A Systematic Review of Screening Instruments for Depression in Antenatal Services in Low Resource Settings

Transcription

1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Format Title Text-based Document A Systematic Review of Screening Instruments for Depression in Antenatal Services in Low Resource Settings Authors Chorwe Sungani, Genesis; Chipps, Jennifer A. Downloaded 4-May :12:10 Link to item

2 A Systematic Review of Screening Instruments for Depression in Antenatal Services in Low Resource Settings Authors: Genesis Chorwe-Sungani, MN-MHL, PhD Student Jennifer Chipps, PhD, Associate Professor

3 Disclosure Faculty Name: Genesis Chorwe-Sungani, MN-MHL, PhD student Conflicts of interest: None Employer: University of Malawi Sponsorship: University of Malawi through NORHED Project (QZA-0484 NORHED 2013) Faculty Name: Jennifer Chipps, PhD, Associate Professor Conflicts of interest: None Employer: University of the Western Cape Sponsorship:

4 Learner objectives To acquire knowledge about effectiveness of validated screening instruments for prenatal depression in low resource settings To identify possible screening instruments for depression in antenatal clinics in low resource settings

5 Introduction In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity for the screening of depression are essential. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted.

6 Review questions The review questions were: 1. What is the methodological quality of papers for validated screening instruments for depression in antenatal in low resource settings? 2. Which instruments could be recommended for use and testing in antenatal care services in low resource settings?

7 Methods Searching, quality assessment, selection and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched. Retrieved studies were evaluated for relevancy and whether psychometric data were reported. Data were synthesised qualitatively and quantitatively.

8 Search and review results The electronic search yielded 3666 published papers (Figure 1). Eleven (11) papers were identified from other sources resulting in a total number of 3677 published papers duplicates were removed leaving 2001 papers.

9 Records identified through database searching 3666) + Additional records identified through other sources (n =11) N=3677 Duplicates excluded (n =1676) Records after removing duplicates (n =2001) Records screened for relevancy [PICO and setting] (n=251) information or were not in English Full-text articles assessed for eligibility (n =38) Full-text articles assessed for quality (n =11) Records excluded [Abstracts, conferences, congresses, reviews, editorials, commentaries, news, old and irrelevant] (n =1750) Records excluded after relevancy screening (n =213) Full-text articles excluded because did not report psychometrics, no gold standard, contained similar information or were not in English (n =27) Included studies (n =11) Figure 1. Study search and selection (Moher et al. (2009)

10 Search and review results 1750 papers [abstracts, conferences, congresses, editorials, commentaries, reviews, news, old ( 1999) and irrelevant papers] were removed. 251 papers which remained were screened for relevancy by reviewers using PICO (Participant, Index test, Comparator test, Outcome). calculated Kappa value of 0.97 indicated excellent inter rater agreement.

11 Search and review results 213 papers were excluded after screening with PICO leaving 38 papers. review of full texts of the 38 papers showed that two pairs of papers [(Adewuya et al., 2007; Adewuya et al., 2006) and (Rochat, 2011; Rochat et al., 2013)] reported the same information from two different studies and only one paper from each pair was retained.

12 Search and review results Another study was excluded because it was in Portuguese and no English version could be found (Araújo et al., 2015), resulting in 35 papers which were included in further review. two more studies (Tsai et al., 2014; Vythilingum et al., 2013) were excluded because they did not use a gold standard as defined by this study

13 Search and review results 22 studies were excluded because of lack of reporting psychometrics, resulting in 11 studies which were included in this review Methodological quality rating of the included studies overall was good with six (6) excellent, three (3) good and two (2) adequate (Table 1).

