Antepartum and postpartum depression screening using the Patient Health Questionnaire-9 and associated factors among obstetric in-patients at a sub-Saharan African referral center

Objective: Perinatal depression is a common but underdiagnosed condition in low-resource settings. This study aimed to examine factors associated with a positive Patient Health Questionnaire (PHQ-9) depression screen among obstetric patients in Ghana. Methods: We conducted a cross-sectional study among antepartum and postpartum patients admitted to the largest teaching hospital in Ghana from November to December 2023. Eligible participants were aged 18 years and older and clinically stable and provided informed consent. Those critically ill or under 18 years were excluded. Sociodemographic and medical history data were collected, and the PHQ-9, a nine-item self-reported instrument that assesses the presence and severity of depressive symptoms over the previous 2 weeks, was administered. Depression was defined as a PHQ-9 score ≥10. Results: Out of 420 enrolled patients, 124 (29.5%) screened positive for depression, including 49 (29.5%) antepartum, and 75 (29.6%) postpartum. Fewer than 1% had a known mental health diagnosis. Among antepartum participants, those with two or more prior spontaneous miscarriages had higher rates of positive screens (41.2% vs 26.3%, P = 0.044). Among postpartum participants, positive screens were associated with higher parity (mean: 2.4 vs 1.5, P = 0.009), lower 5-min Apgar scores (mean: 7.2 vs 8.1, P = 0.032), peripartum blood transfusion (47.4% vs 27.2%, P = 0.029), and single relationship status (40.3% vs 24.4%, P = 0.032). In multivariable analysis, only single relationship status remained significantly associated, with postpartum patients who were single being 19.8% more likely to screen positive. Conclusion: High rates of PHQ-9 screening positive scores for depression were found among both antepartum and postpartum obstetric inpatients. Being “single” was identified as a significant associated risk factor of positive depression screening scores among postpartum women at the Korle Bu Teaching Hospital. These findings support the consideration of routine perinatal depression screening in Ghana for early detection and timely intervention, to prevent adverse outcomes and improve maternal mental health.