In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings.
Searching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots.
Eleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity.
This review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity.
e Couto TC, MMY B, Cardoso MN, Protzner AB, Garcia FD, Nicolato R, et al. What is the best tool for screening antenatal depression? J Affect Disord. 2015;178:12–7. CrossRef
Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes. PLoS Med. 2013;10(5):1–7. CrossRef
Mathibe-Neke JM, Rothberg A, Langley G. The perception of midwives regarding psychosocial risk assessment during antenatal care. Health SA Gesondheid (Online). 2014;19(1):01–9.
Goldstuck ND. Healthcare in Low-resource Settings: the individual perspective. Healthcare in Low-resource Settings. 2014;2(2):4572. CrossRef
World Bank World Bank list of economies. 2016. databank.worldbank.org/data/download/site-content/CLASS.xls. Accessed 17 Mar 2017.
Lahariya C. Introducing Healthcare in Low-resource Settings. Healthcare Low-Resource Settings. 2013;1(1):1. CrossRef
Welch VA, Petticrew M, O’Neill J, Waters E, Armstrong R, Bhutta ZA, et al. Health equity: evidence synthesis and knowledge translation methods. Syst Rev. 2013;2(1):1. CrossRef
Onwuegbuzie AJ, Leech NL, Collins KM. Qualitative analysis techniques for the review of the literature. Qual Rep. 2012;17(28):1–28.
Rochat TJ. Depression among pregnant women testing for HIV in rural South Africa. Doctoral Thesis. Stellenbosch: University of Stellenbosch; 2011.
Aderibigbe Y, Gureje O. The validity of the 28-item General Health Questionnaire in a Nigerian antenatal clinic. Soc Psychiatry Psychiatr Epidemiol. 1992;27(6):280–3. PubMed
Natamba BK, Achan J, Arbach A, Oyok TO, Ghosh S, Mehta S, et al. Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and-uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry. 2014;14(1):1. CrossRef
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011, vol. 4. Chichester: Wiley; 2011.
Kessler R, Mroczek D. Kessler psychological distress scale (K10). Boston: Harvard Medical School; 1996.
Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. CrossRef
WHO. A user’s guide to the Self Reporting Questionnaire (SRQ). Geneva: World Health Organization; 1994.
Zhu W, Zeng N, Wang N. Sensitivity, specificity, accuracy, associated confidence interval and ROC analysis with practical SAS® implementations. 2010:1–9.
Dinnes J, Deeks J, Kirby J, Roderick P. A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess. 2005;9(12):1–128. CrossRef
BOLDER Research Group. Better Outcomes through Learning, Data, Engagement, and Research (BOLDER)–a system for improving evidence and clinical practice in low and middle income countries. F1000Research. 2016;5:693.
- A systematic review of screening instruments for depression for use in antenatal services in low resource settings
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