14 Table 1. Methodological quality rating of studies Study QUADAS ITEMS Quality Adewuya et al. (2006) Y Y Y U Y Y Y Y Y Y Y Y N N Excellent (11) Alvarado-Esquivel, Sifuentes-Alvarez, & Salas-Martinez (2014a) Alvarado-Esquivel, Sifuentes-Alvarez, & Y Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y Y Y Y Y U U Y Y Y N N Excellent (12) Good (10) Salas-Martinez (2014b) e Couto et al. (2015) Y Y Y U Y Y Y Y Y Y Y Y N N Excellent (11) Fernandes et al. (2011) Y Y Y U Y Y Y Y N U U Y N N Adequate (8) Kaaya et al. (2002) Y Y Y Y Y Y Y Y Y Y Y Y N N Excellent (12) Martins Cde et al. (2015) Y Y Y U U U Y Y Y Y Y Y N Y Good (10) Natamba et al. (2014) Y Y Y Y Y Y Y Y Y Y Y Y N N Excellent (12) Rochat et al. (2013) Y Y Y U Y Y U U U U U Y N Y Adequate (7) Spies et al. (2009) Y Y Y Y Y Y N Y Y N N Y N N Good (9) Stewart, Umar, Y Y Y Y Y Y Y Y Y Y Y Y N Y Excellent Tomenson, & Creed (13) (2013) Key: Y= Yes, N= No and U=Unclear

15 Screening instruments Results showed that Beck Depression Index (BDI), Centre for Epidemiologic Studies Depression Scale (CES-D), EPDS, Hamilton Rating Scale for Depression (HAM-D),Hopkins Symptoms Checklist (HSCL)-25, Kessler Psychological Distress Scale (K10) and Self-Reporting Questionnaire (SRQ)- 20 were used for screening antenatal depression in low resource settings

16 Screening instruments Seven studies used a single screening instrument while 4 used a combination of two or three instruments Mini-International Neuropsychiatric Interview Plus (MINI) was the most widely used gold standard. EPDS was the most widely used screening instrument (8 studies)

17 Screening instruments level of accuracy of screening instruments ranged from low (.5 to.7) to moderate (>.7 to.9) to high (>.9) (Fischer,Bachmann, & Jaeschke, 2003). EPDS had the highest level of accuracy (AUC= 0.965) in detecting depression among pregnant women while K10 had the lowest level of accuracy (AUC=.660).

18 Screening instruments BDI, CES-D, HAM-D, HSCL-25 and SRQ-20 had moderate accuracy with AUC range of.82 to.90. These instruments had a pooled sensitivity of.82 and pooled specificity of.79 indicating validity for this setting (Figure 2)

19 Figure 2: Forrest plot of included studies

20 Screening instruments EPDS sensitivity across the included studies ranged from.688 to 1 while specificity ranged from.733 to.915. EPDS AUC ranged from.770 to.965.

21 Screening instruments EPDS was validated in antenatal in Malawi (Stewart et al., 2013), South Africa (Rochat et al., 2013), Brazil (e Couto et al., 2015; Martins Cde et al., 2015), Mexico (Alvarado-Esquivel et al., 2014a; Alvarado-Esquivel et al., 2014b), Nigeria (Adewuya et al., 2006) and India (Fernandes et al., 2011) BDI was validated in Brazil (e Couto et al., 2015; Martins Cde et al., 2015)

22 Screening instruments Sensitivity of BDI in the two studies was.867 and.820 with AUC of.870 and.900 respectively K-10 was validated in South Africa (Spies et al., 2009) and India (Fernandes et al., 2011) K-10 had 2 nd highest (.950) and lowest (.660) AUC among selected studies.

23 Screening instruments K-10 had the highest sensitivity (1.0) and lowest specificity (.540). CES-D was validated in antenatal in Uganda (Natamba et al., 2014) [Sensitivity=.73, Specificity=.79, AUC >.800] HSCL-15 was validated in Tanzania (Kaaya et al., 2002) [Sensitivity=.89, Specificity=.80, AUC >.800]

24 Screening instruments SRQ-20 was validated among pregnant women in Malawi (Stewart et al., 2013) [Sensitivity=.76, Specificity=.81, AUC >.800] HAM-D was validated among pregnant women in Brazil (e Couto et al., 2015) [Sensitivity=.88, Specificity=.75, AUC >.800]

25 Conclusion This review suggests that EPDS can be a suitable instrument of preference for screening antenatal depression in low resource settings. However, it is necessary that EPDS should be validated in a particular setting before it is routinely used for depression screening.

