The Diagnostic Properties of the Translated Chinese Whooley Questionnaire as A Case-Finding Instrument for Depression Among Chinese Women During and After Pregnancy

Introduction: Rising prevalence and undetected perinatal depression has been described in many countries and report that treating those who are already symptomatic, more effort should be targeted towards screening strategies to identify perinatal depression at the early stage. The Whooley questions is the recommended case finding strategy to aid the identification of perinatal depression. An official Chinese version has not been validated. The aim of this study was to evaluate the diagnostic accuracy and stability of the translated Whooley questionnaire against the gold standard measurement during pregnancy (antenatal) and early after pregnancy (postnatal).Materials and method: This observational study recruited 131 pregnant women from antenatal clinics in a hospital setting from September 2019 till May 2020 in Hong Kong. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer assessed diagnostic standard (DSM-IV criteria) among 107 women receiving antenatal care at 26-28 weeks gestation. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis taken as the gold standard.Results: Antenatally, the Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4-93.9), a specificity of 97% (95% CI 90.4-99.3), a positive likelihood ratio of 23.2 (95% CI 7.4-72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1-0.5) in identifying perinatal depression. Conclusion: Prevalence of depression in pregnancy have increased and screening early remains a significant tool in Western countries. The translated Chinese Whooley questionnaire appears to have acceptable diagnostic accuracy and can be implemented into health services among Chinese population as only requiring two yes/no questions.