Depression Common Among Low-Income, Urban, Postpartum Mothers

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February 19, 2010 — Depression is prevalent in low-income, urban, postpartum mothers and can be accurately identified using depression screening tools, according to the results of a study reported online in the February 15 issue of Pediatrics.

"Postpartum depression is common, especially among underserved women," write Linda H. Chaudron, MD, MS, from the University of Rochester in New York, and colleagues. "Many studies have found it is feasible to screen mothers in pediatric clinics. The accuracy of depression screening tools for a low-income, minority population in a pediatric clinic is unknown."

The study goal was to determine the accuracy of screening tools in identifying major depressive disorder (MDD) or minor depressive disorder (MnDD) in low-income, urban mothers attending well-child care (WCC) visits during the postpartum year. These screening tools were the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory II (BDI-II), and Postpartum Depression Screening Scale (PDSS).

A psychiatric diagnostic interview (the reference standard) and 3 screening tests at WCC visits were completed for 198 mothers of infants 0 to 14 months of age. For each screening tool, sensitivity and specificity were calculated for diagnoses of MDD or MDD/MnDD based on psychiatric diagnostic interview.

To determine accuracy for the entire sample during the whole postpartum year, and for subsamples early, middle, and late in the postpartum year, the investigators calculated receiver operating characteristic curves, compared areas under the curve (AUCs) for each screening tool, and calculated optimal cutoff scores.

More than half (56%) of mothers met criteria for either MDD (37%) or MnDD (19%) at some point between 2 weeks and 14 months after delivery. All 3 scales performed equally well when used as continuous measures, with all 3 AUCs being 0.8 or higher.

Using traditional cutoff scores, levels of sensitivity and specificity were less than expected. Optimal cutoff scores were lower than currently recommended for the BDI-II (≥14 for MDD and ≥11 for MDD/MnDD) and for the EPDS (≥9 for MDD and ≥7 for MDD/MnDD).

The optimal cutoff score for the PDSS was consistent with current guidelines for MDD (≥80) but was higher than recommended for MDD/MnDD (≥77).

"Large proportions of low-income, urban mothers attending WCC visits experience MDD or MnDD during the postpartum year," the study authors write. "The EPDS, BDI-II, and PDSS have high accuracy in identifying depression, but cutoff scores may need to be altered to identify depression more accurately among urban, low-income mothers."

Limitations of this study include potential sample bias, lack of generalizability to the general clinic population, large proportion of women lost to follow-up, and cross-sectional design precluding accurate determination of when incident or recurrent cases occurred.

"This is the first study to describe the prevalence of depression, determined with a diagnostic interview, among low-income, young, black mothers attending WCC visits and the first to describe the accuracy of 3 depression screening tools in this understudied population," the study authors conclude.

The National Institutes of Mental Health supported this study. One of the study authors reports various financial relationships with Eli Lilly Corp and Novartis.

Pediatrics. Published online February 15, 2010.