Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application.
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2014-09-17
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Abstract
Randomized controlled trials conducted in resource limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment lay health workers can be trained to effectively administer psychological treatments We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones Pregnant Xhosa speaking women were recruited independently in two cross sectional studies N 1 144 and N 361 conducted in Khayelitsha South Africa and assessed for antenatal depression In the smaller study community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale EPDS during the routine course of their community based outreach We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression defined as an EPDS 10 13 The prevalence of probable depression 475 1144 42 and 165 361 46 was consistent across both samples The 2 item subscale demonstrated poor internal consistency Cronbach s ranged from 0 55 to 0 58 All four subscales demonstrated excellent discrimination with area under the receiver operating characteristic curve AUC values ranging from 0 91 to 0 99 Maximal discrimination was observed for the 7 item depressive symptoms subscale at the conventional screening threshold of 10 it had 0 97 sensitivity and 0 76 specificity for detecting probable antenatal depression The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression