Background: Depressive and anxiety disorders in the postpartum period cause significant suffering for women. State public health officials across the country use the Centers for Disease Control and Prevention (CDC)-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) to assess health behaviors and conditions, including depression and anxiety, that occur around the time of pregnancy. The purpose of the present study was to validate two to three items that could be included on the PRAMS questionnaire to detect depression and anxiety among postpartum women in a surveillance system.
Methods: A comprehensive set of 16 depression and anxiety items was developed and tested in a final sample of 1077 postpartum women, 353 of whom completed Structured Clinical Interview for DSM-IV (SCID) interviews to determine the presence of a major depressive episode (MDE) and generalized anxiety disorder (GAD). Regression analyses reduced candidate items to 5 each for MDE and GAD. Responses were scored on a 5-point scale ranging from never (1) to always (5), and 2 and 3 item combinations of these items were examined for their psychometric properties as indicators of MDE and GAD.
Results: Item sets varied in their psychometric properties. The combination of depressed mood, felt hopeless, and slowed down > 9 (out of a possible total of 15) yielded the highest positive predictive value (PPV=60) and estimated MDE prevalence most accurately (24.4% vs. 25.4% true prevalence). The combination of felt panicky, felt restless, and problems sleeping >9 estimated GAD prevalence most accurately (20.2% vs. 15.7% true prevalence) and had high specificity (83%).
Conclusions: Depression and anxiety can be detected using very few items, which makes assessment feasible in surveillance systems, such as PRAMS, and in primary care settings that have severe limits on time for depression and anxiety screening.