Translation and validation of the Whooley questions to identify perinatal depression in Chinese women: A pilot study

Professor Lok, Yuet Wan   (Principal Investigator (PI))

Dr Lin Jingxia Jessie   (Co-Investigator)

Professor Fong Daniel Yee Tak   (Co-Investigator)

Professor Tarrant Marie   (Co-Investigator)

Dr Smith Robert David   (Co-Investigator)

24

2018-04-30

2020-04-29

111050

Translation and validation of the Whooley questions to identify perinatal depression in Chinese women: A pilot study

Chinese, Perinatal depression, Pregnancy

Psychosocial and Behavioural ResearchHealth Services

201711159208

Seed Fund for PI Research – Basic Research

2017

Completed

Perinatal depression is defined as depression in pregnancy, around childbirth or within the first year postpartum is one of the commonest mental health problems and a major public health burden across the globe. Women are at increased vulnerability to depression during pregnancy. Antenatal depression was found to affect 10.7% of women in a meta-analysis of 21 studies across diverse countries and cultures [1]. In an epidemiological study of 357 Hong Kong Chinese women, 18.9% reported suffering from antenatal depression in the second trimester to 22.1% in the third trimester [2]. Given that even small reductions in population prevalence have a greater public health benefit that treating those who are already symptomatic, more effort should be targeted towards screening strategies to identify perinatal depression at the early stage. Perinatal depression is associated with a range of adverse outcomes [3]. Evidence suggests an association between depressions experienced during pregnancy (prenatal depression) and adverse neonatal outcomes, poor self-reported health, substance abuse and alcohol abuse, and poor usage of antenatal care services [4]. Postnatal depression has been shown to have a substantial impact on the mother and her partner, mother-baby interactions[5], the family[6] and on the longer term emotional and cognitive development of the baby[7]. Despite the significant disease burden of perinatal depression, it often goes undetected during the antenatal stage in Hong Kong. Research suggests that women who experience perinatal depressive symptoms use more healthcare resources during pregnancy than do women who are not depressed, which potentially affords providers greater opportunity to screen for and address depressive symptoms during the antenatal period [8]. Research have found that among women with postpartum depression, over 50% had depression identified either before or during the pregnancy [9]. Despite the significance of the problem, no screening tool for perinatal depression exists in Hong Kong and guidance are taken predominantly from Western countries. In UK, the National Institute for Health and Care Excellence (NICE) produced guidelines on antenatal and postnatal health (NICE, 2007). These set out recommendations for the detection and treatment of mental health problems during pregnancy and the postnatal period. As part of these guidelines, NICE endorsed a case-finding strategy by recommending the use of two questions asking about low mood and loss of interest or pleasure to aid the identification of perinatal depression (see Appendix 1); these questions are often referred to as the Whooley questions. NICE have updated their guidelines in which they continue to recommend the use of the Whooley questions during pregnancy and the postnatal period (NICE, 2014) [3]. The Whooley questions have been validated previously in a small sample of 152 women during pregnancy and the early postnatal period in the UK, with a sensitivity of 100% (95% CI: 77% to 100%) and a specificity of 68% (95% CI: 58% to 76%) during pregnancy, with similar estimates during early postnatal period [10]. Most recently, another popular 2 item questions specifically for use in pregnancy is Patient Health Questionnaire (PHQ)-2, which serve as a screening to indicate some form of risk for possible depressive disorder was validated in Western countries. With a range of scores from 0 to 6, a score of >3 has a sensitivity of 83% and specificity of 92% for major depression [11]. Patient Health Questionnaire(PHQ)-2, a short version of PHQ-9 for screening depression have been tested in Chinese population with a Cronbach’s alpha of 0.76 (internal reliability) and a test and re-test reliability of 0.70 [12]. However, this study did not use diagnostic interviews to test PHQ-2 relative performance in screening depression. Locally, a population-based study of women in Hong Kong completed the Edinburgh Postnatal depression scale (EPDS) in the second and third trimesters and at 6 weeks postpartum and found that EPDS can identify high risk women for postpartum depression and that screening all pregnant women in the second trimester can be a secondary preventive measure [13]. A Chinese version of the EPDS has been tested in Hong Kong and demonstrated good reliability and validity [14], however this is routinely used during postnatal periods and not routinely used during the antenatal stage. Given the known effects of screening during pregnancy in preventing depression, the obvious next step is to research the acceptability of a depression case-finding instrument in routine screening for perinatal depression. There are limited studies examining the acceptability to women and health care professionals of depression case-finding questions, such as the Whooley questions, EPDS [15, 16] and PHQ-2 in Hong Kong. Therefore, this study will also include a qualitative assessment of the acceptability to women and health care professionals of such depression case-finding questions and PHQ-2. This important information will be used alongside the diagnostic estimates of the case-finding questions or PHQ-2 to potentially inform the feasibility of implementation of the NICE-endorsed case-finding or PHQ-2 strategy. The primary objective of this study is to translate the Whooley question into Chinese and to validate the accuracy of Whooley case-finding questions. The secondary objectives are to examine qualitatively the acceptability of such screening or case-finding strategies to patients and health care professionals.