TY - JOUR
T1 - Assessing antenatal depression in primary care with the PHQ-2 and PHQ-9
T2 - Can It Be carried Out by auxiliary nurse midwife (ANM)?
AU - Ransing, Ramdas
AU - Deshpande, Smita N.
AU - Shete, Shreya R.
AU - Patil, Ishwar
AU - Kukreti, Prerna
AU - Raghuveer, Pracheth
AU - Mahadevaiah, Mahesh
AU - Bhosale, Nandkumar
AU - Ramesh, Vallamkonda Om Sai
AU - Puri, Manju
AU - Bantwal, Priyanka
N1 - Funding Information:
This study was funded by Indian Council of Medical Research (ICMR) , New Delhi ((No. 5/4-4/151/M/2017/NCD-I )
Funding Information:
The authors would like to express their sincere thanks and gratitude to Prof. Vikram Patel for his kind permission to use the translated and validated Marathi version of PHQ-9. This work is part of the BIND-P project (CTRI/2018/07/014836). The work was supported by the Indian Council Medical Research (ICMR) under Capacity Building Projects for National Mental Health Programme, ICMR-NMHP. We thank Dr. Soumya Swaminathan (then Secretary, Dept. of Health Research, DHR), Dr. Balram Bhargav, current Secretary DHR, Prof. V.L. Nimgaonkar, Dr. Ravinder Singh, Dr. Harpreet Singh, and Dr. Krushnaji Kulkarni. We thank the faculty of ‘Cross-Fertilized Research Training for New Investigators in India and Egypt’ (D43 TW009114, HMSC File No. Indo-Foreign/35/M/2012-NCD-1, funded by Fogarty International Centre, NIH). We are also thankful to the National Coordinating Unit of ICMR for NMHP Projects for their constant support and guidance. We thank the Data Management Unit of ICMR for designing the database. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of NIH or ICMR. NIH and ICMR had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/10
Y1 - 2020/10
N2 - Antenatal Depression (AD) is prevalent in India but remains unidentified and untreated in primary care settings. The Auxiliary Nursing Midwife (ANM), a non-specialist health care worker at antenatal care (ANC) clinic or at a primary care centre can improve the detection of women with AD. In this study, we aimed to estimate the inter-rater reliability of the Patient Health Questionnaire (PHQ-9) and PHQ-2, administered by ANMs, with mental health professionals, that is, Clinical Psychologists(CP). The prospective, blind, observational study was conducted in an antenatal clinic of tertiary care rural hospital of India. PHQ-2 and PHQ-9(Marathi) valid and translated versions were administered to consecutive antenatal women (n = 108) aged 18–45 years by two raters (CP, ANM) independently. Raters and data analyst were blinded to each other's scores. Kappa Coefficient, weighted kappa, Intra-class correlation coefficients (ICC) were used to assess Inter-rater reliability. The mean age of the study participants was 25.91 ± 4.39 years. Inter-rater reliability for PHQ-2 (Screen -Positive or Negative for depression) and PHQ-9 (Severity of depression) was (k = 0.675) and (kw = 0.732) respectively, which suggested the ‘substantial’ agreement between ANMs and CP. Among raters, the ICC (95 % confidence interval) was 0.90 (0.85, 0.93) for the PHQ-9 score and for the PHQ-2 was 0.873 (0.819−0.911), which was suggestive of excellent and good reliability respectively. The ‘substantial’ agreement and ‘good to excellent’ inter-rater reliability among ANM and CP suggest that these two scales can be used to screen and assess the severity of AD by either qualified or minimally trained, community health workers.
AB - Antenatal Depression (AD) is prevalent in India but remains unidentified and untreated in primary care settings. The Auxiliary Nursing Midwife (ANM), a non-specialist health care worker at antenatal care (ANC) clinic or at a primary care centre can improve the detection of women with AD. In this study, we aimed to estimate the inter-rater reliability of the Patient Health Questionnaire (PHQ-9) and PHQ-2, administered by ANMs, with mental health professionals, that is, Clinical Psychologists(CP). The prospective, blind, observational study was conducted in an antenatal clinic of tertiary care rural hospital of India. PHQ-2 and PHQ-9(Marathi) valid and translated versions were administered to consecutive antenatal women (n = 108) aged 18–45 years by two raters (CP, ANM) independently. Raters and data analyst were blinded to each other's scores. Kappa Coefficient, weighted kappa, Intra-class correlation coefficients (ICC) were used to assess Inter-rater reliability. The mean age of the study participants was 25.91 ± 4.39 years. Inter-rater reliability for PHQ-2 (Screen -Positive or Negative for depression) and PHQ-9 (Severity of depression) was (k = 0.675) and (kw = 0.732) respectively, which suggested the ‘substantial’ agreement between ANMs and CP. Among raters, the ICC (95 % confidence interval) was 0.90 (0.85, 0.93) for the PHQ-9 score and for the PHQ-2 was 0.873 (0.819−0.911), which was suggestive of excellent and good reliability respectively. The ‘substantial’ agreement and ‘good to excellent’ inter-rater reliability among ANM and CP suggest that these two scales can be used to screen and assess the severity of AD by either qualified or minimally trained, community health workers.
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U2 - 10.1016/j.ajp.2020.102109
DO - 10.1016/j.ajp.2020.102109
M3 - Letter
C2 - 32474343
AN - SCOPUS:85085488012
SN - 1876-2018
VL - 53
JO - Asian Journal of Psychiatry
JF - Asian Journal of Psychiatry
M1 - 102109
ER -
