Common Mental Disorders Depression - New Zealand Doctor

Chapter 7 Special issues: women with mental disorders in the antenatal and postnatal period
7.3 Screening and assessment tools:
evidence review
Screening
No randomised controlled trials (RCTs) were found that evaluated routine screening
(versus not screening) for common mental disorders in the antenatal or postnatal period.
Assessment tools
Primary care evidence
Studies of the validity and utility of screening, case-finding and monitoring tools for
common mental disorders in the antenatal and postnatal period were sought. Three
guidelines were found. 440,441 The most recent of these 101 evaluated studies of a range
of diagnostic tools, but only two of the primary studies were conducted in primary
care, one in Australia 442 and one in the UK. 441
The Australian RCT reported that the positive predictive value of the Edinburgh Postnatal
Depression Scale (EPDS) in primary care was 49% to 84% but that its sensitivity and
specificity in this setting remain unknown. Its use has integrated well into routine care
at an Australian Maternal and Child Health Centre. 443 The UK study, which evaluated
screening using the EPDS, reported that routine screening by health visitors in a UK
community-health setting might not be feasible in deprived areas without extra resources:
overall screening rates at 8 months were only 55%. 441 It is unclear whether the findings
of these studies are generalisable to a New Zealand context.
National Institute for Health and Clinical Excellence (NICE) 2007 101 also reported the
findings of a review commissioned by the UK National Screening Committee 440 which
questioned the acceptability of the EPDS in primary care. However, a recent survey
conducted in Australia, demonstrated the acceptability of the EPDS in a community
sample of 407 women receiving antenatal care from midwives. 439
The EPDS has been extensively used to screen for postnatal depression in research
and clinical practice in New Zealand. 444-447 A large screening programme 447 (14,127
screens) used the EPDS to screen for postnatal depression in New Zealand general
practice at child immunisation visits. Twelve percent of women exceeded a cut-off
of 13 on the EPDS, and were offered a free GP consultation for assessment
and treatment options. High-needs patients screening positive had access to free
psychological services. The screening programme demonstrated good utility in
reaching different ethnic and socioeconomic groups and only 5% of women declined
further consultation/treatment. 447
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