A comparison of three screening tools to identify perinatal depression among low-income African American women

Background: The purpose of the current study was to determine the sensitivity, specificity, and positive predictive value of three depression screening tools among a low-income African American population of pregnant and recently delivered women enrolled in home visitation programs in a low-income urban community. Methods: Ninety-five women enrolled in home visitation programs-32 who were pregnant and 63 with a child <6 months comprise the study sample. Each woman completed a structured clinical interview and three depression screening tools the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Depression Inventory II (BDI-II). Results: Over a quarter of women (28.4%) were experiencing major depression. Each screening tool was highly accurate in detecting major depression and major or minor depression among prenatal and postpartum women, with areas under the curve (AUCs) >0.90. Sensitivities of all screening tools were improved when using cutoffs lower than those considered standard by instrument developers. Limitations: Participants were recruited from home visitation programs in an urban context which may limit generalizability to other populations of low-income African American women. Given that no women during pregnancy met criteria for minor depression, it was not possible to determine optimal prenatal cutoff scores. Conclusions: Three depression screening tools-the EPDS, CES-D, and BDI-II-appear to be reliable and brief assessments of major and minor depression among low-income African American perinatal women. Providers using these tools should consider using lower cutoff scores to most effectively identify women in need of depression treatment. (C) 2011 Elsevier B.V. All rights reserved.