Article Text

Download PDFPDF
Original research
Using computerised adaptive tests to screen for perinatal depression in underserved women of colour
  1. Elizabeth Wenzel1,
  2. Beatriz Penalver Bernabe2,
  3. Shannon Dowty1,
  4. Unnathi Nagelli1,
  5. Lacey Pezley1,
  6. Robert Gibbons3,
  7. Pauline Maki1
  1. 1 Psychiatry, University of Illinois, Chicago, Illinois, USA
  2. 2 Biomedical Engineering, University of Illinois, Chicago, Illinois, USA
  3. 3 Department of Medicine, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Pauline Maki, Psychiatry, University of Illinois, Chicago, IL 60607, USA; pmaki1{at}


Background Compared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder. CAT measures have been tailored to perinatal women but have not been studied in low-income women of colour despite high rates of perinatal depression (PND).

Objective This study aimed to examine the concordance between CAT and traditional measures of depression in a sample of primarily low-income black and Latina women.

Methods In total, 373 women (49% black; 29% Latina) completed the Patient Health Questionnaire-9 (PHQ-9), CAD-MDD and CAT-DI at 845 visits across pregnancy and postpartum. We examined the concordance between continuous CAT-DI and PHQ-9 scores and between binary measures of PND diagnosis on CAD-MDD and the PHQ-9 (cut-off score >10). We examined cases with a positive PND diagnosis on the CAD-MDD but not on the PHQ-9 (‘missed’ cases) to determine whether clinic notes were consistent with CAD-MDD results.

Findings CAT-DI and PHQ-9 scores were significantly associated (concordance correlation coefficient=0.67; 95% CI 0.58 to 0.74). CAD-MDD detected 5% more case of PND compared with PHQ-9 (p<0.001). The average per-visit rate of PND was 14.4% (14.5% in blacks, 14.9% in Latinas) on the CAD-MDD, and 9.5% (9.8% in blacks, 8.8% in Latinas) on the PHQ-9. Clinical notes were available on 60% of ‘missed’ cases and validated CAD-MDD PND diagnosis in 89% of cases.

Conclusions CAD-MDD detected 5% more cases of PND in women of colour compared with traditional tests, and the majority of these cases were verified by clinician notes.

Clinical implications Use of CAT in routine clinic care may address health disparities in PND screening.

  • depression & mood disorders
  • adult psychiatry
  • anxiety disorders

Data availability statement

Data are available on reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request.

View Full Text


  • EW and BPB contributed equally.

  • Contributors PM conceptualised the manuscript. EW, BPB, SD, UN, LP, RG and PM assisted in design and implementation of the study. EW and BPB completed data extraction and analysis. EW, BPB, RG and PM interpreted the data. EW, BPB and PM contributed written text. All authors edited, reviewed and approved the text. BPB and PM secured funding for the study.

  • Funding This work was supported by the NIH-NICHD grant number 1 R03 HD095056, and by the University of Illinois at Chicago Center for Clinical and Translational Science (CCTS) award UL1TR002003.

  • Competing interests RG has been an expert witness for the US Department of Justice, Merck, Glaxo-Smith-Kline, Pfizer and Wyeth and is a founder of Adaptive Testing Technologies, which distributes the CAT-MH battery of adaptive tests. The terms of this arrangement have been reviewed and approved by the University of Chicago in accordance with its conflict of interest policies. PM has served as a consultant for Pfizer, Abbott and Balchem.

  • Provenance and peer review Not commissioned; externally peer reviewed.