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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

Research output: Contribution to journalArticle

Louise Michele Howard, Elizabeth G. Ryan, Kylee Trevillion, Fraser Anderson, Debra Bick, Amanda Bye, Sarah Byford, Sheila O'Connor, Polly Sands , Jill Demilew, Jeannette Milgrom, Andrew Pickles

Original languageEnglish
Pages (from-to)50-56
JournalBritish Journal of Psychiatry
Volume212
Issue number1
Early online date4 Jan 2018
DOIs
Publication statusPublished - Jan 2018

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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.

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