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

Research output: Contribution to journalArticlepeer-review

Louise Michele Howard, Elizabeth G. Ryan, Kylee Trevillion, Fraser Anderson, Debra Bick, Amanda Bye, Sarah Byford, Sheila O'Connor, Polly Sands , Jill Demilew, Jeannette Milgrom, Andrew Pickles

Original languageEnglish
Pages (from-to)50-56
JournalBritish Journal of Psychiatry
Issue number1
Early online date4 Jan 2018
Accepted/In press17 Aug 2017
E-pub ahead of print4 Jan 2018
Published4 Jan 2018


King's Authors


There is limited evidence on the prevalence and identification of antenatal mental disorders.

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.

Cross-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.

Population 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).

Endorsement 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.

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