@article {MannE424, author = {Rachel Mann and Joy Adamson and Simon M. Gilbody}, title = {Diagnostic accuracy of case-finding questions to identify perinatal depression}, volume = {184}, number = {8}, pages = {E424--E430}, year = {2012}, doi = {10.1503/cmaj.111213}, publisher = {CMAJ}, abstract = {Background: Guidelines for perinatal mental health care recommend the use of two case-finding questions about depressed feelings and loss of interest in activities, despite the absence of validation studies in this context. We examined the diagnostic accuracy of these questions and of a third question about the need for help asked of women receiving perinatal care.Methods: We evaluated self-reported responses to two case-finding questions against an interviewer-assessed diagnostic standard (DSM-IV criteria for major depressive disorder) among 152 women receiving antenatal care at 26{\textendash}28 weeks{\textquoteright} gestation and postnatal care at 5{\textendash}13 weeks after delivery. Among women who answered {\textquotedblleft}yes{\textquotedblright} to either question, we assessed the usefulness of asking a third question about the need for help. We calculated sensitivity, specificity and likelihood ratios for the two case-finding questions and for the added question about the need for help.Results: Antenatally, the two case-finding questions had a sensitivity of 100\% (95\% confidence interval [CI] 77\%{\textendash}100\%), a specificity of 68\% (95\% CI 58\%{\textendash}76\%), a positive likelihood ratio of 3.03 (95\% CI 2.28{\textendash}4.02) and a negative likelihood ratio of 0.041 (95\% CI 0.003{\textendash}0.63) in identifying perinatal depression. Postnatal results were similar. Among the women who screened positive antenatally, the additional question about the need for help had a sensitivity of 58\% (95\% CI 38\%{\textendash}76\%), a specificity of 91\% (95\% CI 78\%{\textendash}97\%), a positive likelihood ratio of 6.86 (95\% CI 2.16{\textendash}21.7) and a negative likelihood ratio of 0.45 (95\% CI 0.25{\textendash}0.80), with lower sensitivity and higher specificity postnatally.Interpretation: Negative responses to both of the case-finding questions showed acceptable accuracy for ruling out perinatal depression. For positive responses, the use of a third question about the need for help improved specificity and the ability to rule in depression.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/184/8/E424}, eprint = {https://www.cmaj.ca/content/184/8/E424.full.pdf}, journal = {CMAJ} }