Women’s interpretation, understanding and attribution of the anhedonia question in the PHQ-4 and modified-Whooley questions in the antenatal period

ABSTRACT

Objectives

To report on the rates of misinterpretation, confusion, and attribution of the anhedonia question in the PHQ-4 and Whooley questions by pregnant women.

Background

The NICE Perinatal Mental Health guidelines recommend the use of the anhedonia question for depression screening, yet evidence suggests it may be misinterpreted or not be related to mood.

Method

Women attending a public hospital’s antenatal clinic, communicating in English as their language of choice, completed either the PHQ-4 or the Whooley questions. Following comments to general evaluation questions in the first sample, women were asked a targeted anhedonia interpretation question, an anhedonia attribution question, and an ease of understanding question (PHQ-4: N = 37–119; Whooley: N = 31–100).

Results

Across the PHQ-4 and Whooley formats around 15% of participants completely misinterpreted the anhedonia question, with a further 17% finding it difficult to understand. Around two-thirds of those experiencing the symptom said it was due to normal symptoms of pregnancy, and not related to their mood. In the PHQ-4 format, which included all three questions, 48% of the women had one or more of these issues. While CALD women appear to have greater difficulty understanding the question, there were no meaningful associations with whether English was spoken at home.

Conclusion

Almost half of the women incorrectly interpreted the anhedonia question, or said that it was confusing, or that it did not reflect low mood. These data indicate that the anhedonia question should not be used in screening women in the antenatal period, whether in the PHQ-4 or Whooley formats.

KEYWORDS:

• Perinatal mental health
• screening
• depression
• antenatal
• measurement

Acknowledgments

The staff of the Liverpool antenatal clinic.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. A formal complaint regarding the SWSLHD Ethics Committee’s treatment of the Project application PI was required to obtain Ethics approval for the study.