| Purpose: To assess the prevalence of postpartum depression(PPD)among community-based mothers within one week after discharge using the diagnostic interview as the reference standard,to validate the reliability and validity of the 9-question depression scale from the patient health questionnaire(PHQ-9),Edinburgh Postpartum Depression Scale(EPDS),and Whooley Questions for postpartum depression screening,and to determine the optimal screening approach for PPD in a Chinese community setting.Methods: This was a cross-sectional study.All mothers who had postnatal home visits and were at least 18 years old in Kaifu District and Changsha County,Changsha City,Hunan Province were recruited.After fully informed consent,the mothers were asked to complete an electronic questionnaire.Within 7 days after screening,all participants were contacted by members of the research team via text messages in We Chat to schedule an appointment with one of three qualified mental health specialists for diagnostic interview using the Mini International Neuropsychiatric Interviews(MINI).Interviews were conducted using Voo V,an online video App.SPSS 25.0 statistical software was used to analyze the reliability(Cronbach’s alpha coefficient and split-half reliability),structural validity,calibration validity and best cut-off values[sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)] of the candidate scales.Results: From December 1,2020 to June 30,2021,1862 women completed the electronic questionnaire and the MINI.Sixty-two mothers were diagnosed with a current depressive episode based on the MINI,and the prevalence for depressive conditions(major and minor depression combined)was 3.3%(95% CI 2.6% to 4.3%).The reliability analysis showed that the Cronbach’s alpha coefficients of EPDS,PHQ-9 and Whooley Questions were 0.85,0.85 and 0.64 in order,and the split-half reliability was 0.83,0.81 and 0.64 respectively.For structural validity,the principal component method was used to extract the common factors,and the number of principal components with eigenvalues greater than 1 was used as the number of common factors.The results showed that two principal components of EPDS met the extraction criteria,and the cumulative contribution to the total variance was 54.96%;one principal component of PHQ-9 met the extraction criteria,and the cumulative contribution to the total variance was 43.35%.When applying alone,the best cut-off for EPDS was 12.5(sensitivity of 0.71,95%CI 0.58～0.81;specificity of 0.90,95%CI 0.89～0.92;PPV of 0.20,95%CI 0.15～0.26;NPV of 0.99,95%CI 0.98～1.00),4.5 for PHQ-9(sensitivity of 0.73,95%CI0.60～0.83;specificity of 0.77,95%CI 0.75～0.79;PPV of 0.10,95%CI0.07～0.13;NPV of 0.99,95%CI 0.98～1.00),at least one “yes” for Whooley Questions(sensitivity of 0.77,95%CI 0.65～0.87;specificity of0.89,95%CI 0.88～0.90;PPV of 0.20,95%CI 0.15～0.25;NPV of 0.99,95%CI 0.98～1.00).The optimal screening approach involved combining the Whooley Questions(at least one “yes”)first,followed by the EPDS(cutoff greater than 10)in series,with sensitivity of 0.76(95%CI0.63～0.85),specificity of 0.93(95%CI 0.92～0.94),PPV of 0.28(95%CI0.21～0.36)and NPV of 0.99(95%CI 0.98～1.00).Conclusion: The prevalence of PPD among women within one week after discharge in this sample was substantially lower than those reported in previous studies in China,the majority of which used screen positivity in measuring prevalence.Combining Whooley Questions(at least one“yes”)with EPDS(cutoff greater than 10)in series is the most optimal screening approach in this population,though this would still result in a high number of false positives at current prevalence. |
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