HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410078, China.
Department of Psychiatry, University of Rochester, Rochester, NY, USA.
J Affect Disord. 2024 Mar 1;348:191-199. doi: 10.1016/j.jad.2023.12.046. Epub 2023 Dec 27.
Postpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools.
We sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires-the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Out of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one "yes") with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00).
Due to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population.
The prevalence of PPD among women 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 with EPDS 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.
产后抑郁症（PPD）是全球一个重要的公共卫生问题。中国正计划在社区环境中开展 PPD 筛查，但对于社区中 PPD 的流行程度和经过验证的筛查工具仍存在疑问。
我们试图在长沙市的两个区通过家访招募所有符合条件的新妈妈，并在获得知情同意后，使用三个自我管理问卷——爱丁堡产后抑郁量表（EPDS）、患者健康问卷（PHQ-9）和威利斯抑郁筛查问卷（Whooley Questions for Depression Screening）对她们进行 PPD 筛查。合格的专家根据精神疾病诊断与统计手册第四版（DSM-IV）通过在线视频结构化诊断访谈对符合条件的新妈妈进行诊断，这些专家对筛查结果不知情。基于量表的可接受性和包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）在内的诊断准确性指标，确定了最佳的筛查方法。
在 3004 名符合条件的女性中，有 2730 名（90.9%）完成了筛查问卷。在接受筛查的人群中，有 1862 名（68.2%）接受了视频结构化诊断访谈，其中 62 名（3.3%）被诊断为当前抑郁状态。最佳的筛查方法是将威利斯问题（至少一个“是”）和 EPDS（截断值>10）串联使用，其敏感性为 0.76（95%CI 0.63 至 0.85），特异性为 0.93（0.92 至 0.94），阳性预测值为 0.28（0.21 至 0.36），阴性预测值为 0.99（0.98 至 1.00）。
由于样本的区域性以及排除了通过电话而不是家访联系的母亲，我们的发现可能无法完全推广到整个人群。
与中国之前大多数使用筛查阳性率来衡量患病率的研究相比，该样本中 PPD 的患病率要低得多。在该人群中，将威利斯问题与 EPDS 串联使用是最佳的筛查方法，尽管这仍然会导致目前的患病率下出现大量的假阳性。
