Screening to identify persistently elevated depression symptoms in urban mothers

Background: Many depression screening instruments are tested to detect concurrent depressive disorders. Given the adverse impact of severe and chronic maternal depressive symptoms on child well-being, it is important to identify if depression screening instruments can also detect persistently elevated depressive symptoms.

Methods: A convenience sample of 181 urban mothers from community sites in the Boston area (WIC offices, Head Start, Early Intervention sites) were screened at baseline for depressive symptoms using the two-item Patient Health Questionnaire (PHQ-2) and assessed monthly for 6 months using a more detailed depressive symptom inventory, the Quick Inventory of Depressive Symptomatology (QIDS). Sensitivity and specificity of the PHQ-2 to detect persistently elevated depressive symptoms were judged against having two or more time points with scores of 14 or above on the QIDS.

Results: At a cutoff score of two, the sensitivity of the PHQ-2 to identify persistently elevated symptoms was 100% and its specificity was 56%. At a cutoff score of three, the sensitivity decreased to 76% and specificity increased 78%.

Conclusion: Using a PHQ-2 cutoff score of two appears to have perfect sensitivity. Using a PHQ-2 cutoff score of three has more balanced sensitivity and specificity to identify persistently elevated depressive symptoms. Because of maternal depression's adverse impacts on children are a function of both severity and chronicity, being able to identify mothers who will likely have persistently elevated depressive symptoms in pediatric or community settings may help clinicians better identify proper referral and treatment mechanisms.