Skip to main content
×
×
Home

Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy

  • Louise Michele Howard (a1), Elizabeth G. Ryan (a2), Kylee Trevillion (a3), Fraser Anderson (a3), Debra Bick (a4), Amanda Bye (a3), Sarah Byford (a5), Sheila O'Connor (a3), Polly Sands (a3), Jill Demilew (a6), Jeannette Milgrom (a7) and Andrew Pickles (a2)...
Abstract
Background

There is limited evidence on the prevalence and identification of antenatal mental disorders.

Aims

To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR.

Method

Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate.

Results

Population prevalence was 27% (95% CI 22–32): 11% (95% CI 8–14) depression; 15% (95% CI 11–19) anxiety disorders; 2% (95% CI 1–4) obsessive–compulsive disorder; 0.8% (95% CI 0–1) post-traumatic stress disorder; 2% (95% CI 0.4–3) eating disorders; 0.3% (95% CI 0.1–1) bipolar disorder I, 0.3% (95% CI 0.1–1%) bipolar disorder II; 0.7% (95% CI 0–1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6).

Conclusions

Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available.

Declaration of interest

L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012–2014.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Louise Michele Howard, Section of Women's Mental Health, PO31 Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF. Email louise.howard@kcl.ac.uk
References
Hide All
1Howard, LM, Molyneaux, E, Dennis, C-L, Rochat, T, Stein, A, Milgrom, J. Non-psychotic mental disorders in the perinatal period. Lancet 2014; 384: 1775–88.
2Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384: 1800–19.
3Garthus-Niegel, S AS, , Martini, J, von Soest, T, Eberhard-Gran, M. The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study. Psychol Med 2017; 47: 161–70.
4Solmi, F SH, , Stahl, D, Treasure, J, Micali, N. Low birth weight in the offspring of women with anorexia nervosa. Epidemiol Rev 2014; 36: 4956.
5Micali, N DSB, Ploubidis, GB, Simonoff, E, Treasure, J. The effects of maternal eating disorders on offspring childhood and early adolescent psychiatric disorders. Int J Eat Disord 2014; 47: 385–93.
6National Institute for Health and Care Excellence. Antenatal and Postnatal Mental Health Guidelines. Clinical Guidelines CG192. NICE, 2014.
7O'Connor, E, Rossom, R, M H, . Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US preventive services task force. JAMA 2016; 315: 388406.
8Cox, JL, Holden, J, Sagovsky, R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–6.
9Whooley, MA, Avins, AL, Miranda, J, Browner, WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997; 12: 439–45.
10Smith, M, Gotman, N, Haikin, L, Yonkers, K. Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women? Gen Hosp Psychiatry 2010; 32: 544–8.
11Bosanquet, K, Bailey, K, Gilbody, S, Harden, M, Manea, L, Nutbrown, S, et al. Diagnostic accuracy of the Whooley questions for the identification of depression: a diagnostic meta-analysis. BMJ Open 2015; 5: e008913.
12Mann, R, Adamson, J, Gilbody, S. The acceptability of case-finding questions to identify perinatal depression. Br J Midwifery 2015; 23: 630–8.
13First, MB, Spitzer, RL, Gibbon, M, Williams, JB. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. Biometrics Research, New York State Psychiatric Institute, 2002.
14Zanarini, MC, Frankenburg, FR, Sickel, AE, Yong, L. The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). McLean Hospital, 1996.
15Trevillion, K, Domoney, J, Pickles, A, Bick, D, Byford, S, Heslin, M, et al. Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self help for WomeN (DAWN): study protocol for a randomised controlled trial. Trials 2016; 17: 503.
16Pepe, M. Receiver operating characteristic methodology. J Am Stat Assoc 2000; 95: 308–11.
17Pepe, M. The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press, 2003.
18Janes, H, Longton, G, Pepe, M. Accommodating covariates in ROC analysis. Stata J 2009; 9: 1739.
19Farrelly, SCS, Gabbidon, J, Jeffery, D, Dockery, L, Lassman, F, Brohan, E, et al. Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 2014; 14: 157.
20Whooley, M. Screening for depression—a tale of two questions. JAMA Intern Med 2016; 176: 436–8.
21Darwin, Z, McGowan, L, Edozien, LC. Identification of women at risk of depression in pregnancy: using women's accounts to understand the poor specificity of the Whooley and Arroll case finding questions in clinical practice. Arch Womens Ment Health 2016; 19: 41–9.
22Redshaw, M HJ, . Who is actually asked about their mental health in pregnancy and the postnatal period? Findings from a national survey. BMC Psychiatry 2016; 16: 322.
23Prady, SL, Pickett, KE, Petherick, ES, Gilbody, S, Croudace, T, Mason, D, et al. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. Br J Psychiatry 2016; 208: 453–61.
24Darwin, Z, McGowan, L, Edozien, LC. Antenatal mental health referrals: review of local clinical practice and pregnant women's experiences in England. Midwifery 2015; 31: e1722.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
WORD
Supplementary materials

