Utility of Depression Screening Among Pregnant Women in Qatar

Major depression during pregnancy is associated with significant morbidity for the mother and her offspring, so screening for depression is recommended during pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) is widely use for screening during pregnancy, but has not been evaluated for this use in any Gulf Arab countries.We administered the EPDS to a multiethnic group of 768 women who were 8-16 weeks pregnant, and attending prenatal clinics in Doha, Qatar. The EPDS was administered in Arabic, English or Urdu, and the MINI diagnostic interview was administered in the same language to all subjects at the same time to determine DSM-V diagnoses. Women who had major depression at conception were excluded from the study. The EPDS was also administered to subjects again in the second and third trimester, but the MINI diagnostic interview was administered selectively, to all women scoring over 9 on the EPDS.The mean EPDS scores decreased from first to second trimester and were similar to studies of pregnant women from other countries. Rates of major depression were 9.4% in the first trimester, 3.6% in the second trimester and 2.5% in the third trimester, with a combined prevalence during pregnancy of 14.3% for major and 13.3% for minor depression. In our sample, among women with an EPDS score of 12 or greater only 8% had major depression in the first trimester, but 34% had major depression in the second and third trimesters. Urdu speaking women had lower EPDS scores in the first and second trimesters but similar rates of major depression compared to Arabic and English speaking women, suggesting that Urdu speakers may be less likely to endorse depression symptoms on the EPDS.In summary, screening for depression using the EPDS with follow up clinical interviews is likely to be very low yield in the first trimester.However, despite low rates of major depression in the second and third trimesters, high scores on the EPDS do identify a group a women with high risk of major depression, who would benefit from a clinical evaluation and treatment if major depression is confirmed.