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Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis
Open accessAbstract
Objectives Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND.Methods The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity.Results A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate.Conclusions The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.
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“The operating characteristics of the EPDS are similar to those of the other widely used screening instrument for perinatal depression, the Patient Health Questionnaire‐9 (PHQ‐9) [35].”
From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [35]
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2 of the 101 references couldn’t be matched to a known paper.
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- Buttner, 2011, Moving beyond the EPDS: the association between postpartum depressive symptoms and premenstrual dysphoric disorder, Arch Womens Ment Health, 14, S62
- Mendes, 2011, A case-control study of school age children of depressed mothers, Arch Womens Ment Health, 14, S158
- Seino, 2015, Effectiveness of comprehensive interprofessional intervention program (CIIP) for pregnant women with psychiatric disorders during perinatal period, Arch Womens Ment Health, 18, 331
- Owora, 2016, Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: a meta-analysis, J Affect Disord, 205, 335, 10.1016/j.jad.2016.08.014 · DOI
- Stewart, 2016, Postpartum depression, N Engl J Med, 375, 2177, 10.1056/NEJMcp1607649 · DOI · Paper page
Cited by
Sorted by citations
ACOG Committee on Clinical Practice Guidelines–Obstetrics (2023) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000005200 · Cited by 294
Park, S., & Kim, J. (2022) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-022-06525-0 · Cited by 160
Suharwardy, S. H., Ramachandran, M. K., Leonard, S. A., Gunaseelan, A., Lyell, D. J., Darcy, A. M., Robinson, A. H., & Judy, A. E. (2023) · AJOG Global Reports · doi:10.1016/j.xagr.2023.100165 · Cited by 139
Depression and Suicide Risk Screening
O’Connor, E., Perdue, L. A., Coppola, E. L., Henninger, M. L., Thomas, R. G., & Gaynes, B. N. (2023) · JAMA · doi:10.1001/jama.2023.7787 · Cited by 109
Iturralde, E., Hsiao, C. A., Nkemere, L., Kubo, A., Sterling, S., FLANAGAN, T. A., & Avalos, L. A. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03969-1 · Cited by 90
Metadata
- Authors
- Wang, L., Kroenke, K., Stump, T. E., & Monahan, P. O.
- Affiliations
- Indiana University School of Medicine (US)
- Regenstrief Institute (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Kroenke, Kurt
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 68
- Pages
- 74-82
- ISSN
- 0163-8343 (ISSN-L)
- PMC
- PMC9112666
- OpenAlex
- W3115587826
- Cited by
- 153
- References
- 101
- Citations by year
- 2026: 37 · 2025: 39 · 2024: 29 · 2023: 27 · 2022: 14 · 2021: 7
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- National Center for Advancing Translational Sciences (UL1TR002529)
- Indiana Clinical and Translational Sciences Institute
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- perinatal depression, PHQ-9, Edinburgh Postnatal Depression Scale, depression screening, screening validity, sensitivity and specificity, convergent validity, postpartum depression, pregnancy
- MeSH terms
- Patient Health Questionnaire, Depression, Female, Humans, Mass Screening, Pregnancy, Psychiatric Status Rating Scales, Sensitivity and Specificity, Depression, Postpartum
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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