Howard et al supplementary material
Howard et al supplementary material 1

 Word (21 KB)
21 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1020
Total number of PDF views: 2093 *
Loading metrics...

Abstract views

Total abstract views: 3952 *
Loading metrics...

* Views captured on Cambridge Core between 4th January 2018 - 24th September 2018. This data will be updated every 24 hours.

Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy

  • Louise Michele Howard (a1), Elizabeth G. Ryan (a2), Kylee Trevillion (a3), Fraser Anderson (a3), Debra Bick (a4), Amanda Bye (a3), Sarah Byford (a5), Sheila O'Connor (a3), Polly Sands (a3), Jill Demilew (a6), Jeannette Milgrom (a7) and Andrew Pickles (a2)...
Submit a response

eLetters

Prevalence of maternal psychiatric disorder in pregnancy: 1986 and 2016

Susan Pawlby, Developmental Psychologist, King's College London
Deborah Sharp, Professor of Primary Health Care, University of Bristol
Dale Hay, Professor of Psychology, Cardiff University
05 April 2018

We note that the population prevalence rate for a psychiatric diagnosis for women at the first antenatal appointment is 27%, a disturbing one in 4 women.

In 1986 we used a similar two-stage methodology, the Leeds Anxiety and Depression Scales (Snaith et al., 1976) and the Clinical Interview Schedule (CIS: Goldberg et al., 1970), with women booking in at two GP antenatal clinics in the same inner-city location (Sharp, 1992). The point prevalence for a psychiatric disorder (ICD-9) at 20 weeks was 25% and at 36 weeks was 23.5%. The period prevalence was 38%. One in 3 women suffered from a psychiatric disorder during pregnancy.

The pregnant women recruited into Howard’s study have a mean age of 32 years and could well be the offspring of the mothers whom we interviewed in 1986. Why are the point prevalence rates of psychiatric disorder exactly the same as they were 30 years ago? It is likely that one in 3 pregnant women are still suffering from a psychiatric disorder. We have had 2 sets of NICE Guidelines (2007, 2014) for managing perinatal mental health, but this evidence shows that we have not reduced the number of sufferers. We seem to be good at identifying disorder but what are we doing to prevent the next generation from suffering?

My colleagues and I have interviewed the South London Child Development Study cohort of women and children at 8 time points through pregnancy in 1986 and the following 26 years to 2012. We have shown that women’s mental health in pregnancy is a risk factor for psychiatric disorder in the offspring through childhood, adolescence and into young adulthood (Plant et al., 2015). The evidence from Howard’s paper shows that we have not yet been able to stem the intergenerational transmission of psychiatric disorder. Screening without follow-up intervention does not help prevent later mental ill-health or transmission to the next generation. Isn’t it time that we could and should intervene? 

Professor Debbie Sharp

Professor Dale Hay

Dr Susan Pawlby

Sharp, D., 1992, Childbirth related emotional disorders in primary care: A longitudinal prospective study. Unpublished PhD thesis, Institute of Psychiatry, King’s College London

Snaith, R. P., Bridge, G. W., & Hamilton, M. (1976). The Leeds scales for the self-assessment of anxiety and depression. The British Journal of Psychiatry, 128, 156-165. 

http://dx.doi.org/10.1192/bjp.128.2.156

Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B., & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British journal of preventive & social medicine, 24(1), 18.

https://www.nice.org.uk/guidance/cg192

Plant, D. T., Pariante, C. M., Sharp, D., & Pawlby, S. (2015). Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. The British Journal of Psychiatry, 207(3), 213-220

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *