Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis.
Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0082521
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Tomlinson M
中科院分区：
文献类型：
--
作者：
Tsai AC;Scott JA;Hung KJ;Zhu JQ;Matthews LT;Psaros C;Tomlinson M
改善非洲围产期心理健康的一个主要障碍是缺乏当地有效的工具来确定围产期抑郁症的可能病例或衡量抑郁症症状严重程度的变化。我们系统地回顾了在非洲环境中评估围产期抑郁症的工具的可靠性和有效性的证据。在通过检索7个电子数据库确定的1，027条记录中，我们审查了126份全文报告。我们纳入了25项独特的研究，这些研究在26篇期刊文章和1篇博士论文中传播。这些方案招收了12 544名生活在9个不同的北非和撒哈拉以南非洲国家的妇女。只有三项研究（12%）使用了专门为特定文化环境开发的工具。大多数研究提供了标准相关效度（20 [80%]）或可靠性（15 [60%]）的证据，而较少的研究提供了结构效度，内容效度或内部结构的证据。爱丁堡产后抑郁量表（EPDS），评估了16项研究（64%），是最常用的工具，在我们的样本。10项研究估计了EPDS的内部一致性（中位数估计系数α，0.84;四分位距，0.71-0.87）。对于估计EPDS敏感性和特异性的14项研究，我们为每个截止评分构建了2 x 2表。使用双变量随机效应模型，我们估计在临界值≥9时，合并敏感性为0.94（95%置信区间[CI]，0.68-0.99），合并特异性为0.77（95% CI，0.59-0.88），临界值越高，特异性越高，敏感性越低。 EPDS可以可靠有效地测量围产期抑郁症症状的严重程度或筛选可能的产后抑郁症在非洲国家，但需要更多的验证研究其他工具。此外，需要更多的定性研究，以充分表征当地的理解围产期抑郁样综合征在不同的非洲背景。
A major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. Of 1,027 records identified through searching 7 electronic databases, we reviewed 126 full-text reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts.
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