Evidence map›Paper›PMID 29433610›Full record

ArticleThe British journal of psychiatry : the journal of mental science2018

Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy.

Louise Michele Howard, Elizabeth G Ryan, Kylee Trevillion, Fraser Anderson, Debra Bick, Amanda Bye, Sarah Byford, Sheila O'Connor, Polly Sands, Jill Demilew and 2 more

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In one paragraph

Article in The British journal of psychiatry : the journal of mental science, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 73 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
73citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

73 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Postnatal Depression Beyond 12 Months: A Systematic Review and Meta-Analysis.International journal of mental health nursing · 2025
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13 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Louise Michele HowardSection of Women's Mental Health,Institute of Psychiatry, Psychology and Neuroscience and Women's Health Academic Centre, King's College London,London, andSouth London and Maudsley NHS Foundation Trust,London.
Elizabeth G RyanBiostatistics and Health Informatics Department,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Kylee TrevillionSection of Women's Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Fraser AndersonSection of Women's Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Debra BickWomen's Health Academic Centre and Florence Nightingale Faculty of Nursing and Midwifery, King's College London,London.
Amanda ByeSection of Women's Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Sarah ByfordKing's Health Economics,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Sheila O'ConnorSection of Women's Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Polly SandsSection of Women's Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
Jill DemilewWomen's Health Academic Centre, King's College London,London and Women's Health,King's College Hospital NHS Foundation Trust,London.
Jeannette MilgromParent-Infant Research Institute (PIRI),Austin Health, Melbourne School of Psychological Sciences,University of Melbourne,Australia.
Andrew PicklesBiostatistics and Health Informatics Department,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.

Funding

Department of Health NIHR-RP-R3-12-011Department of Health RP-PG-1210-12002
6 · The paper itself

Abstract

backgroundThere is limited evidence on the prevalence and identification of antenatal mental disorders. Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR.

methodCross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate.

resultsPopulation prevalence was 27% (95% CI 22-32): 11% (95% CI 8-14) depression; 15% (95% CI 11-19) anxiety disorders; 2% (95% CI 1-4) obsessive-compulsive disorder; 0.8% (95% CI 0-1) post-traumatic stress disorder; 2% (95% CI 0.4-3) eating disorders; 0.3% (95% CI 0.1-1) bipolar disorder I, 0.3% (95% CI 0.1-1%) bipolar disorder II; 0.7% (95% CI 0-1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6).

conclusionsEndorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available. Declaration of interest L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012-2014.

Indexed as

Prenatal CareAdultAnxiety DisordersBorderline Personality DisorderCross-Sectional StudiesDepressive DisorderFeeding and Eating DisordersFemaleHumansLondonObsessive-Compulsive DisorderPregnancyPregnancy ComplicationsPsychiatric Status Rating ScalesStress Disorders, Post-Traumatic

Identifiers

PMID29433610
PMCPMC6457164

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.