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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.

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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
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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)...
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