A comparison of three screening tools to identify perinatal depression among low-income African American women

Abstract

Background: The purpose of the current study was to determine the sensitivity, specificity, and positive predictive value of three depression screening tools among a low-income African American population of pregnant and recently delivered women enrolled in home visitation programs in a low-income urban community.

Methods: Ninety-five women enrolled in home visitation programs-32 who were pregnant and 63 with a child <6 months comprise the study sample. Each woman completed a structured clinical interview and three depression screening tools-the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Depression Inventory II (BDI-II).

Results: Over a quarter of women (28.4%) were experiencing major depression. Each screening tool was highly accurate in detecting major depression and major or minor depression among prenatal and postpartum women, with areas under the curve (AUCs) >0.90. Sensitivities of all screening tools were improved when using cutoffs lower than those considered standard by instrument developers.

Limitations: Participants were recruited from home visitation programs in an urban context which may limit generalizability to other populations of low-income African American women. Given that no women during pregnancy met criteria for minor depression, it was not possible to determine optimal prenatal cutoff scores.

Conclusions: Three depression screening tools-the EPDS, CES-D, and BDI-II-appear to be reliable and brief assessments of major and minor depression among low-income African American perinatal women. Providers using these tools should consider using lower cutoff scores to most effectively identify women in need of depression treatment.

Fig. 1

ROC curves for MDD.

Fig. 2

ROC curves for MDD/MnDD.