q
Zhong
Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States. Electronic address: bgelaye@hsph.harvard.edu.
Bizu
B
Gelaye
Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru.
Marta
M
Rondon
Universidad San Martin de Porres, Lima, Peru.
Sixto E
SE
Sánchez
Universidad San Martin de Porres, Lima, Peru.
Pedro J
PJ
García
Asociación Civil PROESA, Lima, Peru.
Elena
E
Sánchez
Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States.
Yasmin V
YV
Barrios
Group Health Research Institute, Seattle, WA, United States.
Gregory E
GE
Simon
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
David C
DC
Henderson
School of Medicine, Perdana University, Kuala Lumpur, Malaysia.
Swee May
SM
Cripe
Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States.
Michelle A
MA
Williams
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010568:Peru; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000379:methods*; D015203:Reproducibility of Results; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult
Antepartum depression; EPDS; PHQ-9; Peru