26 References Adewuya, A. O., Ola, B. A., Aloba, O. O., Dada, A. O., & Fasoto, O. O. (2007). Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety, 24(1), doi: /da Adewuya, A. O., Ola, B. A., Dada, A. O., & Fasoto, O. O. (2006). Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women. J Psychosom Obstet Gynaecol, 27(4), Alvarado-Esquivel, C., Sifuentes-Alvarez, A., & Salas-Martinez, C. (2014a). The use of the edinburgh postpartum depression scale in a population of teenager pregnant women in Mexico: a validation study. Clinical Practice And Epidemiology In Mental Health: CP & EMH, 10, doi: /

27 References Alvarado-Esquivel, C., Sifuentes-Alvarez, A., & Salas-Martinez, C. (2014b). Validation of the edinburgh postpartum depression scale in a population of adult pregnant women in Mexico. Journal Of Clinical Medicine Research, 6(5), doi: /jocmr1883w Araújo, P. L., de Andrade, R. B., da Silva, Y. L. R., & de Araújo Silveira, M. d. F. (2015). Screening of depressive symptoms in pregnant women of high-risk prenatal [Portuguese]. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 9(2), doi: /reuol SM e Couto, T. C., Brancaglion, M. M. Y., Cardoso, M. N., Protzner, A. B., Garcia, F. D., Nicolato, R.,... Corrêa, H. (2015). What is the best tool for screening antenatal depression? Journal of Affective Disorders, 178, doi: /j.jad

28 References Fernandes, M., Srinivasan, K., Stein, A., Menezes, G., Sumithra, R., & Ramchandani, P. (2011). Assessing prenatal depression in the rural developing world: a comparison of two screening measures. Archives of Women's Mental Health, 14(3), doi: /s Fischer, J. E., Bachmann, L. M., & Jaeschke, R. (2003). A readers' guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive care medicine, 29(7), Kaaya, S. F., Fawzi, M. C. S., Mbwambo, J. K., Lee, B., Msamanga, G. I., & Fawzi, W. (2002). Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatrica Scandinavica, 106(1), doi: /j x

29 References Martins Cde, S., Motta, J. V., Quevedo, L. A., Matos, M. B., Pinheiro, K. A., Souza, L. D.,... Coelho, F. M. (2015). Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in Southern Brazil. J Affect Disord, 177, doi: /j.jad Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), Natamba, B. K., Achan, J., Arbach, A., Oyok, T. O., Ghosh, S., Mehta, S.,... Young, S. L. (2014). 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, 14(1), doi: /s y

30 References Rochat, T. J. (2011). Depression among pregnant women testing for HIV in rural South Africa. 289 p. : ill. Rochat, T. J., Tomlinson, M., Newell, M.-L., & Stein, A. (2013). Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS). Archives of Women's Mental Health, 16(5), doi: /s z Spies, G., Stein, D., Roos, A., Faure, S., Mostert, J., Seedat, S., & Vythilingum, B. (2009). Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women. Archives of Women's Mental Health, 12(2),

31 References Stewart, R., Umar, E., Tomenson, B., & Creed, F. (2013). Validation of screening tools for antenatal depression in Malawi A comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. Journal of Affective Disorders, 150(3), doi: /j.jad Tsai, A., Tomlinson, M., Dewing, S., Roux, I., Harwood, J., Chopra, M., & Rotheram-Borus, M. (2014). Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application. Archives of Women's Mental Health, 17(5), doi: /s Vythilingum, B., Field, S., Kafaar, Z., Baron, E., Stein, D., Sanders, L., & Honikman, S. (2013). Screening and pathways to maternal mental health care in a South African antenatal setting. Archives of Women's Mental Health, 16(5), doi: /s

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