Test performance of two-question screening for postpartum depressive symptoms

The Edinburgh Postnatal Depression Scale (EPDS) is commonly used to screen for postpartum depression, but it is difficult to consistently administer it to all mothers during busy well-child visits owing to the fact that it is time-consuming. The purpose of the present paper was to evaluate the performance of a concise, two-question screening tool in the detection of mothers with postpartum depressive symptoms who had a high EPDS score.

The study involved 103 mothers attending a single hospital for 1 month well-child visits. The primary outcome measure was the detection of mothers with postpartum depressive symptoms, using the EPDS score as the reference standard. Visiting mothers were asked to complete both the EPDS questionnaire and a two-question questionnaire covering depressive mood and anhedonia while in the hospital waiting room. The sensitivity, specificity, predictive value, and likelihood ratio of the two-question instrument was evaluated using the EPDS as standard.

Taking EPDS as standard, sensitivity of the two-question instrument was 88% (95% confidence interval [CI]: 64-99%), specificity was 76% (95%CI: 65-84%), positive predictive value was 42% (95%CI: 26-59%), and negative predictive value was 97% (95%CI: 90-100%). The stratified likelihood ratios of each of the two-question instrument test scores 0, 1, and 2 were 0.2 (95%CI: 0.04-0.6), 3.4 (95%CI: 1.8-6.2) and 4.2 (95%CI: 1.5-12.3), respectively.

With the cut-off point set at 1, the two-question instrument had high sensitivity in detecting postpartum depressive symptoms at 1 month well-child visits. In primary care setting, negative result with the two-question instrument may be a good indicator of no need for further evaluation for postpartum depression.