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Sensitivity and Specificity of the SRQ-20 and the EPDS in Diagnosing Major Depression Ante- and Postnatally in a South African Birth Cohort Study

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Abstract

We assessed the sensitivity and specificity of the Self-Reporting Questionnaire (SRQ-20) and the Edinburgh Postnatal Depression Scale (EPDS), against the major depression module of the Mini International Neuropsychiatric Interview (MINI). Data were utilised from antenatal (n = 296) and postnatal participants (n = 366) in the Drakenstein Child Health Study (DCHS), a multidisciplinary birth cohort investigating the determinants of child health. Mothers were interviewed using the SRQ-20, the EPDS and the MINI. Receiver operating characteristic (ROC) curve analysis was performed in order to establish optimal cut-off scores. Current major depressive episode was diagnosed in 5% of antenatal and 4% of postnatal participants. At widely used threshold scores, the sensitivity of the tools ranged from 50 to 67%, although the positive predictive values at these scores were much lower (14–25%). Both tools perform acceptably in identifying mothers at risk for major depression perinatally. In identifying appropriate cut-off scores, optimising specificity and maintaining at least 30% sensitivity seems to be a feasible approach given the resourcing of South African mental health services.

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Acknowledgements

We would like to acknowledge the Drakenstein Child Health Study staff for their commitment to the research participants and to excellence in research. We acknowledge the mothers and children who have patiently given us their time during the study.

Funding

Dan Stein and Heather Zar are supported by the Medical Research Council of South Africa. Funding for this study was provided by the Bill and Melinda Gates Foundation (grant number OPP1017641) and by the National Institute of Mental Health Brain Disorders in the Developing World: Research Across the Lifespan program (grant number 1R21MH098662-01).

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Authors and Affiliations

  1. Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa

    Claire van der Westhuizen

  2. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Kirsty Brittain

  3. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Kirsty Brittain

  4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Nastassja Koen, Karen Maré & Dan J. Stein

  5. Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa

    Nastassja Koen & Dan J. Stein

  6. Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Heather J Zar

  7. Unit on Child and Adolescent Health, South African Medical Research Council (SAMRC), Cape Town, South Africa

    Heather J Zar

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  1. Claire van der Westhuizen
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  5. Heather J Zar
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  6. Dan J. Stein
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Correspondence to Claire van der Westhuizen.

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Ethical Statement and Approval

All procedures involving human participants were in accordance with the ethical standards of the Faculty of Health Sciences Human Research Ethics Committee, University of Cape Town, by the Stellenbosch University Health Research Ethics Committee, and by the Western Cape Provincial Health Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

Conflicts of Interest

Authors van der Westhuizen, Brittain, Koen, Zar and Maré declare that they have no conflicts of interest, apart from the funding information given above. In the past 3 years, Prof Stein has received research grants and/or consultancy honoraria from Biocodex, Lundbeck, Servier and Sun. In his career, Prof Stein has received research grants and/or consultancy honoraria from Abbott, ABMRF, Astrazeneca, Biocodex, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, National Responsible Gambling Foundation, Novartis, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah and Wyeth.

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van der Westhuizen, C., Brittain, K., Koen, N. et al. Sensitivity and Specificity of the SRQ-20 and the EPDS in Diagnosing Major Depression Ante- and Postnatally in a South African Birth Cohort Study. Int J Ment Health Addiction 16, 175–186 (2018). https://doi.org/10.1007/s11469-017-9854-8

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