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

J Affect Disord. 2012 Jan;136(1-2):155-162. doi: 10.1016/j.jad.2011.07.014. Epub 2011 Aug 23.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Americans*
  • Depression, Postpartum / diagnosis
  • Depression, Postpartum / ethnology
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / ethnology
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / ethnology
  • Female
  • House Calls
  • Humans
  • Mass Screening
  • Peripartum Period
  • Poverty
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / ethnology
  • Psychiatric Status Rating Scales
  • Urban Population
  • Young Adult